Claire and Matt: An Established Pediatrics Household, Scored

Claire has practiced pediatrics for ten years and earns about $280,000. Matt earns about $110,000 in medical device sales, which puts the household near $390,000. They have two children, 10 and 7, in a large Northeast metro. On the surface this is the picture a decade of attending income is supposed to produce, and in several places it is.

The debt picture is finished work. Claire's student loans were paid off six years ago. There is no consumer or vehicle debt. The only remaining debt is a mortgage of about $550,000 on a home worth about $950,000, which puts total debt at about 1.4 times income, comfortably inside the established bar. The savings machinery runs: about 12 percent of income, automated through the advisor's platform, into investable assets of about $700,000. The emergency fund holds about three months of expenses, about $45,000.

Then the professional layer comes into focus. The household is in the 32 percent federal bracket, which Claire knows, and has made zero deliberate tax moves, because the advisor never did tax planning: no Roth against pre tax analysis, no backdoor Roths, no 529 strategy, no HSA. Goals exist as two or three vague intentions, retire someday and college, with dollars flowing toward them and nothing fully funded. The household does not track its monthly spending.

The protection stack is where the advice did active harm. Disability is the group long term disability policy and nothing else. Life insurance is a $750,000 permanent policy the advisor sold her, the wrong product at the wrong price, counting as partial coverage while its premiums run. The umbrella is $1 million and has never been reviewed. Malpractice is occurrence coverage through her group, the one clean line in this section. Estate documents are a signed will and powers of attorney, with no health care directive.

The Financial Health Assessment grades a household across the same seven frameworks and lands the total in a band. Claire and Matt score 62, in the Corrections band: the household's own systems mostly work, and the professional systems they paid for mostly did not. The episode scored the household in six groups.

The shape of this score is unusual in the case bank: the household outscores its advisor. Every perfect and near perfect group here is a habit the couple built themselves, and every thin group sits in a domain they were paying a professional to run. The points are not the indictment. The fee was.

The first deep dive is the Tax Efficiency Ladder, and the finding is an absence a decade wide. A household in the 32 percent federal bracket, with two incomes, two kids, and an advisor on retainer, made no deliberate tax moves at all. Nobody ran the Roth against pre tax comparison as incomes rose. Nobody opened backdoor Roths for either spouse. Nobody built a 529 strategy for two children now 10 and 7. Nobody asked whether an HSA belonged in the picture. The accounts filled by default, and the defaults compounded for ten years.

The Ladder's claim is that the right dollars in the right accounts, in the right order, is worth more than security selection at this income, and this household is the control group for what skipping it costs. The fix in the prescription starts with the deliberate call: run Roth against pre tax on paper, execute backdoor Roths for both spouses, and commit to two real moves a year so the layer never goes silent again. The framework itself is laid out on the Tax Efficiency Ladder page, and the account order is worked on the retirement page.

The second deep dive is the Protection Stack, and the finding is a stack assembled from what was sold rather than what was needed. Life insurance exists, as a $750,000 permanent policy whose premiums run many times the cost of term coverage for the same protection, building cash value the plan never asked for. Disability exists, as group long term disability only: capped, defined by the plan, taxable, and gone when the job is, on a $280,000 physician income with two children. An umbrella exists, at $1 million, never reviewed against the assets the decade built. Estate documents exist without a health care directive, and the will needs a check to confirm it names a guardian for both children.

The framework orders protection by what each layer does, not by what a product is called. Surrender the permanent policy's logic and the prescription writes itself: stop the bleed, carry $2.5 million of twenty year term instead, add the individual own occupation disability policy, finish the directive, and resize the umbrella. The layers that were fully built here, health for the whole household and occurrence malpractice, show what finished looks like in the same framework on the Protection Stack page.

Five moves, in the order the episode gave them.

One: Make the Roth against pre tax call deliberate, then execute backdoor Roths. Two moves the advisor never made, available this year, for both spouses. The bracket is known; the analysis takes an afternoon and pays for a decade.

Two: Stop the permanent policy bleed and buy $2.5 million of twenty year term. The permanent policy is the wrong product at the wrong price. Term at the right size costs a fraction of the premium, and the difference redirects into the Wealth Engine where it belonged all along.

Three: Add the individual own occupation disability policy. The $280,000 income is the household's largest asset, and group long term disability is not coverage of it. Specialty specific, portable, and sized to the income.

Four: Write four or more goals and fund them fully. Retire someday is not a goal the Decision Filter can check a decision against. Amounts and dates, retirement and college first, funded on the automation that already works.

Five: Track spending for 90 days. The household cannot name its leak because it has never looked. Ninety days of tracking finds what a decade of statements, and the fee that rode on them, never surfaced.

Run all five and the episode's arithmetic is 62 plus 14, a score of 76. None of the five requires a raise. Each one replaces something the household was already paying for with the version that works.

An advisor's invoice is not evidence of planning. This household paid for a decade of professional help and received account management and a product sale. The planning domains, taxes, protection design, goals with numbers, sat untouched because nobody's checklist required them. The lesson for any household with an advisor is to audit the domains, not the returns: ask what tax moves were made this year, what the protection stack looks like layer by layer, and which goals are funded to a number. Silence in any of the three is the answer.

The second lesson is kinder. The couple's own systems, debt discipline, automated saving, spending within reach, carried this score to 62 against professional headwind. Households routinely overestimate what they need to buy and underestimate what their own habits are already worth. Fix the professional layer to the standard of the household layer and this family is finished.

Do you want Ryan to run your household's finances on a future Financial Health Assessment episode? Submit your situation at financialfellowship.com/submit.

Ryan Inman is a retired financial planner who worked with about 500 physician families. He created the Financial Residency podcast (about 3 million downloads) and is no longer affiliated with it. Financial Fellowship is his sole focus. This guide is educational. Last updated October 2026.