Financial Health Assessment
Miriam and Malcolm: Surgical Subspecialty Household Scores 40 Out of 100
By Ryan Inman
Published · Updated
Surgical subspecialtyEstablished · Five years post trainingCouple, two children
Financial Health Assessment score
40 out of 100
Corrections
- Needs a workup 0 to 39
- Corrections 40 to 69
- Stable 70 to 84
- Healthy 85 to 100
The score grades the household on 20 measures across seven frameworks. Miriam and Malcolm lands at 40, in the Corrections band, score 40 to 69.
Miriam is a surgical subspecialist earning a salary of $310,000 plus a productivity bonus. Malcolm works in finance at about $100,000 a year, and rent from a second property adds $32,700. The household earns at least $442,700, lives outside Portland, Oregon, and has two children, three and one. Miriam's father lives in the home and the household pays his health insurance. The assessment scores the household 40 out of 100, in the Corrections band.
The headline already happened: over $300,000 of student debt, paid off in full in 2018, five years out of training. What replaced the payoff is a wide, swinging cash flow. The last three stated months of saving are $6,039, $3,624 and $4,877, against a stated goal of investing at least $50,000 a year, and the record finds no lane system, no measured leak and no stated emergency fund months.
Cover is deep on the surgeon and thin on paper. Miriam holds $3,000,000 of term life across three policies and two disability policies bought to fill each other's gaps, and a $2,000,000 umbrella stands over the rental property. Against that: no estate documents are in place, no guardian is stated for two minor children, Malcolm's disability cover is not stated, and the household's own health cover is not stated. The traced path runs from 40 to a target of 49, and the prescription section shows the three steps that trace.
$932,000
Total stated debt · about 2.11 times income
About $4,847
Average saved in the last three stated months · against a $50,000 a year goal
$3,000,000
Term life on Miriam · across three policies
At least $442,700
Household income · surgeon plus finance plus rent
About 13 percent
Savings rate · on the stated flows
About $40,000
Cash savings · as stated
The short version
- The score: 40 out of 100, in the Corrections band, at the band's floor. The Protection Stack earns 10 of 22 and the Decision Filter the full 4 of 4, while the 3 Bucket Framework earns 3 of 20.
- The student debt is finished: over $300,000 paid off in full in 2018, five years out of training. Education debt earns the full 6 on the established fork, and the remaining debt is two mortgages and one auto loan.
- Saving swings by thousands month to month: $6,039, then $3,624, then $4,877. The hosts' fix is three to six months of tracking, so the $50,000 a year investing goal stops depending on which month it is.
- Cover is deep on one earner: $3,000,000 of term life and two disability policies on Miriam, and a $2,000,000 umbrella. Malcolm's disability cover is not stated, and the household's own health cover is not stated.
- No estate documents are in place, with two children of three and one and no guardian stated. The traced path to 49 runs through the documents (+4), the leak (+3) and the lanes (+2).
The loans are gone. The system that replaces them is not built yet.
What They Did Right
Five years out of training with the student debt already gone. This is the machinery already running.
- Over $300,000 of student debt, gone Paid off in full in 2018, five years out of training. Education debt finished grades at the full 6 on the established fork.
- $3,000,000 of term on the surgeon Three laddered policies on Miriam, plus $1,000,000 on Malcolm for 20 years. The life box grades at full marks.
- Two disability policies that fill the gaps Guardian and Standard carried together on Miriam because each covers what the other leaves out.
- A $2,000,000 umbrella Real liability cover over a household with a rental property, a surgery center buy in and two small children, at $429 a year.
- No credit card debt Two mortgages and an auto loan stand in the file, and the card line states no carried debt.
The Score: 40 out of 100
The Financial Health Assessment grades a household across the same seven frameworks and lands the total in a band. Miriam and Malcolm scores 40, in the Corrections band. This household is scored on the attending rubric, on the established fork of the Transition framework.
20
Measures graded
7
Frameworks
40
Miriam and Malcolm's score
The 3 Bucket Framework earns 3 of 20. Milestones earn 0, because the milestone net cannot be determined from what the intake states. The emergency fund earns 0: cash savings of about $40,000 are stated, and months of cover are not stated on the record's figures. Named lanes earn 0, because no sorting system is stated and the saving varies widely month to month. Goals funded earns 3, with dollars aimed at investing, college and travel while the first goal, at least $50,000 a year invested, sits ahead of the stated flows, so goals are not fully funded.
The Physician Wealth Equation earns 7 of 14. The Debt Anchor earns 5: total stated debt of $932,000 against at least $442,700 of income is about 2.11 times, partial credit on the established bar. Stretch saving earns 2: a savings rate of about 13 percent sits between the 12 percent partial line and the 25 percent full line.
The Protection Stack earns 10 of 22. Health earns 0, because the household's own cover is not stated. Disability earns 2: two policies stand on Miriam, their own occupation status is not stated, and Malcolm's disability cover is not stated. Life earns the full 4, on individual term in force on both earners. Umbrella earns the full 4, at $2,000,000 against the household's stated asset base. Malpractice earns 0, type and tail not stated. Estate documents earn 0: no documents are in place.
The Transition framework, on the established fork, earns 6 of 10. Education debt finished earns the full 6: over $300,000 of student loans paid off in full in 2018. No lingering consumer or vehicle debt earns 0: an auto loan of $29,000 at 1.9 percent is still outstanding.
The Tax Ladder earns 2 of 8: the Roth against pre tax box earns 2, with pre tax rollover IRAs in place and no bracket reason stated, and bracket plus deliberate moves earns 0, with no deliberate move stated. The hosts named the shape of the missed move on the episode: the rollover IRAs block the backdoor Roth until they are rolled into the employer plans. The Decision Filter earns the full 4 of 4 on five stated goals.
The Lifestyle Guardrails earn 8 of 22. The Savings Floor earns 6, on a rate of about 13 percent. The leak earns 0: the unaccounted share of spending is not stated. Wealth first automation earns 2: payroll deferrals run the retirement flows, and the record grades the automation partial.
| Framework | What it covers | Points |
|---|---|---|
| 02 3 Bucket Framework | Milestones 0, emergency fund 0 (months not stated), named lanes 0, goals funded 3 | 3 of 20 |
| 03 Physician Wealth Equation | Debt anchor 5 at about 2.11 times income, stretch saving 2 at about 13 percent | 7 of 14 |
| 04 Protection Stack | Health 0 (not stated), disability 2, life 4, umbrella 4, malpractice 0, estate documents 0 | 10 of 22 |
| 05 Transition | Education debt finished 6, loans paid off in 2018. No lingering debt 0, auto loan outstanding | 6 of 10 |
| 06 Tax Ladder | Roth against pre tax 2, bracket plus moves 0 | 2 of 8 |
| 07 Decision Filter | Goals written 4, five goals stated | 4 of 4 |
| 08 Lifestyle Guardrails | Savings floor 6, the leak 0, wealth first automation 2 | 8 of 22 |
| Total | Corrections band | 40 out of 100 |
Read the shape, not just the total. This file's hardest work is behind it: a six figure student debt, finished. The score now grades what has to replace payoff mode, and that machinery is mostly unbuilt: no lanes, no measured leak, no stated fund months, no documents. The protection that is bought is deep. Everything still open is a system or a signature, and the traced path buys exactly those.
The Prescription
The traced fixes first, then the open items the record carries without a gain.
- Write the estate documents and name a guardian. Two children of three and one, and a father in the home, are the reason this step leads. Documents in force move the estate box from 0 to the full pattern. (+4 points when in force.)
- Track the spending for three to six months. The hosts' window: long enough for the wide monthly swings to show their pattern and for the unaccounted money to be identified. The leak box moves from 0 to its partial pattern. (+3 points when the unaccounted money is identified.)
- Sort the income into named lanes, investing floor first. The $50,000 a year goal gets paid like a bill, ahead of college and travel. Named lanes in use move the lanes box from 0 to its partial pattern. (+2 points when the lanes are running.)
- Get refinance quotes on the primary mortgage. The home carries 4.125 percent while the rental carries 3.75 percent, and the hosts sent the household for physician loan refinance quotes on the primary mortgage. No points are claimed for this step. The Debt Anchor grades the balance against income, not the rate.
The traced path runs 40 to 49: plus 4 for the estate documents, plus 3 for the leak, plus 2 for the lanes. Each step is a system or a signature, which matches the file: the debts that remain are mortgages and a small auto loan, and nothing on the path asks for a bigger income. The target is 49, stated with its arithmetic.
What This Case Teaches
Paying off debt is an event. Replacing it is a system. A payoff has a balance, a rate and an end date, and this household paid off over $300,000 of student debt in full by 2018. The day after the payoff, the same cash flow needs a new set of instructions: lanes, an order for the goals, a measured leak. Without them, the freed money spreads across every goal at once and reaches none of them at pace, which is exactly what a range of $3,624 to $6,039 a month looks like.
A paid off loan frees cash flow. It does not direct it.
The second lesson is about sequencing goals that share one income. The investing floor, two college tuitions and family travel are all good goals, and they cannot all be first. The goals funded box grades whether the flows follow an order, not whether the list is admirable.
Behind the score
The Household
Miriam is 38 and Malcolm is 37. Miriam works in a surgical subspecialty. Malcolm works in finance. They live in a single family home outside Portland, Oregon, with two children of three and one. Miriam's father lives in the basement. He is still working, holds no retirement savings, and the household pays for his health insurance and some other costs.
Investment accounts total about $830,100 on the stated figures: Miriam's rollover IRA at $114,000, current 401k at $29,000 and Roth IRA at $7,600. Malcolm's rollover IRA at about $500,000 and 401k at about $33,000. A stock account at about $17,000. A surgery center buy in of $57,000. Real estate syndications of $50,000 across two deals, and two 529 accounts at $11,800 and $10,700. Cash savings stand at about $40,000. The household banks through Chase for its operating accounts and US Bank for a checking account that pays the mortgage.
The debt is paid. The question now is where the money goes on purpose.
Saving over the past eight months varied widely: June at $6,039, July at $3,624 and August at $4,877 in the last three stated months, and the hosts put the first eight months at about $30,000 against the $50,000 a year goal, about a month short of pace.
Debt sits in three stated lines, and none of it is student debt. The primary mortgage is $674,000 at 4.125 percent, about $3,400 a month. The rental property mortgage is $229,000 at 3.75 percent, about $1,700 a month, on a property bought by Malcolm and Malcolm's father. The auto loan is $29,000 at 1.9 percent, $550 a month. There is no credit card debt. Total stated debt is $932,000, about 2.11 times income. The hosts flagged the rate order: the home carries the higher rate and the rental the lower one, and they sent the household for physician loan refinance quotes on the primary mortgage.
Protection is deep on Miriam and unfinished on paper. Miriam holds two disability policies, Guardian at about $1,900 a year and Standard at about $2,600 a year, carried together because each fills gaps in the other. Own occupation status is not stated. Malcolm's disability cover is not stated. Term life stands at $3,000,000 on Miriam across three policies, $1,000,000 for 30 years, $1,000,000 for 20 years and $1,000,000 for 10 years, and $1,000,000 on Malcolm for 20 years. An umbrella policy of $2,000,000 costs $429 a year. The household's own health cover is not stated. It pays for Miriam's father's health insurance. Malpractice type and tail are not stated. There are no estate planning documents yet, stated as next on the list, and no guardian is stated for two minor children.
| Household fact | Where it stands |
|---|---|
| Careers | Surgical subspecialist. Finance |
| Household income | At least $442,700: $310,000 salary plus a productivity bonus, about $100,000, and $32,700 of rental income |
| Family | Couple, two children, three and one. Miriam's father lives in the home |
| Student loans | Paid off in full in 2018, over $300,000 after residency |
| Mortgages | Primary $674,000 at 4.125 percent, about $3,400 a month. Rental property $229,000 at 3.75 percent, about $1,700 a month |
| Other debt | Auto loan $29,000 at 1.9 percent, $550 a month. No credit card debt. Total stated debt $932,000 |
| Emergency fund | Cash savings about $40,000. Months of cover not stated on the record's figures |
| Saving | Last three stated months $6,039, $3,624 and $4,877. About 13 percent of income. Goal at least $50,000 a year invested |
| Balances | Retirement about $683,600: rollover IRAs $114,000 and about $500,000, 401k accounts $29,000 and about $33,000, Roth IRA $7,600. Stocks about $17,000. Surgery center buy in $57,000. Syndications $50,000. 529 accounts $11,800 and $10,700 |
| Disability | Miriam: two policies, Guardian and Standard, bought to fill each other's gaps. Own occupation status not stated. Malcolm: not stated |
| Life insurance | Miriam $3,000,000 across three term policies. Malcolm $1,000,000 for 20 years |
| Umbrella | $2,000,000 policy at $429 a year |
| Estate documents | None in place yet, stated as next on the list. No guardian stated for two minor children |
| Goals | Five stated goals |
The Two Frameworks Behind the Score
The score grades 20 measures across seven frameworks. Two of them carry this case: the Protection Stack, which scores 10 of 22 on deep cover for one earner, and the 3 Bucket Framework, which scores 3 of 20 because the sorting system was never built.
Framework one
The Protection Stack
The Protection Stack grades the coverage that keeps one bad month from ending the plan. The bought layers on the surgeon are deep. The paper layers are empty.
- Life and umbrella, in force Built
- Term life of $3,000,000 on Miriam across three policies and $1,000,000 on Malcolm, and a $2,000,000 umbrella over a household with a rental property. Each box earns the full 4.
- Disability, on one earner Partial
- Two policies on Miriam, Guardian and Standard, carried together because each fills gaps in the other, own occupation status not stated. Malcolm's disability cover is not stated. The box earns 2 of 4.
- Health and estate, unstated and unwritten Missing
- The household's own health cover is not stated, and no estate documents are in place, with no guardian stated for two minor children. Each box earns 0.
Framework two
The 3 Bucket Framework
The 3 Bucket Framework grades the cash system: milestones, the cash buffer, the lanes the money sorts into, and whether the goals are funded.
- Goals funded Partial
- Dollars are aimed at investing, college and travel, while the $50,000 a year investing floor sits ahead of the stated flows. The box earns 3 of 6.
- The cash buffer Missing
- About $40,000 of cash savings is stated, and months of cover are not stated on the record's figures. The box earns 0 of 4.
- Milestones and lanes Missing
- The milestone net cannot be determined from the intake, and no lane system is stated while the monthly saving swings by thousands. Each box earns 0.
Paid Off, and Pointing at What Is Next
The first look is the achievement the score barely pays for. Over $300,000 of student debt stood after residency, and it was paid off in full in 2018, five years out of training. The hosts opened with the payoff.
The competition is the problem. The first stated goal is to invest at least $50,000 a year and grow the number. The third is two college tuitions, the fifth is travel with the children once they are older. On the hosts' arithmetic, the first eight months saved about $30,000, roughly a month behind the pace the first goal needs, before college or travel takes a dollar. The hosts asked where the college and travel money comes from without robbing the $50,000 investing goal.
The loan payoff was the easy part to measure. The system after it is not built.
The tool they prescribed is the same one this record traces: three to six months of tracking, until the household can see which dollars leak and which goals the flows can actually carry. Saving that swings from $3,624 to $6,039 a month is not a rate yet. It is a range, and a plan cannot be built on a range.
That is why the 3 Bucket Framework grades this file at 3 of 20 while the Transition framework pays the finished loans at full marks. The payoff was an event with an end date. The system that has to replace it, lanes, a measured leak, funded goals in order, has no end date, and it is the part still waiting to be built.
The Ten Year Policy and the Unsigned Will
The second look is two paper clocks running against two small children. The first is a policy: $1,000,000 of Miriam's $3,000,000 of term life runs on a 10 year term. The hosts disliked a $1,000,000 term that expires when the children are eleven and thirteen.
The second clock is the missing one. There are no estate planning documents yet, stated plainly as next on the list. The hosts closed on estate planning now, for the guardian question above all. Two children, three and one, and a father living in the home.
The shortest policy ends when the kids are eleven and thirteen. The will does not exist yet.
The record traces the documents at the full estate pattern, +4, the single largest step on this file's path to 49.
Set beside the $3,000,000 of bought life cover, the pattern is plain. This household buys protection seriously and writes paper slowly. The cover assumes the documents exist. A claim is where the two meet.
Milestones: Scored on What Is Stated
Inside the 3 Bucket Framework, the milestone checklist tracks the markers a household has already hit. This checklist earns 0 for Miriam and Malcolm, because the intake never states a milestone list the net can be computed from. The box pays only for stated milestones.
The rest of the bucket picture: the emergency fund earns 0 with months of cover not stated, named lanes earn 0 with no sorting system stated, and goals funded earns 3 of 6 on aims that reach every goal area below the stated target pace. The framework earns 3 of 20.
Questions this case answers
What score did Miriam and Malcolm receive on the Financial Health Assessment?
Miriam and Malcolm scored 40 out of 100, in the Corrections band. The Protection Stack earns 10 of 22 and the Decision Filter the full 4 of 4, while the 3 Bucket Framework earns 3 of 20.
How did the student loans grade?
The loans are finished: over $300,000 paid off in full in 2018, five years out of training. Education debt finished earns the full 6 on the established fork. The remaining stated debt is two mortgages and an auto loan, $932,000 in all, which the Debt Anchor grades at about 2.11 times income for partial credit.
Why does the 3 Bucket Framework earn only 3 of 20?
The bucket grades the sorting system. The milestone net cannot be determined, emergency fund months are not stated, and no lane system is stated, so those three boxes earn 0. Goals funded earns 3 of 6. The household's saving is real but swings widely, from $3,624 to $6,039 across the last three stated months.
What is missing for Miriam and Malcolm?
No estate documents are in place and no guardian is stated for two minor children. The household's own health cover and malpractice type and tail are not stated, Malcolm's disability cover is not stated, and Miriam's two disability policies are not stated as own occupation.
Sources and Basis
This assessment is built from the household's own intake for the Financial Health Assessment and the episode assessment of it. Every figure on this page comes from that record, and the score is traced box by box under the locked attending rubric.
The attending rubric weights the seven frameworks at 20, 14, 22, 10, 8, 4, and 22, for a total of 100. The bands are Needs a workup from 0 to 39, Corrections from 40 to 69, Stable from 70 to 84, and Healthy from 85 to 100. Attendings are scored on the Transition fork by years since training: for established attendings, whether education debt is finished, and whether consumer or vehicle debt remains.
Written by Ryan Inman, MBA, MAFM. Last updated October 2026.