Pierce and Donna
Financial Health Assessment · Episode FHA-010
Financial Health Assessment. Pierce, 48, is an emergency medicine physician fifteen years out of training. Donna, 46, teaches part time. Their household earns about $680,000 in the Phoenix metro, and the assessment scores them 31 out of 100, in the Needs a workup band.
31
FHA score out of 100 · Needs a workup
$680,000
Household income a year · two earners
$875,000
Total debt · about 1.29 times income
$25,000
Emergency fund · about half a month
The debt math is good: total debt of about $875,000 against about $680,000 of income is about 1.29 to 1, and the student loans were paid off long ago.
Almost everything around that math never caught up with fifteen years of raises. Saving runs at about 8 percent, about $35,000 sits on credit cards, the emergency fund holds about $25,000, disability is the group policy only, and there are no estate documents for five kids. Five fixes take the score to a 55.
Financial Health Assessment score
31 / 100
Needs a workupThe score grades the household on 20 measures across seven frameworks. Pierce and Donna land at 31, in the Needs a workup band, score 0 to 39.
31
FHA score out of 100 · Needs a workup
$680,000
Household income · $620,000 of it from Pierce
$875,000
Total debt · about 1.29 times income
55
Score with the five fixes · Corrections band
Key takeaways
- The score: 31 out of 100, in the Needs a workup band, the band for scores from 0 to 39. The shape is the story. Protection earns 13 and the Wealth Equation earns 10 on the debt anchor alone, while the 3-Bucket Framework, the Decision Filter, and the Lifestyle Guardrails all score zero.
- The debt anchor is the strongest read in the file. Total debt of about $875,000 against household income of about $680,000 is about 1.29 to 1, full credit for an established attending, and the finished student loans earn the full 6 on the transition box they answer.
- Protection is half built. Health covers all seven people, a $500,000 term life policy is in force, and a $1,000,000 umbrella exists. Against that: disability is the group policy only, the umbrella sits under about $1,800,000 of assets, malpractice is claims made with no tail arranged, and there are no estate documents and no named guardian for five kids.
- The lifestyle ate the raise. Saving runs at about 8 percent, about $54,000 a year, against a 20 percent floor of about $136,000, a gap of roughly $80,000 a year. The household carries about $35,000 on credit cards, the emergency fund is about $25,000, and spending is neither tracked nor automated.
- Five fixes move the score 24 points to a 55, in the Corrections band: clear the cards and the car loans for 4, build the emergency fund to three months for 2, automate 15 percent for 12, add individual own occupation disability on both earners for 2, and complete the estate set with a named guardian for 4.
Read the shape, not just the total: a strong debt anchor and a half built protection stack, carried by almost nothing else.
The Household
This is an established household, not a new one. Pierce is fifteen years out of training, in year fifteen of a roughly twenty year earning window, and the biggest paychecks of his career are arriving now. The question this assessment answers is where a $680,000 income went, and why so little of the structure around it was ever built.
Pierce has practiced emergency medicine for fifteen years since training and earns about $620,000. Donna, 46, earns about $60,000 teaching part time, which puts the household at about $680,000. They have been married 20 years, they have five kids, ages 4 to 16, and they live in the Phoenix metro.
Seven people run on this income, and about $620,000 of it comes from Pierce alone.
The debt side is the finished part of the file. The student loans were paid off a long time ago. The mortgage is about $800,000 on a home worth about $1,200,000. The household carries about $35,000 on credit cards and about $40,000 across two car loans. Total debt is about $875,000, which against about $680,000 of income is a ratio of about 1.29 to 1.
The money system never grew up with the income.
The money system never grew up with the income. The emergency fund holds about $25,000, about half a month of expenses for this household. The savings rate is about 8 percent, about $54,000 a year. About $600,000 is invested, and counting the house, total assets are about $1,800,000. Pierce cannot sort most of the household's dollars into buckets, spending is not tracked, and no goals are written down.
On taxes, Pierce does not know the household's federal bracket. He contributes to his 401(k) pre tax because pre tax was the default, and that default is the one tax move on file. Nothing about the lane was chosen on purpose, and nothing has been revisited since.
The protection layer is inventoried in the deep dive below. Health insurance runs through Pierce's employer and covers the whole family. Disability is the group policy through work, with no individual policy. Life insurance is a $500,000 term policy, in force. The umbrella is $1,000,000. Malpractice is claims made, with no tail arranged. There is no will, no power of attorney, no healthcare directive, and no guardian named for the five kids.
| Household fact | Where it stands |
|---|---|
| Careers | Emergency medicine physician, fifteen years out of training, and part time teacher |
| Ages | 48 and 46 |
| Household income | About $680,000 a year: about $620,000 from Pierce, about $60,000 from Donna |
| Where they live | Phoenix metro |
| Family | Married 20 years, five kids, ages 4 to 16 |
| Student loans | $0, paid off long ago |
| Mortgage | About $800,000 on a home worth about $1,200,000 |
| Credit cards | About $35,000, carrying balances |
| Car loans | About $40,000, two cars |
| Total debt | About $875,000, about 1.29 times household income |
| Emergency fund | About $25,000, about half a month of expenses |
| Saving | About 8 percent of income, about $54,000 a year, not automated |
| Investable assets | About $600,000 |
| Total assets | About $1,800,000, home plus investable assets |
| Taxes | Federal bracket not known; 401(k) contributed pre tax by default |
| Disability | Employer group policy only; no individual own occupation policy |
| Life insurance | $500,000 term policy, in force |
| Umbrella | $1,000,000, against about $1,800,000 of total assets |
| Malpractice | Claims made, no tail arranged |
| Estate documents | None: no will, no power of attorney, no healthcare directive, no guardian named |
The Score: 31 out of 100
The Financial Health Assessment grades a household across the same seven frameworks and lands the total in a band. Pierce and Donna score 31, in the Needs a workup band: a strong debt anchor and a half built protection stack, carried by almost nothing else. Three of the seven frameworks score zero.
20
Measures graded
7
Frameworks
31
Pierce and Donna's score
| Framework | What the read is | Points |
|---|---|---|
| 02 3-Bucket Framework | Milestones net zero on the twelve item checklist, an emergency fund at about half a month, most dollars not sortable, and no goals funded | 0 of 20 |
| 03 Physician Wealth Equation | The debt anchor earns the full 10 at about 1.29 times income, and the stretch saving element earns 0 at a savings rate of about 8 percent | 10 of 14 |
| 04 Protection Stack | Health 4, life 4 on the term policy in force, disability 2 for group only, umbrella 2 as underinsured, malpractice 1 for claims made with no tail, and estate documents 0 | 13 of 22 |
| 05 Attending Transition Blueprint | Education debt finished earns the full 6, and consumer and vehicle debt present right now earns 0 | 6 of 10 |
| 06 Tax Ladder | The pre tax 401(k) lane, picked by default and held, earns 2, and the bracket and moves box earns 0 | 2 of 8 |
| 07 Decision Filter | No goals written down at all | 0 of 4 |
| 08 Lifestyle Guardrails | A savings rate of about 8 percent earns 0 on the Savings Floor, untracked spending earns 0 on the leak, and lifestyle first with no automation earns 0 | 0 of 22 |
| Total | Needs a workup band | 31 |
Read the shape, not just the total. The 3-Bucket Framework scores 0 of 20: the milestone checklist nets zero, the emergency fund of about $25,000 is about half a month against a three to five month partial credit line, Pierce cannot sort most dollars into the named lanes, and with no written goals, nothing is documented as flowing to goals.
The Physician Wealth Equation scores 10 of 14, and all 10 come from one box. Total debt of about $875,000 over household income of about $680,000 is about 1.29 to 1, and full credit for an established attending runs to 2.0 times income. The stretch saving element earns 0: a savings rate of about 8 percent, with about $600,000 invested, clears neither scoring line.
The Protection Stack scores 13 of 22, the largest block in the file. Health earns the full 4 with all seven people covered. Life earns the full 4 because an individual term policy is in force. Disability earns 2 for group only coverage, the umbrella earns 2 as underinsured, malpractice earns 1 for a claims made policy with no tail, and the estate box earns 0.
The Attending Transition Blueprint scores 6 of 10 on the established fork. Education debt finished earns the full 6. The second box earns 0, because about $35,000 of credit card balances and about $40,000 of car loans are present right now, outside the mortgage.
The Tax Ladder scores 2 of 8. The Roth against pre tax box earns 2: Pierce picked the pre tax 401(k) lane and stuck with it, which earns partial credit even without a reason behind it. The bracket and moves box earns 0, because he does not know his federal bracket and the single move on file is that same default, already credited in the first box.
The Decision Filter scores 0 of 4, because no goals are written down. The Lifestyle Guardrails score 0 of 22: the Savings Floor pays nothing at a savings rate of about 8 percent, the leak pays nothing because spending is not tracked, and wealth first automation pays nothing because nothing is automated and the lifestyle gets the money first.
The Two Frameworks Behind the Score
The score grades 20 measures across seven frameworks. Two of them carry this case: the Protection Stack, the largest block in the file at 13 of 22, and the Lifestyle Guardrails, which score 0 of 22.
Framework one
The Protection Stack
The finding is protection that stayed where it started while the income grew past it: health and life at full credit, and every other rung partial or empty.
Health insurance
All seven people are covered through Pierce's employer. Health earns the full 4, the one rung at full size.
Life insurance
A $500,000 term policy is in force, and it earns full credit on its box. It is also less than one year of Pierce's income, against a ten times starting point of about $6,000,000: a sizing problem, not an absence.
Disability insurance
Employer group policy only. There is no individual own occupation policy on the physician earner, the person whose roughly $620,000 supports seven people.
Umbrella
$1,000,000 in force, against about $1,800,000 of total assets: a real policy, sized under what they own.
Malpractice
Claims made, with no tail arranged. Who pays for the tail if he leaves is a question this household has not asked yet.
Estate documents
None: no will, no power of attorney, no healthcare directive, and no guardian named. If both parents were gone, no document anywhere says who raises the five kids.
Framework two
The Lifestyle Guardrails
All three boxes score zero. Over fifteen years, the raises kept coming, and the lifestyle grew to meet every one of them.
The Savings Floor
Saving runs at about 8 percent, about $54,000 a year, against the 20 percent floor this show wants every attending household to clear, about $136,000 a year on this income.
The leak
Nobody is tracking spending, so nobody can say where the money goes. Untracked spending earns 0 on the leak.
Wealth first automation
Nothing is automated, and the lifestyle gets the money first. The difference between what comes in and what is spent never gets a lane of its own.
What They Did Right
The milestones that money alone finishes got done. This is what fifteen years built.
The student loans are finished
The education debt is finished, paid off long ago, and that finish earns the full 6 on its transition box.
The debt anchor is strong
Total debt of about $875,000 over household income of about $680,000 is about 1.29 to 1, under both the established full credit line of 2.0 times and the stricter long tenure read of under 1.5 times this show likes to see.
Real money is invested
About $600,000 is invested, and counting the house, total assets are about $1,800,000.
The whole family is covered on health
Health insurance runs through Pierce's employer and covers all seven people, which earns the full 4 on its box.
Layers many households never buy
A term life policy is in force, and an umbrella policy exists. Each of those is a layer many households never buy at all, and the protection stack pays 13 points for what is already standing.
Protection Sized for a Smaller Life
The first deep dive is the Protection Stack, and the finding is protection that stayed where it started while the income grew past it. Pierce and Donna have five kids between 4 and 16. There is no will, no named guardian, no power of attorney, and no healthcare directive. Disability on a $680,000 household income is the group policy only. The umbrella is $1,000,000 against about $1,800,000 in assets. Malpractice is claims made with no tail arranged.
The life policy is $500,000, less than one year of Pierce's income.
Two gaps in this stack are the urgent kind. There is no individual own occupation disability policy on the physician earner, the person whose roughly $620,000 supports seven people. And there are five minors in the house with no will naming a guardian, so if both parents were gone, no document anywhere says who raises the kids.
The Stack has six layers, and each one covers a different way the plan can fail. Health covers someone getting sick. Disability covers Pierce not being able to work: group policies usually cap the monthly benefit, are tied to the job, and stay behind if he leaves, while an individual own occupation policy pays if he cannot practice emergency medicine and moves with him. Life covers him not coming home.
The umbrella covers someone suing them personally, and it gets sized against what they own. They also have a 16 year old in the house, which means a new driver is coming soon, if there is not one already.
Malpractice covers someone suing over clinical work: claims made coverage only covers claims filed while the policy is active, which is what tail coverage is for. The estate layer decides who makes the calls, and who raises the kids, when they cannot.
Every layer gets sized to the life the household has today, and five kids change the math on every layer.
$6,000,000
Life sizing starting point · ten times Pierce's income
$500,000
Life cover in force · under one times income
$31,000
Disability sizing target · about, per month
Every layer gets sized to the life the household has today, and five kids change the math on every layer. The sizing reads are plain. Life starts at ten times income on this show, about $6,000,000 on Pierce's income of about $620,000, against $500,000 in force, under one times. Disability sizes toward about 60 percent of his income, about $372,000 a year, about $31,000 a month. Sizing is a conversation for their own advisor. The gaps above are not.
The fix runs in this order. First, the estate: a will that names a guardian, plus a power of attorney and a healthcare directive for each of them, started with a weekend conversation about who raises the kids. Second, disability: an individual own occupation policy on Pierce, with the group policy as a layer on top, applied for while he is healthy, because at 48 underwriting gets harder and pricier every year.
Third, the umbrella: take it to $2,000,000 or more, so the coverage at least matches what they own. It is usually one of the cheaper policies a family carries. Fourth, the tail: ask the employer, in writing, who pays for the tail if he leaves, and if the answer is him, price it now, so the number is known before it is ever needed. The prescription below carries the scored pieces of this fix.
The Lifestyle Ate the Raise
The second deep dive is the Lifestyle Guardrails, and the finding is a household income of $680,000 with a savings rate of about 8 percent, about $54,000 a year. They are carrying $35,000 on credit cards. The emergency fund is $25,000, about two weeks of expenses for this household. Nobody is tracking spending, and nothing is automated. Over fifteen years, the raises kept coming, and the lifestyle grew to meet every one of them.
The Guardrails come down to three moves. Save the raise: when income goes up, a set share of the increase goes to savings before it ever feels like spending money. Cap the lifestyle: pick a spending number for the household on purpose, and that number does not climb every time the income does. Automate the gap: the difference between what comes in and the cap moves to savings on payday, automatically, so willpower never gets a vote.
8%
Savings rate today · about $54,000 a year
20%
The floor for an attending household · about $136,000
$80,000
The gap each year, roughly
The floor this show wants every attending household to clear is a 20 percent savings rate. On $680,000, 20 percent is about $136,000 a year. They are at about $54,000, so the gap is roughly $80,000 a year going to lifestyle when it could be going toward the life they want at sixty.
When spending has no cap, the credit limit ends up being the cap.
The cards tell the same story. At rates of 20 percent or more, carrying $35,000 costs about $7,000 a year in interest. Carrying a balance on this income says there is no cap on spending, and when spending has no cap, the credit limit ends up being the cap.
The fix has three parts. First, kill the cards, get the balances to zero, and after that pay them in full every month.
Second, automate 15 percent, about $102,000 a year, roughly $8,500 a month moving on payday before it reaches checking. Fifteen percent is not the finish line: it is the first step toward the 20 percent floor, and every raise from here goes to savings first until they clear it. Third, track spending for ninety days, then set the cap based on what they find.
Milestones: What Fifteen Years Built
Fifteen years out, some milestones are banked. The education debt is finished, paid off long ago, and that finish earns the full 6 on its transition box. The debt anchor sits at about 1.29 times income, under both the established full credit line of 2.0 times and the stricter long tenure read of under 1.5 times this show likes to see.
About $600,000 is invested and total assets are about $1,800,000. The family is fully covered on health insurance, a term life policy is in force, and an umbrella policy exists. Each of those is a layer many households never buy at all, and the protection stack pays 13 points for what is already standing.
Against that, the framework's twelve item milestone checklist nets zero for this household, which scores zero on its box. The pattern behind the net is the pattern of the whole file: the milestones that money alone finishes, like the loan payoff, got done, and the milestones that take a decision, a document, or a system mostly did not.
The clock is the last milestone fact. Pierce is in year fifteen of a roughly twenty year earning window, so the biggest paychecks of the career are the current ones. The youngest child is 4, which means the coverage years ahead are long, and every fix in the prescription still has years of peak income in front of it to work with.
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The Prescription
Five moves, in the order the episode gave them. Each move names the points it earns, and the five gains add to 24.
1
Kill the $35,000 in credit cards, and then the car loans. Worth 4 points.
High income only builds wealth when the income goes somewhere useful, and interest at 20 percent or more sends it the wrong way: $35,000 at those rates is about $7,000 a year. On $680,000 of income, carrying that balance is a choice, not a constraint.
Point every spare dollar at the cards, highest rate first, pay them in full every month once they reach zero, and roll the payoff to the $40,000 of car loans next, inside this same item. Clearing all debt outside the mortgage moves the transition box from 0 to its full 4.
2
Build the emergency fund to three months. Worth 2 points.
This is the Safety Net bucket of the 3-Bucket Framework. About $25,000 for seven people is about two weeks of expenses, and this household is one surprise away from more card debt, whether that is the air conditioning dying in a Phoenix July, a broken arm, or a transmission.
If $25,000 covers about half a month, three months is somewhere around $150,000. Get to one month first, then keep going, in its own savings account, separate from checking. Reaching three months earns the partial credit of 2 on the emergency fund box.
3
Automate 15 percent savings. Worth 12 points.
This is the Lifestyle Guardrails. They are saving 8 percent on $680,000. The raise is already there; it just needs a lane. Set up about $8,500 a month, about $102,000 a year, to move automatically on payday into the 401(k) and the investment accounts, before the money reaches checking. After that, every raise goes to savings first until they clear 20 percent.
A rate of 15 percent moves the Savings Floor from 0 to its partial credit of 6 and stretch saving from 0 to its partial 2, and automating on payday earns wealth first automation its full 4. Full Savings Floor credit needs 20 percent and full stretch saving needs 25 percent, so on those two boxes this move claims only the partials.
4
Get individual own occupation disability policies on both earners. Worth 2 points.
This is the Protection Stack. Group coverage alone on $620,000 of income means the income supporting seven people is mostly uninsured, and there is currently no individual own occupation policy on the physician earner in this house. Get quotes through an independent broker who can shop more than one carrier, size the policy toward about 60 percent of income, about $372,000 a year, and apply while he is healthy.
At 48, every year of waiting costs more. Add an individual policy on Donna's teaching income too, because full marks need every earner covered. Together they move disability from the group only partial of 2 to the full 4.
5
Get the will, guardian, power of attorney, and healthcare directive done. Worth 4 points.
This is also the Protection Stack. Five kids and no named guardian is the scariest gap on the board. This item is last on the list and first in urgency. Pierce and Donna, have the guardian conversation this week, just the two of you.
Then book an estate attorney, sign the documents, and tell the person they picked that they picked them. The full document set, with a guardian named for the minors, earns the estate box its full 4, up from 0.
Run all five and the arithmetic is 31 plus 24, a score of 55, in the Corrections band, a full band above where this household starts. The gains are 4 for clearing the consumer and vehicle debt, 2 for the three month emergency fund, 12 for the automated 15 percent, 2 for the disability policies on both earners, and 4 for the complete estate set.
What This Case Teaches
A raise is not a system. This household did the hardest single thing on the board: it finished the student loans and kept total debt at about 1.29 times a very large income. Then the income kept rising for fifteen years and no system was ever built to catch it, so the lifestyle caught it instead, at about 8 percent saved, $35,000 on cards, and half a month of reserves.
It is what share of each raise was ever assigned a job.
The audit question for any established household is not what it earns. It is what share of each raise was ever assigned a job.
The second lesson is that undersized is not the same as absent, and the record matters. A $500,000 term policy is in force here, and it earns full credit on its box, even though under one times income is a sizing problem against a ten times starting point of about $6,000,000.
Group disability is a real layer worth partial credit, and a claims made malpractice policy in force is worth its point. Reading this file as if those layers were zero would misstate both the score and the fix: this household needs sizing and documents, not a start from nothing.
Questions this case answers
What score did Pierce and Donna receive on the Financial Health Assessment?
Pierce and Donna scored 31 out of 100, in the Needs a workup band, which covers scores from 0 to 39. Protection earns 13 and the Physician Wealth Equation earns 10 on the debt anchor alone, while the 3-Bucket Framework, the Decision Filter, and the Lifestyle Guardrails all score zero.
How can a household earning about $680,000 score 31 out of 100?
The debt math is good: total debt of about $875,000 against about $680,000 of income is about 1.29 to 1, and the student loans were paid off long ago. Almost everything around that math never caught up with fifteen years of raises. Saving runs at about 8 percent, about $35,000 sits on credit cards, the emergency fund holds about $25,000, disability is the group policy only, and there are no estate documents for five kids.
What is the most urgent gap in Pierce and Donna's plan?
Five kids and no named guardian is the scariest gap on the board. There is no will, no power of attorney, and no healthcare directive, so if both parents were gone, no document anywhere says who raises the kids. The prescription puts the estate set last on the list and first in urgency.
What do the five fixes do to Pierce and Donna's score?
Run all five and the arithmetic is 31 plus 24, a score of 55, in the Corrections band, a full band above where this household starts. The gains are 4 for clearing the consumer and vehicle debt, 2 for the three month emergency fund, 12 for the automated 15 percent, 2 for the disability policies on both earners, and 4 for the complete estate set.
Sources and Basis
This case is drawn from the household's own Financial Health Assessment record, episode FHA-010, an emergency medicine household at the established attending stage. Every figure on this page comes from that record: the incomes, the debts, the $25,000 emergency fund, the roughly $600,000 invested, and the coverage inventory, stated as the household reported them.
The score was traced box by box against the attending rubric, and the trace governs this page. On the record, a score of 31 sits in the Needs a workup band, which covers scores from 0 to 39. The record also shows a $500,000 term life policy in force, so this household carries no zero life insurance flag: the policy is undersized against Pierce's income, which is a sizing read, not an absence.
The after the fix target follows the same trace. The five prescription gains were each checked against the rubric at the traced score: 4, 2, 12, 2, and 4, for 24 points in total, which is how the target of 55 is built. The estate item earns 4 rather than 2 because the prescription delivers the full document set, with a guardian, from a starting point of no documents at all.
Written by Ryan Inman, MBA, MAFM. Last updated October 2026. This case is episode FHA-010 of the Financial Health Assessment podcast.
About
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.
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