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Financial Health AssessmentNeurologyEstablished

Rachel and Mark

Financial Health Assessment · Neurology case

Neurology Established · 12 years out Two incomes, two kids

Rachel, 48, is a neurologist twelve years out of training. Mark, 50, is an engineer. Their household earns about $550,000 in the Denver metro area, and the assessment scores them 62 out of 100, in the Corrections band.

62

FHA score out of 100 · Corrections

$550,000

Household income a year · neurologist and engineer

12%

Savings rate · about $66,000 a year

$800,000

Invested · student loans paid off

The hard work is done. The student loans are paid off, the only debt is the mortgage at about 0.73 times income, and the Protection Stack earns 20 of 22. Health, disability, life, malpractice, and estate documents are in place.

The running system is thin. Saving runs at about 12 percent, spending is not tracked, and four written goals have no money flowing to them. The tax file holds one move, made by default. Five fixes take the score to a 78.

62

FHA score out of 100 · Corrections

$550,000

Household income · neurologist and engineer

$400,000

Mortgage · the only debt in the house

78

Score with the five fixes · Stable band

Key takeaways

  • The score: 62 out of 100, in the Corrections band, and the shape is the story. The Protection Stack earns 20 of 22 and the Transition framework earns 10 of 10, while the 3-Bucket Framework earns 4 of 20.
  • The debt is done. About $400,000 of mortgage against about $550,000 of income is a debt anchor of about 0.73 times, full marks on the established line, and the student loans are paid off.
  • The Wealth Equation is winning on the anchor and losing on the rate. Saving runs at about 12 percent, about $66,000 a year, in a window with about fifteen years left to build.
  • The tax file holds one move. The 401(k) is pre tax because that was the default, and Rachel knows the 32 percent bracket cold. The Tax Ladder earns 4 of 8 on a rung nobody chose on purpose.
  • Four goals are written down with numbers and dates, and no money flows to any of them. Five fixes move the score 16 points to a 78: savings at 20 percent, tracking, funded goals, a second tax move, and a bigger umbrella.

The debt is gone and the protection is built. The rate never got its orders.

The Household

Rachel is 48 and a neurologist twelve years out of training, earning about $400,000. Mark is 50 and an engineer, earning about $150,000. They have been married twenty years, they have two kids, 16 and 13, and they live in the Denver metro area.

The debt picture is clean. The student loans are paid off, there are no car loans, and the credit cards are paid in full every month. The only debt is the mortgage, about $400,000 on a house worth about $1,200,000.

$550,000 comes in. Twelve percent gets saved. The rest goes where it goes.

They hold about $800,000 invested, and total assets run about $2,000,000. The emergency fund is about $50,000, about three months of expenses. Saving runs at about 12 percent of income, and monthly spending is not tracked.

On taxes, Rachel knows the household sits in the 32 percent federal bracket. The one deliberate move on the books is the 401(k), and it is pre tax because that was the default when it started. Nobody has revisited the choice since.

Protection is nearly complete. The employer health plan covers the whole family, and Rachel holds an individual own occupation disability policy. A $1,000,000 term life policy is in force, malpractice is claims made with the tail arranged, and the estate documents are complete with a guardian named.

Two gaps sit inside that strength. The umbrella is $1,000,000 against about $2,000,000 of assets, and four goals sit on paper with numbers and dates and no money flowing toward any of them.

Household factWhere it stands
CareersNeurologist, 12 years out of training, and engineer
Ages48 and 50
Household incomeAbout $550,000 a year, about $400,000 plus about $150,000
Where they liveDenver metro
FamilyMarried 20 years, two kids, ages 16 and 13
Student loansPaid off
Other debtNo car loans; credit cards paid in full every month
Mortgage and homeAbout $400,000 owed on a home worth about $1,200,000
Emergency fundAbout $50,000, about 3 months of expenses
InvestedAbout $800,000
Total assetsAbout $2,000,000
SavingAbout 12 percent of income, about $66,000 a year
SpendingNot tracked
Taxes32 percent federal bracket, known; the 401(k) is the one move, pre tax by default
DisabilityIndividual own occupation policy on Rachel
Life insurance$1,000,000 term, in force
Umbrella$1,000,000 against about $2,000,000 of assets
MalpracticeClaims made, with the tail arranged
Estate documentsWill, powers of attorney, healthcare directives, and a guardian named
GoalsFour written, each with a number and a date, none funded yet

The Score: 62 out of 100

The Financial Health Assessment grades a household across the same seven frameworks and lands the total in a band. Rachel and Mark score 62, in the Corrections band. This household is scored on the attending rubric, established fork.

20

Measures graded

7

Frameworks

62

Rachel and Mark's score

The 3-Bucket Framework earns 4 of 20. Milestones earn 0 on a net of 2, the emergency fund earns 2 at about three months, and named lanes earn 2 because most dollars can be sorted. Goals funded earns 0, because no money flows toward the four written goals.

The Physician Wealth Equation earns 12 of 14. The Debt Anchor earns the full 10: total debt of about $400,000 against about $550,000 of income is about 0.73 times, well under the established line of 2.0 times. Stretch saving earns 2 at a savings rate of about 12 percent.

The Protection Stack earns 20 of 22: health, disability, life, and estate documents at the full 4 each, malpractice at the full 2, and the umbrella at 2 because $1,000,000 sits under total assets of about $2,000,000. The Transition framework earns 10 of 10 on the established fork.

The Tax Ladder earns 4 of 8: 2 for a pre tax pick that was never thought through, and 2 for knowing the 32 percent bracket with one deliberate move. The Decision Filter earns the full 4 of 4, with four goals written down. The Lifestyle Guardrails earn 8 of 22.

FrameworkWhat it coversPoints
02 3-Bucket FrameworkMilestones 0, emergency fund 2, named lanes 2, goals funded 04 of 20
03 Physician Wealth EquationDebt Anchor 10 at about 0.73 times income, stretch saving 2 at about 12 percent12 of 14
04 Protection StackHealth 4, disability 4, life 4, umbrella 2, malpractice 2, estate documents 420 of 22
05 TransitionEducation debt finished 6, no consumer or vehicle debt 410 of 10
06 Tax LadderRoth against pre tax 2, bracket plus moves 24 of 8
07 Decision FilterGoals written 4, four goals on paper with numbers and dates4 of 4
08 Lifestyle GuardrailsSavings floor 6, the leak 0, wealth first automation 28 of 22
TotalCorrections band62 out of 100

Read the shape, not just the total. The earned points sit in the finished work: the debt, the protection, the documents, the written goals. The missing points sit in the running system: a rate of 12 percent, untracked spending, and goals with no dollars behind them.

The Two Frameworks Behind the Score

The score grades 20 measures across seven frameworks. Two of them carry this case: the Physician Wealth Equation, which earns 12 of 14 on a debt anchor at full marks, and the Tax Efficiency Ladder, which earns 4 of 8 on one move made by default.

Framework one

The Physician Wealth Equation

The Wealth Equation runs five forces on a physician household: a late start, a debt anchor, a high income accelerator, a compressed window, and a complexity multiplier. Here the anchor is cut loose, and the accelerator runs at 12 percent in a window with about fifteen years left.

The Debt Anchor

Total debt is the mortgage only, about $400,000 against about $550,000 of income, about 0.73 times. Under the established line of 2.0 times, the box earns the full 10.

Full marks

Stretch saving

A savings rate of about 12 percent clears the first bar on the stretch saving scale and earns 2 of 4. The full 4 needs 25 percent at this level of invested assets.

Partial

The accelerator at 12 percent

A high income makes up for a late start only when a big share of it gets saved. At 12 percent, about $66,000 a year, the one force fully in their control runs below the 20 percent floor.

Behind

Framework two

The Tax Efficiency Ladder

The Tax Ladder is a set of rungs, and each rung is a choice made on purpose. This household stands on rung one, the 401(k), and the rung picked them: pre tax was the default, and nobody has chosen a second rung since.

Roth against pre tax

The 401(k) runs pre tax because that was the default, never because anyone sat down and picked it for this bracket. A lane picked and held earns 2 of 4.

Partial

Bracket plus moves

Rachel knows the 32 percent federal bracket cold, and the file holds one deliberate move, the 401(k). Bracket knowledge with one move earns 2 of 4.

Partial

The rungs above

The HSA, the 529 accounts, tax loss harvesting, and bunching deductions all sit unclaimed. At 32 percent, every $1,000 sheltered keeps about $320 of federal tax from applying today.

Unclaimed

What They Did Right

A 62 with this much finished work has real pieces in place. This is what is already built.

The debt is done

The student loans are paid off and there is no consumer or vehicle debt. The mortgage is the only debt left, about 0.73 times income, and the Transition framework earns the full 10 of 10.

Protection earns 20 of 22

Health, disability, life, and estate documents all earn full marks, and malpractice earns its full 2. An individual own occupation policy on the physician earner sits at the center of the stack.

Estate documents are complete

Wills, powers of attorney, healthcare directives, and a guardian named for the two kids. With minors in the house, the guardian is the document that matters most, and it is there.

The goals are on paper

Four goals are written down, each with a number and a date, and the Decision Filter earns the full 4 of 4. The paper half of the system is done. The funding half is the prescription.

The bracket is known cold

Rachel knows the household sits in the 32 percent federal bracket, and the 401(k) runs on its own every paycheck. That knowledge is the base the second tax move gets built on.

The Wealth Equation Is Winning. The Rate Is Not.

The first deep dive is the Physician Wealth Equation, and the finding is a rate set in an earlier season. Household income is about $550,000, Rachel is twelve years into her attending career, and the savings rate is about 12 percent, with about $800,000 invested.

The framework runs five forces. The Late Start Penalty: the attending paycheck started in her mid thirties, a decade after friends in other careers started compounding. The Debt Anchor: cut loose now, and paying it off still used the early attending years.

The High Income Accelerator is the force fully in their control, and a high income makes up for a late start only when a big share of it gets saved. The Compressed Window: at 48, practicing to around 63 leaves roughly fifteen years to build.

At 12 percent, the one force they control is not making up for the other four.

The Complexity Multiplier completes the five: two incomes, two kids heading toward college, and a $1,200,000 house, so more moving parts and more places for money to leak. The equation still favors them, because the anchor is gone and the income is high.

The fix is the rate. Twelve percent of about $550,000 is about $66,000 a year, and 20 percent is about $110,000, about $44,000 more a year. Over fifteen years that is about $660,000 of extra contributions before a dollar of growth.

The move does not have to land in one month. Raise the rate two points every six months and they reach 20 percent in about two years. The window is about half closed, so the time to start is now.

One Rung, and the Rung Picked Them

The second deep dive is the Tax Efficiency Ladder, and the finding is a single rung. They sit in the 32 percent federal bracket, Rachel knows it, and the file holds exactly one tax move, the 401(k), which runs pre tax because that was the default.

The Ladder is a set of rungs, and each rung is a choice made on purpose: pre tax against Roth, chosen for a reason tied to the bracket, the HSA, the 529, tax loss harvesting, and bunching deductions into one year so they count.

At 32 percent, every rung is worth a lot, and they are standing on one.

Every $1,000 sheltered at that bracket keeps about $320 of federal tax from applying today. Pre tax at 32 percent may well be the right answer if retirement lands them in a lower bracket. The point is making the call with a reason, and writing the reason down.

The fix starts with the fastest second rung. Add the HSA if the health plan offers a qualifying high deductible option. Pick pre tax or Roth on purpose, based on this bracket and the one expected in retirement.

Then fund the 529 accounts. The kids are 16 and 13, so the runway is short, and many states give a state income tax deduction for contributions. All three moves run past their CPA before anyone pulls the trigger.

Milestones: A Net of Two

Inside the 3-Bucket Framework, the milestone checklist is where an established household shows its momentum. Rachel and Mark net 2 on the checklist. On the attending scale, a net of 2 or less earns 0 of the 6 milestone points, and a net of 5 or more would earn the full 6.

The rest of the bucket picture sits around that net. Most dollars sort into the named lanes, which earns 2 of 4. The emergency fund, about $50,000 at about three months, earns 2. Nothing flows toward the written goals, so goals funded earns 0 as well.

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The Prescription

Five moves, in the order the episode gave them.

1

Push savings to 20 percent.

This is the Lifestyle Guardrails, and it gains 6 points, moving the Savings Floor from 6 to 12. Twelve percent in a compressed window is not enough, and the accelerator has to run hotter.

Go from about $66,000 a year to about $110,000, in steps of two points every six months, and send every raise or bonus straight to savings before it becomes lifestyle. With about fifteen years left, every year at 12 percent is a year they do not get back.

2

Track spending for 90 days.

This is the Lifestyle Guardrails, and it gains 3 points, moving the leak from 0 to 3. About $550,000 comes in, about $66,000 gets saved, and nobody can say where all of the rest goes.

For ninety days, download every card and bank statement and put every charge in a category, together, once a week. The goal is to see the spending first, and the extra savings from item one usually turns up in two or three categories.

3

Fund the four goals with automatic transfers.

This is the 3-Bucket Framework, and it gains 3 points, moving goals funded from 0 to 3. A goal with a number and a date and no money going to it is a wish.

Give each of the four goals its own account and an automatic transfer from every paycheck. Once dollars flow to all four, every future decision gets easier: hold the purchase up against the four goals and the answer is usually obvious.

4

Add a second tax move.

This is the Tax Efficiency Ladder, and it gains 2 points, moving bracket plus moves from 2 to 4. At 32 percent, one rung is not enough, and the fastest second rung is a maxed HSA if the plan qualifies.

If the plan does not qualify, the 529 accounts for the kids are the second move. Either one takes an afternoon. Make the pre tax against Roth call on purpose too, with a written reason, and run all of it past their CPA.

5

Increase the umbrella to $2,000,000.

This is the Protection Stack, and it gains 2 points, moving the umbrella from 2 to 4. A $1,000,000 umbrella does not cover about $2,000,000 in assets, and a 16 year old in the house means a new driver on the policy.

One call to the agent who writes the home and auto policies does it. An umbrella is usually one of the cheaper policies a household owns for the coverage it buys.

Run all five and the arithmetic is 62 plus 16, a score of 78. The gains are 6 for the savings floor, 3 for ninety days of tracking, 3 for funding the goals, 2 for a second tax move, and 2 for the umbrella. A score of 78 out of 100 moves Rachel and Mark into the Stable band.

What This Case Teaches

The finished work does not run itself. Rachel and Mark did the hard part years ago: the loans are paid off, the disability policy is in force, and the estate documents are signed with a guardian named. The lesson of this file is that the running system is separate work: a rate, a look at spending, and dollars behind the goals.

Four goals on paper with no money behind them are wishes with dates.

The second lesson is about defaults. The 401(k) ran pre tax for years because nobody changed it, and the savings rate sat at 12 percent because nobody reset it. At this income and this bracket, a default is a decision too, and it charges full price.

Questions this case answers

What score did Rachel and Mark receive on the Financial Health Assessment?

Rachel and Mark scored 62 out of 100, in the Corrections band. The Protection Stack earns 20 of 22 and the Transition framework earns 10 of 10, while the 3-Bucket Framework earns 4 of 20 and the Lifestyle Guardrails earn 8 of 22.

How does a household earning about $550,000 score 62 out of 100?

Nothing in the seven frameworks pays for income itself. The boxes pay for the savings rate, the debt ratio, the protection in force, and the systems around the money. Rachel and Mark have the debt gone and protection nearly complete, and they save about 12 percent with spending untracked, four written goals with no money flowing to them, and one tax move made by default.

What is the first fix for Rachel and Mark?

Push the savings rate to 20 percent. Twelve percent of about $550,000 is about $66,000 a year, and 20 percent is about $110,000, about $44,000 more a year. The plan raises the rate two points every six months, which reaches 20 percent in about two years, with about fifteen years left in the window.

What do the five fixes do to Rachel and Mark's score?

Run all five and the arithmetic is 62 plus 16, a score of 78. The gains are 6 for the savings floor at 20 percent, 3 for ninety days of tracking, 3 for funding the four goals, 2 for a second deliberate tax move, and 2 for raising the umbrella to $2,000,000. A score of 78 out of 100 moves the household into the Stable band.

Sources and Basis

This assessment is built from the household's record in the show's year end case bank: the build brief, the episode script, and the neurology case file for Rachel and Mark. 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. Established attendings are scored on the Transition fork: education debt finished, and no lingering consumer or vehicle debt.

Written by Ryan Inman, MBA, MAFM. Last updated October 2026.

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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