Rachel and Tom
Financial Health Assessment · Pain Medicine case
Rachel, 44, is a pain medicine physician, anesthesia trained, ten years into attending practice. Tom, 45, is a hospitalist. Their household earns about $750,000 in a large Midwest metro, and the assessment scores them 58 out of 100, in the Corrections band.
58
FHA score out of 100 · Corrections
$750,000
Household income a year · two physicians
$1.4M
Investable · 401(k)s, brokerage, and 529s
$40,000
Emergency fund · about two months
The foundation is poured. The student loans are paid off years ago, total debt sits at about 0.77 times income, and saving runs at about 13 percent, automated, with about $1,400,000 invested.
The picture was never assembled. The buckets leak, spending is not tracked, Tom has group disability only, the umbrella is $1,000,000, and the estate documents are eight years old. Five fixes take the score to a 74.
Financial Health Assessment score
58 / 100
CorrectionsThe score grades the household on 20 measures across seven frameworks. Rachel and Tom land at 58, in the Corrections band, score 40 to 69.
58
FHA score out of 100 · Corrections
$750,000
Household income · pain medicine and hospitalist
$578,000
Total debt · mortgage plus car loans
74
Score with the five fixes · Stable band
Key takeaways
- The score: 58 out of 100, in the Corrections band, and the shape is the story. The Physician Wealth Equation earns 14 of 14, while the 3-Bucket Framework earns 6 of 20.
- The debt side is finished work. The student loans are paid off, and about $578,000 of total debt against about $750,000 of income is a debt anchor of about 0.77 times, full marks on the established line.
- Protection has a thin layer. Rachel holds an individual own occupation disability policy, and Tom, earning about $300,000, has group long term disability only. The umbrella is $1,000,000 against about $1,400,000 invested plus home equity.
- The portfolio runs on autopilot. About $700,000 sits in 401(k) target date funds picked at the start and never reviewed, and about $500,000 sits with an advisor at 0.8 percent, about $4,000 a year.
- Five fixes move the score 16 points to a 74: a disability policy for Tom, a $3,000,000 umbrella, an estate refresh, named buckets with ninety days of tracking, and written goals fully funded.
Two physicians, leaky buckets, and a portfolio on autopilot.
The Household
Rachel is 44 and in pain medicine, anesthesia trained, ten years into attending practice, earning about $450,000. Tom is 45 and a hospitalist, earning about $300,000. They have been married fifteen years, they have two kids, 12 and 9, and they live in a large metro area in the Midwest.
The student loans are paid off, years ago, and there is no credit card debt. About $28,000 is left on car loans, and the mortgage is about $550,000, so total debt is about $578,000 against about $750,000 of income.
Asked to sort their money into buckets, they could not. Leaky buckets.
Investable assets are about $1,400,000. About $700,000 sits in their 401(k)s, still in the target date funds picked when they started. About $500,000 sits in a brokerage account with an advisor at 0.8 percent, and about $200,000 sits in 529s for the kids.
The emergency fund is about $40,000, about two months. Saving runs at about 13 percent, about $98,000 a year, and it is all automated. Monthly spending is not tracked, and the leak is estimated at about 5 percent of income, roughly $37,000 a year.
Protection is half built. Health coverage runs through their employers for the whole family, and each spouse holds a $1,500,000 20 year term policy. Rachel holds her own disability policy. Tom has group coverage only, the umbrella is $1,000,000, and the wills are eight years old with no healthcare directives.
The goals on paper are three, and all vague: retire comfortably, pay for college, and maybe get a lake house someday. None carries an amount or a date.
| Household fact | Where it stands |
|---|---|
| Careers | Pain medicine, anesthesia trained, 10 years attending, and hospitalist |
| Ages | 44 and 45 |
| Household income | About $750,000 a year, about $450,000 plus about $300,000 |
| Where they live | Large Midwest metro |
| Family | Married 15 years, two kids, ages 12 and 9 |
| Student loans | Paid off years ago |
| Other debt | Car loans about $28,000; no credit card debt |
| Mortgage | About $550,000 |
| Emergency fund | About $40,000, about 2 months |
| Investable | About $1,400,000: 401(k)s about $700,000, brokerage about $500,000, 529s about $200,000 |
| Saving | About 13 percent, about $98,000 a year, automated |
| Spending | Not tracked; leak estimated at about 5 percent, roughly $37,000 a year |
| Taxes | 35 percent federal bracket, known; no deliberate tax moves |
| Disability | Rachel: individual own occupation policy. Tom: group long term disability only |
| Life insurance | $1,500,000 20 year term on each spouse, in force |
| Umbrella | $1,000,000 against about $1,400,000 investable plus home equity |
| Malpractice | Occurrence coverage through both groups |
| Estate documents | Wills and powers of attorney signed 8 years ago, never updated; no healthcare directives |
| Goals | Three written, all vague: retire comfortably, college, maybe a lake house |
The Score: 58 out of 100
The Financial Health Assessment grades a household across the same seven frameworks and lands the total in a band. Rachel and Tom score 58, in the Corrections band. This household is scored on the attending rubric, established fork.
20
Measures graded
7
Frameworks
58
Rachel and Tom's score
The 3-Bucket Framework earns 6 of 20. Milestones earn 3 on a net of 3, goals funded earns 3 with money flowing, and the emergency fund and named lanes both earn 0: about two months of cash, and no dollars sorted into buckets.
The Physician Wealth Equation earns the full 14 of 14. The Debt Anchor earns 10 at about 0.77 times income, under the established line of 2.0 times. Stretch saving earns the full 4: past $1,000,000 invested, 13 percent clears the 12 percent bar.
The Protection Stack earns 16 of 22: health, life, and malpractice at full marks, and disability, umbrella, and estate documents at 2 each. The Transition framework earns 6 of 10: education debt finished earns 6, and the car loans keep the second box at 0.
The Tax Ladder earns 4 of 8, with 2 for a lane picked and held and 2 for knowing the 35 percent bracket with no deliberate moves. The Decision Filter earns 2 of 4 on three vague goals. The Lifestyle Guardrails earn 10 of 22.
| Framework | What it covers | Points |
|---|---|---|
| 02 3-Bucket Framework | Milestones 3, emergency fund 0, named lanes 0, goals funded 3 | 6 of 20 |
| 03 Physician Wealth Equation | Debt Anchor 10 at about 0.77 times income, stretch saving 4 at about 13 percent | 14 of 14 |
| 04 Protection Stack | Health 4, disability 2, life 4, umbrella 2, malpractice 2, estate documents 2 | 16 of 22 |
| 05 Transition | Education debt finished 6, car loans present 0 | 6 of 10 |
| 06 Tax Ladder | Roth against pre tax 2, bracket plus moves 2 | 4 of 8 |
| 07 Decision Filter | Goals written 2, three goals on paper, all vague | 2 of 4 |
| 08 Lifestyle Guardrails | Savings floor 6, the leak 0, wealth first automation 4 | 10 of 22 |
| Total | Corrections band | 58 out of 100 |
Read the shape, not just the total. The earned points sit in the finished work: the loans gone, the anchor light, the saving automated. The missing points sit in the picture nobody built: buckets, tracking, and the second income left on group coverage.
The Two Frameworks Behind the Score
The score grades 20 measures across seven frameworks. Two of them carry this case: the Protection Stack, which earns 16 of 22 with one thin layer per gap, and the 3-Bucket Framework, which earns 6 of 20 because no dollar has a named job.
Framework one
The Protection Stack
The Protection Stack is six layers, health, disability, life, umbrella, malpractice, and estate documents, and the stack is only as strong as its thinnest layer. This household earns 16 of 22, with three layers at full marks and three at partial.
Disability, one earner short
Rachel holds an individual own occupation policy. Tom earns about $300,000 and has group long term disability only through his job, so the box earns 2 of 4.
The umbrella at $1,000,000
Coverage sits under about $1,400,000 of investable assets plus home equity. Under the asset base, the box earns 2 of 4, and the prescription resizes it to $3,000,000.
Estate documents, eight years old
Wills and powers of attorney were signed eight years ago and never updated, and there are no healthcare directives. Two document elements in place earn 2 of 4.
Framework two
The 3-Bucket Framework
Every dollar gets a job, in three buckets: the Safety Net, the Wealth Engine, and the Accelerator. This household cannot sort its dollars into buckets at all, and the framework earns 6 of 20.
The Safety Net
The emergency fund is about $40,000, about two months. At 0 to 2 months the box earns 0 of 4. Six months, on the same math, is about $120,000.
Named lanes
Asked to sort dollars into buckets, Rachel could not. No lanes are named, so the box earns 0 of 4, even with about $1,400,000 invested.
Goals funded
Money flows to goals, retirement contributions and 529s funded to about $200,000, without written targets to aim at. Money flowing, short of fully funded, earns 3 of 6.
What They Did Right
A 58 ten years in has real foundation under it. This is what is already built.
The Wealth Equation is full marks
The Physician Wealth Equation earns 14 of 14. The Debt Anchor is full marks at about 0.77 times income, and stretch saving is full marks at 13 percent past $1,000,000 invested.
The student loans are gone
Education debt was paid off years ago, earning the full 6 on the established Transition box. For an established attending, the question is whether the transition stuck, and it did.
Health, life, and malpractice are full marks
The whole family is covered on employer health plans, $1,500,000 of term is in force on each spouse, and malpractice is occurrence coverage through both groups, with no tail bill waiting at an exit.
Saving runs itself
About 13 percent, about $98,000 a year, is automated, with wealth paid first. That habit earns the full 4 on automation and carries the savings boxes around it.
Rachel's income is protected
Rachel holds an individual own occupation disability policy, written around her work in pain medicine. Half of the disability layer was built on purpose, and Tom's half is the prescription.
Two Physicians. One Income Protected.
The first deep dive is the Protection Stack, and the finding is a stack with thin layers. There are two physicians in this house, and only one of them has income protected the way it should be. Rachel holds her own policy. Tom has group coverage only.
Tom earns about $300,000 a year as a hospitalist. Twenty more years at that pay is about $6,000,000 of future income before a raise, the biggest asset in the household, bigger than the whole portfolio. Group coverage usually ends when the job ends.
The stack is only as strong as its thinnest layer.
Group long term disability can also be taxable when the employer pays the premium, and benefits are often capped at a monthly maximum a physician income passes quickly. Many group policies define disability around your own occupation for a set period, then switch to any occupation.
The umbrella tells the same story in a smaller number. The policy is $1,000,000 against about $1,400,000 invested plus home equity, and the scoring rule is plain: coverage at least as big as what you own. At $1,000,000, the layer earns partial credit.
The estate layer is age. The wills and powers of attorney were signed eight years ago, when the kids were 4 and 1, and never touched since. There are no healthcare directives, so their own family would be left guessing about care decisions.
The fix runs in three moves inside this one framework. Tom gets his own individual own occupation policy, the umbrella resizes to about $3,000,000, and the estate plan gets refreshed with directives and a confirmed guardian.
Leaky Buckets, and a Portfolio on Autopilot
The second deep dive is the 3-Bucket Framework, and the finding is a missing picture. About $1,400,000 sits across two 401(k)s, a brokerage account, and the 529s, and nobody has ever pulled it into one view. Rachel's own words for it: leaky buckets.
The framework gives every dollar a job. The Safety Net is the cash that keeps a bad month from becoming a bad year, with a target of six months. Their fund is about $40,000, about two months, so the Safety Net target is about $120,000.
Each bucket gets its own lane, so a balance tells you what the money is for.
The Wealth Engine is the long haul money, retirement accounts and the brokerage account, meant to compound for decades. The Accelerator is money aimed at goals with dates: college goes here, and the lake house goes here too, if it is real.
The leak is the dollars with no job. Spending is not tracked, and the best estimate is about 5 percent of income, roughly $37,000 a year on about $750,000. That is more than a third of what they save on purpose.
The portfolio runs on defaults. The 401(k)s sit in target date funds picked at the start and never reviewed, and the brokerage account costs 0.8 percent a year, about $4,000 on $500,000, with nobody looking at all of it together.
The fix: name the lanes, each with its own account and target, track spending for ninety days to find where the 5 percent goes, and review every account on one page, with the advisor decision made on purpose.
Milestones: A Net of Three
Inside the 3-Bucket Framework, the milestone checklist is where an established household shows its momentum. Rachel and Tom net 3 on the checklist. On the attending scale, a net of 3 to 4 earns 3 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. The emergency fund, about $40,000 at about two months, earns 0. No dollars sort into named lanes, so named lanes earn 0 as well. Dollars flow to goals without written targets, so goals funded earns 3.
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The Prescription
Five moves, in the order the episode gave them.
1
Get Tom his own disability policy.
This is the Protection Stack, and it gains 2 points, moving disability from 2 to 4. It goes first because it is the most time sensitive item on the list: every year he waits, underwriting gets harder.
Get quotes through an independent agent who can show several carriers side by side, aim for a benefit around 60 percent of his income, and look for a true own occupation definition written around his specialty. The group coverage stays underneath as another layer.
2
Resize the umbrella to $3,000,000.
This is the Protection Stack, and it gains 2 points, moving the umbrella from 2 to 4. The rule is coverage at least as big as what you own, with room to grow into.
One call to whoever writes the home and auto policies: what does it cost to go from $1,000,000 to $3,000,000, and what liability limits are required underneath it? Umbrella coverage is usually one of the cheaper lines on the whole stack.
3
Refresh the estate plan.
This is the Protection Stack, and it gains 2 points, moving estate documents from 2 to 4. The documents were signed eight years ago, and the kids, the assets, and the picture have all changed since.
Book an estate attorney. Update both wills and both powers of attorney, sign a healthcare directive for each of them, and confirm the guardian for the kids. Pull the beneficiary forms on the 401(k)s and both life policies while they are in there.
4
Name every bucket and track spending for 90 days.
This is the 3-Bucket Framework and the Lifestyle Guardrails together, and it gains 5 points, moving named lanes from 0 to 2 and the leak from 0 to 3. Every dollar gets a job, starting with the Safety Net at about $120,000.
Open a separate account for each lane and give each one a target. Then, for ninety days, every dollar gets categorized, using whatever tool they will actually open. At the end, they will know where the 5 percent went.
5
Write four or more goals, fund them, and review the portfolio.
This is the Decision Filter and the 3-Bucket Framework together, and it gains 5 points, moving goals written from 2 to 4 and goals funded from 3 to 6. Three vague goals become four or more goals with amounts and dates.
Put numbers on retirement, college for each kid, and the lake house as a yes or no with a price and a year, then point money at each one. Pull every account onto one page and decide about the advisor on purpose: $4,000 a year should buy something they can name.
Run all five and the arithmetic is 58 plus 16, a score of 74. The gains are 2 for disability, 2 for the umbrella, 2 for the estate refresh, 5 for named buckets with tracking, and 5 for written goals fully funded. A score of 74 out of 100 moves Rachel and Tom into the Stable band.
What This Case Teaches
Automation saved the money. Nobody aimed it. Rachel and Tom automated about $98,000 a year and paid off the student loans, and the saving habit carried the Wealth Equation to full marks. The lesson of this file is that the picture is separate work: buckets named, spending seen, and goals with amounts.
A default is a decision too, and it charges full price.
The second lesson is about the second income. One spouse built an individual disability policy and the other stayed on group coverage, and an eight year old estate plan sat untouched while the family changed around it. Protection built for one season needs a review in the next.
Questions this case answers
What score did Rachel and Tom receive on the Financial Health Assessment?
Rachel and Tom scored 58 out of 100, in the Corrections band. The Physician Wealth Equation earns 14 of 14 and the Protection Stack earns 16 of 22, while the 3-Bucket Framework earns 6 of 20 and the Lifestyle Guardrails earn 10 of 22.
How does a household earning about $750,000 score 58 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 Tom save about 13 percent on autopilot, with spending untracked, no buckets named, and one earner on group disability only.
What is the first fix for Rachel and Tom?
An individual own occupation disability policy for Tom. Rachel holds her own policy, and Tom, a hospitalist earning about $300,000, has group long term disability only through his job. The prescription aims at a benefit around 60 percent of his income, with the group coverage kept as a layer underneath.
What do the five fixes do to Rachel and Tom's score?
Run all five and the arithmetic is 58 plus 16, a score of 74. The gains are 2 for disability, 2 for the umbrella, 2 for the estate refresh, 5 for named buckets with ninety days of tracking, and 5 for written goals fully funded. A score of 74 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 pain medicine case file for Rachel and Tom. 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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