Sarah and Michael: A First Year Pediatrics Household, Scored

Sarah finished pediatrics training and took her first attending job at about $180,000. Michael works as a software engineer at $120,000, which puts the household near $300,000 in her first attending year. They have been married five years and have a toddler of two. It is a deliberate household: the kind that reads the instructions before assembling anything, and it shows in the places deliberateness reaches.

The debt picture carries their best decision. When training ended, Sarah refinanced about $280,000 of student loans to a ten year fixed rate with a payment the budget holds, instead of letting the loans drift. The mortgage is about $450,000 on a home worth about $600,000, and the credit cards are paid in full every month. Total debt against income lands at about 2.4 times, under the new attending bar in the rubric.

The savings machinery exists and runs underfilled. The emergency fund holds about $25,000, roughly two months of expenses. Saving runs at about 12 percent: the 401(k) to the match, automated, and a 529 for their child funded when there is money left at the end of the month. Investable assets are about $80,000. The household is in the 24 percent federal bracket, knows it, tracks its spending with under 3 percent unaccounted for, and has three goals written with numbers and dates, partially funded.

The protection stack is one layer short. Health coverage is in place for the family. Life insurance is a $1 million thirty year term policy, in force. An umbrella policy of $1 million sits behind it. Malpractice is claims made with the tail arranged. Disability, though, is the group policy through work and nothing else, and the estate shelf holds a signed will with no powers of attorney or health care directive beside it.

The Financial Health Assessment grades a household across the same seven frameworks and lands the total in a band. Sarah and Michael score 59, in the Corrections band: a household doing most things on purpose, with the unfinished list concentrated in funding levels rather than missing systems. The household scores in five groups.

Read the groups against the groups in the other cases in this hub and the difference in kind shows. Two boxes score zero for absence: contract clarity and the estate set. The emergency fund box scores zero for size: two months of reserve lands on the lowest step of its scale. The contract clarity box scores zero because the record is silent: nothing in it shows the contract was professionally reviewed or the pay structure fully understood, and silence earns nothing. Where the other boxes fall short, they fall short on level, not absence. The household built the systems in training and the first year; what remains is to fill them to attending levels before the lifestyle prices the filling out of reach.

The first deep dive is the Three Bucket Framework, and the finding is a framework adopted in shape but not yet in amounts. The Safety Net holds about $25,000, roughly two months, against the six month standard the framework sets, which for this household is about $75,000. The Wealth Engine runs at 12 percent against its 20 percent mark. The Accelerator, the goals bucket, holds three written goals with money flowing and no monthly amount assigned to any of them, and the college account inside it is funded from whatever survives the month, which in a household with a toddler and a new mortgage is a number that trends toward zero.

The framework's point is that a bucket without an amount and an automation is a wish with a label. The fix in the prescription is mechanical: a $2,000 monthly transfer that fills the Safety Net on a schedule, a $500 payday automation that takes the 529 out of the leftovers permanently, and a number written beside every goal so the Accelerator can be judged instead of hoped about. The Three Bucket Framework page carries the full model.

The second deep dive is Lifestyle Guardrails, and its finding is timing. This is year one of attending income: a toddler, a $600,000 house just taken on, and a bigger house already written on the goals list. Each item is reasonable. Together they describe a lifestyle expanding to meet the income at exactly the moment the savings rate is cheapest to raise, because nothing has been gotten used to yet. The Guardrails framework is the spending control that keeps the raise from becoming the lifestyle: save the raise, cap the lifestyle, automate the gap.

The arithmetic the episode ran is plain. Twelve percent of $300,000 is $36,000 a year. Twenty percent is $60,000. The difference is about $2,000 a month, and in year one that difference is a decision, while in year five it would be a deprivation. The first attending year sets the baseline the rest of the career defends, which is why this fix is sequenced now and why the new attending guide puts the rate ahead of almost everything.

Five moves, in the order the episode gave them.

One: Build the emergency fund to six months. Two months is not a Safety Net. Automate $2,000 a month into a separate high yield savings account until it reaches about $75,000, a little over two years, then point the same transfer at the next goal instead of letting it drift back into spending.

Two: Automate the 529 on payday. When there is money left means never. Five hundred dollars a month, pulled the day the paycheck lands, starting while their child is two, gives the college goal sixteen years of compounding instead of leftovers.

Three: Push savings to 20 percent. Twelve percent is the floor, and the attending raise should go to wealth, not lifestyle. Raise the 401(k) first, then an automatic brokerage transfer for the rest, stepping up across the first year if a single jump is too much.

Four: Get an individual own occupation disability policy. Group only coverage on the physician income, with a toddler and a mortgage, is the one unfinished layer of an otherwise built stack. The individual policy pays if she cannot practice pediatrics and travels with her between jobs. The insurance page sizes it.

Five: Write the fourth goal, retirement, with a number and a date. Three goals are on paper and the largest one is not. The Decision Filter checks every money decision against written goals, and it cannot check against a blank.

Run all five and the episode's arithmetic is 59 plus 16, a score of 75. None of the five requires a raise or a refinance. Each one is a decision and an afternoon.

Building the system and funding the system are different jobs, and the second one has a deadline. Sarah and Michael did the hard part early: the deliberate loan call, the automation, the tracking, the term policy bought on time. Households stall here anyway, because funding levels rise only when someone raises them, and the first attending year is when raising them costs nothing but attention. A year later the same dollars are spoken for by the lifestyle, and the fill becomes a negotiation instead of a setting.

The second lesson is about leftovers. Any goal funded from what survives the month is a goal the household has decided not to fund, whatever the intention was. Payday automation is not a budgeting trick in this framework. It is the difference between a goal with a mechanism and a goal with a hope, and it is the single cheapest fix in this household's entire picture.

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.