How does paying for college work on an OB/GYN's income?

It works from the last rung of the waterfall, never from the first dollars: college is a written goal funded inside the final step, after the retirement steps are done, in a 529, at a target you choose. College funding sits at the waterfall exit, with taxable investing and written goals. The order ahead of it is fixed. First, capture the full employer match, and nothing past it. Second, build one month of reserves at the new lifestyle. Third, take credit cards to zero. Fourth, place coverage, disability above all, plus term life and umbrella. Fifth, run the student loan plan in parallel. Sixth, fund the backdoor Roth IRA, $7,500 for 2026, before debt above 7 percent. Seventh, max retirement in its tiers, the health savings account first, then the 401(k) or 403(b) to $24,500, then a governmental 457(b) where offered, then mega backdoor space last. Eighth, add two more months of reserves, for three total. Ninth, extinguish remaining debt above 7 percent. Tenth, finish the reserve at six months of expenses on W2 income, up to twelve months on 1099 or sporadic income. Eleventh, a taxable brokerage account alongside written goals is the exit, and college funding lives inside that eleventh step, as one of the written goals the taxable stage supports.

Part of the OB/GYN hub.

Why retirement comes first, in plain terms

The rule sounds harsh until the arithmetic is stated. Retirement account room expires every year: a missed $24,500 deferral, a missed $7,500 backdoor Roth IRA, a missed year of health savings account space at $4,400 for self only coverage or $8,750 for family coverage, is gone permanently, and no later raise buys it back. College money has no such deadline. A parent can borrow for a child's education. No one lends a parent money for retirement. So the funding order protects the irreversible thing first and the flexible thing second, and any plan that pauses the match or skips the Roth room to fill a 529 has the sequence exactly backwards.

There is a second reason specific to this specialty. The retirement accounts funded in the strong early years are what later buy the option to change models, change states, or reduce call. Diverting those years into college accounts spends that freedom at the exact moment it was cheapest to buy. The college goal still gets funded, in its turn, from a surplus that actually exists.

The households in this hub, read as college cases

Heidi and Spencer are the early version. Heidi, 33, is a first year attending OB/GYN earning about $320,000, and Spencer, 35, teaches at $80,000, for household income of about $400,000. They have one child, age 2, in the Portland metro. Their file lists four written goals that are vague and not funded, about $35,000 of reserves at about three months, about $100,000 invested across six accounts, group disability only, no umbrella policy, and an estate file with a will only and no powers. For this household, college has the longest runway of any goal on the page: a child age 2 gives the goal well over a decade to fund. What the file needs first is coverage placed, the reserve finished at its turn, and the four vague goals rewritten as named goals with targets. Then college takes its place inside the final step as a written goal with a number.

Lisa and Mark are the later version. Lisa, 41, is an OB/GYN eight years out earning about $370,000, and Mark, 43, is an attorney at $180,000, for household income of about $550,000. They have two kids, ages 8 and 5, in a large Southeast metro. Student debt is paid off, credit cards are paid in full monthly, and investable net worth is about $400,000. Their emergency fund is about $25,000, about one month of expenses, where their case prices three months at about $75,000. They save about 12 percent, with the 401(k) taken to the match and the rest left as leftovers. For this household the college runway is shorter, and the same order still governs: finish the reserve, max the retirement tiers as a system rather than as leftovers, and then fund the college goal at the exit. Two children at ages 8 and 5 mean two staggered targets.

The account, the target, and the conversation

The standard vehicle is the 529 college savings plan: funded with after tax dollars, growing tax deferred, and withdrawn tax free for qualified education expenses, with many states adding a deduction or credit for contributions. Open one account per child.

Set the target like a physician, not like a brochure. Households on this site choose from the honest range: the full cost of a public university, a fixed dollar amount per child, or a chosen share of whatever school they attend. Each is defensible. What is not defensible is letting a sticker price encountered at application time set the number by fear. A funded target then converts the college conversation with a seventeen year old from a negotiation about debt into a presentation of options.

Follow up questions

We started late and the oldest is already in high school. What changes?

The target is set again to what the remaining years of surplus can honestly hold, the account still opens, and the conversation with the child starts now rather than at acceptance letters. A smaller, clearer goal funded from a finished plan, with the difference carried openly, by cash flow in the college years or by the student's own borrowing, serves the child better than a large goal funded by raiding retirement room that is approaching its own finish line.

What if a child does not go to college?

Then the 529 flexibility is the consolation the vehicle was chosen for: the beneficiary can be changed within the family, which in a two child household means an unused balance has an obvious next home, and current rules allow limited rollovers from a long held 529 to the beneficiary's own Roth IRA. The worst case of underfunding the plan is a household improvising at application time by pausing its own retirement, which is the outcome the order exists to prevent.

Related questions

• What order should an OB/GYN fund retirement accounts?
• What does an OB/GYN's net worth path look like?
• Is OB/GYN worth it financially?

Sources

• Internal Revenue Service, Notice 2025-67, which establishes the 2026 limits: elective deferral of $24,500 and IRA limit of $7,500, accessed October 2026.
• Internal Revenue Service, Revenue Procedure 2025-19, which establishes the 2026 health savings account limits of $4,400 self only and $8,750 family, accessed October 2026.
• Medscape Physician Compensation Report 2026, which establishes average OB/GYN compensation of $390,000, accessed October 2026.
• Financial Fellowship Heidi and Spencer case and Lisa and Mark case, which establish the two household positions used as examples, accessed October 2026.

Takeaways

• College is funded inside the final step of the waterfall: after the match, reserves, cards, coverage, the loan plan, the backdoor Roth IRA, maxed retirement, and the finished reserve, never before.
• Retirement room expires annually and college money does not, so the order protects the irreversible step first. A student can borrow for college. No one lends for retirement.
• Heidi's child, age 2, gives the goal its longest runway; Lisa's children, ages 8 and 5, make it two staggered targets. Both households fund it as a written goal at the exit.
• Their cases set the sequence honestly: coverage gaps, unfinished reserves, and vague unfunded goals are fixed before the next 529 dollar moves.