Can I stack a 403(b) and a 457(b) at a children's hospital?

Yes, when your employer offers both plans, because the two deferral limits are separate by law and neither plan's deferrals reduce the room in the other. For 2026, the elective deferral limit is $24,500 for a 403(b) and a separate $24,500 for a 457(b), governmental or non governmental (IRS Notice 2025-67), so a pediatrician with access to both can defer $24,500 plus $24,500, which is $49,000 of salary into retirement accounts in one year, before the employer match, before the backdoor Roth at $7,500, and before the health savings account. On average pediatrics compensation of $266,000 (Medscape 2026), the two deferrals alone are $49,000 divided by $266,000, which is a little over 18 percent of gross pay sheltered in workplace plans alone. Few moves available to the lowest paid specialty in medicine change the savings picture this much in a single decision.

Part of the pediatrics hub.

Two limits, not one

Most physicians meet the workplace plan as a single bucket with a single ceiling, and at many employers that picture is accurate. A children's hospital or academic center that sponsors both a 403(b) and a 457(b) breaks the picture in your favor. Each plan carries its own elective deferral limit of $24,500 for 2026, and the limits do not offset each other. Deferring the full amount into the 403(b) leaves the full $24,500 of 457(b) room untouched, and the reverse is also true. What the plans do not share is just as important. The 403(b) has a total annual additions limit of $72,000 for 2026, counting your deferrals, the employer match, and other employer contributions together. Watch that ceiling when the match is generous, because a maxed deferral plus a large employer contribution can approach it faster than households expect.

Confirm which kind of 457(b) your employer sponsors before you build on it. A governmental 457(b), offered by a government employer such as a public hospital or a state university system, holds its assets in trust for participants and carries the separation rule described below. A nongovernmental 457(b) at a private nonprofit employer is a different animal, with different distribution timing and creditor exposure, and it deserves its own careful read before large balances accumulate. The separate deferral limit is the shared feature. Almost everything else depends on the plan type, so ask human resources which one you have, in writing.

The separation rule that makes the governmental 457(b) special

A governmental 457(b) has no 10 percent early withdrawal penalty on distributions after separation from service (IRS). Money in a 403(b) or 401(k) taken before the usual retirement ages can draw that penalty, with narrow exceptions. Money in a governmental 457(b) becomes available when you leave the employer, at whatever age that happens, taxed as income but not penalized. For a pediatrician, that feature builds an early retirement and career change bridge into the stack. The 457(b) balance is the account that can fund the years between leaving a hospital job and the age when the other accounts open up, which makes it the natural first source for a planned move to part time work, a practice change, or an early exit. The same feature argues for respecting the plan for what it is: it is retirement money with a flexible door, not a general savings account, and the tax bill on withdrawal is real even when the penalty is absent.

Building the full stack, in order

Stacking does not change the order of operations; it widens one tier of it. The waterfall still runs first: capture the full employer match and nothing past it, hold one month of reserves sized at the new attending lifestyle, bring credit cards to zero, and put disability and term coverage in force. The student loan plan runs in parallel, at minimums on a Public Service Loan Forgiveness track. The backdoor Roth at $7,500 comes before student debt above 7 percent. Inside the max retirement tier, the order on this site is the health savings account first, at $4,400 for self only coverage or $8,750 for family coverage in 2026, then the 403(b) to $24,500, then the 457(b) to its own $24,500, then mega backdoor contributions where the plan allows them.

Now add the full stack for a pediatrician who can reach every tier. The 403(b) at $24,500 plus the 457(b) at $24,500 plus the backdoor Roth at $7,500 is $56,500 a year. Add a family health savings account at $8,750 and the total is $65,250 a year into tax advantaged accounts, before the employer match adds a dollar. On starting pay of $258,000 (AMN Healthcare), that full stack will not fit in year one for most households, and it does not have to. Fill the tiers in order, raise the deferrals at every raise, and let the second plan be the tier you grow into. The career wide funding ladder says the same thing in one line: match, backdoor Roth per spouse, health savings account, workplace plan to the limit, additional employer plans, taxable, education accounts. The 457(b) is the additional employer plan, and for a specialty paid at the bottom of the table, it is the closest thing to found room the tax code offers.

Follow up questions

Does deferring into both plans change my employer match?

Usually the match follows the plan that offers it, most often the 403(b), and deferring into the 457(b) neither earns a second match nor reduces the first one. Read your plan documents, because match formulas are employer specific. Capture the full match in the matched plan first, then direct additional deferrals to the 457(b).

Which plan should I fill first, the 403(b) or the 457(b)?

Fill the 403(b) first when it carries the match, because unmatched deferrals elsewhere never recover a match left behind. After the match is captured, the order on this site runs the 403(b) to its limit, then the 457(b) to its own limit. A household planning an early exit may weight the 457(b) sooner for its separation rule, and that is a deliberate choice, not an error.

What happens to my 457(b) if I leave the hospital?

That depends on the plan type, which is why confirming it early matters. A governmental 457(b) balance can be rolled over or left in the plan, and distributions after separation carry no 10 percent early withdrawal penalty. A nongovernmental 457(b) follows its own distribution schedule set at deferral, which can force timing you did not choose. Ask before you defer, not after you resign.

Related questions

• What order should a pediatrician fund retirement accounts in?
• What savings rate does a pediatrician need to build wealth?
• Can a pediatrician retire on time on a pediatrician salary?

Sources

Internal Revenue Service, Notice 2025-67 (2026 elective deferral limit of $24,500 each for 403(b) and governmental 457(b) plans, total annual additions of $72,000, and the IRA limit of $7,500, accessed October 2026)

Internal Revenue Service, Revenue Procedure 2025-19 (2026 health savings account limits of $4,400 for self only coverage and $8,750 for family coverage, accessed October 2026)

Internal Revenue Service, 457(b) plan guidance (a governmental 457(b) carries a separate deferral limit from a 403(b), and distributions after separation from service carry no 10 percent early withdrawal penalty, accessed October 2026)

Medscape Physician Compensation Report 2026 (average pediatrics compensation of $266,000, accessed October 2026)

AMN Healthcare, 2025 Review of Physician and Advanced Practitioner Recruiting Incentives (average starting salary of $258,000 for pediatricians, accessed October 2026)

Takeaways

• The 403(b) and the governmental 457(b) carry separate $24,500 deferral limits for 2026, for $49,000 of combined deferrals.
• The full stack with the backdoor Roth and a family health savings account reaches $65,250 a year before the employer match.
• A governmental 457(b) has no 10 percent early withdrawal penalty on distributions after separation from service.
• Confirm whether your 457(b) is governmental or nongovernmental before building on it, because the rules differ.
• Stacking widens the max retirement tier of the waterfall; it does not change the order that comes before it.