How does stacking a 403(b) and a 457(b) work at a university eye institute job?

Why the 457(b) is separate, and which kind matters

The 457(b) exists in two species, and only one belongs in this plan. A governmental 457(b), offered by state universities and public hospitals, holds its assets in trust for the employee and behaves at separation much like other retirement money, including rollover options into other plans and IRAs. A nongovernmental 457(b), offered by some private nonprofits, is legally the employer's asset subject to the employer's creditors, and its distribution rules force choices at separation that can bunch income painfully. The stack described on this page is the governmental form. A physician at a private nonprofit eye center offered a 457(b) reads its species before valuing it, and prices the creditor exposure honestly: the deferred money is a promise, not an account, until it pays out.

The stacking itself has no trick to it once the species is right. Deferrals come from salary, so the household's cash flow has to carry $49,000 of deferrals plus the HSA, the backdoor Roth mechanics, and the rest of the waterfall, which is a first attending year's real constraint: the order fills the tiers as the income allows, across the first years, and the stack's full value arrives when production or seniority raises the salary past what the tiers consume. Catch up provisions layer differently on the two plans in the later career, and the governmental 457(b) carries a special final years catch up of its own. Those provisions are priced at the established stage, and the catch up question on this hub works them in sequence.

Where the stack sits in the order

The stack lives inside step seven of the waterfall, max retirement, after the match, the reserves to their current step, the cards, coverage, the parallel loan plan, and the backdoor Roth. The internal order inside the tier runs: the health savings account first, for its triple tax advantage, then the 403(b) to the deferral limit, then the governmental 457(b) to its own limit, then mega backdoor contributions where the 403(b) plan's design allows them under the $72,000 annual additions limit. For the academic household on the forgiveness track, the stack does double duty: the deferrals reduce the income that prices the income driven loan payment, which lowers the payments made toward a balance that will be cancelled, a quiet interaction worth more at large balances than any other line in this comparison. It never justifies taking the academic job by itself. It belongs in the honest total, where it is routinely forgotten by physicians comparing salaries and remembered by the ones who run the full package.