What order should an emergency physician fund retirement accounts?

The Double Up Rule sets the size of the flow

The waterfall tells you where money goes. The Double Up Rule tells you how much money there is to send. Live on double the resident net. If residency netted about $65,000 a year, the first attending lifestyle is capped at $130,000 a year. Every dollar of attending income above that line flows into the waterfall until you reach the taxable account at the end of it. You may not leave the rule until you reach that taxable rung.

Work it on emergency medicine income. Average emergency medicine compensation is $421,000 in the Medscape Physician Compensation Report 2026, and Marit Health reports an average of $402,500 for emergency physicians with 0 to 2 years of experience, from 1,905 self reported salaries in October 2026. Take a gross income of $400,000 as a round early career figure drawn from that Marit average. Taxes take their share first, and the exact share depends on your state, your filing status, and whether the income arrives as W2 or 1099 pay. Set the lifestyle at $130,000 for the year. Everything the household takes in above its tax bill and that $130,000 lifestyle is waterfall money, assigned rung by rung until the rungs are full.

The rule anchors on the resident net because you already know how to live on it. Doubling it is a real raise: better housing, real food, help at home. What it refuses is the third and fourth doubling that happen by drift, when every purchase feels small next to a $400,000 income.

The rungs, in the order you will actually meet them

The match comes first because matched dollars are a 100 percent return on the dollars that earn them. Contribute at least enough to capture all of it from the first paycheck. One month of reserves comes second, sized at the new lifestyle. At a $130,000 lifestyle, one month is $130,000 divided by 12, which is about $10,833. Credit cards go to zero third, because no investment rung outruns card interest.

Coverage is fourth, and disability sits above all of it, because this income depends on one body working unpredictable hours in a physical job. Disability insurance typically replaces up to 60 to 70 percent of pre disability income at issue, per Medical Economics. The loan plan, fifth, runs in parallel: on a Public Service Loan Forgiveness track, pay minimums on an income driven plan, recertify on schedule, and never send a dollar extra, because extra principal on a loan headed for forgiveness buys nothing.

The backdoor Roth IRA comes sixth, before debt above 7 percent, because the $7,500 of annual space for 2026 expires if you skip it, while a debt balance waits at rung nine. The max tier is seventh: the health savings account first, at $4,400 for self only coverage or $8,750 for family coverage in 2026, then the workplace plan to $24,500, then a governmental 457(b) to its own separate $24,500 where offered, then mega backdoor space last. The stacking question works that stack in full.

What changes if the paycheck is 1099

The order does not change. The instruments do. A 1099 physician has no match to capture, so the waterfall effectively starts at reserves, with a tax account treated as a first call on every check, because nothing is withheld for you. The solo 401(k) takes the workplace plan seat in the max tier: deferrals as the employee to the same $24,500 limit for 2026, plus employer contributions computed under the self employed rules the Internal Revenue Service publishes for one participant plans. The reserve finish line rises to up to twelve months, because sporadic income is the stated reason for the longer reserve.