Pediatrician Finances

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Three moves, in this order. Everything else on this page supports them.

1. Read the contract by its FTE split

   Price the clinical fraction, the call stipend, and the band review process before you sign. The salary line is the last thing to read, not the first, and the employer's PSLF status goes in writing.

   Read the contracts page

2. Run the waterfall from paycheck one

   The full employer match first, one month of reserves at the new lifestyle, credit cards to zero, coverage in force, then the backdoor Roth and the account maximums in their order. Live on double the resident net and let the rest flow the waterfall.

   Read the retirement page

3. Put coverage in force, disability above all

   Group disability is capped, follows the plan's definition, and ends when the job does. The individual own occupation policy is the layer that stays, and the residency window for buying it cheap has just closed.

   Read the insurance page

Why pediatrics is different

Pediatrics hands you one dominant first job: the employed position at a nonprofit children's hospital or academic center. The pay arrives on an academic band, the job is described in FTE fractions, and the employer almost always qualifies for Public Service Loan Forgiveness. That combination means the first year decisions here are employer shaped in a way they are not in most specialties. The loan plan is usually decided by the employer's tax status. The retirement menu is usually a 403(b) with a 457(b) beside it. The contract argument is usually about how much of your week is clinical.

The numbers:

Employer mix: children's hospitals and academic centers dominate pediatric hiring, which is why the forgiveness count and the two deferral menu show up so often in this specialty, and why so many pediatricians hold a qualifying employer without planning to. Private groups add the ownership track and take forgiveness off the table. Which employer you pick sets your loan options, your retirement menu, and your coverage gaps in one move, which is why this page treats the first job as the decision everything else hangs from.

Your First Year in Order

First year timeline

Five checkpoints that keep the attending income jump from turning into five disconnected decisions.

1. Before Day 1 Price the contract by the FTE split and the call stipend, confirm the employer qualifies for PSLF, and get both in writing
2. Paycheck 1 Capture the full employer match in the 403(b) or 401(k), and nothing past it yet
3. Month 3 First month of reserves banked at the new lifestyle, every spare dollar on the credit cards, individual disability policy in force
4. Month 6 The loan plan running on paper: forgiveness count certified with training months banked, or the payoff or refinance plan chosen on purpose with real numbers
5. Month 12 Clinical load and stipends reviewed against the contract. Reserves are past the three month waypoint and building toward the finished fund: six months of expenses on W2 income, up to twelve months on 1099 income

Contracts and Compensation

Read a children's hospital offer as an FTE split. The salary line assumes a job description: a clinical fraction that sees patients, plus teaching, research, quality, or administrative fractions that do not produce visits. If the clinical fraction grows after you sign, and it usually tries to, the same salary buys more work and the pay per clinical hour falls without anyone cutting your pay.

Then the rest of the real terms surface: how call is counted and what the stipend pays, whether any production or incentive component exists above the band (the Medscape average incentive bonus for pediatricians is $26,000, the second lowest in the report, so do not budget a large one), and how the band itself is set and reviewed. The full treatment is on the contracts and income page.

Worked math: What should a pediatrician check in a first contract at a children's hospital?. How much do pediatricians make?.

Student Loans

Pediatrics is where the loan decision and the employer decision are the same decision. Take the nonprofit children's hospital job and the forgiveness track usually wins by a wide margin: training months already banked, income driven minimums at attending pay, and the remaining balance cancelled tax free at payment 120.

Take the private practice job and the same balance has to be repaid in full, and payoff speed or a refinance becomes the plan. While any forgiveness chance exists, loans sit at waterfall step five: minimums on an income driven plan, employment certified every year, never a dollar extra. The default plan, the exceptions, and the employer help fine print are on the student loans page.

Worked math: Is PSLF at a nonprofit children's hospital my best loan strategy?. How long will it take to pay off $200,000 in student loans as a pediatrician?. Can my employer repay my student loans tax free under Section 127?.

Insurance

Your biggest asset is still your ability to earn, and the protection order does not change at the lowest salary in medicine: disability above all, term life if anyone depends on the income, umbrella behind both. What changes is the discipline. At a pediatrician's pay, every premium dollar competes with the savings rate, so each layer gets sized to the income it protects and no layer gets sold past its job.

The academic trap is assuming the benefits packet is the plan: group disability at a children's hospital is capped, built on the plan's definition, and ends when the job does, and the guaranteed issue offers that were open in residency close at graduation. The full treatment is on the insurance page.

Worked math: Does a pediatrician need own occupation disability insurance?. How much term life insurance does a pediatrician need?.

Retirement

The account menu follows the employer, and academic employment deals pediatricians the strongest hand in this hub. A nonprofit system hands you a 403(b). Government employers add a governmental 457(b). Many nonprofit systems offer a non governmental 457(b) with the same separate limit, but the money stays exposed to the employer's creditors. The 457(b) carries its own separate $24,500 deferral limit for 2026, which means two full deferrals before anything else opens.

Inside the waterfall the order is fixed: the match first, then coverage and the reserve steps, then the backdoor Roth, then the max tier in its own order, the HSA first at $4,400 for self only coverage or $8,750 for family coverage in 2026, then the workplace plan to the $24,500 deferral limit, then the governmental 457(b) where you have one, then mega backdoor space last. Then the reserve finish, then taxable. The two deferral menu and the part time reality of this workforce are on the retirement page.

Worked math: What order should a pediatrician fund retirement accounts in?. Can I stack a 403(b) and a 457(b) at a children's hospital?. Pediatrics pays among the least in medicine. How do I still retire on time?.

Ownership and Housing

Ownership in pediatrics is an honest fork. The hospital employed job needs no buy in, keeps the forgiveness count alive, and caps your upside at the band. The private practice buy in opens an equity door at the specialty where reimbursement pressure is the most documented in medicine, which means the books, the payer mix, and the partner income spread decide whether the door is worth walking through. The ownership page prices the buy in and names what employed pediatricians build instead of equity.

Housing runs on the same discipline as every other specialty here: rent through the first year in a new market, buy after the reserve is finished and the job has proven itself, and let the payment, not the approval, size the house. A physician mortgage avoids PMI with a low down payment. It does not make a first year house on a new contract a safe move.

Worked math: Should I join the private pediatrics practice offering partnership or take the hospital employed job?. Is buying into a pediatrics practice still worth it with reimbursement falling?. How much house can a pediatrician afford?.

Estate Planning

The estate layer at this stage is plain, and it is the layer this specialty's cases most often find unfinished. Guardians come first: if both parents die while the children are minors, a court chooses who raises them unless a signed will names a guardian. The floor after that is three documents per adult, a will, a financial power of attorney, and a health care directive. Documents govern only what titling and beneficiary forms let them govern, so the signing and the beneficiary pass belong on the same afternoon. The full treatment is on the estate planning page.

Worked math: What estate documents does a new attending pediatrician need first?.

Top Questions From New Attending Pediatricians

Scan by topic, then open the question that matches the decision in front of you.

Student loans 5 questions

1. Can my employer repay my student loans tax free under Section 127?
2. How long will it take to pay off $200,000 in student loans as a pediatrician?
3. Is PSLF at a nonprofit children's hospital my best loan strategy?
4. How should a pediatrician household split savings and loans when my spouse earns more?
5. Should I refinance my student loans in my first attending year?

Contracts and income 5 questions

6. What should a pediatrician check in a first contract at a children's hospital?
7. How much do pediatricians make?
8. Should I join the private pediatrics practice offering partnership or take the hospital employed job?
9. Is a signing bonus worth more than a higher base salary for a pediatrician?
10. Who pays for tail coverage when a pediatrician leaves a job?

Coverage 2 questions

11. How much term life insurance does a pediatrician need?
12. Occurrence or claims made malpractice: which should my contract have?

Retirement and accounts 2 questions

13. Governmental or nongovernmental 457(b): does the difference matter for a pediatrician?
14. Two physicians, one household: what order do we fund two sets of accounts?

Housing and cash 4 questions

15. How much house can a pediatrician afford?
16. How long should it take to save a house down payment on a pediatrician's salary?
17. How many months of expenses should a pediatrician keep in cash?
18. Should I buy a house in my first attending year?

Estate and benefits 2 questions

19. What estate documents does a new attending pediatrician need first?
20. What happens to my benefits if I go part time as a pediatrician?

Common Pitfalls

Have a different money question? Browse our full question bank.

Five Items to Fix Before You Sign

Contract red flags

If any one of these is vague or missing, the contract is not ready.

1. FTE split left verbal

   A salary quoted for a job described in fractions, with the fractions nowhere in the document, lets your clinical load grow while the pay stays put.

   Fix before signing
2. Call counted but not paid

   Call nights named in the duties with no stipend and no comp time means the hardest hours of the job are priced at zero.

   Fix before signing
3. Employer status unconfirmed

   If nobody has verified in writing that the employer qualifies for PSLF, your loan plan rests on an assumption worth six figures.

   Fix before signing
4. Moonlighting banned outright

   A contract that bars all outside work removes the one income lever a pediatrician can pull without changing jobs.

   Fix before signing
5. Band review with no process

   An academic band the employer can freeze for years with no review mechanism is a salary that shrinks in real terms while nobody breaks a promise.

   Fix before signing

Resources: Everything in One Place

Red Flags From a Real First Year Household

Sarah and Michael scored 59 out of 100 in their Financial Health Assessment, with five fixes that take them to a 75. Their systems were built on purpose. What was missing is underneath, and it is the standard first year list in this specialty.

1. Group disability as the whole disability plan

   Health, term life, an umbrella, and malpractice with the tail arranged were all in place. Disability was the group policy through work and nothing else, on the physician income a toddler and a mortgage depend on.

   Add the individual policy
2. The college account funded from leftovers

   Their 529 gets money when there is money left at the end of the month, which in a household with a toddler and a new mortgage means rarely. Any goal funded from what survives the month is a goal the household has decided not to fund.

   Automate it on payday
3. No retirement goal written down

   Three goals are on paper with numbers and dates. The largest one is not. The Decision Filter checks every money decision against written goals, and it cannot check against a blank.

   Write the fourth goal
4. The raise becoming the lifestyle

   Saving runs at about 12 percent in year one, with a bigger house already written on the goals list. Twelve percent of $300,000 is $36,000 a year and 20 percent is $60,000, and the difference is about $2,000 a month. In year one that difference is a decision. In year five it would be a deprivation.

   Save the raise first
5. The Safety Net stuck at two months

   The buckets exist and are labelled, but the emergency fund holds about $25,000, roughly two months, against a six month standard of about $75,000 for this household. A bucket without an amount and an automation is a wish with a label.

   Fund it on a schedule

Read the full case: Sarah and Michael, scored 59 out of 100, with five fixes to a 75.

If Your Situation Is Different

The New Attending Checklist

The first attending year, in order. Print it and work down it.

• Price the contract by the FTE split and the call stipend, and confirm the employer qualifies for PSLF, both in writing, before you sign.
• Capture the full employer match from paycheck one, and nothing past it yet.
• Bank one month of reserves at the new lifestyle.
• Take the credit cards to zero.
• Put coverage in force: individual own occupation disability above all, term life if anyone depends on the income, umbrella behind both.
• Put the loan plan on paper: the forgiveness count certified with training months banked, or a payoff or refinance plan chosen on purpose with real numbers.
• Fund the backdoor Roth IRA for each spouse, $7,500 for 2026, before attacking student debt over 7 percent.
• Max the retirement tier in order: the HSA first, then the workplace plan to the $24,500 limit, then the 457(b) where offered, then mega backdoor space last.
• Build reserves to three months, extinguish remaining debt above 7 percent outside the forgiveness track, then finish the reserve: six months of expenses on W2 income, up to twelve on 1099 income.
• Rent through the first year in a new market, and let the payment, not the approval, size the house after the reserve is finished.