Pediatrician Finances: The Resident and Fellow Guide

For most pediatrics trainees, the loans are a counting problem, not a payoff problem. The median education debt for the class of 2025 is $200,000, and pediatrics training happens overwhelmingly at employers that qualify for Public Service Loan Forgiveness: government hospitals and 501(c)(3) nonprofit children's hospitals and academic centers. Enroll in an income driven plan, make the required payment and nothing more, certify your employment every year, and the months accumulate at trainee prices. A resident who trains three years and fellowships three more can bank half of the 120 payments before the first attending paycheck arrives, and those are the cheapest payments of the entire schedule because they are priced off the smallest income of a career.

The discipline is paperwork, not money. File the employment certification form annually and every time you change programs, recertify income on time, and keep your own copies of everything. The pediatrician version of this lesson is on the question page for the third year resident deciding between investing and paying off loans: on a forgiveness track, the Roth room beats the prepayment every time. The full attending version of the strategy lives on the student loans page.

The trainee version of the waterfall is short on purpose. Capture any employer match your program offers, hold a starter reserve of one month of expenses, keep the credit cards at zero, and put the next dollars into the Roth IRA, up to $7,500 for 2026. Training income sits in the lowest bracket of your career, which makes Roth space bought now the cheapest tax free compounding you will ever own, and the space closes at each year's tax filing deadline with no way to buy it back.

What training does not ask of you is heroics. There is no taxable account in this stage, no extra principal on forgiveness track loans, and no shame in a small automated contribution. The habit is the asset: a payment that leaves on payday, sized to a trainee budget, running without a monthly decision. When the attending income arrives, the same automation carries the Double Up Rule, and the size changes instead of the system.

Residency is when disability insurance is cheapest and easiest to get, and pediatrics programs are exactly where the guaranteed issue offers live: coverage you can buy during training without full medical underwriting, sized to grow with your income. The reason to act in the window is simple. An individual own occupation policy bought healthy at 30 prices the risk of a long career; the same policy bought after a diagnosis, or after a claim shaped year, prices something else or is not offered at all.

The group policy your program hands you is a floor, not a plan. It is capped, it follows the employer's definition of disability, and it ends when training does. The individual policy is the layer that stays. Premium discipline matters at a trainee salary, so size the benefit honestly, take the longest elimination period the household reserve can carry, and let the future increase option do the growing. The full sizing treatment is on the insurance page, and the definition that does the work is explained on the own occupation page.

No specialty asks more honesty of the fellowship decision than this one. Three more years at trainee pay is the price of every pediatric subspecialty. What you get for it depends entirely on which door you pick. In the Doximity 2025 data, neonatology averages $354,841 and pediatric cardiology $352,197, both well above the general pediatrics average of $265,230, and pediatric emergency medicine averages $312,271. The cognitive subspecialties run the other way: pediatric endocrinology averages $230,426, pediatric rheumatology $231,574, pediatric infectious disease $248,322, and pediatric hematology and oncology $255,733, each below the general pediatrics average they trained three extra years to reach.

None of that makes the lower paid fellowships wrong. It makes them a purchase, and purchases deserve prices. The worked version, with the attending years priced both ways, is the question page on whether a pediatrics fellowship pays for itself. Run it before the match list is due, not after.

Three more years of training buys very different destinations depending on the door. Every figure below is average total compensation from the Doximity Physician Compensation Report 2025, with general pediatrics as the line each fellowship is priced against.

The choice is still yours, and a fellowship chosen for the work can be the right purchase at any line of this table. What the table ends is choosing it as a raise without checking which line you are on. The worked version is the question page on whether a pediatrics subspecialty fellowship pays for itself, and the full pricing is in The Pediatrician Pay Paradox.

Read the full case: Harriet and Darren, scored 35 out of 100, with ten moves to a 70.

Ryan Inman is a retired financial planner who worked with about 500 physician families. He created the Financial Residency podcast (about 3 million downloads) and is no longer affiliated with it. Financial Fellowship is his sole focus. This guide is educational. Last updated October 2026.