What order should a pediatrician fund retirement accounts in?

Fund them in the site's ladder order, and do not skip rungs to reach the accounts that feel more sophisticated. The order is: capture the full employer match and nothing past it, then a backdoor Roth IRA at $7,500 for each spouse, then, inside the max retirement tier, the HSA first, then the workplace plan to its $24,500 limit for 2026, then additional employer plans such as a governmental 457(b), then a taxable brokerage account, and education accounts last (Internal Revenue Service). The ladder is career wide. It is the same order at a children's hospital, in a private practice, and in a subspecialty, because the tax logic that ranks the accounts does not change when the employer does. What changes is which rungs your employer offers.

Part of the pediatrics hub.

The ladder, rung by rung

The match comes first because it is the only rung that pays you to occupy it. Contribute enough to capture the full employer match and nothing past it, then leave the workplace plan alone until the ladder returns to it. Money sent past the match before the Roth is filled is money parked in a taxable at withdrawal account while tax free space sat empty.

The backdoor Roth IRA comes second, $7,500 for 2026, and the rung is per spouse, so a married household fills two of them for $15,000 a year in total. Roth space is the scarcest space in the system. It is capped, it expires each year, and at attending income it is reached through the backdoor route. The waterfall on this site places the backdoor Roth ahead of student debt above 7 percent for exactly that reason: the debt can be attacked next year, and the Roth year cannot be bought back.

Inside the max retirement tier, the HSA goes first. For 2026 the limit is $4,400 with self only coverage and $8,750 with family coverage, and the account only exists alongside a high deductible health plan, so this rung is conditional on your health plan choice. Then the workplace plan to its limit, $24,500 of elective deferrals for 2026 in a 401(k) or a 403(b). Then additional employer plans. A governmental 457(b) carries its own separate $24,500 deferral limit, apart from the 403(b) limit, and distributions from a governmental 457(b) after separation from service carry no ten percent early withdrawal penalty (Internal Revenue Service). Where a plan offers a mega backdoor route, it sits last inside this tier. Only after every tax advantaged rung is full does the taxable brokerage account open, and education accounts, the 529 and its kin, come after taxable in the ladder, because retirement you can fund only once, while education has more than one funding source.

The math at children's hospital pay

Add the rungs for a married pediatrician at a children's hospital with family health coverage, and the capacity surprises people who think of pediatrics as a low capacity specialty. Backdoor Roths for two spouses are $15,000. The family HSA is $8,750. The 403(b) takes $24,500, and a 457(b), where offered, takes another $24,500. The sum is $72,750 a year of tax advantaged contributions before the employer match and before a single taxable dollar. Against average pediatrics compensation of $266,000 (Medscape Physician Compensation Report 2026), $72,750 is about 27 percent of gross income. Against the average starting salary of $258,000 (AMN Healthcare), it is about 28 percent.

Change the household and the arithmetic changes with it, rung by rung. A single pediatrician with self only health coverage fills one backdoor Roth at $7,500, an HSA at $4,400, the 403(b) at $24,500, and a governmental 457(b) at $24,500, for $60,900 a year. Drop the 457(b) because your employer does not offer one, and the married household total falls to $48,250, which is $72,750 minus $24,500. The 403(b) and 457(b) stacking question works through the two plan combination in full. The pediatrics retirement guide holds the same ladder inside the wider new attending plan.

What breaks the order

Three errors recur. The first is funding a taxable account or a 529 while Roth space sits empty, usually because the taxable account feels like real investing and the Roth feels small. Small and expiring beats large and always available. The second is sending extra money to student loans while on a forgiveness path and leaving the match or the Roth unfilled. On Public Service Loan Forgiveness the plan is minimums and recertify, and every extra loan dollar is a dollar that forgiveness was going to cancel and the Roth year was not. The third is treating this account ladder as the whole financial order. It is not. The waterfall governs the cash before and around these rungs: one month of reserves comes before investing beyond the match, cards go to zero, and coverages are placed early, because a retirement order built on an empty reserve and an uninsured income is an order built on sand. Fill the rungs in sequence, in the months the cash allows, and let finishing take the time it takes.

Follow up questions

Where do emergency reserves fit in this order?

Reserves sit in the waterfall around the ladder, not inside it. Capture the match first, build one month of reserves sized at your new attending lifestyle, clear card debt, and place coverages, all before you push deep into the max retirement tier. Two more months of reserves come after the retirement accounts are maxed, and the reserve gets finished, six months of expenses on W2 income, before the first taxable dollar.

What if my employer offers no 457(b) and no HSA?

The order does not change. You simply have fewer rungs. Fill the match, both backdoor Roths, the workplace plan to $24,500, and then move to taxable, with education accounts after. A shorter ladder is a reason to be more exact about the rungs you have, not a reason to reorder them.

Should both spouses max their own workplace plans?

Each spouse holds an individual deferral limit of $24,500 for 2026, so a two physician or two plan household has two workplace rungs to fill, plus a backdoor Roth for each spouse. Work through the household in ladder order: both matches first, both Roths, the HSA if your family coverage sits with one employer, then each workplace plan in turn.

Related questions

• Pediatrics pays among the least in medicine. How do I still retire on time?
• Can a pediatrician stack a 403(b) and a 457(b) at a children's hospital?
• How should a pediatrician split savings and loans when a spouse earns more?

Sources

Internal Revenue Service, Notice 2025-67 (the 2026 elective deferral limit of $24,500 for 401(k), 403(b), and governmental 457(b) plans, and the 2026 IRA limit of $7,500, accessed October 2026)

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

Internal Revenue Service, IRC 457(b) deferred compensation plans (the 457(b) separate annual contribution limit, apart from the 403(b) limit, and the absence of a ten percent early withdrawal penalty on governmental 457(b) distributions after separation from service, 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 pediatrics starting salary of $258,000, accessed October 2026)

Takeaways

• The ladder is match, backdoor Roth per spouse at $7,500, HSA first inside the max tier, workplace plan to $24,500, additional employer plans, taxable, and education accounts last.
• A married pediatrician at a children's hospital can shelter $72,750 a year before the match and before taxable investing.
• Roth space expires every year. Fill it before extra loan payments and before any taxable account.
• The account ladder sits inside the waterfall. Reserves, card debt, and coverages come before the deep retirement rungs.
• A missing rung, no 457(b) or no HSA, shortens the ladder. It never reorders it.