What order should an OB/GYN fund retirement accounts?

The waterfall is the order, and the order does not change by specialty. Ryan's waterfall runs like this. First, capture the full employer match, and nothing past it. Second, hold one month of reserves, sized at the new lifestyle. Third, bring credit cards to zero. Fourth, put coverage in place: disability above all, plus term life, plus umbrella. Fifth, the student loan plan runs in parallel, on its own rules. Sixth, fund the backdoor Roth IRA, at the $7,500 limit for 2026, before debt above 7 percent. Seventh, max retirement: the health savings account first inside the tier, then the 401(k) or 403(b) to $24,500, then a governmental 457(b) where you have one, then mega backdoor space last. Eighth, add two more months of reserves, for three total. Ninth, extinguish remaining debt above 7 percent, with Public Service Loan Forgiveness loans excluded. Tenth, finish the reserve before the first taxable dollar: six months of expenses on W2 income, up to twelve months on 1099 or sporadic income. Eleventh, a taxable brokerage account, alongside written goals, is the exit.

Part of the OB/GYN hub.

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 a real household. Heidi, 33, is a first year attending OB/GYN in the Portland metro earning about $320,000. Spencer, 35, teaches high school at $80,000. Household income is about $400,000, with one child age 2, a mortgage of about $500,000 on a $650,000 home, and student debt of about $280,000 on the Public Service Loan Forgiveness track, with 24 of 120 payments made. Taxes take their share first. Set the lifestyle at $130,000 for the year. Everything above the tax bill and that lifestyle is waterfall money. Average compensation in the specialty is $390,000 in the Medscape Physician Compensation Report 2026, and Heidi sits a little below that average in year one, which changes none of the order. It only changes the speed at which the rungs fill.

The rungs, in the order you will actually meet them

The match comes first because matched dollars pay a return no later rung can match. Contribute at least enough to capture all of it from the first paycheck, and nothing past it until later rungs call you back. 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. Heidi holds about $35,000, about three months of expenses, so her early reserve rungs are already partly built. That head start moves her faster through the ladder. It does not let her skip a rung.

Credit cards go to zero third, because no investment rung outruns card interest. Heidi's cards are already zero, which is one rung she can simply confirm and pass. Coverage is fourth, and disability sits above all of it, because this income depends on hands, eyes, and stamina in a procedural specialty with call. Heidi carries group disability only, no umbrella policy, and $750,000 of term life in force, so the coverage rung is her real work: an individual disability policy of her own, term life reviewed against the new income, and umbrella cover added.

The loan plan, fifth, runs in parallel. On a Public Service Loan Forgiveness track, pay minimums, recertify on schedule, and never send a dollar extra, because extra principal on a loan headed for forgiveness buys nothing. Heidi has 24 of 120 payments made, so 96 qualifying payments remain if her employment stays qualifying. 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. Her car loans of about $25,000 are the kind of balance rung nine reads by rate when its turn comes.

The max tier is seventh. Inside it, the health savings account goes first, at $4,400 for self only coverage or $8,750 for family coverage in 2026. Then the workplace plan, a 401(k) or a 403(b), to $24,500. Then a governmental 457(b) to its own $24,500, where the employer offers one. Then mega backdoor space last. After that tier, add two more months of reserves for three total at rung eight, extinguish remaining debt above 7 percent at rung nine with forgiveness track loans excluded, and finish the reserve at rung ten before the first taxable dollar moves.

Follow up questions

Should I pay extra on my student loans before I max retirement?

Follow the loan plan, not the balance. If the loans are on a forgiveness track, extra payments buy nothing, and the waterfall funds around them while minimums and recertification run in parallel. If the loans are on a payoff track and carry a rate above 7 percent, they wait for rung nine, after the match, the first reserve, coverage, the backdoor Roth IRA, and the max tier have had their turn. Median education debt is $200,000 for the class of 2025, per the AAMC, and Heidi carries about $280,000, which is exactly why the plan matters more than the instinct to attack the largest number first.

When do I get to raise my lifestyle?

When the waterfall reaches the taxable account. That is the written exit from the Double Up Rule, not a date on the calendar. Reaching it means the match is captured, coverage is in place, the reserve is finished, and debt above 7 percent is gone. A lifestyle raised at that point is funded by a system that is already built.

Related questions

• How many months of expenses should an OB/GYN keep in cash?
• How do I stack a 403(b) and a 457(b) at a hospital OB/GYN job?
• How does paying for college work on an OB/GYN's income?

Sources

• Medscape Physician Compensation Report 2026, which establishes average OB/GYN compensation of $390,000, accessed October 2026.
• Internal Revenue Service, Notice 2025-67, which establishes the 2026 elective deferral limit of $24,500 and the IRA limit of $7,500, accessed October 2026.
• Internal Revenue Service, Revenue Procedure 2025-19, which establishes the 2026 health savings account limits of $4,400 self only and $8,750 family, accessed October 2026.
• Financial Fellowship Heidi and Spencer case, which establishes the household income, debt, reserve, and account figures used as the worked example, accessed October 2026.
• AAMC, class of 2025, which establishes median education debt of $200,000, accessed October 2026.

Takeaways

• The order runs eleven steps: match, one month of reserves, cards to zero, coverage, the loan plan in parallel, backdoor Roth IRA, max retirement, three months of reserves, debt above 7 percent, the finished reserve, then taxable.
• Inside the max tier for 2026: the health savings account first, at $4,400 self only or $8,750 family, then the 401(k) or 403(b) to $24,500, then a governmental 457(b), then mega backdoor last.
• The Double Up Rule caps the first attending lifestyle at double the resident net: $65,000 becomes $130,000, and every dollar above it flows the waterfall.
• Heidi's household earns about $400,000 and already saves. What the waterfall adds is order: coverage placed, goals funded in line, and six accounts given one system.