PGY Planning
Smart financial decisions start in training — not after.
Residency and fellowship are among the most demanding periods of any physician's life. The hours are long, the stakes are high, and financial planning is rarely at the top of the priority list.
But the financial decisions made during training — about disability insurance, student loan repayment strategy, and your first attending contract — have consequences that extend decades into your future. A residency that ends without an Own-Occ disability policy in place, or a loan repayment path that forecloses PSLF eligibility, or a first contract signed without understanding what's negotiable — these mistakes are common, and they are costly.
We work with residents and fellows to build a financial foundation during training, so that when your income increases, your plan is already in place.
Common challenges we help residents and fellows navigate
• Building a realistic financial plan on a resident salary while managing loan payments
• Securing affordable Own-Occupation disability insurance during training — before health changes affect insurability
• Deciding between PSLF, IDR repayment, and refinancing — and understanding the long-term implications of each path
• Making the rent-vs.-buy decision when relocation after training is likely
• Preparing for the financial transition from resident to attending physician salary
• Negotiating your first physician contract with confidence
A Rare Opportunity: Guaranteed Standard Issue Disability Insurance
Many residency and fellowship programs participate in Guaranteed Standard Issue (GSI) disability insurance programs. This means residents can obtain high-quality, Own-Occupation disability coverage without full medical underwriting — a significant advantage for anyone with health conditions that might otherwise affect their insurability.
This coverage window is limited to your time in training. Once you leave the program, you lose access to guaranteed issuance terms and often to the group pricing that makes coverage affordable during residency.
Why GSI coverage during residency matters
• No medical underwriting — coverage is issued regardless of health history (within program limits)
• Own-Occupation definition — protects your specific medical specialty, not just your ability to work in general
• Lower premiums during training — residency salary qualifies for lower initial benefit amounts at affordable rates
• Future increase options — allows you to add coverage as an attending without new underwriting
• Once you leave the program, this opportunity is gone
GSI Program Affiliations
• Lahey Hospital & Medical Center — Residents & Fellows: GSI disability insurance available through this program
• Massachusetts General Brigham Hospital — Pediatric Residents & Fellows: GSI disability insurance available through this program
• Additional hospital partnerships available — contact Andrew to confirm whether your program qualifies
Student Loan Strategy During Training
With medical school debt frequently exceeding $200,000, the choice of repayment strategy is one of the most consequential financial decisions a resident will make. The right path depends on your employer, your income trajectory, and your personal goals — and changing course later can be costly.
Public Service Loan Forgiveness (PSLF)
• Designed for physicians employed at qualifying non-profit or government hospitals
• Requires 120 qualifying monthly payments on an income-driven repayment (IDR) plan
• Forgiven balance is currently tax-free at the federal level
• Payments during residency at a qualifying employer count toward the 120
• Best path for those planning to remain at qualifying employers for 10+ years
• Certification of employment should be filed annually — do not wait
Refinancing & Standard Repayment
• Converts federal loans to private — permanently forfeits PSLF eligibility
• May offer lower interest rates for high earners post-training
• Best for those heading to private practice or non-qualifying employers
• Requires careful long-term projection — lower rate doesn't always mean lower total cost
• Some refinancing lenders offer rate holds or medical professional programs during residency
• Once refinanced, there is no path back to federal loan programs
We help residents model both scenarios — including projected forgiveness amounts, interest accrual, and 10-year vs. 20-year cost comparisons — so you can make an informed decision before it's too late to change course.
Your First Physician Contract
Your first attending physician contract will likely be the most significant financial agreement you have ever signed. Most residents sign it without fully understanding what they are agreeing to — or what is negotiable. The items below are the areas where we most commonly see residents leave money on the table or accept unfavorable terms.
Key contract elements to evaluate before you sign
• Base salary vs. RVU-based productivity compensation — understanding both models and what's realistic for your specialty
• Signing bonuses and repayment clauses — what triggers repayment if you leave early
• Non-compete clauses — geographic scope, duration, and enforceability in your state
• Call schedule, overtime expectations, and administrative responsibilities not reflected in compensation
• Malpractice insurance type: occurrence vs. claims-made — and who pays for tail coverage if you leave
• Partnership track timeline, buy-in requirements, and what partnership actually means at this practice
• Retirement plan availability, employer match, and vesting schedule
• CME allowance, licensing reimbursement, and professional dues
• Paid time off, maternity/paternity leave, and disability leave provisions
Your financial foundation starts during training — not after.
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PGY financial planning addresses the unique financial challenges residents face: living on a salary of $55,000–$75,000 while carrying six-figure student loan debt, making decisions about housing and savings under time pressure, and preparing for a dramatic income change when training ends. Decisions made during these years — especially around disability insurance and student loans — can have consequences that last decades.
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Get it during residency. Rates are based on your age and health at the time of application — locking in a policy as a healthy resident means potentially lower premiums for the life of the policy. More importantly, many residency programs offer Guaranteed Standard Issue (GSI) disability insurance, which allows residents to obtain coverage without individual medical underwriting, regardless of pre-existing conditions. This window closes when you leave training. Andrew works with residents at Lahey, BIDMC, MGB among others, to access GSI programs.
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During residency, a policy covering $5,000–$7,500/month is typical and affordable on a resident salary. The more important consideration is that your policy includes a Future Increase Option (FIO) rider — this allows you to increase coverage as your attending income grows, without new medical underwriting. Getting the right policy structure now, even at a lower benefit amount, protects your ability to obtain full coverage later.
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For most residents, aggressive loan repayment during training is not the right strategy. With a resident salary and high loan balances, an Income-Driven Repayment (IDR) plan typically keeps payments low and preserves cash flow. If you're working at a non-profit hospital, those IDR payments also count toward Public Service Loan Forgiveness (PSLF). Refinancing during residency can eliminate PSLF eligibility permanently — a mistake that can cost six figures. Every situation is different, which is why a personalized strategy review is important.
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This is one of the most common — and consequential — questions residents face. The answer depends on your residency length, likelihood of staying in the area for fellowship or attending practice, and overall financial picture. With high student debt and a 3–7 year training window, buying often exposes residents to significant transaction costs and illiquidity risk if they need to relocate. That said, physician mortgage programs with no or low down payment requirements have made buying more accessible. A careful rent-vs-buy analysis is essential before deciding.
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The 6–12 months before finishing training is a critical planning window. Key steps include: reviewing and upgrading your disability insurance before group residency coverage ends, deciding on a student loan strategy (PSLF continuation, refinancing, or IDR), understanding your first attending contract (compensation structure, non-competes, malpractice tail coverage), establishing a retirement savings plan, and preparing for the tax implications of a dramatically higher income. Most residents who don't plan ahead lose significant value in this transition window.