By Dr. Leif Dahleen of Physician on Fire, WCI Network Partner
I recently took a deep dive into the finances of four imaginary but realistic physicians in A Tale of 4 Physicians 2021: The Impact of Lifestyle on Financial Independence. All are married and have total household salaries of $340,000. A reader chimed in: “What about us single primary care physicians?”
That’s a good question, reader. Your finances as an unmarried individual filing taxes as a single filer while earning significantly less than a specialist or a dual-income household will look a lot different.
Specifically, I was asked to look at a doctor earning less than $200,000 with student loans to tackle. According to a recent Medscape Compensation Survey, even the lowest-earning primary care physicians (pediatrics and preventive medicine are tied for the distinction) earn an average of $232,000.
We’ll look at not one but four single physicians with salaries well below the mean of $230,000-$250,000 for most primary care specialties, and we’ll see what it will take for them to reach financial independence as quickly as the higher-earning married doctors previously discussed.
A Tale of 4 Single Primary Care Physicians
For this exercise, each of our single primary care physicians will have a salary of $195,000.
While a salary just shy of $200,000 is nothing to sneeze at, it is on the low side for a doctor, and it could represent a primary care doc in an academic institution or any physician who is working part-time.
These four physicians are given profit-sharing and a potential 401(k) match for total monetary compensation of $210,000 annually, with up to $15,000 of that being pre-tax money placed directly in the 401(k) as an employer contribution.
While their employer does offer a 457(b), it’s a non-governmental plan with no low-cost index fund options, and their employer’s finances were rocked by COVID. Knowing that any “contributions” are actually considered to be deferred compensation until collected years later and are potentially subject to creditor risk if the hospital system is unable to meet its financial obligations, these physicians opt not to invest in the plan.
With High Deductible Health Insurance plans, they can put up to $3,650 into an HSA in 2022 (and $3,850 in 2023), and, not having any tax-deferred IRA money in their names, they can also do the Backdoor Roth each year.
That is, of course, if they have enough money left to do so.
After years of delayed gratification, it can be challenging to continue to live like a resident, and these four physicians take different approaches to spending.
We meet them early in their careers. They have begun to lay down roots in their respective communities, and they have worked long enough for their modest retirement saving to match what began as their not-so-modest student loan debt. Their net worth is approximately nothing.
Meet the 4 Single Primary Care Physicians
The Budgets of the 4 Physicians
Dr. A
Dr. Aitkin realizes she can’t afford a significant upgrade in her lifestyle after residency, and she chooses to practice in a relatively low cost of living area while driving the same beater that got her to rotations in med school.
With a mortgage payment of a little over $800 a month on a $150,000 home—split evenly between interest and principal—and $2,000 a month in student loan payments, about half of her $60,000 annual budget goes to debt service.
That leaves her with $26,000 to spend over 12 months—or a little over $2,000 per month for everything else. It may not be that easy, but as an individual, she’s actually lived on less for years. If not for the peer pressure of higher-earning and bigger-spending docs all around her, it might not feel like that much of a challenge to manage this budget.
She even finds a way to support her favorite charities with $2,000 a year. When Sarah McLachlan talks and shows her all those sad animals on TV, she can’t just look the other way!
Dr. B
Dr. Baxter doesn’t see the point of sacrificing his 20s to become a physician only to maintain that same ascetic existence as a physician in his 30s. On the other hand, he realizes that he’ll never have the income of the dermatologists and orthopedic surgeons and lives his life accordingly.
He drives a reliable Honda to a cozy, low-maintenance two-bedroom townhome in a college town, the life of which revolves around the university and tertiary care center at which he works and teaches.
With a travel budget of $6,000 a year, he takes one domestic trip and one international vacation each year. He also uses his CME fund to travel to more exciting cities for conferences, staying a day or two before or after to score a nearly free vacation.
Altogether, it adds up to $90,000 or nearly half of his $195,000 salary. How does this bode for Dr. Baxter’s future? We’ll find out soon.
Dr. C
Dr. Crosby wishes her budget could look more like that of Dr. Aitkin or Dr. Baxter, but having grown up in “The Cities” with family throughout the metro area, it made good sense for her to take a job at “The U” and make the city her home for good.
Unlike her friends up north, she wasn’t able to find a suitable home for under $300,000, but she did find a decent condo within walking distance of the metro transit line, parks, and running trails.
Like the others, she’s paying $2,000 a month toward her student loans, but just about everything else costs more. Her $10,000 travel budget gets her to Mexico or the Caribbean twice each winter. She learned in residency that one trip south just wasn’t enough.
The “giving” portion of her budget includes gifts for family all around town, as well as charitable giving, highlighted by fundraising she does for the Special Olympics before taking the Polar Plunge through a hole cut in the ice.
Add it all up, and she sees $120,000 go out the door each year.
Dr. D
Dr. Deerwood thinks it’s cute when Dr. Crosby complains about the cost of living in her city. You see, Dr. D moved to a windier city to experience bigger city life, and for better or worse, he’s paying for it.
He figures he’ll eventually move on to a better-paying gig. He might also one day start spending less, but as a single dude, he tries hard to maintain a certain image, an image that requires him to spend a little beyond his means.
In reality, he’s not spending that much more than Dr. C, and he’s not even getting as much for his money in most respects. He’s got a studio condominium near the loop, and it seems like half of his food and dining budget is spent at happy hours. He has a good time when he has time off, but saving for the future is something he plans to do sometime in the future.
With $140,000 spent annually on a $195,000 salary, he’s living more or less paycheck to paycheck.
The Path to Financial Independence for the 4 Single Primary Care Physicians
Take a minute or three and study the table above. The financial futures of these doctors is spelled out, assuming they maintain their income and spending rates indefinitely.
Dr. A
With inflation-adjusted returns of 2%-6%, Dr. Aitkin will reach financial independence in 11-13 years. With an annual spend of $60,000, she’ll have 25 years’ worth of spending for a 4% safe withdrawal rate with $1.5 million.
It’s worth noting that neither Dr. A nor any of her friends will have student loan payments forever. Eventually, those will end with forgiveness or will be fully paid off, freeing up $2,000 a month and allowing her to increase her lifestyle significantly. She could also refinance her student loans in the interim to lower her monthly payments and create a little more breathing room.
One interesting twist with the single physicians is that they’re able to itemize their deductions. With a standard deduction of $12,950 in 2022, half that of their married counterparts, most of their mortgage interest and charitable giving benefits from a tax deduction.
After deducting $20,500 for her employee 401(k) contributions, $3,650 for HSA contributions, $4,000 in pre-tax health insurance premiums, the $10,000 max for combined state income and property taxes, and mortgage interest and charitable giving, she’s got $148,950 in taxable income.
She pays about $28,400 in federal income taxes, $8,400 in state income tax in a middle-of-the-road income tax state, and $11,400 in FICA (Social Security and Medicare) taxes.
When you add in the $15,000 in 401(k) contributions made on her behalf by her employer, she’s putting $97,800 toward retirement annually—or just over half of her stated salary of $195,000.
When calculating her gross savings rate, the employer contributions are included in both the numerator and denominator, giving her a gross savings rate of 46.6% and a net (after-tax) savings rate of 62%. You can also calculate your savings rates in a similar fashion.
The taxes owed were calculated via TurboTax’s free web app TaxCaster. Would you have believed taxes on a nearly $200,000 salary could be this low? It’s true, and the physicians with bigger mortgages actually pay a bit less, as they have higher itemized deductions thanks to more money spent on mortgage interest.
Dr. B
Dr. Baxter won’t be financially independent in his 40s like Dr. Aitkin, but with 18-25 years to the $2.25 million goal, the “Retire Early” part of FIRE is still achievable.
Putting nearly $6,000 a month toward retirement gives Dr. B a 32.6% gross savings rate and a 43.2% net savings rate. If Dr. Baxter could cut expenses to about $80,000 a year, he’d have a savings rate that would meet my live on half challenge that all but guarantees financial independence within two decades.
Dr. C
Dr. Crosby, with $120,000 a year in spending and debt service, is able to max out her 401(k), getting the full match from her employer. She also maxes out an HSA. You’ll notice, however, that there’s not enough left over to contribute to a Backdoor Roth IRA, and she puts just $1,400, or a little more than $100 per month, into a taxable brokerage account.
Altogether, the nearly $3,300 a month in retirement savings give her a savings rate of about 19% gross and 25% net. This comes very close to a common recommendation for physicians to save 20% of gross income toward retirement.
Note that with realistic expectations of 2%-6% real returns (equal to ~ 4%-9% nominal returns assuming 2%-3% inflation) over 3-4 decades, it will take 3-4 decades to become financially independent.
Again, it should be noted that the student loan payments won’t be with her forever, and if she wisely puts some of that monthly $2,000 toward retirement when her balance is paid off or forgiven, Dr. Crosby can shave at least a few years off of her FI timeline.
Dr. D
Our dear Dr. Deerwood had better like doctoring, because without any changes in his circumstances, true financial independence will be difficult to achieve. He’s looking at a 60- to 124-year path, which is tricky to navigate fully when the path starts in one’s early 30s.
Student loan payments, taxes, and spending take up just about all of his $195,000 salary and then some. Sadly, he’s using credit cards the wrong way, racking up a little bit of debt that will snowball into something much larger if he lets this go on much longer.
His taxes are quite a bit higher than those of his counterparts. By not contributing to his 401(k) or HSA, he’s missing out on a tax deduction that would reduce both his state and federal income taxes. This faux pas costs him about $7,000 a year.
By not contributing to a Roth IRA or taxable account, he’s got no after-tax money invested, which means his taxes will be higher in the withdrawal phase if he ever does get to enjoy any kind of retirement.
All hope is not lost, though, for Dr. Deerwood. He can find a way to earn more money. He could also take a cue from Drs. Aitkin, Baxter, or Crosby, and spend less. Or both. No one’s going to tell him what he ought to do, but he should reevaluate his situation and see if there isn’t something he can do to alter the equation in his favor.
With a lifetime of good but not great earnings, he’s still earning enough to hit the maximum Social Security contribution every year for 35+ years. That will give him the highest Social Security benefit possible, a benefit that could support more than one-third of his current level of spending. So he’s got that going for him, which is nice.
Comparing 2 Sets of 4 Physicians
As compared to the four married households with higher incomes from our previous case studies, these four single primary care physicians have different household finances.
They earn less, but their student loan burdens are the same. They don’t set aside as much for retirement, but as they’re only saving to support one person—their required nest eggs to reach FI are substantially lower.
They’re not saving for their kids’ college in 529 plans, but they’re not benefitting from child tax credits either.
Interestingly but not surprisingly, their times to FI don’t vary much. If you compare Dr. A, B, C, or D in one scenario vs. the other, they’re on fairly similar tracks.
It all boils down to savings rate. The higher the savings rate, the quicker one is financially independent and has the option to retire early or do whatever he or she wants to do with the rest of their life.
Life Happens
These examples are realistic as a snapshot for four individuals in one particular year. Over the years, some line items in the budget will swell while others shrivel. If the status quo is maintained for the most part, things can average out.
In reality, the status quo is almost never maintained. Some of these single physicians will partner up and perhaps marry. Their spouse may earn more than them, less, or nothing at all. Our married physicians may find themselves divorced someday.
Single or married, some may choose to have children or adopt. Both can be expensive but very worthwhile propositions.
Family members get sick. Physicians become burned out, disillusioned, or disabled. Desires change, and with them, spending habits will be altered, as well.
Still, it’s important to establish a baseline and to project what sort of a financial picture will best help you reach your goals. That’s my goal with these posts. When life happens, make adjustments as necessary with future goals somewhere in the back of your mind.
Being a primary care or part-time physician relying on a sole income does present some unique challenges, and the budget will be smaller out of necessity. But financial independence remains a goal one can strive for.
What do you think? Which of these four examples are most relatable to you? What else can these doctors do to change the trajectory of their path to financial freedom? Comment below!
I see that none of the four doctors contributed to their 457(b) out of fear of being taken by creditors. What a scary scenario. Has this ever happened to hospital employees somewhere?
I’d hate to pass up this tax-deferred avenue in my job, but also don’t want a significant portion of my retirement to disappear suddenly as I near retirement .
I don’t actually know of a case of it happening, but it is a potential risk.
After further reading, I see that ours is a governmental 457(b), so loss of assets to creditors is not a risk. Good news for us, though a bit silly that these two fairly different account types are both “457(b)” See: https://www.whitecoatinvestor.com/457-retirement-plan/
It’s theoretically possible, as the money is deferred compensation; it’s not yours until you withdraw it. That said, I am not aware of an instance in which employees lost their 457(b) funds in a bankruptcy.
The primary reason I had these doctors not invest in it was to give them a somewhat realistic spending budget. Using COVID and shaky finances made the decision to opt out more realistic.
Cheers!
-PoF
The examples shows the importance of increasing income and maybe choice of location. Even Dr. D doesn’t have a super luxury life even though higher than the average person’s income. If they could move to a state with no income tax and lower cost of living the numbers would work out much better.
Email comment from a reader:
“This advice is completely ridiculous, nowhere in America is rent or Mortgage payments that low in any place were you either want to live or wont get robbed or murdered on the regular. Update your numbers!”
My response:
“These doctors may not be able to live in your neighborhood, but I assure you such homes exist.
We paid $90,000 for a home (read all about it here: https://www.physicianonfire.com/90k-house/) a few years ago and it was a nice, small place in a good neighborhood. It’s worth more now (we sold it for $135,000 last year), but the mortgage payment would be under $825 a month even at that inflated price with mortgage rates now doubled.
I’ll add that no one gets murdered “on the regular,” even in the worst of neighborhoods. It happens once at most.
Cheers and have a great weekend!
Leif
How often are people killed around here?
Oh, no more than once per person.
When we finished training we moved to a nice neighborhood. Pleasant surroundings, safe, quiet. Dead end street. We loved it. There were no other doctors in the neighborhood. No lawyers or corporate executives. School teachers and fire fighters were our neighbors and they were wonderful people. As our income grew, we could have moved to a more expensive place but we did not. Our kids were friends with many others who had family incomes far below ours. They had friends from school who did not live in our neighborhood but whose families were rich, not that our kids noticed or cared.
We ended up living there for a long time. Only moved when when I took a job in a different city.
Those school teachers are still good friends. They did not accumulate money like doctors can, but they educated their kids, gave to charity and overall had nice lives. I cannot see that we missed anything by spending like they did.
Perhaps instead of encouraging people to “live like a resident” for a few years, we should tell them to “live like a school teacher” throughout their careers. Then have a safe and comfortable retirement.
I can’t even get most of them to live like a school teacher for two years, much less an entire career. But maybe your comment will resonate with a few.
From what I can tell, the housing budgets seem low. The median monthly mortgage payment in April 2022 was $1,967, according to the MBA data.
Insurance seems low as well… looks like Dr A managed to find health insurance, disability insurance, home, auto, and umbrella insurance… All for less than $210/month?
I’m not a single physician but thanks for posting your numbers and showing the math so people can run their own budgets with their own insurance/mortgage/rent and other expenses!
The housing cost was addressed above.
Regarding insurance, these are employed physicians, so their health insurance and some basic disability insurance is a part of their benefits package, although they each put $4,000 a year towards health and dental insurance pre-tax, as depicted in the table. There’s a separate budget for auto & transportation, and that’s where auto insurance costs, if incurred, would go. In a few cities, cars are optional. So, yes, while on the low side, I do believe $2,500 to $7,000 a year is a reasonable estimate for home and umbrella insurance.
If you want Dr. A to have true, own-occ disability insurance, increase the insurance cost and decrease a different line in her budget. You’ve got 16 others to choose from.
Cheers!
-PoF
That’s fair… I guess when it comes to insurance, my perspective is skewed since I’m self-employed (also have wife and kids). It just seems that generally, the WCI crew encourages hardy insurance coverage… which at first glance seemed at odds with the minimal insurance budget in these examples.
The high cost of housing though… that does seem to make wealth increasingly difficult nowadays. Seems like the biggest boost to wealth accumulation would be to live somewhere inexpensive (which in turn lowers expenses generally)… and find ways to increase income (which for physicians is also achieved by living somewhere less populated)
Agree that housing is expensive overall, especially in today’s world. But what type of housing does one actually need to live, particularly if they are single? A 4-bedroom house in an affluent suburb with highly-rated schools and high property taxes? Probably not. There are societal pressures that kind of establish the expectation that by middle age people find a partner and start having kids, buy a single-family home with a yard, etc.
Partnering up and/or having kids will increase the pressure to spend more on housing and other things. Consider, perhaps, that increasing household size, and the spending that often follows, serves as a barrier to wealth accumulation, moreso than living in a HCOL area in a small condo/apartment as a single person.
Aside from societal pressure, it’s just really nice to have a big house in a nice suburban neighborhood with good schools to raise kids in. I don’t feel like I bought that primarily due to peer pressure.
I just came out of residency a little over a year ago and settled down in the rural Midwest doing FM. Bought an older 5-bedroom house and did some needed updating. My mortgage/escrow is $1,050 per month and health insurance premiums are covered by my hospital for my entire family of 5. The numbers presented here are attainable for those who are willing to live in rural communities and sacrifice some of the amenities that come with a big city. Living in a big house in a small town where my kids can grow up does feel nice as well.
Finding women or spouses (women) who are economically sensible in modern America is a very challenging thing, or in the case of the above poster, a lotto that he hit to “live like a school teacher.” Especially if you are a doctor, considering all things. This makes housing far more expensive for the modern person, funny enough, regardless of sex.
My view of America in this regard (and its recent past leading up to this reality) makes the 20s have fun period relevant for only maybe a man, since marriage isn’t a priority anymore (for women, mostly except when they are old and losing major value). The problem is that since the pairing isn’t there early anymore, it just sets off a cascade of events that have decade after decade, made this worse. Add the legal/divorce angle and threat of instability to life and resources, and you see why we are where we are, with fertility plummeting. But we can always import the third world to keep the ponzi going, since all the professionals don’t have kids anymore! Yay!
Misogynistic much?
People use this term often but most don’t know what it means – which actually makes perfect sense if you understand what’s going on.
On costs. Remember that most people live on far less than even Dr. A. So, yes. It can be done.
As to not needing a car in some cities- those are usually dense high cost places. You would be better off living in a low COL smaller town, even if you needed a car.
Unless she is quite old at retirement, I do not believe 25 years of expenses represents financial independence. I figure age 95 for the outside of my potential age at death. 25 years would be just on the borderline to retire at 70.
Since the calculation gives a total after the years of savings modelled, this implies that Dr. A is early career. Retiring at 45 with savings equal to 25 years of spending would be risky.
25x expenses if absolutely enough for retirement assuming you can be even somewhat flexible. That meets the 4% rule where you increase youre spending with inflation every year and still usually end up with over twice youre starting account balance.
This also ignores social security which can be a pretty large percentage of your needs for some people.
I urge young physicians to pay off your student loans as soon as possible, even if you have to live like a med student for a decade. Here’s why: You will get little to no help with your kids’ college tuition. Our older son was a national merit finalist. A prestigious liberal arts college offered him a $2,500 merit award. Thank goodness, we had started saving for college tuition the month our sons were born through UGM accounts. For two years, both of our sons were in college at the same time. Not fun. But who am I to complain? My dad, who practiced surgery for 52 years, paid for 84 years of tuition for his five kids, and the care of my mom, who was bed-bound with MS for 12 years. We worked, and had no fancy vacations or cars. But my dad achieved his legacy– that giving your kids fine educations is the most enduring gift of all.