How much should a physician have saved by 50?

A common rule of thumb is ~5x salary by 50, but physicians who started after fellowship are often behind that through no fault of planning — the fix is a high sustained savings rate and maxing every available tax-advantaged account, not chasing returns.

What's a cash-balance plan and should I have one?

It's a defined-benefit plan that lets a stable, high-income practice contribute six figures pre-tax per year on top of a 401(k). For partners over 50 with reliable income it can compress the retirement timeline dramatically — but it has actuarial cost and funding commitments and is a CPA/actuary decision.

Should I pay off student loans or invest?

Loans above ~7% generally deserve aggressive payoff ahead of taxable investing; sub-5% loans can usually run while you capture match and tax-advantaged limits. Run it against your actual rates and remember PSLF math differs for academic/non-profit employment.

Why does the backdoor Roth keep coming up for physicians?

Physician income usually exceeds the Roth IRA contribution limit, so the backdoor (non-deductible traditional IRA then conversion) is the standard route. The trap is the pro-rata rule: an existing pre-tax IRA balance makes the conversion partly taxable, so clear or roll it into a 401(k) first.

By profession · Physician

Retirement planning for physicians

A profession-specific look at the retirement levers a physician actually has — pension rules, tax-advantaged accounts, and the Social Security wrinkles unique to your job.

Last reviewed May 4, 2026

Editorial review pending — see editorial process

The retirement landscape for a physician

Pension

Most physicians have no pension. The exceptions are meaningful: VA physicians are on FERS (a real pension plus TSP), some academic medical centers offer a defined-benefit or generous defined-contribution plan, and physician-owners of stable practices can create their own defined-benefit cash-balance plan. The defining feature of physician retirement planning is not a pension — it is a compressed accumulation window: residency and fellowship push the first real savings year into the early-to-mid 30s, so the plan has fewer compounding years and must do more per year.

Tax-advantaged accounts

Hospital-employed physicians often have a 403(b) or 401(k) AND a 457(b), each with its own limit, so both can be funded — the 2026 elective-deferral limit is $23,500 (under 50) or $31,000 with the age-50 catch-up per plan. SECURE 2.0 adds a larger catch-up for ages 60-63 — confirm the exact 2026 figure on the IRS cost-of-living-adjustments page before relying on it. Note that a non-governmental (private-sector) 457(b) is an unsecured promise of the employer and carries creditor risk the governmental version does not — read the plan document. Private-practice physicians typically run a group 401(k) with profit-sharing plus, for stable high earners, a cash-balance plan that can shelter six figures pre-tax annually. Because income usually exceeds the Roth IRA limit, the backdoor Roth IRA is standard practice; coordinate it with any pre-tax IRA balance to avoid the pro-rata rule.

Social Security

Physicians pay Social Security on the standard wage base, but because the benefit formula is steeply progressive and capped, high earners get the least benefit per payroll-tax dollar — Social Security will replace a small fraction of a physician's pre-retirement income, so the plan must lean almost entirely on personal savings. Locums and 1099 work is self-employment income subject to the full 15.3% SECA tax and opens Solo 401(k) contribution room separate from a W-2 job's plan.

Common pitfalls

The expensive ones: lifestyle creep that scales with attending income and quietly raises the retirement number; staying in cash or over-conservative allocations after a late start, compounding the short-runway problem; triggering the backdoor-Roth pro-rata tax by leaving a pre-tax IRA balance in place; ignoring malpractice tail-coverage cost when modeling the transition out of clinical work; and carrying student loans above ~7% while making only minimums — high-rate debt payoff often beats marginal taxable investing.

Worked example

A 42-year-old hospital-employed physician, $280,000 income, $380,000 saved, started real saving at 34. Maxing both a 403(b) and a 457(b) plus a backdoor Roth routes well over $50,000/year into tax-advantaged space; the compressed runway means the savings rate, not the start date, has to carry the plan. Targeting retirement at 60 with ~25 working years, the model is dominated by personal-portfolio drawdown — Social Security is a rounding error at this income. Keep some Roth and taxable balances so retirement-year tax brackets and IRMAA (Medicare premium surcharges, which hit high-income retirees hard) can be managed; the calculator can show the IRMAA-aware drawdown is worth real money.

Run the calculator with a typical physician starting point

Pre-filled: age 42, savings $380,000. Adjust to your actual numbers from there.

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Frequently asked

How much should a physician have saved by 50?
A common rule of thumb is ~5x salary by 50, but physicians who started after fellowship are often behind that through no fault of planning — the fix is a high sustained savings rate and maxing every available tax-advantaged account, not chasing returns.
What's a cash-balance plan and should I have one?
It's a defined-benefit plan that lets a stable, high-income practice contribute six figures pre-tax per year on top of a 401(k). For partners over 50 with reliable income it can compress the retirement timeline dramatically — but it has actuarial cost and funding commitments and is a CPA/actuary decision.
Should I pay off student loans or invest?
Loans above ~7% generally deserve aggressive payoff ahead of taxable investing; sub-5% loans can usually run while you capture match and tax-advantaged limits. Run it against your actual rates and remember PSLF math differs for academic/non-profit employment.
Why does the backdoor Roth keep coming up for physicians?
Physician income usually exceeds the Roth IRA contribution limit, so the backdoor (non-deductible traditional IRA then conversion) is the standard route. The trap is the pro-rata rule: an existing pre-tax IRA balance makes the conversion partly taxable, so clear or roll it into a 401(k) first.

Primary sources

Every profession-specific rule above traces to one of these primary sources. We re-verify each link annually; current as of the last-reviewed date below.