Audio Coursesby JellypodLesson 11 of 17
Overview
Get practical tips on managing your finances early in your hospital medicine career. Learn about budgeting, student loan strategies, insurance essentials, and smart investing to build a secure financial future.
Beth Blimmer: Hey everyone, welcome back to another episode of Starting Strong! I’m Beth, and I’ve got Mark and Vicky with me today. We’re talking money smarts for new hospitalists, and honestly this might be the episode I wish I’d had right out of residency.
Mark Krause: Yeah, absolutely. I wish someone had handed me a “how not to accidentally spend your whole first paycheck on Thai takeout and new scrubs” guide, y’know? There’s a lot of excitement when you start earning, and if you’re not tracking, it disappears so fast. So, let’s hit the basics—budgeting. I always start people with Mint or, if you’re kinda old school like I am, just plug numbers into Excel. There’s more elaborate budgeting tools too, but honestly... I got confused and just bailed after a week.
Beth Blimmer: Ha, YNAB is like the Peloton of finance apps. You’ve really gotta want it! I still have this gnarly spreadsheet I built as an intern. Wasn’t pretty, but I could see where every dollar went—even if a LOT of them went to LaCroix and frozen burritos. But, seriously, it kept me out of trouble! If you’re not tracking your spending, you’re almost guaranteed to overspend, especially right after that big pay jump out of training.
Vicky Muller: And speaking of peace of mind, the very first thing you should do as an attending is stash some money away for emergencies. Target at least three, ideally six, months of living expenses—just tuck it in a high-yield savings account. Don’t worry about fancy investments—just quick access. Because, trust me, the unexpected will happen. Your car will eat its timing belt or your dryer explodes or—well, life, you know?
Mark Krause: Totally. And if you can, honestly just pretend you're still living like a resident! I know, not glamorous. But those habits carry over. Like, I used to do these “residency pizza nights”—I mean, literally splitting Little Caesars four ways and eating cold slices on night float. Now I do it by choice, but back then it was necessity! The idea’s the same—don’t let spending instantly match your new income. You’ll thank yourself later.
Beth Blimmer: I still have moments where I think, “Wait, should I buy the fancy coffee or keep putting it towards my emergency stash?” Living like a resident, even for just a couple more years, gives you so much wiggle room to build a solid base—and avoids that ‘doc lifestyle inflation trap’ we’ve all heard horror stories about. Vicky, you’ve always been a laser with this stuff—any rookie budgeting tips?
Vicky Muller: Don’t be too rigid, but do prioritize what matters most—travel, family, whatever it is. As long as you see the big picture, you’ll do great. And check your budget every couple months—just like following up on your patients, things shift!
Vicky Muller: Let’s move into insurance and legal stuff. Not the sexiest topic, but, if you mess it up, it gets real ugly, real quick. First up: student loans. OK, if you’re going for Public Service Loan Forgiveness—PSLF—don’t, and I mean do NOT, refinance. PSLF is only for federal direct loans, you guys. If you refinance, you’re done for. I actually forgot to submit my PSLF employment form one year—had to dig through emails, track down HR... it was a pain. Submit your forms annually. If you’re not going PSLF, look for a lower interest rate and maybe refinance, but read that job contract very carefully. Some places help with loan repayment, but you might have to pay it back if you leave early. Just—ugh, so many fine-print traps!
Beth Blimmer: Yeah, and for disability insurance, it’s confusing straight out the gate. What you want is “own occupation” coverage. There’s “any occupation” out there—and the group policy’s usually that. It’s cheaper, but, like, if you can do ANY job, even at a flower shop or something, you stop getting paid out. But our specific medical skills are irreplaceable, so protect that. Oh! Ask about benefit increase riders—improves your payout over time if your salary goes up. Always, always consider how you’d pay your bills if the worst happened, not just “oh well, I’ll bounce back.”
Mark Krause: And then, the insurance the sales people love to push: life insurance. Get term. I can’t say it more. Whole life sounds fancy, but it’s expensive and by most regards considered a scam. It pays high commission to the seller and the cost to the consumer is high enough they usually end up quitting before they even see a return. With term, if you don’t die, you don’t get anything, right, but it’s cheap when you’re young. Oh, and while we’re on this, malpractice insurance—ask if your employer covers tail coverage! Claims-made policies are standard, but when you leave, you may need tail. That’s a huge bill if you’re not expecting it.
Beth Blimmer: I got totally paranoid when I learned about the homestead exemption. It’s pretty state specific, but really valuable—protects your home if you’re sued. Just another small safety net to keep you from losing your house if you ever land in litigation. It’s worth seeing how that applies where you live!
Vicky Muller: I actually made a checklist of what to ask employers on all this: disability details, life insurance options through work, what happens if you go on leave, tail coverage—get all that in writing. You’ll sleep better knowing you have all your bases covered!
Mark Krause: Alright, so you’ve got a budget and insurance in place—let’s talk investments and growing your future. First, the earlier you start, the better. Employer plans—401k, 403b, even 457b if you’re lucky—are money machines if you use them right. There is usually a part of these plans that the employer pays and another part that you can put in additional funds--the voluntary plan. The main thing is: try to max them out if you can. That’s pre-tax money, lowers your tax bill, and most jobs will put in a match. Free money! Don't let that go!
Beth Blimmer: And those numbers—like the annual limit for the voluntary plan—change, so check the IRS website each year. But even if you can’t max it out right away, start small and slowly ramp up. That first paycheck when I finally got to max my 401k felt like I was an actual adult for real for the first time.
Vicky Muller: Don’t forget Roth IRAs—they’re after-tax and grow tax-free. But there’s an income limit, so once you’re making attending money, you probably need to use a backdoor Roth. I always laugh about the group chat that blew up when someone realized we could still do a “backdoor Roth” in our last resident year. Suddenly everyone was frantically Venmo-ing and screenshotting their Vanguard logins! Classic.
Mark Krause: Yeah, and HSAs if you’ve got a high-deductible plan—triple tax benefit, love that. Also, consider just opening a regular brokerage account if you’re maxing everything else. Mix things up – diversify, and don’t forget to keep insurance up to date. Umbrella coverage, for example, protects if you get sued beyond malpractice. The key: sock away at least 15-20% of your salary, pay off high-interest stuff, and keep at it. The magic’s in consistency. Compound interest is your friend--if you invest early, time will do the heavy lifting.
Beth Blimmer: If you’re overwhelmed, that’s normal! Focus on the biggest levers first: enroll in your employer plan and make sure you get the match if it there--avoid leaving free money on the table, and don’t touch your retirement savings early unless absolutely critical. Penalties are real! Second: enroll in voluntary plans. For most new hospitalists this means Roth IRA with backdoor. Third: Start your loan repayment. Fourth: budget. Fifth: start putting leftovers into a mutual fund or some other account.
Beth Blimmer: Let’s close out by tackling student debt—a huge stressor for most of us starting out. So, when I first refinanced, I was terrified I’d mess it all up. I went with the “avalanche” method—target the loans with the highest interest rate first. Some folks do the “snowball,” start with the smallest balance to get momentum. There’s no one right answer—just whatever keeps you moving forward.
Mark Krause: Some people are okay with debt and some are very debt adverse. I have a colleague a few years ahead of me who is paying down their debt down slowly because they have good rates so the pressure is different. For me, the interest rates were super high and my school was very expensive. So, I focused on getting those numbers down early.
Vicky Muller: If your payment feels impossible, don’t panic—income-driven repayment plans ARE out there and can make life workable, especially those first attending years when finances are still tight. Just be sure you know what you’re signing up for—they have different requirements and implications down the road, especially if you plan to go for forgiveness later.
Mark Krause: Yeah, and keep all your documentation! For PSLF in particular, you want to submit your employment certification every year, keep those emails, and watch for updates. The requirements shift sometimes, and you don’t want to get disqualified for a technicality. But even if you’re not eligible for forgiveness, just chipping away—little by little—gets you there. Eventually those big numbers move.
Beth Blimmer: Alright, so that’s a wrap on building your financial life foundations in hospital medicine. If you want more, there’s plenty of podcasts and books out there—honestly, go binge on White Coat Investor or Choose FI next shift. And we’ll keep hitting these early career pearls in future episodes.
Vicky Muller: Love it! Take care of yourselves, and remember—you worked way too hard to let money stress take over now. Thanks for hanging out!
Mark Krause: Yeah, good luck everyone—make those smart moves, and see you on the next one!
