Retirement Planning 101 (Part I): Your First Steps to Saving

For the young physician just beginning their career, retirement can seem infinitely far away. Retirement planning, however, requires dedication early in your career to ensure a smooth transition years down the road. Here is the first installment of several that will address and simplify this daunting topic. By Matthew Dellaquila MD MBA FASA

Retirement planning is one of the most crucial topics for a person’s financial well being. A 2019 survey of consumer finances published by online blog NerdWallet showed that the median household with earners between ages 55 and 64 only had $134,000 in retirement savings; nowhere near enough to comfortably retire. This begs the question, “How much money do I need to retire?” and “How do I get there?”

How Much Do I Need?

Conventional wisdom is that you will need approximately 80% of your pre-retirement salary annually to retire1. As an example, if you take a pre-retirement salary of $300,000, you would expect to need $240,000 annually in retirement. The drop in required expenses will, of course, vary from person to person: some people want to travel extensively in retirement, some have children later in life, still others have expenses drop by more than this amount. It’s important to remember that these are rules of thumb, and will require personal thought as to what your needs are in retirement. To arrive at that number, another conventional rule of thumb is the “4% rule”, meaning that you can comfortably draw 4% of your retirement savings annually at retirement2. The median retiree listed in the intro will then be able to draw a little more than $5,000 annually for retirement. To have $240,000 annually in retirement, you would need a nest egg of $6 million, assuming no other savings or sources of income. This number is, again, a rough estimate using rules of thumb; but the size of it should not be ignored or minimized. Saving for retirement is a huge undertaking that requires careful planning and sacrifice from an early age to execute successfully.

The Time Value of Money and Power of Compound Interest

Because it is a huge undertaking, it’s important to begin saving for retirement early. Many residents don’t even think about saving for retirement, and leave a considerable amount of money on the table without even knowing it. The traditional 26 year old resident who works at a health system with 1:1 matching of retirement funds and manages to save $200 monthly during residency (a total of $9,600) could expect over $150,000 of retirement savings at age 65 assuming the usual 6% rate of return on the overall stock market. For example, here's a graphic showing what a different saving at, say, 25 vs. 35 can make:
Similarly, compound interest can work against you: the same 26 year old who has a $200,000 medical school loan at 7% interest can expect to accumulate over $60,000 in debt by forbearing their loan instead of other options discussed in the previous post. Similar calculations can be done for the early career physician. By maxing out a Backdoor Roth IRA at $6,000 and contributing the IRS max of $19,500 to both a 401(k) and a 457, with 50% employer matching of the 401(k), the first year physician who begins their career at age 30 can have $420,000 in retirement funding out of their $55,000 initial contribution. Indeed, merely maxing out your retirement using the above methods can get you over that $6 Million hurdle by age 65 as long as you start early. Saving early for retirement is, therefore, crucial; especially as physicians who aren’t reaching a full salary until their thirties.

You Might Have a High Income, but You Might Not be Rich

What does being wealthy mean? The general public uses the term 'rich' to refer to both those with high-incomes and those with high-net wealth, but 'income' and 'wealth' are in fact radically different concepts. Consider a neurosurgery attending who has just finished training and who makes $750,000 a year at her first job, but simultaneously only has $10,000 in her bank account, $300,000 in debt, and no other appreciable assets. She would thus have a very high income but have a net worth of -$290,000 and thus would likely rank as one of the poorest individuals on earth with respect to wealth. Simultaneously, consider a couple who have retired, planned impeccably, have $7,000,000 in retirement accounts and investments, no debt, and a yearly 'income' through their investments and social security of $350,000. This couple has a lower income than our neurosurgeon, but they are substantially wealthier with a net worth of over $7,000,000.

Only having a large amount of wealth makes you truly 'rich', do not let high income or cash flow fool you into thinking you are 'rich'. It is the number one mistake new attendings make when they see a large rise in income and thus automatically assume they are now 'rich'. Until you pay down your debt and move your net wealth position into positive territory, you are in fact still quite poor

401(k)? 457? What is all of this stuff?

A 401(k) is a plan where you can contribute money for retirement into an account, usually done pre-tax (you are not taxed on the money you put in when you put it in). For those of us who work for tax-exempt organizations (such as universities), they offer a 403(b), which is functionally the same as a 401(k). Money put into these plans is then taxed when you take it out, though usually at a lower rate since you are withdrawing less in income from the plan when you take it out than you made when you put it in. If you withdraw from these plans prior to age 59.5, you face a penalty (with one exception where you can withdraw at age 55, but this is the 101 course, not the advanced). The penalty for early withdrawal is 10%, a huge amount that makes it prohibitively expensive to withdraw (and forces you to keep the money saved for retirement). As noted above, often employers make matching contributions, so it is in your best interest to contribute the IRS maximum to this account if you can. For 2021, this amount is $19,500 (for those under 50).

A 457 is a similar tax deferred account offered by some non-profit and state employers. It differs slightly from the 401(k)/403(b), but is an additional account that you can contribute another $19,500 to on a tax deferred basis (for those under 50). These plans are less likely to have employer matching, and have more rigorous standards for withdrawing prior to retirement (though it is easier to withdraw from these plans for an early retirement). Additionally, if offered through a private nonprofit, if that entity were to go bankrupt, the 457 would (in theory) be subject to creditors in a bankruptcy case; in practice this is exceedingly rare and unlikely.

A Roth IRA is, in a nutshell, a special type of retirement account from which the earnings are not subject to tax when withdrawn. Many physician earners are ineligible for this account, as it is only eligible for earners with income below $137,000. Many practitioners will instead contribute to a traditional IRA and then convert that contribution to a Roth IRA, which is legal. This is called a Backdoor Roth IRA, and can get you additional savings for retirement where the earnings are not taxed. The IRS limit for contribution to this entity is $6,000 for those under age 50.

Simply using these three accounts can get you most of the way toward retirement (assuming the stock market chugs along at the 6% average rate of return it has shown for the last 100 years or so). In part two, we will discuss other strategies to save for retirement for those people who do not have the option of a 457 or who wish to contribute additional amounts to retirement savings.


  1. Income vs expenses can make this calculus different. For an introductory article, basic rules of thumb and estimates were employed.
  2. The technicalities and specifics behind a general rule of thumb again are numerous, but for an introductory article, this is a good rule to stand by.

Matthew Dellaquila, MD, MBA, FASA is a physician anesthesiologist at Henry Ford Health System in Jackson, MI and Detroit, MI, where he serves in departmental leadership roles involving practice management, operations, and departmental strategy. His clinical practice includes general, regional, obstetric, and ambulatory anesthesiology.

The ASA Committee on Young Physicians is pleased to present this monthly article series on personal finance. These articles are not written by hedge fund managers or real estate tycoons but by practicing physicians. Some have business degrees and some do not – but every contributor is an anesthesiologist who has some guidance to offer the rising generation of attending physicians. It is not the intention of the committee to offer definitive financial advice, but rather some pearls of wisdom to consider while developing a personal fiscal plan.


ASA Community Blog is published as a benefit for ASA members. The views expressed on this blog are those of the individual contributing writers only and do not necessarily represent the opinions of ASA.