Financial Planning Considerations for Surgical Trainees: Webinar Highlights

Authors: Camila R. Guetter, MD MPH*; Rachel E. Mooney, MD*; Alizeh Abbas, MD; Kylie Dickerson, MD

*Indicates co-first authors.

This blog summarizes key advice and resources from the AWS Webinar on Financial Planning, held on April 9th, 2026, and co-hosted by the Resident & Fellow and the Medical Student Committees. You can find the recording for this webinar here.

Building Good Habits and Budgeting as a Medical Student or Resident

From college to medical school to residency, each stage of training brings a new financial reality requiring different strategies and habits. Medical students often carry loan balances that only grow, while residents navigate, in many cases, their first paycheck and the challenge of dividing income between fixed expenses, personal wants, and savings.

One of the most powerful habits trainees can build is automating their finances. Setting up automatic transfers to savings, loan payments, and retirement contributions eliminates guesswork and protects against overspending. A simple framework: cover fixed essentials first (rent, utilities, minimum loan payments), build a short-term emergency fund, contribute to retirement (even if modestly), and if finances allow, begin setting aside funds for broader investments. Of course, not everyone will be able to follow this framework right away; student loans, family obligations, or unexpected hardships can make saving or automating contributions feel out of reach, and that’s okay. Progress looks different for everyone, and even small steps forward count. Financial wellness during training is a marathon, not a sprint. The goal is balance; building a solid financial foundation while still allowing time to recharge and enjoy life outside of training.

Student Loans

         For many residents, student loans are one of the largest financial stressors during training. Understanding repayment strategy early can help maximize flexibility and support long-term financial goals.

         Income-Driven Repayment (IDR): Most residents pursuing federal loan forgiveness should enroll in an IDR plan, which bases payments on a resident’s income, keeping payments relatively low during training. Filing taxes as an MS4 is important, as it can significantly lower the first year of payments. Those planning to pursue Public Service Loan Forgiveness (PSLF) must be enrolled in either the standard 10-year repayment plan or an income-based repayment program to qualify. Residency is often “the cheapest time” to accumulate qualifying PSLF payments, as these lower monthly payments still count toward forgiveness.

         PSLF: This is one of the most valuable options for residents planning careers in academic medicine or nonprofit institutions. Remaining federal balances may be forgiven after 120 qualifying monthly payments while working full-time for a nonprofit or government employer. For those pursuing PSLF, making extra loan payments is counterproductive, as this only reduces the amount eligible for tax-free forgiveness later.

When to Refinance: Refinancing can lower interest rates but permanently eliminates access to PSLF and federal protections. Refinancing may be worth considering for trainees planning to enter private practice, who do not anticipate qualifying for PSLF, or who can secure significantly lower interest rates.

When transitioning into residency, trainees should consider enrolling in an IDR plan immediately after graduation, confirming whether their residency institution qualifies for PSLF, and certifying employment annually. Ultimately, the right repayment strategy depends on each trainee’s career path, debt burden, and long-term financial priorities.

Retirement and General Investments

Once you become a resident, it can feel counterintuitive to contribute to retirement while already carrying a significant loan debt on a resident’s salary, but starting early matters more than starting big. Trainees with access to a 401(k) or 403(b) account should try to contribute at least enough to capture any employer match (if your program offers one); that is an immediate return that no other strategy can beat. A Roth IRA is also something to consider during residency, as your lower tax bracket makes it an ideal time to invest for tax-free growth later.

Beyond retirement accounts, broader investing is also worth considering once the right foundations are in place. Investing during residency may feel out of reach, but even small, consistent contributions can have a meaningful long-term impact. Before doing so, trainees should ensure a basic emergency fund exists and that high-interest debt is being managed. Once those foundations are set, index funds are a widely recommended starting point, offering broad market exposure without requiring active management. A financial advisor can help tailor an investment strategy to individual goals and risk tolerance.

Financial Planning for the Growing Physician Family

Short-term considerations and goals for trainees with partners, children, or other dependents include maintaining an emergency fund with approximately 2-3 months’ worth of savings and using high-yield savings accounts (average 4% interest rates) to build wealth for money that will be needed within 2-3 years. Having a small safety net helps avoid the high interest rates associated with credit card debt, and high-yield savings accounts are low-risk and offer a superior return on investment compared to traditional savings accounts. If family members rely on your income and would suffer financially from your demise, it is important to consider getting life insurance. Life insurance provides compensation to dependents in the event of death, and term life insurance typically provides a better cost-benefit ratio compared to permanent life insurance for trainees. For trainees pursuing PSLF who are married, there might be some consideration to file taxes independently rather than jointly; however, the benefits of a lower monthly payment are not significantly different, and simplicity may be favored. Trainees with children may feel pressured to start saving for future expenses such as college education using a 529 account; however, the first priority in general should be funding retirement accounts, including 401 (k), which are far more flexible and will provide more savings in the long run (though individual situations may vary).

Final Takeaways

Financial wellness during training is built gradually, through small, consistent habits rather than perfect decisions. The strategies discussed throughout this article, from loan repayment and budgeting to retirement and investing, are meant to serve as a starting framework, not definitive financial advice. Every trainee’s financial situation is unique, and consulting with a qualified financial advisor or planner before making major financial decisions is strongly encouraged. Many hospitals and training programs offer access to financial planning services at reduced or no cost, so trainees are encouraged to check with their institution to see what may be available to them.

Camila Guetter, MD, MPH, is a General Surgery Resident at Beth Israel Deaconess Medical Center (BIDMC) in Boston, MA. She is currently completing her professional development years as a research fellow in vascular surgery outcomes at BIDMC, while pursuing a PhD in Clinical Epidemiology at the Harvard T.H. Chan School of Public Health. Her research interests lie at the intersection of vascular surgery and epidemiology, with a particular focus on leveraging modern epidemiological methods and causal inference frameworks to answer clinical questions in vascular surgery. She served as the Chair of the AWS Resident and Fellow Committee in 2025-2026.

Rachel Mooney, MD, is a recent graduate of the University of Kentucky College of Medicine. She will be starting her Preliminary General Surgery Residency at the University of North Carolina-Chapel Hill this year. She served as the chair of the AWS National Medical Student Committee Journal Club in 2025-2026.