Retirement Accounts for Physicians: A 2026 Funding Guide
Yohance Harrison
June 27, 2026
Most new attendings save in one place: the employer 401(k) or 403(b). That is a fine start, and it leaves a lot on the table. As a high earner, you have access to several tax-advantaged accounts, and using them together is what turns a strong income into lasting wealth.
Wealth gets built brick by brick. Early on, the order you fund these accounts changes your result more than the raw amount, because the first dollars capture free money and the strongest tax treatment. We lay out the full priority list in a dedicated article.
The Backdoor Roth is one of the most useful tools available to a physician, and it carries a tripwire called the pro-rata rule that can turn a tax-free move into a taxable one. The details are worth getting right the first time.
Three patterns keep physicians from using these accounts well. Status quo bias leaves you in the 401(k) alone, because it is the default. Overconfidence leads to a DIY Backdoor Roth that trips the pro-rata rule. Present bias makes the next purchase feel more urgent than the next contribution. A clear order, set up once and automated, settles all three.
If you want your accounts funded in the right order, with the pro-rata rule handled, book a 15-minute complimentary discovery call.
A 401(k) or 403(b) allows $24,500 of salary deferral, a Backdoor Roth adds $7,500, and an HSA adds $4,400 for individual or $8,750 for family coverage. With a Mega Backdoor Roth, total 401(k) additions can reach $72,000.
Using only the employer 401(k) and stopping there. The Backdoor Roth and HSA often go unused, and the funding order gets ignored.
Most attendings earn above the direct Roth limit, which is why the Backdoor Roth exists. These accounts are built for high earners.