The decisions arrive before the income does.

You could work all of this out yourself.

That part is not really in question. You got through medical school and you matched. Give you a free weekend and a spreadsheet and you would probably land somewhere reasonable.

That is most of what I am for. Not smarter than you. Just already holding the map for this particular stretch of road.

Three moments, and they are not far apart.

1. While you are still in training

   Residency and fellowship

   Six figures of debt against a trainee's salary. Which repayment plan, whether to rent or buy, and the protection you put in place now at an age and health status you may not have again. Small decisions here can run for decades.

2. When you know where you are going

   Usually your final year

   You finally have a number. That is often the point where planning stops being hypothetical: what the income actually looks like after taxes, what to put in place before the larger checks start, and what not to commit to yet.

3. The first full year of attending income

   Year one

   Income can multiply several times over. So can the tax bill, and the number of people who want to sell you something. This is often the year a plan either gets built or gets postponed, and postponing is often the more expensive option.

The questions that actually get asked.

• What do I do about my loans?

  Income-driven repayment, forgiveness programs, and refinancing point in different directions depending on where you end up practicing. The right answer during training is often not the right answer the year after.

• Should I buy a house?

  Physician loan products make it possible earlier than most people can. Possible and advisable are different questions, and the answer usually turns on how likely you are to move when training ends.

• Does a Roth make sense on my income now?

  Your tax rate today may be the lowest it will ever be, which can shape the answer as much as anything else. What you can contribute and what else the money is needed for both matter too.

• What coverage do I actually need right now?

  Coverage is generally cheaper and easier to qualify for the younger and healthier you are, which is an argument for looking during training rather than after. What matters is less which company than what the contract actually says.

• What do I do with the first big paycheck?

  The jump is large enough that it can disappear into lifestyle without anyone noticing it happened. Deciding where it goes before it arrives can be most of the work, and it is usually easier to do in advance than to unwind later.

• Am I already behind?

  Many people in medicine do not start saving on the schedule the retirement calculators assume. Starting later with a much larger income can be a different problem rather than a hopeless one.