This is a two-part post on “if I knew what I know now.”

Part I covered pre-med and medical school.

Today, Part 2 covers residency and fellowship.


Internal medicine residency was 3 years long and a big change to our cash flow with both of us working again.

We were moving up in the world and adulting.

HR emailed him several insurance plans that we had to read over and choose. The prospectus of every fund available in his 403b came in the mail.

Family situation:

  • Kid #2 was born during PGY2.


  • We both worked and funded all accounts available to us.
  • He now had a HSA, which he previously didn’t have before, and funded that.
  • We got into a income-driven repayment plan for his student loans.
  • *We submitted paperwork for Public Service Loan Forgiveness (PSLF) every year.
  • **We bought term life insurance for both of us in PGY1.
  • ***For his student loan payments, we waited until Kid #2 was born to increase (+1) the number in our household.
  • We bought own-occupation (“own-occ” for short) disability insurance for my husband in PGY1.
  • We opened a 529 for Kid #2.
  • He moonlighted as soon as he was allowed.

What I wish I knew:

*Because we were planning to do PSLF, we could have gotten out of the 6-month $0 grace period to have a head start on having more low payments count towards PSLF. We didn’t because we thought the grace period was mandatory.

**We should have bought term life insurance as soon as Kid #1 was born in MS4. Instead, we waited until PGY1.

***Because Uncle Sam counts unborn children when calculating student loan payments, we should have increased (+1) the number in our household when I became pregnant and not waited until I gave birth. We missed out on 8-9 months of lower IDR payments.

What we did well:

  • Lived below our means.

My advice:

  • Buy term life insurance as soon as you have dependents (kids or a spouse). Stay away from whole life.
  • As soon as intern year starts, get disability insurance quotes from an independent agent for ALL six own-occ companies. If you or your spouse is a female physician, most definitely get it before the first pregnancy.
  • Handle those student loans and get into the right IDR payment plan (your only good options are IBR, PAYE, or REPAYE) the moment he graduates. If his residency program is #1) not a 501c3 or #2) you know 100% that he wants to go into private practice, refinance.
  • For the vast majority of families, renting will come out ahead over buying a home.
  • Save more aggressively than your friends who didn’t go to medical school because of unique expenses. Related: 10 Expenses Unique to Medical Families.
  • Learn to DIY your finances and begin saving for retirement.


Towards the very end of residency, my husband became interested in subspecializing in GI. By the time he decided to go into it, he hadn’t published enough research that’s needed to match into GI.

We decided to go for his dream and meet that requirement by doing a research fellowship.

So my fairy tale continues:

“and thus her husband became a forever doctor-in-training, never to practice medicine independently, and continued to accrue interest on his student loans…THE END.“

Family situation:

  • Baby #3 was born one week after he started research fellowship. With three kids who are aged four and under, our cash flow is probably the tightest it ever will be in our lives. I know this is going to just be a story one day, but man is living different than writing about it!


  • Baby #3’s birth was a tipping point between SAHM vs. working mom. I could have chosen either. I went down the middle and reduced my hours at work.
  • We lowered or stopped our contributions to our accounts.
  • We opened a new 529 for Baby #3.
  • *Accepting that My husband is much more interested in private practice and highly unlikely to go academic, we jumped ship (saying bye to PSLF forever) and refinanced with a private company.

What we did well:

  • Kids were clothed and fed.
  • Rent was made.
  • Lights were kept on.

What I wish I knew:

*Had we had a crystal ball that told us DocH wanted to go into private practice, we would have refinanced with a private company the minute he got his residency contract.

Advice for myself:

Living paycheck to paycheck is OK, for now. Marathon runners know there are times to slow down and speed up to finish well.

Right now we’re “slowing down” to grow and raise our family. After training, we will “speed up” by not inflating our lifestyle.

Good advice is intelligent and optimized. Great advice meets you in the real world and works with your dreams and what you’ve got now.

If kids are a part of your dream, too, you get me.

The truth about finances is that sometimes not all decisions are based on money.

I write this post while our three carefully budgeted, dream babies are asleep. #blessedmom


We’re not there yet. This website will grow with us as we continue the medical journey.

We’re at negative net worth right now. We plan to take the first 2-5 years after training to aggressively pay off his student loans and catch up on retirement savings.

I can’t wait for the day to have positive net worth. At that point, I will break the bubbly and celebrate with him saying:

“Yes!! We are now worthless!”

To continue to see how we progress towards worthlessness along our medical journey, subscribe to my emails and follow me on Twitter, Facebook, and Pinterest.

Imagine yourself going back in time. What would you tell your younger self, colleagues, or co-residents? Share below in the comments. It may help a lot of people.