1. ⁠Maximally fund 401K if offered at work. Talk with the HR and to see if your work offers mega back door Roth. You can ask them if your plan allows doe after-tax contributions and in plan Roth conversion or transfer. This will allow you to put up to $66K in 401k every year.
2. ⁠Contribute to traditional IRA for yourself and the spouse. Roth may not make sense if your marginal tax rate is > 24%.
3. ⁠Set aside 6+ months of expenses in a high yield savings.

4 Fund HSA if you are eligible. Save all the healthcare receipts (paper and digital copies). You can let your money in HSA grow till later date and redeem those previously incurred expenses then.

1. Invest in low cost index funds like VTI/ VXUS/ BND. I’ve lost 10s of thousands trying be an investment guru and chasing individual stocks/cryptocurrency. Stick to the safe and invest in the S&P500 nothing fancy.

2. Depending on your mortgage rate, you can aggressively pay off your mortgage. If you got sweetheart 2-3% mortgage, consider just investing money in brokerage rather than paying back low interest rate mortgage.

3. Look into opening 529 account for your child for future education expenses.

Make sure you are keeping track of your monthly expenses lifestyle creep can really get you especially if you’re not careful and don’t know how much you are spending.

As someone else commented on here this is from the “prime directive” on the personalfinance subreddit wiki.

I think you’ve identified a key here, which is what you do not know. This is ok - you will have time to learn about all the financial jargon just as you’ve learned about medicine.

Some thoughts:

1.) Take the 500k job. Frankly, no one cares about what institution you came from. I’ve seen amazing attendings that came from Caribbean schools and rural residencies…and some horrid docs from all those ivory tower institutions. Also keep in mind that a good deal of new grads will leave their first job within 24 months - do you also want to make less money?

2.) You have no debt which is massive. Do not severely overspend, but you wouldn’t be wrong in getting a nice house to live in. This was my only “splurge” getting into the attending life, and coming home to a cozy home in a great area is the perfect way to unwind.

3.) Start educating yourself. No one will do this for you, and any type of financial advisor (even fee for service) will take your money for something you should be doing yourself. If you are absolutely at a loss, use only fee for service…but this may cost you thousands.

4.) Understand your tax situation and how to legally reduce the income subject to taxes. For example, certain accounts will let you put in money, and that amount comes off the taxes you pay! You’d be doing these things anyways (contributing to a health savings account, 401(k) retirement investment account) and at your income level you’ll be saving like $0.35 of every dollar you place into those accounts (assuming you’ll be in a higher tax bracket making 350k, the top one is 35%)

Best of luck!

For general personal finance questions, I always refer people to the r/personalfiance wiki located here. It should cover a good range of topics generally for financial advice, retirement accounts, credit scores, etc.

The common advice you get here is as a fresh attending, don't make big financial commitments right out the gate if you can avoid it because you don't know if you're going to like your first job. Continue to live below your means as well and make sure you're saving well for when you're settled you have cash on hand to minimize what you need to finance.

How are you going to practice in US if you did residency outside the U.S.?

Search white coat investor YouTube videos. There is one 10-15 minutes that gives checklist

First off, if you’re on this subreddit I’m assuming you’ve already read The Whitecoat Investor book and if you haven’t yet, this should be your first read as it covers a lot of stuff asking about. Dahle also wrote a second book called WCI Financial Bootcamp that covers pretty much every major topic that wasn’t covered in the first book. I’ll throw out there that Ramit Sethi’s I Will Teach You to be Rich was also helpful for me.

Take the higher paying job - that is a massive pay disparity. and while this rule isn’t always true, what I’ve learned from my colleagues who have trained/worked at super prestigious academic centers is that generally, quality of life is significantly worse and the price you pay in exchange for the prestige. Obviously do your homework and figure out if people are happy at the other institution and all that, but unless you super duper love your job at your current place, that is a massively deflated salary!

WCI book

You don't have to learn all it at once. I would definitely go with the 500k job though. That's a huge salary gap and will have a major impact on your life.

It's nice that you don't have debt, so you should be able to max out the retirement plans offered by your work. Retirement accounts are taxed less relative to regular brokerage accounts, so you should always try to max them out.

Then you can read about traditional versus Roth for your 401k/403b. Perhaps you'll have a 457b too, which can be nice. Maybe your 401k/403b will offer after tax contributions which will get you up to the $70 k limit (traditional and Roth are capped at 23.5 k), and maybe it will allow in plan conversion of the after tax amount to Roth (mega backdoor roth).

Outside of your work accounts, you can open a personal brokerage account and do a backdoor roth (7k per year)

Note the max contributions I have above are for 2025, and usually increase slightly each year.

At some point, might want to look into your own long term disability (with own specialty rider) and life insurance, to supplement what your work offers.

Fellow immigrant here. I will teach you how to be rich, yes very questionable book name, is what i would recommend for basic personal finance/ retirement account. Health insurance you just have to look up youtube, making sure you understand HSA vs PPO. Disability insurance for physicians by Billy Gwaltney is a very good easy read. Rich dad poor dad, while i hate the writer, is a good and easy book to understand tax. Read all of the above and then proceed with WCI materials. Controversial take but The Total Money Makeover by Dave Ramsey is also a good motivational read to stay within budget and dont fall into the constant lifestyle creep that American doctors tend to do. Very controversial figure but I agree with his paying debt snowball + never going into debt for anything other than your house mindset, and my husband and I are super proud we've paid off his student loan only half way into his PGY-2.

Just take it one step at a time and don't try to drink from a firehose. Focus on one topic, understand the ins and outs, then move on to the next and soon you will connect the dots. Don't overwhelm yourself thinking you need to master all the concepts as quickly as possible. I went from 23 years in medicine to a CFP, but it took about 5 years for me to learn enough to even consider changing professions.

Here's a good "to-do" list from one of the WCI podcasts: (PS don't forget to protect your income) https://www.whitecoatinvestor.com/financial-priorities-as-a-new-attending/

https://youtu.be/LRPI5OMxjGw?si=SQrp7OkCvnA-1Oyu

Focus on strategy, not planning. What is it you actually want to accomplish? Maximize lifetime income? Early retirement? Low stress? Something completely different? Write it all down somewhere, come back and look at it in a few months. Does it still make sense?

Any thoughts on weighing salary vs academic prestige/career growth

I started out in academia, with my first attending job being at the same institution where I did my fellowship. I was hooked on the whole prestige thing, until I realized something important: prestige doesn't pay the bills.

If your long-term goal is to maximize your income while working in the USA, you really should consider redoing your residency in the USA. I've met several IMGs who have gone the long route: foreign med school, foreign residency, US fellowship, US residency. It sucks ass, but being board certified makes a huge difference in job opportunities and income. Also doing your residency the 2nd time is a lot easier.

I don't know what specialty you are in, but seems likely you are in a surgical field. My experience is that private practice is easily 2x the pay of academic surgery. If we factor in that academic medicine takes place primarily in high cost of living areas and states with high state income tax the difference becomes even bigger.

Here are some good youtubers who make content about personal finance and investing:

https://www.youtube.com/@BenFelixCSI

https://www.youtube.com/@ThePlainBagel

Are you an MD or MBBS?

They are both academic institutions, but the salary gap is -150k/year??!