Dual Physician households definitely present a little bit of a unique scenario with various positives and negatives.

I don’t have any info on your background, location, specialties, families, etc. All of those things can change the picture. Obviously, everyone’s experiences are different, but I’m happy to give you some perspective off of my personal situation.

In my opinion the biggest hurdles, by far, in a dual-physician household are relationship driven, not financial. The biggest financial victory you can have as a DPH is to not get divorced…

For one, somebody has to take at least a slight backseat in terms of job location unless you both get offered dream jobs in the same location directly out of training. This can be tough on the “secondary” person who just worked their ass off through school/training to feel kind of pigeon-holed into a job just because the spouse has a great offer in whatever town. This should be discussed at length.

Communication is key!

Division of housework for a lot of couples can be a hurdle. But I think this is exaggerated in DPH. Especially when/if kids come into the picture. If one spouse feels like they’re doing all the cooking, cleaning, laundry, shopping, etc, while also working as a full-time doc, that can create resentment and strife. Kids make everything 10x harder. Again, communication. Both sides need to be stepping up to make it work.

Other possible sources of strife: call schedules, late working days, different ideas about how and/or how much money to be spending or saved.

We both come from lower-middle class families. Never went hungry, but had to take full loans for med school. We both had scholarships for undergrad. There’s a decent chance we may have to support parents financially at some point. We expect no inheritance from either side. We met in med school when we were both broke. We survived residency with a couple years of long distance thrown in. So we’re in this thing together, and that helps.

She’s the more specialized. So my first job was where she matched into fellowship. We’ve moved twice since she finished fellowship, and she found the job first at both locations.

We combined our finances. We’re both W2… There’s really nothing super special or tricky that I’ve heard of that will maximize efficiency for taxes or anything. You just max your tax advantaged accounts and put the rest of it in taxable. It’s all right there in WCI book/blog/podcast.

We aggressively paid off our loans, but SLF is definitely an option worth looking into if you will be working at hospitals that qualify.

In terms of goals and working together, that’s really more relationship advice and kinda differs from couple to couple…. My wife knew I wanted to save pretty aggressively, and she was on board for the most part. She lets me manage the finances, and we have regular meetings for check-ins. We spent more on a house than I ever thought I’d spend in a million years. It’s a pretty modest 2600sq ft. But in a super desirable neighborhood, in our dream city. Having to do that with inflated 2024 prices was/is frustrating, but what are you going to do?

After kids, we definitely had some lifestyle inflation, but we’re still saving 25-30% of gross. We discuss big purchases, but don’t sweat the small stuff. I really want to retire early, because I kind of hate my job/specialty, and she’s supportive of that.

As we got rid of loans, and a more sizeable nest egg, we started hiring out some things. This helps a lot (especially with kids). We have a house cleaner. We get baby sitters all the time if needed.

I know some couple who keep finances completely separate, but this just seems weird and overly complicated to me.

I know this was kind of all over the place, but hope it helped a little. Feel free to PM me if you want other details or have questions.

Wife and I are both surgeons with HHI >$1.2M and we combined our finances from day 1. Makes it easier to have everything in one place. Adds transparency and everything is on the table at all times to allow us to maximally invest in any extra dollars. We use traditional accounts (401k, backdoor Roth, HSA, 529, MBDR, brokerage account). Only index funds. Don’t need to get fancy

You can make every wrong choice and still be better off than 99% of the world.

You’ll be ok I promise.

Trying to optimize the fringe 1-2% of your investing with 2 physician household is literally not worth your time.

Stop overthinking and just live life. Seriously.

It really doesn’t change much financially in my opinion, you just have a “bigger shovel” to work towards your goals. Obviously maximize retirement, pay off loans aggressively before “investing in real estate” unless you mean a primary residence. I would get a fee only financial advisor and accountant to help navigate this. 

Like others stated the biggest challenge is relationship, managing child care, call schedule, location to live etc. My wife’s job market is highly restrictive so we choose a location most consider less desirable. We can’t travel during traditional holidays because her schedule, she works more hours than me and makes significantly less than me. I tried to get her to do part time since the difference would make no realistic difference in our life but she doesn’t want to because her job is “meaningful” and she “worked hard to get to where she is”. Thats the drawback of marrying a motivated professional I guess.

You should have enough cash flow to do a little bit of everything. My wife and I max our 401K/IRA/HSA, contribute to the taxable each paycheck, aggressively pay down loans, saved for a home purchase within a year of starting our jobs, traveled internationally, had a baby, funded a 529, started a taxable account for our child.

We combined all of our financials. Both 2 years out of training, early 30s as well. My spouse is the spender and I’m the saver lol. As long as we hit our financial goals, I’m fine with whatever spending happens.

I’m an M4 so not attending but this will be future situation for me as well. Recommend the book “money for couples”, read most of it with my gf and I feel like it helped navigate a game plan for us.

I don't see how you can combine your lives without combining your finances. Several years after I got married we had kids. My wife decided she wanted to be a stay at home mom (for the most part). She went from making 250K to about 40K. We could easily afford to live on my salary, but just because she wasn't working full time didn't mean her contribution to the family was any less. Both our salaries went into one account (which she managed). I've never had second thoughts about this arrangement.

Also dual income physician couple here. I went nontraditional path to medicine with finance background. I manage our finances but it’s a shared conversation and shared vision. Physician incomes can be very high but lifestyle creep is real. Easy to have the big house, nice cars, 2-3 kids with private school, expensive travel and dining with very little left at the end of the month to show for it. I would get intentional about spending on the things that matter and skipping any purchase that might be the expectation of others. If neither of you are interested in managing finances, look into fee only advisor to help guide you.

Combined finances are simple and effective Best way to prioritize financial goals is to talk about them Usually you will make much better financial decisions if you work together than if you’re each doing your own thing As with relationships in general

are you married? everything is one....

if you are not, then separate.

its not that hard.

- dual physician household married 10+ yrs.

Are you both W2 or is one S-Corp. If one of you is not S-Corp you should start there. Only one of you should ever be W2 unless you are in roles that may be hard to transition to a 1099 role. I am a psychiatrist so it is really easy but i could see a hospitalist or pathologist etc struggle with this.

Then you pay a bunch at Cerebral Tax Advisors (wci) and you find all the ways to reduce your taxable income. The main thing is to pay a CPA a lot of money to help do most of the leg work for you. Don't try to save money with a CPA, it will be 100% worth the investment in year one. You should definitely have a Cash Balance plan, and mega back door etc etc. Real-estate makes sense in some states but I am in California and stay very far away from it.

If you can both be 1099 do it S-Corp opens the world of write offs to you, look into cash balance accounts and defined benefit plans. Each of you can lock up $180-200k a year pretax into retirement accounts depending on your ages and that is a direct line deduction from your salaries. Do that for 10 years, have it set to invest in broad spectrum ETF's and watch the cash pile up. After 10 transition to Short term rental acquisitions and then roll the cash from the cash balance accounts into IRA's sheltering that cash with the STR accelerated depreciation, keep buying properties till you convert all of the cash to IRA's. Once you have, you have won the game. You'll have a solid 10-12m in IRA's (Post tax) accounts, and probably 10-12 properties that should be income generating. You have a solid net worth of 20-25m at 50.

!Updateme