Coast FIRE for Physicians: Starting Late and Catching Up Fast

Doctors can reach Coast FIRE surprisingly fast once they’re attendings, even though they start saving about a decade later than most people. A 33-year-old physician who invests $8,000 a month can have enough by her early 40s that she never needs to save for retirement again, and from there she can cut to part-time or locums work while her investments grow.

The late start is real, and so is the debt. But an attending’s income changes the math more than either of those.

Why do doctors start so late?

Four years of medical school, then residency, which the Bureau of Labor Statistics says runs 3 to 9 years depending on specialty, with 1 to 3 more for a fellowship. That puts the first attending paycheck around 30 at the earliest, and later for longer specialties or anyone who took time off before medical school.

Residency pays like an entry-level job. The average first-year stipend was $68,166 in the AAMC’s 2025 stipend survey of 350 nonprofit teaching institutions, as reported by the AMA. Then the jump comes: the BLS puts the median wage for physicians and surgeons at $275,930 in May 2025, and pay varies a lot by specialty.

Debt comes along for the ride. In the AAMC’s debt fact card for the class of 2025, 70% of new MDs had education debt, and the median among them was $215,000.

A late start matters for Coast FIRE because the whole idea rests on time. Money invested at 33 has 32 years to grow before 65, not the 40 it would have had at 25. The attending salary is what makes up for it.

What should you do about the student loans?

This depends mostly on who you work for, and the rules changed this year.

Public Service Loan Forgiveness forgives the remaining balance on Direct Loans after 120 qualifying monthly payments made while working full-time for a government employer or a 501(c)(3) nonprofit. It’s about the employer, not the job, so residency at a nonprofit hospital can count. A doctor employed by a for-profit physician group that staffs a nonprofit hospital doesn’t qualify, because for-profit contracted organizations are excluded. The payments have to be full and on time under a qualifying plan, and only certain deferments and forbearances count, so check your record rather than assuming every training month is in.

The 2026 change is the One Big Beautiful Bill Act. According to StudentAid.gov, anyone who receives a new federal loan on or after July 1, 2026, has to repay all their eligible Direct Loans under the new Repayment Assistance Plan (RAP) or the Tiered Standard Plan. RAP counts toward PSLF. Tiered Standard doesn’t. If all your loans came before that date, you can still use IBR, and ICR and PAYE remain open until they’re eliminated, no later than July 1, 2028. A new consolidation loan counts as a new loan, so consolidating now would cost you access to those older plans.

RAP sets your payment at 1% to 10% of adjusted gross income, minus $50 a month for each dependent, and any remaining balance may be discharged after 30 years of payments, per StudentAid.gov’s income-driven repayment page.

For students still in medical school, borrowing got tighter too. New professional-student borrowers can take up to $50,000 a year in unsubsidized loans, $200,000 in total for professional study, and $257,500 over a lifetime, and Grad PLUS loans are gone for new borrowers. Some students qualify for an interim exception that keeps the old limits for a few more years, and a court has paused part of the Education Department’s definition of a professional degree, so ask your school’s financial aid office which rules apply to you.

My view on the choice: if you’ll work for a nonprofit or public hospital anyway and already have years of qualifying payments from training, PSLF is hard to beat. If you’re headed to private practice, you’re choosing between paying the loans off fast and investing. I lean toward paying off anything above about 6% before going beyond the employer match, and investing alongside anything cheaper.

How fast can a new attending reach Coast FIRE?

Take Anika. She’s 33 and just started as an attending at a nonprofit academic hospital after six years of residency and fellowship. She has $30,000 in her 403(b) and a Roth IRA from training, and $215,000 of federal loans, all taken out before July 2026. She wants to retire at 65 and spend $100,000 a year in today’s dollars.

At 7% returns and 3% inflation, her FIRE number is $2,500,000 and her Coast FIRE number today is $738,670. Here’s how her crossing age depends on what she invests each month:

At $8,000 a month she crosses at 41, with about $1,047,180 invested by 42. That’s $96,000 a year counting the hospital’s contribution, roughly 35% of the median physician’s pay before tax. It’s a lot, but it’s the kind of savings rate an attending who keeps living near a resident’s budget for a few years can actually hit. The savings rate calculator shows the same trade-off from the take-home side.

The loans change the timeline depending on which path she takes. If she stays at the hospital and her six training years all counted, she has 72 qualifying payments and needs 48 more, so her balance would be forgiven around 37 while she invests the full $8,000 and makes income-driven payments on the side. If she instead moves to private practice and throws most of her extra cash at the loans for three years, investing only $3,000 a month in that time, she has $147,865 at 36 and crosses the line at 44 once she’s back to $8,000. Three years of loan payoff costs her about 3 years on the Coast FIRE date. Not a disaster.

Which accounts should a hospital doctor use?

Hospitals often offer more than one plan, and the limits stack in ways worth knowing.

A 403(b) is the main plan at nonprofit hospitals. For 2026 you can defer $24,500. That limit is per person, not per plan: the IRS says your deferrals to all your 401(k), 403(b), SIMPLE and SARSEP plans share one limit each year, even across employers.

A 457(b) has its own separate limit, also $24,500 for 2026, so a doctor with both can defer $49,000. The type matters, though. A governmental 457(b) at a public hospital is the better kind. Its withdrawals aren’t hit with the 10% early-withdrawal tax once you leave, apart from money rolled in from other plans. A nonprofit hospital’s 457(b) is different. The IRS limits it to a select group of management or highly compensated employees, and the money stays the employer’s property, available to its creditors if the hospital runs into trouble. I’d still use one at a financially solid hospital, after the 403(b), and read the payout rules before putting money in.

Some hospitals put their own contribution into a separate 401(a) plan. The ceiling on total additions from all sources to a defined contribution plan is $72,000 for 2026 under IRS Notice 2025-67.

Most attendings earn too much for a direct Roth IRA. For 2026, contributions phase out between $153,000 and $168,000 of modified AGI for single filers and between $242,000 and $252,000 for married couples filing jointly, according to the IRS. The backdoor Roth gets around this: put $7,500 into a traditional IRA without deducting it, then convert it. It only works cleanly if you have no pre-tax IRA money, because the Form 8606 instructions count traditional, SEP and SIMPLE IRAs together when working out how much of a conversion is taxable.

Anika’s $8,000 a month breaks down like this: $56,500 a year of her own money into the 403(b), 457(b) and backdoor Roth, about $15,000 a year from the hospital into its 401(a), and the rest into a taxable brokerage account. The Coast FIRE 401(k) calculator lets you model the employer contribution separately from your own. The same stacking of 403(b) and 457(b) plans shows up in our post on Coast FIRE for nurses, which works through the hospital-plan details at a lower salary.

What does coasting look like in medicine?

Once Anika crosses at 41, her paycheck only needs to cover her life now, and medicine offers more ways to earn less on purpose than most careers do.

Going down to 0.6 or 0.8 FTE is the obvious one. At 0.6, the median physician wage works out to about $165,558 a year, which covers most household budgets with room to spare. Locum tenens work is another. You pick assignments and can take long gaps between them. If the agency pays you as an independent contractor, you owe self-employment tax of 15.3% on net earnings and get no employer benefits. If you’re doing locums alongside a hospital job, a solo 401(k) is the better home for that income than a SEP IRA, since a SEP IRA balance gets in the way of the backdoor Roth. Your solo 401(k) deferrals still share the one $24,500 limit with your 403(b).

Some doctors move into nonclinical work: teaching, administration, utilization review, industry roles. Those often pay less than clinical work but come with regular hours.

If she wants to stop entirely at 60 instead of 65, her Coast FIRE number today rises to $893,682 and she crosses at 44. That’s the version I’d look at if I were in her shoes, because retiring from medicine at 60 with no money worries is a strong outcome.

Health insurance is the thing to check before cutting hours. Hospitals set their own rules for when part-time staff lose benefits, and contractor work comes with none. Our guide to health insurance before 65 covers the Marketplace options.

Where the plan breaks

Lifestyle creep is the big one for doctors, because the income jump is so large. If Anika’s retirement budget drifts from $100,000 to $130,000, her crossing age moves from 41 to 45. At $150,000 it’s 47. The house and cars that come with the first attending contract tend to set the retirement number too.

PSLF sets a trap for anyone who wants to coast early. You have to be working for a qualifying employer when you apply for forgiveness, so going part-time is fine only as long as you stay at the 30-hour average PSLF counts as full-time, and moving to private locums before your 120th payment could cost you the whole benefit. Finish PSLF first, then coast.

Then there’s your ability to work. A physician’s income is the asset that makes all of this possible, and until you’ve crossed the line, losing it would upend the plan. That’s the argument for strong disability insurance during the years you’re building the balance, and for not quitting clinical work entirely before you’re sure you won’t need it.