First Premier Bank works with physicians and dentists on the short list of money decisions that come with a late start, large student loans and often a practice. Each decision gets made in order of due date, with the numbers on the table.
You finish training in your early 30s, owing six figures, and then the income arrives all at once. Clients meet with us by video or phone from wherever they practice, and the client minimum is $500K in investable assets.
Saving hard after a late start
Say a hypothetical physician starts saving at 36 and puts away $60K a year until 61. Assuming 5% a year, for illustration, that grows to roughly $2.9M (the sum of 25 yearly deposits, each growing for the years left). Returns aren't guaranteed, and every investment can lose money, including what you put in.
The first $24,500 goes into the 401(k), 403(b) or TSP in 2026, with an extra $8,000 once you're 50. Anything above that needs another home, and that's where the next decisions come in.
Should I pay the loans or invest first?
Compare the loan rate to what you'd calmly expect from investing; a loan near 6% or higher usually gets paid down faster, and one near 3% or 4% usually doesn't. Take any employer match first, because it's an immediate return.
A hypothetical dentist owing $300K at 6% pays $18,000 a year in interest alone. That's $1,500 a month before touching principal. Refinancing or forgiveness programs change the math, so check the current terms before you pick a path.
The backdoor Roth and its pro-rata catch
Your income sits above the Roth IRA phase-out ($153,000 to $168,000 single, $242,000 to $252,000 married filing jointly in 2026), so a direct contribution is off the table. The workaround is a nondeductible IRA contribution of up to $7,500, converted to Roth.
The catch is the pro-rata rule. If you hold $92,500 of pre-tax IRA money and add $7,500, about 92.5% of the conversion is taxable, roughly $6,900. Rolling old IRAs into your current 401(k) first often clears the way; you'll see it on Form 8606.
Disability and malpractice coverage
Your biggest asset is the next 25 years of paychecks, so own-occupation disability insurance usually comes before extra investing. Check how the policy defines your specialty; a surgeon who loses hand function should be able to collect even if she could teach.
- Own-occupation wording: confirm it covers your specialty, not just any work.
- Malpractice tail: if your policy is claims-made, ask who pays for tail coverage when you leave.
- Employer group coverage: find out whether the benefit is taxable and whether it follows you.
Can I buy into the practice without hurting my savings?
Yes, if the buy-in price fits inside the savings you'd have made anyway. Ask for the valuation method, the payment terms and what happens to your share if you leave or become disabled. If you can't answer the exit question, wait.
A buy-in paid with a loan adds a second debt next to your student loans. First Premier Bank runs both payments together before you sign.
The order First Premier Bank puts decisions in
Our advisors write a roadmap with each decision, its due date and the number behind it. Before First Premier Bank suggests moving money, it estimates the tax cost of the move. If you served in the military, a TSP to IRA rollover, Survivor Benefit Plan analysis and tax planning for veterans get their own line.
- Due this month: the employer match, an open enrollment choice or a benefits form.
- Due this year: the backdoor Roth steps and the loan payoff decision.
- Due before you sign: the practice buy-in terms.
Frequently asked questions about First Premier Bank
Do I need a financial advisor if I'm a physician with student loans?
Why is my backdoor Roth conversion partly taxable?
Should a new dentist buy into a practice right away?
Who We Help
This is general information and education, not individual investment, tax, or legal advice. Investing involves risk, including loss of principal. Before making any financial decision, talk to a qualified professional about your specific circumstances.