Roth IRA for physicians:
from residency to attending

Your physician Roth scorecard

Eight checks—not a one-size-fits-all verdict

A Roth IRA is an individually owned retirement account, not a special investment reserved for doctors. The useful question is not “Do physicians need a Roth?” It is “Which route is available, and what would it change this year?” These cards point to the checks below; they do not grade your finances.

01 · EligibilityCan I contribute directly?

Check full-year Roth-specific income and filing status, not just this month's paycheck. See the 2026 bands.

02 · Training transitionWill my new salary change this year's room?

Count training pay, attending pay and taxable bonuses in one annual estimate. Follow the July example.

03 · Two jobsDoes a new hospital reset my limit?

No new employee-deferral allowance just because you change 401(k)/403(b) plans. Reconcile both payrolls.

04 · Side practiceIs my practice plan independent?

Not necessarily. A hospital 403(b) can share an annual-additions limit with a plan for a business you control. Check the ownership trap.

05 · Backdoor RothWill the conversion be tax-free?

A nondeductible deposit alone does not answer that. Your other non-Roth IRAs and basis records matter. See the 10%/90% example.

06 · Student loansCould my tax choice affect loan payments?

Income-driven repayment and retirement taxes are connected, but not identical calculations. Check the current loan plan.

07 · MarriageDoes filing separately preserve Roth access?

If you lived with your spouse during the year, the direct-Roth phase-out is only $0–$10,000. Do not decide from the loan payment alone.

08 · Old accountsShould I move my old hospital plan into an IRA?

Check what that would add to your conversion-year IRA pool before authorizing a rollover. Gather the records first.

“Roth” can mean three different routes

Sources: IRC §408A, IRS IRA guidance and IRS designated Roth account FAQs.

The attraction is future tax treatment, not guaranteed growth. For Roth IRA earnings to come out as a qualified tax-free distribution, you generally need the five-tax-year period and age 59½, disability, death or the limited first-home condition. Ordinary contribution withdrawals have different rules; conversions have their own early-withdrawal considerations. IRS Publication 590-B explains the distinctions.

A lower-income training year can make paying tax now worth comparing with a deduction now. But debt costs, cash reserves, an employer match, state taxes and future income all matter. “Residents always Roth; attendings always pre-tax” is not a decision rule.

First check the 2026 direct-contribution rules

The combined regular Traditional-plus-Roth IRA ceiling is $7,500 for someone under 50, or $8,600 if age 50 or older by year-end. You also need enough eligible compensation. A second IRA does not double that allowance, and using a workplace plan does not itself prevent an IRA contribution. [2026 limits] [IRA rules]

MAGI means modified adjusted gross income. It is a tax-return calculation, not take-home pay. For Roth contributions, start with adjusted gross income and make the specific adjustments. For example, the student-loan-interest deduction is added back; taxable IRA-to-Roth conversion income is removed for this particular eligibility test. Do not use that removal for other income tests. [Roth MAGI worksheet]

On a small screen, swipe the table sideways to see every column.

Below the relevant band, the income test does not reduce room; within it, calculate the reduction rather than rounding income to a cutoff. For the married-separate row, reduction begins above $0. A married-separate filer who lived apart from their spouse all year uses the single-filer band. Compensation and other regular IRA contributions still limit the amount. IRS Notice 2025-67; Publication 590-A, chapter 2.

Worked example · the resident-to-attending year

A July raise reaches back to January's IRA decision

Meet Maya, a fictional physician who files single and is under 50. She has enough eligible compensation, no other regular IRA contributions and no other income, deductions or Roth-MAGI adjustments beyond the pre-tax workplace deferrals shown. These are chosen teaching amounts—not typical physician salaries.

On a small screen, swipe the table sideways to see every column.

If she already deposited $7,500 in January, the middle scenario leaves a $2,500 excess; the bonus scenario leaves a $7,500 excess. A deposit that looked affordable during residency is not protected from the year's final income result.

That is fixable, but use the right transaction. Ask the custodian and your tax preparer about a timely return of excess adjusted for attributable earnings or loss, or an eligible recharacterization to a Traditional IRA. Recharacterizing a contribution does not guarantee a deduction. Merely withdrawing the original deposit or converting something else is not automatically a correction. See the excess-contribution guide and IRS Publication 590-A's Roth excess-contribution guidance.

Regular IRA contributions can generally be made through that tax year's unextended federal return due date, subject to applicable relief. A conversion is a separate transaction and cannot simply be assigned to the earlier contribution year. Confirm actual transaction dates and reporting, not just when you submitted a request. [Contribution timing] [Split-year reporting]

Keep three contribution totals—not one “retirement max”

Amounts: IRS Notice 2025-67. Coordination: IRS multiple-plan guidance and Publication 571. This base-limit comparison excludes catch-ups.

Changing hospitals: assume Maya puts $10,000 into her first employer's 403(b). With no special catch-up, that leaves at most $14,500 of the $24,500 employee limit for a new 401(k) or 403(b), subject to compensation and plan terms. Tell the new payroll team what you already contributed; the two systems may not coordinate it for you.

A 457(b) has a separate contribution limit, including employer contributions. Its rules are not interchangeable with a 401(k) or 403(b); check whether your hospital's plan is governmental or nongovernmental before making rollover or access assumptions. [IRS multiple-plan guidance]

The hospital 403(b) + side-practice trap

A side practice does not automatically provide a second $72,000 allowance. IRS guidance requires combining a 403(b) with qualified-plan and SEP contributions of businesses in which the participant has more than 50% control for the annual-additions test. Both the individual-plan and combined requirements matter. The IRS specifically identifies healthcare doctors with outside practices as a setting where this issue arises. [Publication 571] [IRS aggregation analysis]

If you receive 1099 income, have the plan administrator check business ownership, eligible employees, actual plan compensation and your hospital plan together. Gross receipts are not the contribution base. An owner-only 401(k) has eligibility conditions; hiring eligible employees changes the analysis. The self-employed guide handles the entity and compensation calculations. [IRS business-plan guidance]

High income does not make a backdoor Roth automatically tax-free

“Backdoor Roth” is shorthand for an eligible Traditional IRA contribution, usually reported as nondeductible, followed by a Roth conversion. Basis is the documented after-tax amount that should not be taxed again. Form 8606 uses that basis and the relevant IRA totals; opening a fresh account does not isolate the new deposit from the rest. [Form 8606 instructions]

Suppose a physician has $67,500 in their own pre-tax traditional SEP IRA at December 31, 2026. They make their only $7,500 nondeductible Traditional IRA contribution in 2026 for 2026, and convert exactly $7,500 in 2026. Assume enough contribution room and compensation, no earlier basis, no gains or losses, no withholding, no other relevant distributions or conversions, and no rollover or special repayment adjustments.

Calculation follows the simplified facts above and Form 8606, Parts I–II. “Taxable” is income added to the return—not the amount of tax owed.

The after-tax money has not disappeared: $7,500 of starting basis minus the $750 used here leaves $6,750 of unrecovered Traditional-IRA basis to carry forward. Keep that record for future distributions and conversions. [Form 8606, line 14]

The pool generally includes your own Traditional, traditional SEP and traditional SIMPLE IRAs across providers. It excludes Roth accounts and workplace-plan balances; properly separate inherited accounts have separate treatment. Year-end values and relevant same-year transactions matter. Each spouse has their own calculation. [Definitions and instructions]

Some employer plans accept eligible pre-tax IRA roll-ins, but acceptance is not guaranteed and IRA basis cannot be moved into the plan. SIMPLE restrictions and transaction timing can matter. Do not liquidate or move an account based on this illustration; use the backdoor Roth guide and pro-rata explanation to review the actual facts.

Student loans: compare the whole decision, not one payment

Income-driven repayment uses income and family or dependent information. A Roth IRA contribution is not deductible, while eligible pre-tax workplace deferrals can reduce federal taxable wages. That can make the retirement choice relevant to a loan-payment calculation—but it does not promise an immediate or dollar-for-dollar payment reduction. Confirm the plan, income documentation and recertification timing. [Federal Student Aid] [Pre-tax versus Roth]

Use current StudentAid.gov information rather than an old residency blog's repayment-plan recipe. Available options depend on loan types and disbursement dates. A taxable conversion can increase ordinary adjusted gross income even though it is removed from the special Roth-contribution MAGI test. Those are different calculations. [Current options] [Roth-only adjustment]

Married filing separately needs two checks

A filing choice made for loan repayment can sharply restrict direct Roth IRA contributions. For a married-separate filer who lived with their spouse at any point in 2026, direct room is zero at $10,000 of Roth MAGI. Living apart all year has a different rule. Compare the combined tax and loan consequences; do not infer a Roth allowance from the loan estimate. [2026 limits] [Filing-status condition]

PSLF is not a “doctor” benefit

For Public Service Loan Forgiveness, check qualifying employment and the other program requirements—not just the hospital's name or your clinical duties. Working at a nonprofit facility through a separate group can require a closer look. Federal Student Aid describes a specific exception when state law prevents direct employment; it is not a blanket exception for every contractor. Use its employer-search and certification guidance. [FSA employer guidance]

Your next-job handoff: five things to gather

1. A whole-year income estimate. Include both jobs, taxable bonuses and side-work net income; then calculate Roth-specific MAGI. Recheck after a contract or filing-status change.
2. Year-to-date payroll contributions. Separate your pre-tax/Roth deferrals from employer money. Ask the new plan how prior-job amounts are coordinated.
3. An account inventory. List your own Traditional, SEP and SIMPLE IRAs, workplace accounts and any separately inherited accounts. Before rolling an old hospital plan into an IRA, check the pro-rata consequences.
4. Your basis and transaction records. Keep prior Forms 8606, contribution confirmations and Forms 1099-R/5498. A conversion and a contribution may belong to different reporting years.
5. The current plan and loan documents. Confirm match/vesting, fees, roll-in acceptance, practice ownership and loan recertification facts. Bring unresolved details to the relevant plan administrator or qualified adviser.

Three quick questions