Your First Attending Paycheck: What You Will Actually Take Home in 2026

Where a $300,000 salary goes

Take a single physician starting at $300,000 in 2026 with no pre-tax deferrals. Social Security tax takes 6.2 percent of wages up to $184,500, about $11,400. Medicare takes 1.45 percent of all wages plus an additional 0.9 percent above $200,000, about $5,250. Federal income tax on $300,000 less the $16,100 standard deduction runs through the 2026 brackets to roughly $68,100. Before state tax, that leaves about $215,000 a year, or $17,900 a month. Add a 5 percent state income tax and the monthly figure drops by roughly $1,250. The paycheck calculator on this site runs these numbers for your own salary, filing status, and state.

The same physician as a resident at $72,000 took home about $4,950 a month. The difference, roughly $13,000 every month, is money you have never had and do not yet miss. That is the opportunity, and it is a brief one, because lifestyle expands to meet income within months if nothing is decided in advance.

Why the first year’s withholding falls short

When an attending job starts in July or August, employer payroll systems withhold as if the new salary applied all year, or they simply do not account for the resident income already earned. A signing bonus adds a second problem: supplemental wages are commonly withheld at a flat 22 percent, well below an attending’s marginal rate of 32 to 35 percent. The result, for many new attendings, is a four- or five-figure balance due the following April plus an underpayment penalty. The fix is simple if done early: complete a new W-4 using the IRS estimator when you start, withhold an extra amount per paycheck or make one estimated payment in the fall, and have the first attending-year return prepared professionally.

The live-like-a-resident plan

The idea is not austerity. It is sequencing. You already know how to live on a resident’s income; you have done it for years. Continue for two or three more, give yourself a defined and meaningful raise for lifestyle, and route the rest of the gap into debt and investments automatically the month the first paycheck arrives. Directing the full $13,000 monthly gap for three years produces about $467,000 before any investment growth. Half of it produces about $234,000. Either number changes the trajectory of a career.

The order of operations

1. Build the emergency fund to three to six months of expenses.
2. Capture the full employer match in the 401(k) or 403(b).
3. Put protection in place: own-occupation disability sized to the new income, umbrella liability, and term life if anyone depends on you.
4. Decide the loan strategy: PSLF track with income-driven payments, or refinance and attack the balance.
5. Fill every tax-advantaged account: 401(k) or 403(b), a governmental 457(b) if offered, the HSA, and the Backdoor Roth IRA.
6. Invest the remainder in a taxable account, and decide the house from the budget rather than from a pre-approval letter.

The house

Physician mortgage programs will approve a new attending for a home with little or no down payment, no private mortgage insurance, and lenient treatment of student loans. The ease of approval is the risk. A house that consumes the entire gap converts the most valuable three years of a financial life into a mortgage payment. Rent the first year in a new city or a new job. Buy when the job is proven and the budget, not the lender, says yes.