Question: As an emergency physician, I see people become disabled and even die in their 30s, 40s, and 50s all the time. I know I need to save something for retirement, but you only live once. How can I find the right balance?
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ACEP Now: September 2026
Two concerning financial statistics should be on the radar of all emergency physicians. The first comes from the annual Medscape Physician Wealth and Debt Report. It’s been a few years since Medscape broke the data out by age, but the last time they did, we learned that approximately 25 percent of doctors in their 60s are not millionaires, and, in fact, 11-12 percent of them do not even have a net worth of $500,000.
Remember that net worth is the measurement of wealth. It is everything you own minus everything you owe. All your assets, including investments, retirement accounts, and your home, minus all of your liabilities, like mortgages, student loans, auto loans, and credit card debts. This is a damning statistic. Presumably, by the time physicians are in their 60s, they have been earning $200,000 to $600,000 per year for 20 to 30 years. Thus, they have cumulatively earned between $4 million and $18 million. It is shocking that these physicians have less than $1 million of those earnings left, even with decades of help from the miracle of compound returns on their investments and home appreciation.
The second statistic comes from a 2025 Goldman Sachs survey. Respondents were asked to describe their financial situation and then the results were broken out by income. The worst financial situation, described as “living paycheck to paycheck,” was chosen by 57 percent of survey respondents with an income of less than $50,000 per year. By the time income reached $200,000 to $300,000, that number had decreased to 16 percent of survey respondents.
However, as income climbed above $300,000, the number describing their situation as living paycheck to paycheck actually increased to about 40 percent— meaning four in 10 of those earning more than $300,000 per year were saving essentially nothing. Well, if it wasn’t clear why 25 percent of physicians in their 60s have not built much wealth despite having a high income, I hope it is clear now. They literally spend all or almost all of their income. It really is that simple. The way to have more money in your retirement accounts is to put more money into your retirement accounts.
Of course, it is true that some people will die young and never get to enjoy those retirement savings. Even if you do not die young, in his book, Die With Zero, author Bill Perkins has famously pointed out that it becomes increasingly more challenging to turn money into happiness as we age. That around-the-world trip that sounds awesome at age 50 will not sound nearly as appealing, and may not even be possible, at age 85. So, you have to find a balance between your current financial needs and your future financial needs.
Where is that balance? Well, it varies by person, but the vast majority of people who run the numbers with reasonable assumptions will realize the variation is actually pretty small. It turns out that most physicians will need to save and invest approximately 20 percent of their gross income throughout their careers to have a comfortable retirement that allows them to do what they want during their golden years.
Maybe 15 percent is enough for some people, but 5 percent is not enough for anyone. So, if an emergency physician is earning $375,000 per year, $75,000 of that should be saved for retirement each year in some combination of 401(k)s, Roth IRAs, brokerage accounts, and investment properties. If you want to retire early, or you had a really late start, you will probably have to save a little more to get to the same place.
So that is the balance: 20 percent goes to “future you” and 80 percent goes to “current you.” It turns out that, with reasonably careful budgeting, you can have a pretty good financial life on 80 percent of an emergency physician’s income. For the most part, you will find you can buy anything you want, just not everything you want. You will have to choose and prioritize. Make sure you align your spending with your values. Be generally frugal and selectively extravagant. Track your spending. Pay future you first, then spend the rest guilt-free on whatever you want.
It is sexy to talk about investments. Your latest real estate investment, cryptocurrency purchase, or initial public offering opportunity might be fun to talk about in the doctors’ lounge or at a cocktail party. However, the financial game of life is won at the little desk in the corner of your dining room, or more likely at the budgeting table with your spouse. It is a single-player game—you against your financial goals. You are not playing against the other physicians or anyone else: thus, everybody can win.
Naturally, it will take some time to build a nest egg large enough to support you through a multidecade retirement. A disability or untimely death can interrupt that process. Most physicians cannot afford to self-insure against those risks for the first decade or two of their careers.
They should buy a high-quality disability insurance policy. Those policies might feel expensive, but that is only because claims are actually fairly common. Population statistics suggest that about one out of four 20-year-olds will have a disability lasting at least three months before they reach full retirement age. Although a three-month disability is not necessarily a financial catastrophe, a permanent one certainly is and needs to be insured against until that nest egg is built. If anyone else depends on your income besides you, a seven-figure, 20- to 30-year term life insurance policy also seems wise.
Balancing current financial needs and wants with future needs is a lifelong challenge. Developing and implementing a plan deliberately is the best way to find the right balance.
Dr. Dahle blogs at whitecoatinvestor.com and is a best-selling author and podcaster. He is not a licensed financial adviser, accountant, or attorney and recommends you consult with your own advisers before acting on any information you read here.
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