Annex Wealth Management: financial planning for doctors built on the monthly budget

What does financial planning for doctors at Annex Wealth Management fix first?

It fixes the order of the money. Annex Wealth Management lists the fixed monthly costs first (daycare, the mortgage, the loan payment), then inventories every account. Savings get sized to whatever is left each month, not to a round number someone picked in advance.

An attending's full income often arrives around age 38, after daycare, the mortgage and a six-figure loan payment have already claimed the month. Take Reena (hypothetical), 38, a hospital-employed anesthesiologist married to a public school teacher, with two kids under 6. We list her fixed outflows, then her 403(b), her 457(b), the rollover IRA left from residency and her husband's pension.

Now a choice. Her husband could keep teaching, or step away for two years while both kids are small. His $70,000 salary nets about $49,000, assuming 30% goes to taxes (for illustration). Daycare for two costs $30,000 a year. Their income-driven loan payment is about 10% of income above an allowance, so losing $70,000 of income cuts it by about $7,000 a year. Net: $49,000 − $30,000 − $7,000 = $12,000 a year, or $1,000 each month.

The one assumption behind the table is the 30% tax rate on his pay. Daycare and the lower loan payment cover most of his lost take-home pay, which leaves a gap of about $1,000 each month.

Two things tip the choice. First, whether his pension lets him buy back the two missing service years, and at what price. A price well under the $24,000 two-year cash cost tips it toward staying home. Second, whether his district will hold his job. Annex Wealth Management asks for the pension benefit statement before giving a view.

The rule: before a spouse cuts hours, subtract the costs that stop from the lost take-home pay. If the gap is bigger than the monthly surplus left after retirement contributions, the plan names which spending line covers it before anyone resigns.

Timing is where this goes wrong. Resigning first and recertifying the loan payment at the usual yearly date keeps it tied to the old, higher income. That can mean up to about $7,000 overpaid in a year (about $580 each month), and PSLF never refunds it. Send proof of the lower income to the servicer right after the pay stops.

Schedule an extra review when a paycheck, a job or a child's age changes

The plan gets a yearly review after your tax return is filed. An extra review comes before these decisions, never after: a job offer or a move into private practice, a spouse changing hours, a child leaving daycare, a loan recertification notice, a practice buy-in offer. Each one changes the monthly spending plan, so we redo the portfolio numbers after it. Investments can lose value, which is why the budget gets fixed first.

Who files the 1040, drafts the will and holds the accounts?

You bring the paperwork and make every decision. At Annex Wealth Management, we build the spending plan and set how much goes to each account. Your CPA files the return and confirms the filing status, since joint versus separate changes the income-driven loan payment. Your attorney drafts wills and names guardians for children under 6. The custodian holds the assets and sends the 1099-R and year-end statements.

Which dates run a doctor's plan: April 15, the 457(b) election and loan recertification?

Three dates matter most. You can still make IRA contributions for the prior year up to the federal filing deadline, usually April 15. A 457(b) deferral change has to be elected before the month the pay is earned. Income-driven loan payments come up for recertification every year, and earlier if you ask.

The IRS limit for 2026 is $7,500 for an IRA. Annex Wealth Management puts the April date on the plan so the rollover IRA question is settled before then.

For 2026, the IRS allows $24,500 in a 403(b) and $24,500 in a governmental 457(b), up to $49,000 combined. The catch-up contribution doesn't start until age 50.

A hospital's non-governmental 457(b) stays the employer's asset until it is paid out, and it can't be rolled into an IRA. We read the plan's distribution election rules before Reena changes jobs. Check your own plan, since hospitals differ.

PSLF counts 120 qualifying payments, and borrowers can recertify early when income drops. Ask the servicer for the current count in writing.

Bring the pay stubs, the loan servicer letter and the pension statement

In the first meeting we go over three things: your monthly spending, the next decision that has a date on it, and a list of every account. We meet online or by phone, whichever you prefer. You sign an agreement that sets out the fees before we start any work. Annex Wealth Management requires $500K in investable assets to take you on.

Bring these:

You reach Annex Wealth Management through the request form; the firm publishes no phone number.

One honest limit. Ongoing planning is often more than a doctor needs with one job, no children, loans on autopay and nothing changing. A one-time review may do. And we don't file tax returns or draft wills; the CPA and the attorney still do that work.

• Recent pay stubs for both spouses
• Loan servicer statement with plan and payment count
• Year-end statements: 403(b), 457(b), rollover IRA
• Spouse's pension benefit statement
• Latest tax return