Educational only. This is not legal, tax, or financial advice. Tax rules, contribution limits, state laws, and regulatory guidance change frequently. Consult your CPA, attorney, or financial advisor before acting on anything below. Last reviewed dates are shown at the bottom of each guide — numbers may be outdated.
The first year out of training is when the largest number of important decisions get made — and the least amount of time is available to think about them. This is the sequence we wish we had followed, condensed into a timeline you can actually work through on weekends.
Month 1 — the "do now" list
These are the items where delay costs real money or leaves you legally exposed.
- Own-occupation disability insurance. Get a policy with a true own-occupation rider and specialty-specific language before your first claim history builds up. Rates get worse every year and any documented medical issue narrows your options. Most radiologists can afford $15-20k/month benefit.
- Term life insurance if anyone depends on your income. 20- or 30-year level term, $1-3M face value, underwritten while you are young and healthy. Pricing is dramatically cheaper than whole-life products and adequate for most situations.
- State medical license in every state you might read for (teleradiology complicates this — if your group reads nighthawk for five states, you need five licenses).
- DEA registration if you place orders for contrast or sedation.
- NPI if you did not already get one as a resident.
- Credential with every payer your group bills. This is the single slowest administrative step — it can take 90-180 days, and you cannot bill for your work until it is done.
Month 3 — structural decisions
Now that paychecks are landing, decide the container those paychecks live in.
- Pick a banking structure. Separate checking for your practice income if you are 1099 or own an LLC. Separate "tax holding" account where 30-40% of every 1099 deposit goes immediately. This one habit prevents the quarterly-tax scramble.
- LLC / PC / S-corp decision. See our Entity Structure guide. Do not default to whatever your group recommends without checking the fit.
- Retirement plan enrollment. If you are W-2, max the employer 401(k) to the match immediately. If you are 1099 or owner, a solo 401(k) can be opened the same day online; see Retirement Plans.
- Umbrella liability insurance. $1-3M is common for radiologists with attachable W-2 wages. This sits above your auto and home policies, not your malpractice.
Month 6 — tax posture
You now have enough income history to see the shape of the year.
- Meet with a CPA who has radiologist clients. Not an H&R Block walk-in — a CPA who has seen this exact situation before. A one-hour consult (~$300-500) can save five figures.
- Estimate your quarterlies. Q3 estimated taxes are due September 15. If you are 1099 and did not set money aside, this is where trouble shows up.
- QBI (Section 199A) review. Most high-earning radiologists phase out of the QBI deduction because radiology is a "specified service trade or business." Do not bet on capturing it without confirming your entity structure, income, and filing status.
- Will + healthcare proxy. An estate attorney can draft a basic package for $500-1500. Without one, your state decides.
Month 12 — stepping back
A full tax year is the first time you can honestly evaluate your setup.
- Review benefits enrollment in whatever open-enrollment window your group uses. HSA contributions, supplemental disability, dependent coverage.
- Compare your actual income to the offer letter. Did the production bonuses materialize? Is the RVU rate what was quoted? If not, document the gap now, because partnership-track math depends on these numbers.
- Look at partnership track transparency. If your group says the buy-in number is "still being calculated" two years in, that is a flag — see Group Valuation.
- Revisit your advisors. If your CPA did not catch obvious things, switch. Same for financial advisors. The first year you are a small client; by year 3 you are a high-income professional, and the advisor who ignored you in year 1 will not suddenly become proactive.
Questions to ask your advisor
- Am I on track for my annual tax withholding?
- Is my entity structure right for my income level, or should I revisit it next year?
- What is the best-case and worst-case tax outcome this year?
- Are we maxing every tax-advantaged space I am eligible for?
Common mistakes
- Buying whole-life insurance marketed as "retirement" — it almost never outperforms a taxable brokerage + term life for radiologists.
- Defaulting to the group's preferred CPA or advisor without checking for conflicts of interest.
- Treating the signing bonus like a windfall instead of a prepaid loan (it is usually clawback-able).
- Skipping disability insurance because "nothing will happen" — disability is more common than early death for physicians, and a single musculoskeletal or psychiatric claim can end a career.
Last reviewed: 2026-04. Rules and limits change — verify current numbers before relying on any specific figure.