Wealth Building · 9 min read
Net Worth: Understanding Your Number
Most physicians in their thirties have a negative net worth. This is normal. Not knowing it — and not tracking it — is the problem.
Negative is a starting point, not a problem
A physician finishing residency with $280,000 in student loans, $15,000 in savings, no home equity, and a used car worth $12,000 has a net worth of approximately negative $253,000. This is normal. The average new attending starts their career with a six-figure negative net worth. The number is not the issue. The trajectory is the issue. A physician moving from -$253,000 to -$180,000 in year one of attending income is on a great path. One stuck at -$253,000 three years in is not. Tracking is what separates the two.
What goes in the calculation
Tap each card. The calculation is simple — but several common items confuse new physicians.
What counts as an asset
Cash + savings + checking + brokerage + retirement accounts (401k, 403b, IRA, HSA) + home equity (market value minus mortgage) + vehicle current value. Personal items (furniture, clothing, jewelry) generally do not count unless valuable enough to insure separately.
What counts as a liability
Student loans + mortgage + car loans + credit card balances + medical debt + any other money owed. Use the full balance owed, not the monthly payment.
Why student loans make physicians look worse
A typical new attending has a -$250,000 net worth largely because of student loans — but those loans paid for a $300,000+/year earning ability. The standard net worth calculation does not credit human capital. Net worth understates the financial position of new physicians.
Trajectory matters more than the number
A physician at -$200,000 moving to -$100,000 in one year is on a wonderful path. A physician at +$50,000 stuck flat for three years is on a poor path. The annual delta — change in net worth from one year to the next — is the single best summary metric.
Read the trend, not the single value
A single net-worth figure is one blood pressure reading in a hallway — almost meaningless in isolation, and easy to over-read. What you actually want is the trend line: the same measurement, taken the same way, plotted over time. A physician at −$200,000 trending toward −$100,000 is a patient whose numbers are improving on therapy; a physician at +$50,000 flat for three years is one quietly decompensating despite looking fine on a spot check. Chart the trajectory and review it on a fixed interval, exactly as you would a chronic condition.
You would never act on one number here. Treat your net worth the same way.
Shadow net worth (for PSLF candidates)
Shadow net worth is your net worth calculated as if the loan balance headed for tax-free PSLF forgiveness were already gone — i.e., excluding the federal balance you fully expect to have forgiven.
If you are pursuing forgiveness, the standard calculation actively misleads you.
Why it matters: A PSLF candidate carrying a $280,000 balance that will be forgiven looks $280,000 "poorer" on paper than they truly are, which can panic them into the wrong move — refinancing or aggressive payoff that destroys the forgiveness. Track both numbers: standard net worth (everyone), and shadow net worth (PSLF candidates) so the forgiveness-bound balance does not distort the picture you are steering by.
What matters most early career
This step is a quick self-check. Open the full module to try it with your numbers →
Physician net worth at 35
Same physician, same salary — completely different net worth depending on the loan strategy.
| Strategy | Loans at 35 | Retirement at 35 | Net worth at 35 |
|---|---|---|---|
| Aggressive payoff (private refinance) | $0 | ~$120,000 | ~$200,000 (with home equity) |
| PSLF track (IDR + invest difference) | $280,000 (will be forgiven) | ~$220,000 | ~$50,000 (loans drag the number) |
| Minimum payments + lifestyle inflation | $240,000 | ~$60,000 | ~negative $150,000 |
How to start
- A negative net worth in early attending years is normal — focus on annual delta, not absolute level.
- Update monthly. Use the same calculation method every time. Consistency matters more than precision.
- PSLF candidates have a misleading net worth on paper — the loan balance to be forgiven distorts the number. Track shadow net worth (excluding PSLF-eligible loans) alongside.
Do this next: List your accounts: 403b/401k, Roth IRA, HSA, brokerage, checking/savings, and any loans. Write down the current balance of each. Add them up: assets minus liabilities is your net worth. Track this number quarterly — the trajectory matters more than any individual number.
Run this with your own numbers
The interactive version of this lesson works through your actual paycheck, loans, and benchmarks — and your AI advisor can take it from there. Free to start, no card required.