Fellowship is the seam year. Behind you sit three to five years of resident-level payments and habits; twelve to twenty-four months ahead sits an income that may quadruple. Nearly every high-stakes decision of this stage — the repayment plan, the first contract, the last direct Roth contribution — is a decision about crossing that seam without dropping anything. This guide sequences seven shipped modules into a reading order built for the seam, dollar-frames the three problems that define it, and names the deep cuts for when a module is not enough. If you want the whole curriculum filtered to this stage, the fellow stage lens shows it in one view.
Problem one: PSLF momentum is easiest to break exactly when it is worth the most
A fellow finishing six years of training can hold as many as 72 qualifying payments — 60 percent of the required 120 — earned at trainee income. The seam is where counts break: an employer change, a lapsed income recertification, a forbearance during the gap between fellowship and the first attending start date. The repayment landscape itself also moved underneath you. As of July 2026: the SAVE plan is terminated under the March 2026 settlement, PAYE and ICR are closed to new enrollment, the Repayment Assistance Plan (RAP) went live July 1, 2026 with payments of 1 to 10 percent of adjusted gross income by income band and full PSLF eligibility, IBR remains with its hardship test removed, and PSLF applications are now processed directly by Federal Student Aid.
Example calculation
Assumptions, stated explicitly: $300,000 federal balance on the PSLF track; fellow AGI of $80,000, which lands in RAP's 7 percent band (payment $5,600 per year, roughly $467 per month); first attending AGI of $350,000, which lands in the 10 percent band (payment $35,000 per year, roughly $2,917 per month).
Cost of one fellowship month that fails to qualify: it must be replaced later by one attending-income month. $2,917 − $467 = $2,450 of additional lifetime payments per lost month. A six-month paperwork gap at the seam: 6 × $2,450 = $14,700. A three-year forbearance mistake across training: 36 × $2,450 = $88,200.
Every month of trainee-income payments you protect is a month you never have to repurchase at attending prices. That single sentence justifies the first two modules in the sequence.
Problem two: the first contract arrives mid-fellowship, when you have the least time to read it
Attending contracts now commonly arrive 12 to 18 months before the start date — which means the biggest financial document of your life lands during your busiest clinical year. The numbers inside it are not abstractions. On a productivity contract, a $2.00 difference in the conversion factor multiplied by 5,000 is $10,000 per year, $30,000 over a standard three-year initial term. Tail coverage, if the contract shifts it to you, commonly runs to five figures. A non-compete radius decides whether changing jobs later means changing cities.
Problem three: these are the last years the front door to a Roth IRA is open
For 2026, direct contributions phase out between $153,000 and $168,000 of modified AGI for single filers and $242,000 to $252,000 for married filing jointly (IRS Notice 2025-67). A fellow earning $80,000 walks straight through the front door with the full $7,500 contribution. An attending earning $350,000 cannot — the route becomes the backdoor, which adds steps and a trap.
Example calculation
Assumptions, stated explicitly: $7,500 contributed at age 33; 7 percent nominal annual return; no withdrawals until age 58.
$7,500 × 1.07^25 ≈ $40,700, entirely tax-free at withdrawal. Two fellowship-year contributions (ages 33 and 34) ≈ $78,700 tax-free at 58.
Two years of $625 per month, contributed while the front door is open, buys a five-figure tax-free block you cannot buy this simply again.
The sequence: seven shipped modules for the seam
The order is deliberate: protect what you have earned, understand the rules you are under, then prepare for what is arriving.
1. PSLF Tracking and Recertification — protect the count before anything else
The count is the asset. PSLF Tracking and Recertification covers how to read your payment count, when recertification is due, and how employer certification works now that Federal Student Aid processes PSLF directly. One action: pull your current qualifying payment count today and write it down with the date.
2. The IDR Deep Dive — because your plan was probably chosen under rules that no longer exist
If you enrolled in an income-driven plan before 2026, the plan you chose may be terminated, closed, or changed. The IDR Deep Dive maps the post-settlement landscape — RAP versus IBR, who keeps access to what, and how payments are computed under each. One action: confirm in writing which plan you are actually enrolled in right now.
3. Moonlighting Income — because extra income moves three numbers at once
raises AGI, which raises your income-driven payment; it often arrives as , which changes your tax filing; and it can quietly under-withhold you into an April surprise. Moonlighting Income works through all three. One action: if you moonlight, set aside a fixed percentage of every payment for taxes before you spend any of it.
4. Contract Basics — read before the first offer, not after
You cannot negotiate a document you are reading for the first time under a deadline. Contract Basics covers compensation structure, term and termination, restrictive covenants, and tail coverage — the four sections where the money hides. One action: write down your three non-negotiables before you open any offer.
5. wRVU, Explained — because you cannot evaluate a productivity contract without it
Most first contracts are productivity contracts, and the conversion factor is where comparable offers diverge by tens of thousands of dollars. wRVU, Explained covers what a wRVU is, how thresholds and tiers work, and how to compare offers on dollars per wRVU rather than headline salary. One action: for any offer you hold, find the conversion factor and the threshold and compute the payout at a realistic volume.
6. The Attending Transition Plan — the twelve-month checklist for the seam
The seam has a schedule: recertification timing, insurance gaps between employers, the first attending paycheck's withholding, the 90-day window when lifestyle either inflates or does not. The Attending Transition Plan turns it into a checklist. One action: draft your one-page transition plan this month, even if your start date is a year away.
7. Backdoor Roth — the bracket-window read
At fellow income, this module describes your near future rather than your present: Roth contributions are simply direct at $80,000 of AGI — no backdoor needed. The backdoor is what comes next, at attending income, and the pro-rata rule it turns on is shaped by decisions (like where an old rolls) that you make during the seam. Backdoor Roth is the read that keeps you from closing your own door. One action: contribute directly to a Roth IRA this year while you remain under the phase-out, and read the pro-rata section before attending year one.
Important
The single most expensive seam mistake is silence: letting recertification lapse or sitting in forbearance between fellowship and the attending start date because no one told you the gap months could count. The fellowship gap-year deep cut below exists for exactly this.
Three deep cuts when the modules are not enough
- PSLF through fellowship and the gap year — how the count survives employer changes, gap months, and delayed start dates.
- wRVU rate benchmarks for 2026 — the numbers to hold next to any conversion factor you are offered.
- When a contract lawyer is worth it — the review typically costs $500 to $2,000 against a contract worth $1,000,000 or more over its initial term; the article shows when that trade is obvious and when it is not.
The capstone: a written plan and a reviewed contract
Two artifacts close this stage. First, a one-page written transition plan: your PSLF count and recertification date, your repayment plan, your insurance coverage through the seam, and your first three attending-paycheck money moves. Second, a professional review of your contract before you sign — including before any letter of intent. A $1,500 review of a $1,200,000 three-year contract is roughly one-tenth of one percent of the contract's value, and it is the only step on this path you cannot redo after signing.
Quick takeaway
Fellows who cross the seam with a written plan and a reviewed contract convert the trainee years into 60 to 72 protected PSLF payments, two direct Roth contributions, and a first contract negotiated from data. Fellows who improvise the seam repurchase those months at attending prices.
Common questions
Do fellowship payments count toward PSLF?
Yes, if two conditions hold: your fellowship employer is a qualifying one — most academic fellowship employers are 501(c)(3) or public institutions, but verify rather than assume — and you are enrolled in a qualifying repayment plan making on-time payments. Certify employment now, not retroactively at year ten.
Should I switch to RAP as an existing borrower?
It depends on your balance, your AGI trajectory, and your forgiveness horizon. Existing borrowers retain access to IBR; RAP's band structure produces low payments at fellow income but reaches 10 percent of AGI above $100,000. Run both numbers before the seam using The IDR Deep Dive — the right answer at $80,000 of AGI and the right answer at $350,000 can differ.
Does moonlighting hurt me if I am on the PSLF track?
It raises AGI, which raises your income-driven payment, which reduces eventual forgiveness — so you keep less of each moonlighting dollar than the shift rate suggests. It is still usually net positive, but compute your marginal keep-rate (after tax and after the payment increase) before you commit to a standing shift.
When should the contract lawyer see the contract?
Before you sign anything, including a letter of intent — some letters bind more than fellows expect. The deep cut above covers when a full review is worth it; the short answer is that for a first attending contract it almost always is.
What to do next
- Pull your PSLF qualifying payment count and write it down with today's date. Free, fifteen minutes.
- Confirm your current repayment plan and your next recertification date in writing.
- Contribute directly to a Roth IRA this year while your income remains under the $153,000 phase-out floor.
- Write your three contract non-negotiables before you receive or reopen any offer.
- Draft your one-page attending transition plan.
- Send any contract to a qualified reviewer before signing anything.
Fellowship compresses a decade of financial consequence into its final eighteen months, which is why this stage rewards sequence over speed. The path above works with or without us — the modules simply arrange the seam's decisions in the order they arrive. This is education, not individualized financial advice.