A $350,000 attending who fills every account available through a typical academic employer can shelter more than $115,000 in 2026 — and cut their federal tax bill by five figures in the process. Most physicians capture less than a third of that, not because they cannot afford to contribute, but because nobody ever showed them the full list of accounts or the order to fill them.
This is the full list. Every account, the exact 2026 IRS limit, who gets access, and a worked example for a $350,000 attending at the end. The numbers below come from IRS Notice 2025-67 (retirement limits) and Rev. Proc. 2025-19 ( limits) — they are the 2026 figures, not last year's.
One framing note before the details: physicians start saving 7 to 10 years later than other professionals and compress a 40-year accumulation window into 25 or 30. The accounts in this guide are how you compensate for that compression. A dollar sheltered at 35% marginal tax does more work than a dollar invested in a taxable account, every single year it compounds.
The 2026 limits, all in one table
| Account | 2026 limit | Notes |
|---|---|---|
| //457(b) employee deferral | $24,500 | Per plan type — 457(b) is a separate limit |
| Catch-up, age 50+ | $8,000 | On top of the deferral |
| Super catch-up, age 60–63 | $11,250 | Replaces the $8,000 catch-up (SECURE 2.0) |
| §415(c) total DC limit (employee + employer + after-tax) | $72,000 | The ceiling that makes the mega possible |
| Traditional/ | $7,500 | Per person, including spouse |
| IRA catch-up, age 50+ | $1,100 | |
| HSA, self-only coverage | $4,400 | Requires HDHP enrollment |
| HSA, family coverage | $8,750 | |
| HSA catch-up, age 55+ | $1,000 | Per spouse, but requires separate HSAs |
The Roth IRA income phase-out for 2026: single filers $153,000–$168,000 , married filing jointly $242,000–$252,000. Nearly every attending is above the top of those ranges, which is why the backdoor Roth section below exists.
Quick takeaway
The single number to memorize for 2026: $24,500. That is the employee deferral limit for your 401(k) or 403(b) — and separately, again, for a 457(b) if you have one.
401(k) and 403(b): the foundation
Your employer plan is the first account to fill, for two reasons: the deferral is large ($24,500), and the is free money you forfeit if you under-contribute.
Hospital and health-system physicians usually have a 403(b); private groups and physician-owned practices usually have a 401(k). For contribution purposes they are nearly identical: you defer up to $24,500 of salary pre-tax (or Roth, if the plan allows), your employer adds a match or a fixed contribution, and the combined total of everything — your deferral, the employer money, and any after-tax contributions — is capped at $72,000 under §415(c).
Two decisions matter here.
Pre-tax or Roth deferral? At attending income, the pre-tax deferral usually wins. A married attending with $350,000 of household income sits in the 24% federal bracket for 2026 (taxable income between $211,400 and $403,550 MFJ); a single attending at that income is in the 35% bracket. Deferring pre-tax at 24–35% and withdrawing in retirement at a likely lower average rate is the standard play. Roth deferrals make more sense early in your career, in low-tax years (fellowship, parental leave, a partial year), or if you expect to retire into a higher bracket than you are in now.
Match mechanics. If your employer matches per-paycheck rather than annually, front-loading your $24,500 in the first half of the year can cost you matching dollars in the back half unless the plan has a true-up provision. Read your summary plan description or ask HR one question: "Does the plan true-up the match at year end?" If no, spread your deferrals across all 26 pay periods.
If you are 50 or older, add the $8,000 catch-up for a $32,500 deferral. If you are 60 through 63, the SECURE 2.0 super catch-up replaces it: $11,250, for a $35,750 total deferral. Those four years are the single best deferral window of your career — use them.
The 457(b): a second $24,500 most physicians ignore
Here is the fact that surprises attendings every time: the 457(b) deferral limit is separate from the 401(k)/403(b) limit. If your employer offers both — and most academic medical centers and many nonprofit health systems do — you can defer $24,500 into each. That is $49,000 of pre-tax deferrals before any employer money, any IRA, or any HSA.
There is one distinction you must understand before contributing, because it changes the risk profile entirely:
- Governmental 457(b) (state university hospitals, county health systems, VA-adjacent entities): your money is held in trust for you. It is functionally a second 403(b), and you can withdraw at any age after separation with no early-withdrawal penalty — a quietly excellent feature for physicians considering early retirement.
- Non-governmental 457(b) (private nonprofit hospitals — the majority of health systems): the assets legally belong to your employer until paid out, and they are exposed to the employer's creditors in a bankruptcy. Distribution options are also rigid — many plans force a lump sum or a short payout schedule at separation, which can dump six figures of ordinary income into a single tax year.
A non-governmental 457(b) is still usually worth funding for a financially stable employer — a 24–35% immediate tax deferral covers a lot of risk — but check your system's credit rating and read the distribution options before you commit. If your hospital is mid-merger or running operating losses, think harder.
Important
Non-governmental 457(b) assets are your employer's property until distributed. If the hospital goes bankrupt, you stand in line with its other unsecured creditors. Fund it with eyes open.
The backdoor Roth IRA: $7,500 per spouse, every year
At attending income you cannot contribute directly to a Roth IRA — the 2026 phase-out tops out at $168,000 single / $252,000 MFJ. The backdoor Roth is the lawful workaround: contribute $7,500 to a as a nondeductible contribution (no income limit applies to nondeductible contributions), then convert it to Roth. There is no income limit on conversions. Done cleanly, the tax bill on the conversion is zero or a few dollars.