Managing Early-Career Finances: Budgeting, Paying Off Debt, and Building Wealth

This episode of the AAOS Career Podcast tackles one of the most pressing concerns for orthopaedic surgery trainees: managing money on a resident's salary while carrying significant student debt. Host Ellen Lutnick, MD, is joined by Maxwell P. Courtney, MD, FAAOS, an adult reconstruction surgeon at Rothman Orthopaedic Specialty Hospital, for a candid, practical conversation about budgeting, saving, debt, and building long-term financial stability.

Dr. Courtney speaks openly about his own financial starting point — a first-generation college student who, together with his physician wife, left training with a combined $500,000 in student loan principal that grew to $800,000 with interest by the end of residency. That personal experience grounds his advice: Avoid consumer (credit card) debt and start saving or investing if it’s financially feasible, but do not feel obligated to save or invest every spare dollar. He encourages residents to enjoy themselves as a reward for the hard work and grueling hours and shares how he managed to have fun, including traveling at every opportunity, without breaking the bank.

The conversation covers the practical mechanics of getting ahead financially, including why Dr. Courtney favors low-cost index fund investing over active stock-picking or a paid financial advisor, the benefits of starting a Roth IRA during training, and how loan repayment programs like Public Service Loan Forgiveness work (and how recent policy changes have affected them). He also discusses the pros and cons of having a financial advisor and when it makes sense to hire an accountant.

A significant portion of the episode focuses on insurance and risk management. Dr. Courtney shares his own experience being diagnosed with and treated for a low-grade brain tumor, and how having "own occupation" disability insurance and term life insurance in place beforehand gave him and his family critical protection and peace of mind. He also walks through the tradeoffs between academic, private practice, and hospital-employed positions, what to look for in a first contract (restrictive covenants, CME budgets, retirement contributions), and why avoiding lifestyle creep after residency matters as much as any single investment decision.

Key topics covered:

• Dr. Courtney's own path through medical school and residency debt, and how his financial picture has changed since becoming an attending

• How to set a realistic budget as a resident and why avoiding credit card debt is the top priority

• The case for still enjoying residency — travel, meals out, time with co-residents — without derailing your finances

• When and how much to save during training, and why compound interest favors starting early even in small amounts

• Roth IRA contributions as a resident and how income limits change that picture as an attending

• Navigating student loan repayment options, including Public Service Loan Forgiveness and recent program changes

• Why Dr. Courtney invests in low-cost index funds rather than actively picking stocks or using a financial advisor

• Why it makes sense to hire an accountant once you are an attending, if you plan to have additional revenue streams (consulting, legal work, etc.)

• Balancing those “side hustle” opportunities against additional call shifts and family time

• The importance of disability insurance, including "own occupation" coverage, illustrated by Dr. Courtney's personal health story

• Term life insurance considerations for residents and early-career attendings with families

• Differences in compensation and lifestyle across academic, private practice, hospital-employed, and hybrid job models

• What to evaluate in a first job contract, including restrictive covenants, CME budgets, and retirement/profit-sharing plans

• Avoiding lifestyle creep after residency and reframing student debt relative to attending-level income

Guest: Maxwell P. Courtney, MD, FAAOS, Adult Reconstruction Surgeon, Rothmann Orthopaedic Specialty Hospital; Associate Professor of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University; Assistant Residency Program Director; National Service Chief of Joint Replacement

Host: Ellen Lutnick, MD, AAOS Resident Assembly Executive Committee Chair