Finishing residency is both exhilarating and terrifying. Overnight, the structure falls away and you’re suddenly responsible for decisions that residency never really prepared you for: clinical, professional, and financial decisions.
Looking back, there are a few financial lessons I wish I had learned earlier. They would have saved me stress, money, and a fair bit of trial and error. If you’re stepping into independent practice here are the top five things I wish I knew from day one.
1. Billing Is Far More Important (and Complex) Than Anyone Tells You
Billing is rarely taught well in residency, yet it directly affects your income, your efficiency, and even your burnout risk. Early on, I underestimated how much money I was leaving on the table simply because I didn’t fully understand the billing rules.
The single most helpful (and painfully boring) thing I eventually did was read the General Preamble of my provincial Schedule of Benefits that most of us never look at. It’s not exciting, but it’s foundational.
Beyond self-study, ask mentors, senior colleagues, or your department’s business manager about common billing mistakes. Attend billing education sessions or simply choose a billing provider that offers ongoing support from experienced billing agents for recovering rejections and optimizing claims.
Also, I have colleagues who have missed out on months of billing as they did not realize there is a deadline to submit your billings. In Ontario, the deadline recently went from submitting within 6 months of providing the medical service to 3 months. Get your billings submitted in a timely manner!
2. If You Don’t Track Your Work, You Can’t Improve It
In the beginning, focus on clinical care first—but over time, start tracking your own data. Simple metrics like:
- Number of patients per day/shift
- Total billings per day/shift
- Different types (day vs night, clinic vs hospital)
Patterns emerge quickly when you look at your own numbers. You may discover that certain shifts or types of work play to your strengths, or that efficiency changes dramatically depending on context. Without data, these insights stay invisible.
Tracking isn’t about productivity pressure. It’s about self-knowledge. The more you understand how you work, the more intentional you can be about shaping a practice that fits you.
3. Insurance Decisions Early On Matter More Than You Think
As physicians, we’re familiar with liability protection through organizations like the CMPA—but disability insurance is often an afterthought. This is a mistake.
Locking in disability coverage while you’re young and healthy can protect your assets for decades. Once your health changes, options narrow quickly.
Insurance isn’t exciting, but it’s foundational. Getting this right early creates long-term stability and peace of mind.
4. Lifestyle Creep Can Quietly Erase Financial Freedom
A sudden jump in income makes it incredibly easy to upgrade everything: house, car, travel, lifestyle. The danger isn’t spending, t’s spending too fast.
Physicians who delay large lifestyle jumps and invest early often gain a massive long-term advantage. Early contributions to RRSPs, TFSAs, and corporate investing benefit enormously from time and compounding.
You don’t need to live like a resident forever but a short delay can buy tremendous flexibility later.
5. Taxes Are Your Largest “Expense”—and Incorporation Isn’t Always the Answer
Many new physicians are surprised to learn that marginal tax rates can exceed 50% in provinces like Ontario. Instalments, HST obligations, and deductions add another layer of complexity.
Incorporation is often discussed early, sometimes too early. A professional corporation can defer taxes and provide flexibility, but its biggest advantages appear once you’re earning more than you need to live on. If most of your income is going out the door, incorporation may add cost and complexity without much benefit.
A Final Thought: Think Beyond One Income Stream
Medicine offers incredible opportunities and it’s wise to think long-term. Physician “side gigs” aren’t exit strategies; they’re longevity strategies.
Side projects can safeguard against changes in health or your field, provide additional flexibility, and even reignite your passion for medicine. They give you options and options matter over a long career.
No one expects you to master finance overnight. But a little attention early on, especially around billing, insurance, taxes, and lifestyle choices can profoundly shape your future. Your career is a marathon, not a sprint. Set it up to last.
