It has been 17 ½ years since we first met twins John & Jane on their financial journey, who are now 35 years old.  Dr. Jane Doe, MD, is a married family medicine physician about to deliver her first baby.  John Doe, PA, works in urgent care, is married, and is about to become a father.  Life is good for the siblings as 2023 comes to an end.

     You can access Part 1 and Part 2 of this series by clicking the links.  As a recap, the Year 17.5 Net Worth statements for the two medical professionals and a list of the Rules and Assumptions for this exercise are provided below.  

Net Worth
Rules of Finacial Journey

The Near Future (Years 18-21)

     In 2024, John returned to paying off his student loans as he had been before the pandemic, despite having paid off the private loan.  He paid the original payment amounts plus an extra $607.02/mo. towards the principal of the college loan.  In January 2024, John & Susan welcomed a healthy baby girl named Estella.  Given their new addition, John wanted to increase his family’s spending budget but felt he couldn’t do it with his current student loan burden. 

He decided to focus for a few more years and get the debt paid off, so he continued with a 25% savings rate.  His total student loan payments equaled $20,675.10 for 2024, but he was able to pay off the college loan in July of that year.  He then put the total amount towards his PA School federal loan.  John contributed just enough to his 401k to get his employer’s match, then put the rest of his available save/invest money into his family’s Roth accounts.  In 2024, the government increased the contribution limit to $7,000.  Unfortunately, he couldn’t max them both out.    

John’s Growing Family and Financial Journey Milestones

     By paying extra each month, he was able to make his final student loan payment in April 2025.  The family had a small party in June celebrating this achievement and announcing Susan’s pregnancy!  John continued his current savings rate through the end of the year, maxing out the Roth and nearly maxing out his 401k.  

     At the beginning of 2026, the Doe family added a new member, a little boy named James.  After 20 years of hard work, John was able to relax a little and drop his savings rate to 20% now that his student loans were finally gone.  He wanted some extra money each month to spend on his growing family.  He decided that since their lifestyle would increase, he needed to enlarge his emergency fund, so he added $6,000 to the account.  Then he maxed out his Roth and still made a substantial contribution to his 401k.  His contribution log is below. 

202420252026
Roth IRA9,3553.3014,00014,000
401K15,015.2025,044.2618,538
Cash Savings006,000
PA School Loan Paydown14,182.326,001.34
College Loan Paydown6,492.78
Brokerage Account000
                John’s Total Contributions, including Employer Contribution to 401k

Jane’s Journey Into Motherhood

     In 2024, Jane and Derek welcomed their first child, a boy named Ricky.  Jane’s employer provided two months of paid maternity leave, then she reluctantly returned to her job.  Through hard work, she still made her incentive bonus for the year.  The employee contribution limit for the 401k increased to $23,000 in 2024.  Jane maxed it out while resuming payments on her two remaining student loans.  She did not choose to add money to her minimum payments as John did.  She felt more comfortable paying the minimum on the two loans, maxing out her 401k, and putting the rest of the money in her brokerage account.  She felt that over time, she would get a better return in the stock market than the 6.8% she was paying in interest on the loans.  

Second Maternity Leave and New Career Decisions

     2025 passed in much the same fashion, except that Jane announced that she was pregnant with their second child, due at the end of the year.  In late 2025, Jane gave birth to a daughter, Mattie.  She had a surprise planned after her maternity leave – she left her job for an established private practice starting in January of 2026.  Her new salary was $280,000 with a 401k match of 7%.  She was also promised a raise to $300,000 in 3 years if she hit a few productivity metrics.  Jane felt that her new job was perhaps not as secure as her hospital system job, so she wanted to increase her emergency fund, which she completed in 2026 at the expense of investing in her brokerage account.  

     Jane rolled over her 401k into her new employer’s plan, which fortunately contained the same low-cost index funds.  Unfortunately, Jane’s former plan had a 1-year vesting period, so she lost the employer-contributed portion for the previous year.  This change is reflected in the contribution record for this period.

202420252026
Roth IRA000
401K35,50023,00042,600
Cash Savings0018,636.08
Medical School Loan Paydown23,379.9623,379.9623,379.96
College Loan Paydown4,983.964,983.964,983.96
Brokerage Account11,136.0811,136.080
                      Jane’s Total Contributions, including Employer Contribution to 401k

Sibling Comparison at Age 39

     At the end of 2026, the twins are nearly 39 years old.  They are each married with two kids, are firmly established professionals in Knoxville, and are happily living their lives.  Additionally, they are now quietly becoming wealthy.  The siblings’ financial journey demonstrates the importance of starting early and the power of compound interest.  For example, they could both be considered “coast FI.”  Given their current investments, they could never add another dollar and likely still have plenty of money to retire at age 65.  If neither invested anything else and their blended stock/bond returns were 8% per year on average, Jane would have a projected $3,886,354 and John $4,845,159 at age 65.  The twins’ net worth statements from the end of 2026 are below.

Net Worth Year 20.5 Financial Journey

John’s Salary Increase and Saving Strategies

Neither of the twins was ready to take their foot off the gas yet and continued to work hard.  John received another raise at the beginning of 2027 to $75/hr.  He also received his $5,000 bonus, which brought his total gross salary to $156,200.  The family continued their 20% savings rate.  He began to feel that he might not want to work until age 65, so he diverted $5,000 per year from his 401k contributions to his brokerage account. 

He was concerned that he would have plenty of money in his 401k but wouldn’t be able to access it if he retired early.  He wants to let his Roth continue to grow tax-free, so he feels this new strategy is his best option.  He knows he will pay more in taxes now but is willing to make that trade for a little more flexibility down the road.  The Roth contribution limit increased to 7,500 in 2027.  His contributions for this period are below.

2027202820292030
Roth IRA15,00015,00015,00015,000
401K20,05020,05020,05020,050
Cash Savings0000
PA School Loan Paydown
College Loan Paydown
Brokerage Account5,0005,0005,0005,000
John’s Total Contributions, including Employer Contribution to 401k

Jane’s Salary Increase and Future Plans

     With two children and a significant net worth, Jane wanted to drop her savings rate to 20%, but she decided to wait a few more years until she finished paying off her student loans.  She continued maxing out her 401k.  The employee contribution limit increased in 2027 to $24,500/yr; otherwise, Jane’s financial plan remained the same.  

     True to their word, Jane’s employer increased her salary to $300,000 at the start of 2029.  Jane continued to save/invest 25% of her gross income during 2029 and 2030.  With the raise, Jane and Derek were now able to spend $14,894 per month.  Her contribution log is below.

2027202820292030
Roth IRA0000
401K44,10044,10045,50045,500
Cash Savings0000
Medical School Loan Paydown23,379.9623,379.9623,379.9623,379.96
College Loan Paydown4,983.964,983.964,983.964,983.96
Brokerage Account17,136.0817,136.0822,136.0822,136.08
Jane’s Total Contributions, including Employer Contribution to 401k

     Twenty-four and a half years after starting college together, John still has a narrow advantage in net worth, but Jane is catching up fast.  Their net worth statements as of the end of 2030 are below.

net worth

The Grind for Family

John’s Adjustments in his Financial Journey

     At the beginning of 2031, John and Jane were both millionaires but were still working every day, mired in the daily grind of life.  John decreased his 401k contribution to the minimum needed to receive his employer match (5%), then used the money to increase his emergency fund in anticipation of some life changes.  He held this same pattern in 2032.  

     At the beginning of 2033, John made a significant decision.  He was nearly 43 years old and had done shiftwork in urgent care for 20 years.  Susan was tired of him working weekends, and he was just tired.  He wanted a more stable schedule so he could eat dinner at home every night with his family.  He accepted a job teaching full-time at his old PA school.  He will now have a salary of $120,000 with medical insurance and a 5% 401K match.  With his lower salary, he decreased his savings rate to 10%, meaning he would save $12,000 annually and spend $6,600 monthly.  He contributed 5% to get his 401k match, then put the rest towards the Roth IRA, although he couldn’t max it out.  He felt this was a pattern he could continue until he was ready to retire.  His contributions are below. 

2031203220332034
Roth IRA14,00014,0006,0006,000
401K15,62015,62012,00012,000
Cash Savings4,4304,43000
PA School Loan Paydown
College Loan Paydown
Brokerage Account5,0005,00000
John’s Total Contributions, including Employer Contribution to 401k

Jane’s Adjustments in her Financial Journey

     Jane paid off her student loans in May of 2031.  This was a massive boost to her family’s finances as she had been paying $28,363.92 a year towards her loans since September of 2023, when they came out of forbearance.  Jane finished the year with her current savings rate of 25% and elected to place another $10,000 in her emergency fund instead of investing it all in her brokerage account.  

     Now that her student loans were finally paid off, Jane decreased her savings rate to 20% in 2032.  She also placed another $20,000 in her emergency fund.  With the change, Jane and Derek could now spend $16,154 monthly.  

Mystery Solved: Jane Surpasses John’s Net Worth

     Jane reached an important milestone in 2032 that gives us the answer to the original question in this study.  By the end of the year, Jane’s net worth surpassed her brother’s!  So, the answer to our question in this case was 26.5 years, or when the twins were just under 45 years old.  John, Susan, Jane, and Derek all had an expensive dinner to celebrate the occasion, this time paid for by Jane.  

     As 2033 dawned, Jane radically changed her life, which she had been secretly planning for the last year.  Her children were growing up fast.   Now that her student loans were paid off and she had a 7-figure net worth, she decided to go part-time at her job.  Jane worked out an arrangement with her employer to work three days a week with a salary of $200,000.  She would have a few administrative duties, but they could be done from home.  She continued to have medical insurance and her 401k match. 

Jane dropped her savings rate to 15%, which still allowed her to max out her 401k each year and invest in her brokerage account.  Despite lowering her savings rate, her lower salary meant her monthly spending dropped to $12,239.  She felt the trade of time for money was worth it and planned on continuing this pattern indefinitely.  Her contribution log follows.  

2031203220332034
Roth IRA0000
401K45,50045,50038,50038,500
Cash Savings10,00020,00000
Medical School Loan Paydown9,741.65
College Loan Paydown2,078.65
Brokerage Account28,679.7015,5005,5005,500
Jane’s Total Contributions, including Employer Contribution to 401k

     Both twins are now in new jobs, working less and spending more time with their families.  They have slowed down their savings rates but still invest in retirement accounts each year.  At the end of 2034, they are nearly 47 years old and feel they are in a holding pattern until retirement.  During their investment careers up to this point, they have averaged a return on their 80/20 stock/bond split of 8.82% per year.  Their net worth statements are below.

Even net worth financial journey

The Glidepath to Early Retirement 

     John and Jane continued to work and save in this pattern until James and Ricky graduated from college in June 2048.  The only change to their investment portfolios was that starting in 2035, they each changed from an 80/20 stock/bond split to a more conservative 60/40.  This approach will lower their average returns to 6.62% per year in exchange for decreasing risk.  The twins both decide to retire early at age 60.  Their net worth statements at the time of their retirement are below.  

year 42 net worth

     Both John and Jane are multimillionaires who have retired early.  Jane technically has a higher net worth, though their asset location varies.   Given that John has more money in his Roth IRA, it could be argued that their post-tax portfolio values are nearly identical.  Either way you look at it, they both should have a secure retirement.  Using the 4% rule and only investible assets, Jane can spend $185,463 annually in retirement or $15,455.26 monthly.  This amount replaces all her pre-retirement income.  John can spend $160,404 per year or $13,367 per month.  This amount vastly exceeds his pre-retirement spending.

Since the 4% rule is indexed for inflation, both should feel comfortable with their retirement spending.  Obviously, this is just one fictional scenario, and countless other scenarios could exist.  This example tried to compare apples-to-apples as much as possible despite one sibling being a physician and the other a physician assistant.  The following sections will discuss the findings, other options that would have changed what happened, and what lessons we can learn from the fictional financial lives of Jane & John.    

Analysis of Financial Journey:  Options That Could Have Affected the Outcome

  Real Estate

   While in this scenario, John and Jane are permanent renters, do not dismiss real estate as an investment strategy.  This asset class was omitted because outside investments would disrupt the apples-to-apples comparison.  If residential real estate had been included, it probably would have benefitted Jane slightly more than her brother.  Throughout the years, Jane earned and spent more money than John.  She likely would have purchased and paid off a more expensive house, further increasing her net worth advantage at retirement.  However, the twins live in the same area, and John would have bought his house first, so it may have evened out.  There are just too many variables to know for sure.  What if John had fixed up an old house?  What if the real estate market had taken off before Jane finished her residency?  For these reasons, real estate was not included in the calculations.

Savings Rate    

     Savings rates could have been adjusted up or down.  While it would have been difficult for John to save more, especially after he started a family, Jane certainly could have.  Her wealth would have accumulated faster if she reduced her lifestyle and lived off the same amount as John.  Saving more is always an option for higher-income earners, although it is rarely exercised.  John took his foot off the gas at age 43, opting for a teaching job that paid substantially less money than the urgent care.  He continued to save 10% for retirement but was already “coast FI” at that point and could have safely spent his entire salary.  Alternatively, he could have continued to earn a higher salary and increased his net worth to compete with his sister. 

Specialty Choice

     Different career choices would have made a difference in this exercise, especially for Jane.  Jane never made more than $300,000 in a year during her career.  While this is above the median salary for a physician in the US, it is certainly less than many physicians make.  Employed physicians have a much broader range of salaries than do employed PAs.  If Jane had been an emergency physician with a three-year residency, her income would likely have been much higher, dramatically changing the results.  If she had been an interventional radiologist, her training would have been longer, but her much higher salary would have more than compensated.  The choice of specialty is probably the most significant factor in this study.   

Timing

     The timing of the study affected the outcome.  John started investing in 2010, after the great financial crisis and at the start of one of the longest bull markets in history.  Jane missed several years of the run-up before she could start investing.  Additionally, the twins began college in 2006 when average student loan rates were 6.8%.  If they had begun a decade earlier (1996), the rates were 8.25%, while a decade later (2016), they were 4.29%.  Since Jane borrowed more money, changing interest rates would disproportionately affect her.   

Early Retirement

     If our twins had continued working until retirement age, the results would have favored Jane since she was accumulating wealth faster than her brother.  PAs naturally have an advantage in the early years since physicians get a later start and have a higher debt load.  As time passes, the higher physician salaries ultimately tip the scales in their direction.  Thus, PAs must start saving and investing early.  

Investment Fees

     I did not include any investment fees when doing the calculations.  We assumed that both siblings invested in low-cost, broad-based index stock and bond funds with very low fees.  Neither sibling used an investment advisor.  Had they hired someone who charged an assets-under-management fee (AUM), their overall wealth accumulation would almost certainly have been less. 

Student Loan Repayment

     Both John and Jane directly paid off their student loans.  The outcome of the study could have been affected if either had participated in a repayment or forgiveness program.  Since using these programs would have increased the variables, they were omitted.  Additionally, government forbearance during the pandemic affected the outcome.  Jane had loans representing 166% of her base salary at the start of her career, while John had 124%.  Their decision to aggressively pay down the loans during forbearance thus disproportionately benefited Jane.     

Entrepreneurship

  This vignette did not include entrepreneurship, as John and Jane remained employees throughout their careers.  If one of them had started their own practice or side hustle, the outcome may have been different.  Here at Business is the Best Medicine, we firmly believe that physicians and APPs can and should start and own their practices.  Keep reading the site for advice on starting and running your medical practice.  Click here for side hustle ideas for APPs.   

Other

     Several other factors that could have impacted the outcome were left out.  The twins lived in a state with no state income tax.  Had one of them moved to a high-tax state, it could have materially affected the outcome.  College savings plans were not considered and would have been harder on John as his salary was lower.  Finally, neither of their spouses worked nor entered the marriage with assets or liabilities.  Clearly, this was to aid the apples-to-apples nature of the exercise, but it is not realistic.  If the twins had married differently, the outcome would have changed.  

Final Conclusion:  What is the Break-even Point Between an MD and a PA?

     Is it more lucrative to be a physician than a PA?  The answer is generally yes, with a few serious caveats.  First, how old you are matters.  It took Jane 22 1/2 years after graduation from college to catch up to John.  If you are starting a medical career later in life, consider your age and how long you intend to work.  Next, how much you pay for school matters.  Jane finished her residency with $365,733 in student loan debt.  I know graduating physicians with twice that amount.  Your debt will be higher if you pay out-of-state tuition or attend a private or offshore medical school. 

That increased debt load will weigh heavily on you during your career.  Finally, your specialty matters, especially if you are on the wrong side of the other two considerations.  If you are an older, non-traditional student who was only accepted to an expensive out-of-state medical school, you might want to avoid going into pediatrics.  You may also want to consider becoming a PA instead.

     There are many lessons to learn from this study, but three stand out—first, income matters.  Jane caught up with her brother despite the late start simply because she earned more money.  Both siblings changed jobs to earn higher salaries.  Everyone should attempt to increase their income in order to build wealth.  Second, your savings rate is vitally important.  Earning more money only makes you wealthy if you don’t spend it all!  You must spend less than you earn so that you can save/invest the difference. 

Finally, starting early is imperative.  John held an enormous lead over Jane because he began saving 25% of his income immediately upon starting his career.  Those early invested dollars have a longer time to compound and make a difference at retirement age.  Similarly, if Jane had decided to wait 5-10 years after graduating from her residency to start investing, she would never have surpassed her brother.

      John and Jane are successful by any metric.  Jane studied longer and took more risk in the form of debt but was able to spend substantially more money during her working career.  John got an earlier start and took less risk but had to live a more modest lifestyle by comparison.  However, they ultimately took different paths to end up in nearly identical places.  All medical professionals can have a successful financial life if they follow some simple guidelines. 

The twins followed Business is the Best Medicine’s Financial Vitals Checklist, a step-by-step guide on what to do with your money.  You can read about the checklist and download a free copy here.  These guidelines will allow any medical professional to succeed financially, regardless of the letters behind their name. If you have enjoyed being a voyeur of the financial lives of John and Jane, subscribe to BusinessIsTheBestMedicine.com for future articles about the siblings.