The Rules of Retirement: What Is Die with Zero?

​​Too often, physicians approach retirement with one financial goal in mind: save as much money as possible, then protect it aggressively. And if you think about it from a 30-year time horizon of delayed income, residency debt, and career risk, that advice makes perfect sense.

But it rarely addresses something physicians know instinctively. Time, energy, and health don’t wait for your portfolio to hit a magic number.

Enter: die with zero.

What Is Die with Zero?

Die with zero is a philosophy popularized by Bill Perkins in his book Die with Zero: Getting All You Can from Your Money and Your Life. Perkins isn’t a physician. He’s a hedge fund manager, energy trader, and professional poker player. But his framework has struck a nerve with high-income professionals, including doctors, because it challenges the default financial advice most of us grew up hearing.

The core idea is disarmingly simple. Your life will end with zero time and zero health no matter what you do. So why not plan to end it with zero money too, having converted your wealth into experiences, impact, and memories along the way?

There’s actually serious economic theory behind this. Back in the 1950s, Franco Modigliani won a Nobel Prize for something called the Life-Cycle Hypothesis. His argument was pretty straightforward: people should save when they’re earning well and then run those savings down in retirement. Not hoard indefinitely. The whole point of saving, in Modigliani’s view, was to fund the years when you’re no longer working. If you die with a huge pile of money left over, you miscalculated. Perkins took that academic idea and turned it into something people actually want to read about.

What Perkins did was take that economic theory and make it personal. He wrapped it in nine rules, gave it a provocative title, and forced people to ask uncomfortable questions about what they’re actually saving for.

Perkins’ Nine Rules

The book is structured around nine principles, each one building on the last:

1. Maximize your positive life experiences.
2. Start investing in experiences early.
3. Aim to die with zero.
4. Use all available tools to help you die with zero.
5. Give money to your children or to charity when it has the most impact.
6. Don’t live your life on autopilot.
7. Think of your life as distinct seasons.
8. Know when to stop growing your wealth.
9. Take your biggest risks when you have little to lose.

Reading them quickly, they seem almost obvious. Who would disagree with “maximize your positive life experiences”? But the real weight is in how Perkins applies them. Each rule forces a specific financial decision point that most people, including physicians, would rather not think about.

Rule 8 is the one that really gets under people’s skin. Know when to stop growing your wealth. Perkins says most people should hit their peak net worth somewhere between 45 and 60, then start deliberately running it down. If you’re a physician who didn’t finish fellowship until 33, that timeline feels almost absurd. You barely started earning real money. But Perkins would say that’s exactly why you can’t afford to waste the years you do have.

The Three Resources Problem

Here’s the framework that makes the whole thing click. Perkins says we’re all juggling three things: money, time, and health. Early in life, you’ve got time and health in spades but no money. So you work. You trade hours for dollars. You take cheap trips that require a lot of physical effort and that’s fine because your body can handle it.

Middle age is what Perkins calls the real Golden Years. Not retirement. Your 40s and 50s. You’ve still got reasonable health and now you’ve actually got income. This is when you swap money for time. You fly direct instead of taking the connection. You hire the babysitter so you can have a weekend away. You say yes to the trip you’ve been postponing.

Eventually, health declines enough that no amount of money can buy back the experiences you once could have had. And that’s the tragedy Perkins is trying to prevent: dying with a large bank account and a short list of memories.

For physicians, this framework hits differently than it does for, say, a software engineer who started earning at 22. A doctor who finishes fellowship at 33 and starts paying off $250,000 in loans doesn’t have the same runway. The money arrives late. The health is already ticking down. And the career itself is physically demanding in ways that compound over decades.

Why This Matters More for Physicians

Physicians aren’t alone in saving aggressively for retirement. But the shape of a medical career creates a specific kind of mismatch that makes the die with zero philosophy especially relevant.

On one hand, physician incomes tend to rise throughout a career. Trainees have less experience, lower incomes, and heavy loan burdens. Established physicians with higher incomes tend to peak later. On the other hand, your physical capacity to enjoy experiences, take on travel, or remain active typically peaks much earlier. Hours are long. Overnight call gets harder with age. Certain procedures just aren’t possible later in life.

The data backs this up. A 2023 Medscape survey found that physicians think they need about $4 million saved to retire comfortably. Most are shooting for somewhere between 65 and 70 to call it quits. In reality, about 60% of physicians end up retiring with a net worth between $1 million and $5 million. That sounds decent until you learn that a full quarter of doctors over 65 haven’t even cracked $1 million in net worth. Not in investments. Total.

So what does that actually mean? It means the physician population is split. You’ve got one group that’s sitting on more money than they’ll ever spend, afraid to touch it. And you’ve got another group that’s genuinely behind. Die with zero is really talking to that first group. The doctors who have the resources to live well and just… aren’t. Because saving became a habit they never questioned.

The Memory Dividend

One of Perkins’ more compelling ideas is what he calls the memory dividend. When you spend money on a meaningful experience, you don’t just get value in that moment. You replay the memory for the rest of your life. It compounds, in its own way.

Have you ever tried to forget a great vacation? Probably not. Those memories follow you. A week in Patagonia at 38 doesn’t just give you a week of enjoyment. It gives you decades of recollection, of stories with your kids, of a sense of identity that’s richer than what any portfolio statement can provide.

Physicians are problem-solvers. We put a lot of value on things we can measure and quantify. But memories aren’t found on a balance sheet. They enrich our lives in ways that monthly dividends never will.

Now, there’s a fair counterpoint here. The White Coat Investor, which published a thoughtful critique of the die with zero philosophy, raised the concern that Perkins leans too far toward hedonism. The pursuit of pleasure for its own sake. And that’s a legitimate concern. If die with zero becomes an excuse to spend without thinking, it defeats the purpose.

But Perkins’ version of experience-maximization doesn’t have to mean extravagance. It can mean being present for your daughter’s soccer games instead of picking up extra shifts. It can mean taking a sabbatical at 45 instead of waiting until 65. It can mean flying your aging parents out for a holiday while they can still enjoy it.

The point isn’t hedonism. It’s intentionality.

Give While You’re Alive

One of the more provocative ideas in the book, and one the original version of this article didn’t address, is Perkins’ argument about inheritance. He calls it giving with a warm hand.

Research shows that the average age people receive an inheritance is around 60. Perkins argues that’s far too late for the money to have its maximum impact. A poll he conducted of over 3,500 people found that the ideal age to receive an inheritance was between 26 and 35, old enough to be trusted with money, young enough to actually use it.

For physicians who are also parents, this reframes the entire concept of legacy. Instead of accumulating as much as possible and passing it down when you die, what if you helped your child with a down payment at 30? Or funded a grandchild’s education directly? The impact is more tangible, more immediate, and you actually get to see it.

The same applies to charitable giving. If you care about a cause, contributing now creates impact now. Waiting until after death introduces randomness into a decision that should be deliberate.

The Risks of Die with Zero

Like any financial philosophy, die with zero isn’t without its risks. And it’s important to address them honestly rather than hand-wave them away.

The biggest practical problem is sequence of returns risk. You don’t know when you’re going to die, and you don’t know what your investments will do between now and then. Perkins says he wants your last check to bounce, but the real world doesn’t cooperate that neatly. Running out of money at 82 is a very different outcome than dying with $500,000 left at 91.

Some tools can help manage this uncertainty. Annuities can convert a lump sum into guaranteed income. Life expectancy calculators can give you a rough planning horizon. Perkins himself suggests a “survival threshold” calculation: multiply your annual expenses by how many more years you expect to live, then multiply by 0.7. That gives you a floor below which you shouldn’t dip.

But there’s a psychological risk too. Most physicians who’ve spent decades saving aren’t going to flip a switch and become comfortable spenders overnight. Good savers don’t automatically become good spenders. The muscle memory of frugality runs deep, and for some doctors, the die with zero concept will be more aspirational than operational.

And honestly? That’s fine. You don’t have to literally die with zero for this to be useful. Even getting halfway there changes the way you think about money in your 40s and 50s. It loosens the grip a little. That’s worth something.

Retirement Is Becoming More Fluid

Here’s the other thing that makes die with zero resonate with physicians specifically. Retirement in medicine isn’t what it used to be. Fewer and fewer doctors are working full tilt until Friday and then just… stopping. What’s more common now is a slow wind-down. You drop to four days a week. Then three. You pick up some consulting. Maybe you teach a couple of sessions at the medical school. You keep your hand in.

That gradual transition actually changes the financial equation in a way that works in favor of the die with zero approach. Because you’re not really trying to fund 30 years of zero income. You’re covering a few years of reduced income, maybe supplemented by part-time work or passive investments. That math is friendlier. It gives you permission to spend more freely in your 40s and 50s without the fear of some financial cliff at 65.

Perkins would frame it in terms of seasons. The residency season looks nothing like the early-career season, which looks nothing like the years after your kids leave home. Each one comes with different resources and different opportunities. What he really pushes back against is autopilot. Doing the same thing decade after decade, maxing out the 401(k), never asking whether the plan still fits your actual life.

Making Die with Zero Work for You

The concept is compelling. But nobody ever funded a family trip to Tokyo with a compelling concept. So how does this actually translate for a working physician?

Think about the experiences you want and when they make sense. Your kids are 8 and 11 and you’ve been talking about Japan for three years? Stop talking about it. Look at what the trip costs, check your calendar, and go. They won’t want to travel with you forever. Vague plans stay vague.

Look at where you are in your career and let that inform your spending. A physician twenty years into practice should be leaning on investments differently than someone five years out of residency. If you’ve built a solid financial base and you’re still living like an intern, something’s off.

And before any of this, build the safety net. This is non-negotiable. Die with zero doesn’t work without robust disability coverage, income protection, and a plan for healthcare costs. The philosophy isn’t about spending recklessly. It’s about spending confidently, because you’ve already covered the downside.

Run your survival threshold number too. Know the floor. Perkins’ formula is simple: annual expenses times remaining years times 0.7. Everything above that line is money you have permission to use on purpose.

And maybe most importantly: start now. The whole premise of die with zero is that waiting costs you the thing you can’t get back. Not money. Time.

Live Your Values Today

Die with zero is about a lot more than spending your savings. It’s about living your values throughout your career.

That might mean traveling early and often. It might mean taking more vacations with your family. Or maybe you value your work so deeply that you hope to practice into your 90s. Your retirement plan should reflect what actually matters to you, not what a default savings calculator says you should do.

Physicians Thrive has spent decades helping doctors figure this out. Retirement planning, income protection, investment portfolios built around how you actually want to live. Not a template. A plan that fits.

If retirement still feels like some far-off reward you’re grinding toward, something needs to change. It doesn’t have to look like that. Get in touch with us and we’ll help you build something better.