What residents are making, and how much debt they're holding

Assessing the personal finances of US medical residents is a matter of perspective. One view isn’t so bad: The average annual salary of $64,200 is close to the median US household income of $67,521.^[]

While the average American is $96,371 in debt, half of US medical residents carry more than $200,000 in medical school debt alone.^[] But there is hope their economic situation will improve.

Wages are rising

The research reveals a challenging financial outlook for residents. A 2022 Medscape analysis that asked 1,376 residents about their debt, wages, and working hours revealed some positive developments.^[]

This year, average earnings for year 1 residents reached $58,700, and $66,600 for those in year 4. Residents in years 6–8 earned an average of $68,800.

But despite these gains, only 27% of residents surveyed felt they were fairly compensated. This represents a major dip since 2015, when 62% said they were satisfied with their earnings.

Significantly underpaid

Joshua McGough, MD, an emergency medicine resident at Stony Brook University Hospital in Stony Brook, NY, is among the residents who want better compensation.

Now in his first year of residency, Dr. McGough’s annual salary is about $68,000. That doesn’t go far in New York, which placed 37th in U.S. News & World Report’s affordability rankings.^[] He also carries about $360,000 in student loan debt.

“We create far more in terms of reimbursement for hospitals than we are compensated for, and that discrepancy is even more dramatic when you consider more procedural or surgical specialties,” Dr. McGough said.

Exploitative strategy

Of course, residents are trainees, and some employers use this status to justify lower compensation.

Grant Lin, MD, PhD, a child neurology resident at Stanford Medicine in California, called this rationale an “exploitative strategy.”

“This is highlighted by the cost it takes to replace a resident physician with non-physician providers,” Dr. Lin said. “For example, when the University of New Mexico neurosurgery residency program was discontinued, they had to hire 23 advanced practice providers to replace eight residents.”

Dr. McGough said that at a minimum, residents should receive cost of living adjustments that account for inflation—otherwise, they’re actually receiving annual pay cuts. This makes the frequent rejoinders of “You’ll make much more as an attending,” or “Just be patient for a few more years,” difficult to hear.

Debt relief not much help

For many doctors, student loan debt lingers long after those attending salaries kick in. And the Medscape data indicate the average debt load is quite the sum.

Half of surveyed residents must repay more than $200,000, and a quarter face debts that exceed $300,000. Notably, 22% have no medical school debt.

While Americans greeted President Biden’s student loan forgiveness plan with cheers or jeers, many residents, like Dr. McGough, responded with a shrug of the shoulders.

“Instead of a one-size-fits-all model, I would rather see more transparency or assistance on getting residents involved in public service loan forgiveness as an option, especially for specialties with traditionally lower income potential,” Dr. McGough said.

Better peer education

Dr. McGough also thinks medical professionals could do a better job informing trainees about intra-specialty income differences. He noted that an EM doctor in a large urban academic center could expect to earn about $250,000 per year, whereas the same physician in a lower-cost-of-living, Midwestern town could earn more than $400,000.

Until that attending salary kicks in, Dr. McGough suggested that it’s best not to dwell on debt-to-income ratio and instead learn how to budget and avoid keeping up with the Joneses.

“Try shopping at ALDI, make your own coffee, and live within your means,” he said. “At the same time, if your $7 matcha-oat-milk-iced caramel-latte is the only thing that gets you through a tough shift, go for it!”