By Josh Katzowitz, WCI Content Director
We already know that 61% of doctors surveyed recently think that, despite the anecdotal evidence that physician salaries increased between 3%-4% last year, they’re still underpaid. Here’s how one survey-taker put it to Medscape:
“Do I feel I am paid well? Yes, in comparison to other Americans. However, I gave the time, money, and sacrifice to do it.”
For the 2024 Medscape report, the average physician income was $363,000. The 2024 Medscape Resident Salary & Debt Report, however, showed that fourth-year residents made an average of $70,000 with third-years at $68,000 and first- and second-years at $65,000. And boy oh boy, many of them are absolutely livid about it.
One survey-taker, a fourth-year plastic surgery resident, told Medscape, “It’s a disgrace.” A third-year in psychiatry said, “There is no need to provide slave labor in order to learn a trade.”
While that language seems harsh, keep in mind that resident salaries haven’t increased substantially in the last decade. In 2015, the average resident earned $55,000. In 2020, they made $63,000. In the four years since, those salaries have increased by 11%. That’s not necessarily a horrendous percentage, particularly since it stayed flat during the pandemic, but for many of the survey-takers, it’s still unacceptable.
How many residents think that’s the case? According to Medscape, 90% think they should be making more money, 10% believe their salaries are spot on, and, well, 0% say that residents are overpaid (as compared to 5% of attendings who think they themselves make too much).
“I am barely surviving,” one resident said. “It’s difficult to support a family with kids on this stipend.”
Said another: “As a group of major revenue-earners for the institution who are only paid a fraction of what full-time physicians earn, it’s not appropriate.”
What, then, would be appropriate? Some said bumping up their salaries to what mid-level healthcare workers make is a good start. For a nurse practitioner, that’d be in the neighborhood of $120,000 per year. For a registered nurse, it’d be closer to $86,000. For a physician assistant, we’re talking about $126,000.
Other residents think they should double their current salary—in part because it would give them a chance to pay off student loans in a timelier manner (more than half of those surveyed have more than $150,000 of debt) and because it’d be more equitable.
“I will reiterate my point from my overrated/underrated column that if a health system employs PA and NP ‘fellows’ who graduated from school and are in a similar apprenticeship as physician residents, the employer should—at a minimum—pay the residents the same annual salary as they pay the ‘fellows,’” WCI columnist Dr. Francis Bayes told me. “Increasing the salary would mean applicants can focus more on finding programs that are a better fit in terms of training and residents and programs can focus more on non-financial sources of stress and burnout—basically, a better pay would save everyone's time and energy.”
Chart and photo via Medscape
Perhaps the perceived low pay is why some resident programs have begun forming unions, turning individual dissents into a powerful collective voice that can collectively bargain for better working conditions and pay.
In May 2023, about 150 residents in New York went on strike for three days before their hospital was forced to negotiate a new deal. The month before that and again in the month afterward, tens of thousands of doctors in the UK participated in a strike to protest low pay during high inflation. Residents and fellows at Penn Medicine overwhelmingly voted to unionize in 2023 (joining the 100,000 or so overall doctors who are in unions).
But remember: individual institutions can't do much about resident pay. Congress was in charge of figuring out how to fund their salaries, via Direct Graduate Medical Education and Indirect Graduate Medical Education payments, and hospitals only get a certain amount of money per year to train all their residents. There simply isn't much, if any, room for large salary increases.
For some residents, though, it's not all about the money. When asked about the factors that will guide them when deciding on their first attending job, 36% of Medscape survey-takers said their work and call schedule would be paramount compared to 19% who said their starting salary would be the No. 1 factor. Seventeen percent also said “supportive organization/practice environment” was key, which basically means that 53% of residents are more interested in work-life balance than how much money they’ll initially make.
Of course, no matter how hard you’re trying to prevent your burnout and prolong your career, more money is always nice—and most residents would say that it’s imperative.
“The truth is that residents make very little and are working the hardest,” Ava, a third-year resident who you've met in our From Fourth Year to the Real World series, told me. “Most hospitals truly do run on residents, and I would say most, if not all residents, think that they are not being compensated accordingly for all of their hard work. Additionally, most residents have a lot of debt which is an added financial stressor. At my program, several residents have spoken up about the need for a raise in our salaries and have been successful in getting a little bit of a raise for us. But we are still underpaid.”
More information here:
Will More Money Make Me Happier?
16 Ways to Earn More Money as a Doctor
Where Do Millennial Doctors Make the Most Money (and How Much Do They Make)?
What Side Jobs Can Residents Do?
Money Song of the Week
One of the bands that encapsulates the mid-1990s for me is the alt-rock four-piece Soul Asylum. I wasn’t necessarily a huge fan, but I really enjoyed its 1992 album Grave Dancers Union and I particularly loved Somebody to Shove, the kind of angsty, grunge-y, almost punk-y single that I probably first saw on MTV’s 120 Minutes.
Some rock observers feel that singer/guitarist Dave Pirner is an underrated superstar from that era (the band did manage to win a Grammy with Runaway Train), and after seeing Soul Asylum live for the first time earlier this month, I can kind of see their point. On stage, he's kind of all over the place when playing his guitar and singing, and in between songs, he told some groan-worthy dad jokes.
Today, let’s talk about Black Gold, one of the more well-known tunes off Grave Dancers Union with songwriting material that is very early 1990s. Think Iraq and Kuwait and the US invasion and what it was all about. Black gold in this tune = oil and the money, power, and greed that comes with it (which is why countries were fighting about it in the first place).
As Pirner sings,
“Two boys on a playground/Trying to push each other down/See the crowd gather 'round/Nothing attracts a crowd like a crowd.
Black gold in a white plight/Won't you fill up the tank, let's go for a ride/I don't care 'bout no wheelchair/I've got so much left to do with my life.”
As noted by Song Facts, the two boys on the playground symbolized the US and Iraq.
“[It] was begging people to grow up, and I guess it doesn't happen,” Pirner told Song Facts about Black Gold. “People just try to stay the way they are, and that's unfortunate. To that effect, I just keep on singing the song. The song does not present an answer, but I think that it's something that people need to be reminded of . . . I had no idea how adaptable this song was. It can be interpreted as something that's more micro and macro.”
Not everybody agrees that the song is actually about oil. Some think it’s about racism. Others think it’s about overcoming hardships in life. The video seems to support the idea of oil and war and power (the flying dove, the siphoning of gas). But then again, George Wendt of Cheers fame is pushing a car that Pirner is just sitting in during the video, so in the end, who really knows? Maybe it's simply about making sure everybody knows your name.
But did the fact Soul Asylum was going to play this song (along with a few others that I liked) compel me to pay $35 to see Pirner sing it live more than 30 years after he wrote it? The answer is yes.
More information here:
Every Money Song of the Week Ever Published
Thread of the Week
There’s still hope for all of us.
Do you think residents should be paid higher salaries? How would an increase in salary benefit or hinder physicians who are still in training?
[EDITOR'S NOTE: For comments, complaints, suggestions, or plaudits, email Josh Katzowitz at [email protected].]
I’m not sure about this one. Either you’re in favor of free markets or you’re not. Some programs (plastics/ derm) would fill with a salary of zero.
Nobody is in favor of completely unrestricted free markets. You may think you are, but you’re not. A prime example is monopolies like US steel in the late 1800s. The problem with monopolies is that they can artificially restrict supply and demand to increase profits. The fact that residencies could pay $0 sounds a lot like a monopoly doesn’t it?
Just think, dental residents typically PAY for their residency rather than getting paid to work during their specialized training program. (USC orthodontics is about $300K.)
If paying derm and plastics residents $0 sounds like a monopoly, what kind of super monopoly makes residents pay for their training?
I was a dental resident in an orthodontics residency. I got free tuition and was thankful that I only had to borrow living expenses for the 3 years of trainings. I would have loved to have gotten paid $65k a year.
The very best rebuttal to medical residents complaining about their “low salary” will always come from orthodontics residents still paying tuition.
Do free market principles really apply to training comp? I don’t think there’s much competition between programs when it comes to salary. Isn’t it indexed to the standard of living costs in that area by HHS? And more importantly it’s not like anyone is ranking based on salary.
I felt underpaid as a resident but as my practice gets better I feel that way less. We all work like dogs during training but I doubt these centrally planned comp rates are that far off from what our skill sets are worth during that time.
Instead of higher comp during training I think more programs should help with loan payback.
A recent NYT article showed that perceived level of income is far greater than real level. So when the nurses union gets a 40% raise, and the pilots union gets a 40% raise and the longshoremen get a… the list goes on. Residents are not alone in feeling their relative decline to other professionals and blue collar work, I feel it too. America sorts value with money, and when the ratios start to change the value is perceived.
Residents also see hospitals as a business, hiring PAs to do their work with 3 years of graduate school and zero years of residency making almost twice their salary in half their hours.
The hospitals will always hide behind congressional funding but congressional funding is a floor, not a ceiling.
I do worry that a market driven pay structure would clearly favor large profitable hospitals and systems and likely put small, rural, urban hospitals out of business. That should not be the responsibility of residents to shoulder.
My first year tesident’s pay in 1990 was $25K. Second year, it was also $25K as I moved to SC from Florida, having chosen not to finish in OB/GYN and changed to Psychiatry.
The change in hours was from an average of one hundred hours a week down to fifty, essentially doubling my pay per hour. In addition, the hours were low enough and the call infrequent enough (two nights per month) that I was able to moonlight. I took all the moonlighting I could get, and took my wage up to $40K that year, $60K the next year, and $80K the last year.
I wish we had saved some of that money or used it to pay off my $83K of student loans, that had gone up with interest from $67K. We spent it all. The best purchase we made was our wedding and honeymoon, back then, about $10,000 total.
Looks like everything has tripled in the last 30 years. Now residents are paid $75K and the average wedding costs $30K. Medical school debt seems to have tripled also. Did physician income triple?
First year out, I made $135K plus a bonus.
Now, psychiatry job postings are frequently about $290K to $325K, but I’ve seen a few that are triple the 1990 wages, mostly in high COL states.
My best earning years were not from my primary job and the salary there, but from moonlighting weekends and holidays for over a decade in order to finish full time work by age 58.
Residents are always going to be paid poorly based on where that funding comes from, and the “captive” group they represent. But, if one is willing to work “extra”, then you can make more money where moonlighting is allowed.
I met an anesthesiologist this past year who moonlighted for hundreds of thousands of dollars In residency/fellowship, and he just made $800K last year doing locums in his second year out. He should be OK despite his $300K of student loans.
Of course, WCI recommends “living like a resident” for a few more years after training to pay off loans and optimize early retirement contributions. That’s a bitter pill to swallow, but it’s good advice.
In my day, residents got paid $34,000. And I biked to the hospital, uphill both ways through 3 feet of snow. Okay, maybe not in Tucson. But I did bike, even if it was a flat half mile.
We all know pulling yourself up by the toe clips is much easier than by the bootstraps, sir.
Hilarious article. I trained in surgery in the 1990s. We were paid under a dollar an hour. Maybe under a quarter. We barely slept. Residency is not a job. You’re not expected to support a family on it. You’re expected to get the best training you can bec in a short time people are trusting their lives to you. The idea that any medical student would choose a residency based on salary not where he can get the best training is absurd and shows the person to be unserious, a small child incapable of making grown up decisions, and probably someone who doesn’t understand what it means to be a physician.
And a psychiatry resident complaining about residency? He’s kidding right? 9 to 5 and an hour for lunch? The hours of a secretary? I remember most days of residency marveling that I didn’t go to the bathroom and wondering how I did it. Then I remembered I never had an urge. Then I remembered I didn’t eat or drink nearly the whole day and there was nothing to express.
I think I’m the old man shouting at the sky. But there’s certainly a lot less grit today than years past.
“I think I’m the old man shouting at the sky.” See! You got to the point eventually. “I tortured myself so you should too” is a disingenuous argument and a poor one at that.
You were paid “under a dollar an hour” and don’t see the problem?
Massive eye roll at the “back in my day” rant. New grads value work life balance. Get over it.
lol this comment has to be a joke. a 30 year old doctor working 80+ hours a week should certainly be able to house, clothe, and feed their family.
Tough issue. The wages are probably too low. But there isnt much alternative for these folk if they want to practice independently. there is also a big difference between the work of an intern (usually fact gathering) and a senior resident (can do a lot on their own).
One of the quoted statements about residents being a major source of revenue to the hospital isn’t really true. While there is a lot of work done, most of it isn’t bill-able.
It’s still revenue to the hospital. If the residents weren’t being underpaid to do that work, the hospital would have to pay someone real value to do it. i’m not convinced that the reimbursement would cover the difference.
Originally from a top 10 academic center.
I teach and lead a resident team in the ICU, and I have my own private service. When rounding with teaching teams, my workload is tripled. I typically finish around 10pm, and a day rarely goes by without a near miss. On my own, overnights are staffed by 11am and generally I am sitting on my arse until shift change at 7PM.
House officers sometimes do not realize the investment that is going into them to get them to the point where they can one day be functioning independent practitioners. Lecture time, SIM labs, countless residency review committee meetings, curriculum revisions, subsidized conferences…in addition to hours of rounding during etec. etc.. Not to mention the access trainees have to coaching from senior physicians, both professionalism coaching and with respect life, that most people in other walks never benefit from.
We provide mentorship in an environment that ACPs never get with the hopes of producing the future generation of physicians.
We call it training the next generation for a reason. We aren’t compensated for it, and resident’s may be monetarily undercompensated…but we do it for the betterment of our profession and what they get out of these programs hopefully makes them worthy of that coveted doctor’s salary, and white coat, in the future.
I don’t know if trainee salaries should be higher–I survived in a major city a decade ago on 49k and felt like I did just fine, I never wanted for much, Gascon was ‘the best.’ One of my trainee’s just bought a BMW, I drive a 10 yo Subaru. I do not know if there is a monetary amount that will make trainees, or any of us, satisfied.
There is cost to training house officers. Both to them, and to us (increasingly more the latter!). Some of it is has to be monetary.
I mention it in both my quote and column, but maybe I should’ve been more specific. My health system has pediatric and psych NP “fellows” who just graduated from “school” and earn 100K+ and work 40hr/week.
This is not my health system, but I assume they get paid as much as those in mine
https://www.chla.org/blog/hospital-news/new-fellowship-sets-apps-success-clinical-care
Yikes. The article says they don’t have the classroom understanding down yet so they start with classroom and then they don’t have the clinical down yet so they’re followed. I think PA/NP can be great for situations where there is a limited number of bad things to consider such as post op checks where practical concerns can be trained in, or in situations where challenging problems and nonchallenging problems are easily recognized. In my field most things are clearly challenging or not, but there are enough things that look benign but are really bad that a midlevel would miss that we can’t have them in our practice. I appreciate that they can spend more time with patients but there are too many problems that appear on the surface to be benign that mask bad stuff that I’m not comfortable with them. Post op checks yes. Evaluating new problems no.
There are several mistakes of context that the older posters make here that are mostly irrelevant to the question at hand. First, and boomer types do this all the time (just classically, to be fair most humans do), because YOU did something or had to do something doesn’t make it right, proper, correct, or even incorrect. The conveniently leave things out like
1) Training is longer than ever, regarding the number of years and extra requirements, not shorter
2) Money is relative to similar workers, AND inflation/cost of living is a significant change to past years
3) Hospitals have lobby power, not all that dissimilar to universities who overcharge for undergrad and professional schools, because of similar government subsidies or “interference”.
There are some tradeoffs that are positive for more recent residents, like things being easier and whining and claims of abuse being taken more seriously; basically versions of metoo that allow systems closer to the patients running the asylum.
Back to training, though. They charged us more in 3rd year medical school than any other year (maybe 4th? Even more laughable) and the claim was that it costs a lot “to train” the medical students. Really? We just followed residents around and bothered them, then took a shelf exam at the end. Ooooh, the med school had to pay a coordinator for the organization of the “rotation.”
Fast forward to residency. Not all are even at academic places, but the residents work overnight and aren’t paid as much as nurses, but are physicians. The attendings that take academic gigs willingly choose to take that job, a lot of times because they have residents and overnights done by other is a bonus, they get time off, etc. CMS gives the hospitals 150k+ per year per resident. I did the math at a lot of different places – they clearly know they are getting a good arbitrage.
I’d just like to have an honest discussion with proper context, because people leave a lot of things out. I’m not bullish about the medical system for many reasons, and to be honest I don’t really even care, but I do think people should have discussions or arguments in good faith. Doctors 30 years ago in a LOT of specialties made the same or MORE back then and while their training may have been harder, they got a lot more respect, could easily buy houses, had a more traditional society, etc.
I’m just keeping people honest here.
Training is longer than ever? Medical school is still four years. I assume residency is still 3 for medicine, 5 for surgery plus research years if academic, Ob 4 and surgical subspecialties 5? I did see that UCLA added DEI training at their medical school which necessarily decreases real training in medicine and that their board scores subsequently decreased meaningfully. I know current residents – old man yelling at the sky – spend less time learning patient care as compared to 15 y ago because of limitations put on how many hours they can spend in the hospital and so surgeons among all residents come out with less training. As there are only 24 h in a day it seems to me they have much more time available for sleep and relationships.
Old man yelling at the sky I know. I think I’d feel more comfortable with the doctor who didn’t go home until all issues were tucked in rather than the one who says “it’s six o’clock and shifts over. You figure out the problem. Im going home.”
I left IM residency 8.5 years ago. I’m not a boomer. Between my wife and I, we came out with 800k worth of student debt and paid it off in 8 years by limiting costs and moving to an area where we could participate in geographic arbitrage. I’m not oblivious to the financial burdens that are incurred by degrees, possible increases in length of training, changes to the system in terms of respect etc..
I don’t disagree there is waste in the system–middle management etc.. I could write an entire post on how GME programs have been tailored at private hospitals to become a ‘profitable service line.’ I hear you. My wife has been thinking of writing to the WSJ about it for a long time now…
They are real issues, but structural ones. I dont think a marginal increase in trainee salary addresses them! Example given, one of my residents just bought a new BMW on his newly increased stipend I advocated for before the boards last year.
With respect to teaching, show me a trainee that doesn’t triple my workload and I’ll kiss his or her boots (an old reference from the house inserted a bit facetiously). The workload, an IM resident writing the notes that I have to fix, doesn’t make up for rounding and teaching procedures. Seriously, your attendings have a responsibility to pass on the art of medicine and that takes a lot of work. I’m usually working on chalk talks about patients in the morning while the resident’s are rounding. I’m not screwing off, I’m not making money on trainees that I couldn’t be making easier seeing more patients.
What I am saying above is that the apprenticeship works, and there is a lot of money moving in the background to make sure it works. Some of that is reflected in the salary trainees receive. Everyone wants to be paid more, if I paid our house officers as much as the extended practitioners make…soon they would want that and more because they have an MD.
I’ve yet to meet a trainee sleeping in the slums. Living at 50k is a good life lesson in how to budget, makes the future attending salary sweeter, and probably appropriate for someone still in training
There’s not a right answer here but trade offs. I think in general the pay is fine. It’s a hard, busy, and temporary time. The pay is only one part of the “value” of residency. It’s hard to put numbers on the value of learning a skill. Which takes a lot of resources. Not just the academic teachers but support staff, standardization, resources, etc. Similar to college athletics in that the value of a scholarship is more than billed in that you also get access to high level coaches, facilities, etc. That kind of thing costs a lot when you have to pay for it. Also most residents are a net negative early in their training. Apprenticeships were typically unpaid for a reason. The help you provide is the pay for the skill you learn. The big comparison point in a residents favor is the APPs. Especially the usefulness/workload of a new APP vs an experienced resident. The difference can be massive. That said I do think to some degree you “pay” for the credentials of completing a training program. But overall I think upper level residents at longer training programs have the biggest ground to stand on. As an EM resident I felt like it was only 2/3 years where I was actually useful and 3 years is not long. So maybe we just need a more sharply graduated pay scale as the PGY years progress.
I’ve said this before and it’s not always popular, but I think it’s true.
A PGY1 should pay tuition.
A PGY2 should make about what residents are paid.
A PGY3-5 should have a six figure income not too dissimilar from what they will eventually make.
On average, it probably works out to about what residents get paid.
Dr. Dahle, what do you think of a bonus system for house officers? I’ve often thought an wRVU compensation model would be a nice addon at our program’s base salary for residents….whilst costing us minimal capital.
Problem with training now is the volume of patients that trainees don’t see. Delays the maturation process. I always thought this would kill two birds with one dollar bill…there is a lot of psychology behind productivity based models…
(by the way, thanks for getting us out of debt. I owe you)
The downside of a productivity bonus is people start rushing things that shouldn’t be rushed. You get what you incentivize, for better or worse.
point taken.
Given ACGME restrictions, teams having moved from 20 patients a day to 14-16 daily encounters, I can tell you that presently they are not rushed 🙂
Which is another point I would make. Trainees yelled a lot about work hours and patient load. Those were all decreased.
Now, yelling about more pay…I say work for it…dollar cost per patient encounter over training turns out to be a huge pay raise for trainees
JD,
That’s fair regarding the PGY1 and up idea, but you left out my point about how 3rd and 4th year of medical school cost you more often, and are basically a tuition scam like most of university stuff in the US. What’s more, we have a subsidized health care system with printed world reserve currency notes. The grift by hospitals is ridiculous, in general, compared to what physicians receive.
And for the people curious about longer training, and continuous cert (another thing they left out conveniently), there are people who didn’t have to do intern years for some specialties (some even with shorter residencies entirely), there are changes in laws that don’t allow physicians to own certain things (hospital lobby) and PE came into medicine. Dahle can tell you all about that I’m sure, as they’ve made ER, Radiology, ridiculous and even Derm I hear is prey now …
I agree medical school costs too much. Most medical schools don’t actually cost more for MS3 and MS4. I actually think it’s fine for them to cost more during the clinical years, so long as they are organizing and running the rotation with faculty, rather than outsourcing them to community docs like me like so many schools without associated hospitals are doing these days. US DO schools and Caribbean MD schools and even USUHS are all somewhat guilty of this. If the med student has to arrange the rotation and the doc teaching the student isn’t getting paid by the med school, then why in the world is the student paying the school $60K in tuition? That part is a scam for sure.
…most places have interventional pulm training after PCCM training. another 2 years. thing is, you dont get to do EBUS unless you do IP. IP docs take all that bus, forcing longer training
it is happening.
Sure higher pay sounds great. But the ridiculous comments, lack of perspective or entitlement are getting old. No, most hospitals truly do NOT run on residents. Psych residency is not slave labor. And there’s plenty qualified, capable individuals who didn’t match that would happily take that disgraceful plastic surgery residency pay. Along with thousands of others who’d happily take similar pay for the opportunity to be a any type of doctor in the US. But maybe pay should be determined by hours worked, revenue generated or production. Some residents seem to overestimate their value and abilities.
Indeed. For everyone who complains how hard it is and how low the pay is… 1) it’s only a limited period of time. For most under 5-6 y at a time in life when for most, outside responsibilities are minimal. Make hay while the sun shines. And 2) Exactly as you said, if you don’t want to maximize how good training you’re going to get, there are plenty of people just as smart as you who would jump at that opportunity. No one is that important. Not the PGY1. Not the PGY5. Not the fellow. Not the attending. As they say the graveyard is filled with irreplaceable people.
Just a few more points to think about. Academic physicians often make significantly less than private practice docs. A significant reason for this is because our productivity is lower to perform academic tasks, of which training residents is a big part. Hospitals often have to support the salaries of attending physicians to make salaries competitive. If this did not happen, many would not stay in academics because the pay gap would be too much. As an anesthesiologist, I make well into the 6 figures less to be in an academic job than private practice.
And when I spend time to doing any teaching task, my academic department supports me at the pay of anesthesiologist for that time, which is not cheap. What about the program directors? The program director for our residency is 50% non clinical. He generates no revenue when he does this, but this much non clinical time is mandated by the GME office a program the size of our residency. Would there be anyone that would want to do this job if it was not paid as an attending physician?? It is very expensive to train residents. Sure, some hospitals might not be doing a great job with training residents and making money off the residents, but I would bet this is not the case at most reputable academic centers.
Procedural areas are also significantly less efficient with trainees. I can only supervise 2 ORs when I work with residents, compared to 4 when I work with CRNAs. Procedures often take much longer with trainees. If attendings were working without trainees, we could perform significantly more procedures. Sure, there are alot of things residents do that save money for hospitals or make an attending physician life a little easier, but I can assure you, there is also a tremendous cost to a hospital system to train residents. The decrease in productivity in an operating room is significant. And we sacrifice this productivity/efficiency to train residents.
I trained in Ontario in past ten years and residency was unionized across the province. It was quite good, nice sliding scale of pay which I felt was reasonable and included mandatory call stipends of approx $55 for home call or late nights, $110 for in house call. Also they negotiated pay scale and benefits actively. Currently PGY1 is 66k going up to 90k PGY5, although the weak Canadian dollar now makes this less great although it was closer to parity in my time. Also we could moonlight in 3rd year and beyond – I cleared over 150k in my PGY5 which let me graduate debt free (paid off 150k total debt) which felt amazing. The sense I get now working in the US is residents have no voice or power and are expected to be taken advantage, both by hospitals and by the crushing financial situation they get put in. I have financial talks with them and they don’t even know where to begin.