Internal medicine residents and fellows make up one of the largest groups in graduate medical education. But how do their training experiences stack up against the broader resident and fellow population? Survey data from Panacea Financial’s 2025 Residents & Fellows Survey reveal key differences in salary, debt, financial stress, and career outlook.

Compensation and Workload

Across all specialties, the average annual salary for trainees is $70,021, but internal medicine trainees earn slightly less at $67,981. That gap may seem small on paper, yet it carries weight when coupled with long hours, rising living costs, and significant educational debt. Not surprisingly, satisfaction with compensation is slightly lower among IM trainees—4.9 out of 10 (where 1 was very unsatisfied and 10 was very satisfied), compared to 5.1 overall.

The lower pay coincides with heavier workloads. Internal medicine trainees report working an average of 67.7 hours per week including on-call duties, compared to the overall average of 64 hours. They also perceive their workload as more demanding, rating it 6.4 out of 10 (where 1 was manageable and 10 was overwhelming) versus 6.2 for all trainees.

Despite this, burnout levels are identical across groups: 6.5 out of 10 (where 1 is rarely and 10 is always). This suggests that burnout is less about specialty choice and more reflective of the broader residency experience, where long hours, high responsibility, and modest compensation are common across the board.

Debt and Financial Stress

Debt is one of the most pressing issues facing today’s trainees, and internal medicine physicians-in-training bear an especially heavy burden. On average, IM trainees carry $324,276 in student loan debt—nearly $28,000 more than the overall trainee average of $296,540.

This debt load directly contributes to stress levels. Internal medicine respondents reported an average financial stress rating of 7.6 (where 1 was no stress and 10 was very stressed), slightly higher than the 7.4 average across all residents and fellows.

When asked what contributes most to their financial worries, internal medicine trainees pointed to several factors:

• Student loan debt: 71% (slightly lower than the 75% overall)
• Low income: 50% (vs. 45% overall)
• Non-student loan debt: 44% (vs. 40% overall)
• Growing a family: 40% (vs. 43% overall)
• Unexpected expenses: 26% (vs. 33% overall)

The data reveals that while student loans remain the dominant source of stress, concerns about low income and non-student loan debt are more acute among IM trainees. In their own words, many noted that compensation has not kept pace with inflation or cost-of-living increases, leaving them struggling to manage basic expenses despite long workweeks and advanced degrees.

Read the full report »

Career Plans and Satisfaction

In terms of career goals, internal medicine trainees are similar to the broader trainee population but with a few distinctions. They are slightly less likely to pursue careers in academic medicine (20% vs. 24%) and more likely to seek employment in a hospital or large health system (53% vs. 51%). Interest in practice ownership remains close to the overall average (19% vs. 18%).

Satisfaction scores reveal a more nuanced picture. Internal medicine trainees rate their overall residency or fellowship experience at 7.0 out of 10 (where 1 is not satisfied and 10 is very satisfied), compared to 7.3 for all trainees.

Yet despite lower satisfaction during training, IM trainees express strong commitment to both the field and the profession. Seventy percent say they would choose medicine again, slightly higher than the 68% overall average. Even more striking, 78% would choose internal medicine again, compared to only 70% of all trainees who would select their same specialty. This suggests that although the training years are financially and emotionally taxing, many IM trainees see long-term value in their chosen path.

Voices from Internal Medicine Trainees

Survey comments add depth to the data, highlighting the lived experiences behind the numbers.

On debt:

“I had to do it because I need to complete my training. I have no other option.”

On income:

“With rising cost of living and worsening inflation, the compensation for residents has not gone up accordingly. It has become extremely hard to keep up with managing costs for basic living…we are basically living paycheck to paycheck.”

On career-life balance:

“No options for time off in case you become pregnant. Having to focus only on work during this whole time. Not able to focus on self.”

Other respondents pointed out the challenges of limited moonlighting opportunities, the financial strain of owning a home on a resident’s salary, and the reliance on spousal income just to cover essential expenses. Together, these voices paint a picture of trainees stretched thin by the competing demands of education, financial obligations, and personal life.

Insights on Internal Medicine Trainees

Internal medicine residency is a demanding path, and this survey makes clear that the challenges IM trainees face often extend beyond the hospital or clinic. Compared to their peers across all specialties, they earn less, work longer hours, and carry heavier student loan debt. These factors contribute to lower satisfaction with both compensation and training overall, as well as heightened stress about finances.

And yet, there is a resilience embedded in the responses. Despite long hours and financial strain, a larger share of internal medicine trainees would choose the specialty again compared to the broader trainee population. This loyalty speaks to the sense of purpose and opportunity many find in internal medicine, even when the short-term realities are difficult.

The data also reveal systemic issues that extend across medical education: compensation not keeping pace with inflation, inconsistent moonlighting opportunities, and limited support for life events like pregnancy or family building during training. Addressing these areas could have an outsized impact not only on internal medicine trainees but on all physicians-in-training.

No matter your demographics, residency and fellowship training will have its challenges. We hope that this data will provide insight into this step of your past, current or future career. Find the full survey report here.