What’s it really like to train in medicine today? Internal medicine-pediatrics physicians Michael Jerkins, MD, M.Ed and Ned Palmer, MD, MPH dive into the results of the Panacea Financial 2025 Annual Residents and Fellows Survey, which captured the voices of nearly 500 medical trainees across the country. The findings? Over half of respondents reported feeling extremely financially stressed—and the stories behind that number paint a deeper picture of the challenges facing today’s doctors-in-training. 

From rising living costs and ballooning student debt to the emotional weight of working long hours while living paycheck to paycheck, Drs. Jerkins and Palmer explore the toll this financial pressure is taking on the future of medicine. They unpack why student loan stress jumped 26% in just one year, what it means when 1 in 3 trainees wouldn’t choose medicine again, and how instability is hitting certain specialties the hardest. 

What can we learn from the doctors who are still in the thick of it? How does financial stress impact patient care and what could a better training system actually look like? With data, personal insights, and a dose of realism, this episode is a candid look at what’s working, what’s broken, and why meaningful reform matters now more than ever. 

Here are four takeaways from Michael and Ned’s discussion:

1. Financial Stress is Widespread and Deeply Impactful

Over half (53%) of residents and fellows report experiencing severe financial stress, with many living paycheck to paycheck. Michael and Ned discuss how this stress affects not only personal well-being but also clinical performance and patient care. Quotes from survey respondents highlight the emotional toll of juggling long hours with financial insecurity, painting a sobering picture of life in training.

2. Student Loan Uncertainty Fuels Anxiety

Student loan stress has surged from 49% to 75% in just one year. Michael and Ned attribute this to the chaotic and unpredictable nature of federal loan policies, which leave many trainees feeling helpless. Unlike mortgages, student loans lack transparency and support, making it nearly impossible for borrowers to plan their financial futures with confidence.

3. One in Three Wouldn’t Choose Medicine Again

A striking 33% of respondents said they would not choose medicine if given the chance to start over. This “golden handcuffs” phenomenon—where debt locks individuals into a career they no longer want—raises serious concerns about long-term satisfaction and retention in the medical field. Michael and Ned reflect on how systemic issues in training and compensation contribute to this disillusionment.

4. Burnout and Career Preparedness Vary by Specialty

Burnout is highest in OB-GYN, family medicine, general surgery, and pediatrics—fields that are both essential and under strain. Meanwhile, residents in radiology, orthopedics, and emergency medicine report feeling the most prepared for independent practice. Michael and Ned explore possible reasons for these trends, including clinical exposure, training structure, and systemic support.

Transcript

Michael Jerkins:
It has become extremely hard to keep up with managing costs for basic living, let alone any life event or medical emergency. We are basically living paycheck to paycheck and have extremely long work hours.

Welcome back to another episode of The Podcast for Doctors by Doctors. I’m Dr. Michael Jerkins, joined by the one and only Dr. Edwin Palmer.

Ned Palmer:
Dr. Ned Palmer.

MJ:
There he is. Today is a great episode because we’re diving into the results of the Panacea Financial 2025 Resident and Fellow Survey, which was a nationwide look at what doctors in training are really experiencing. We talk about financial stress, burnout, and other insights we learned about career preparedness and things that residents and fellows go through. We’re going to unpack the most revealing stats, react to some of the write-in quotes that we got from our trainees, which I think are especially powerful, and maybe talk about what could or couldn’t change.

Financial Stress in Residency & Fellowship

MJ:
Let’s just get right to it, Dr. Palmer. In our survey of almost 500 residents and fellows, over half reported that they are very financially stressed. Over half.

NP:
How much over half?

MJ:
I think it was like—now you’re really questioning me—I think it’s 53%. Just over half. Are you surprised that number isn’t higher?

NP:
Yeah, I mean, that’s why I was wondering: was it just more than half—like 51% or 99%? And I frankly would have expected it to be the latter, honestly.

MJ:
Well, to be fair, 53% said they were 8 out of 10 stressed. A much higher percentage said they were 6 or 7, but that’s the highest tier.

NP:
I get it, okay. So, 53% of people are what we would consider severe financial stress.

MJ:
That’s right. And here are some quotes. These are from residents and fellows. One says, “It’s hard to focus on learning and patient care when I’m constantly worried about paying rent or covering my loans.” Another says, “I knew it would be hard, but I didn’t realize how much of that hardship would be financial.” And then lastly, “It has become extremely hard to keep up with managing costs for basic living, let alone any life event or medical emergency. We are basically living paycheck to paycheck and have extremely long work hours.”

NP:
Yep. Okay. Yeah, that all seems exactly in line with what I expected. It’s disheartening, of course, that 53% of our colleagues in residency feel that kind of severe financial stress. Not at all surprised. Residency salaries are completely agnostic to inflation, completely agnostic to macroeconomic forces. They’re set lightly by Congress with a rough cost-of-living adjustment. Maybe if you’re in a high-cost-of-living area, you’re at a high-income residency that’s able to give you a small stipend, but outside of a couple of New York and Kaiser programs, you’re beholden to the same rising prices as everyone else right now.

Just for fun, I went back and looked at the same rental properties I lived at in Cleveland when I was in residency. The dollar value for rent is nearly twice what we paid 10 years ago, and the salary is maybe up 30%. So, look—a 30% salary raise in 10 years seems great until you realize what the cost of living has done for everybody.

MJ:
Can I ask where you went to residency in Cleveland?

NP:
That’s actually pretty embarrassing. That was before you and I met in Cincinnati. I did a different residency. That’s why I’m actually so much older than you—this is my third time through residency before it really stuck.

MJ:
Makes sense. Although you and I both trained with someone who did a peds residency, then an anesthesia residency, then a critical care fellowship. So those kinds of people are out there.

NP:
That’s the DIY triple-boarder.

MJ:
Yeah, and his partner is also a triple boarder, which means there are six board certifications between the two of them.

NP:
That’s a hexa-boarder.

MJ:
That’s never been said. I think you made up a term.

NP:
I absolutely did. But more to the point, that’s a devastating fact to find out. I look forward to tracking this survey as it evolves over time because it’s such a great snapshot of what’s happening right now. Really peeling back the layers there—the very first comment you mentioned—none of us want a doctor who’s thinking about where their next paycheck is coming from. Yet we have 150,000 residents across the country who are feeling some amount of financial stress, and more than half of them—more than 75,000—are feeling extreme levels of financial stress, distracted at work due to their financial scenario right now. It’s not a situation anybody would choose. We’re all patients; we’re not all doctors, but we’re all patients in a way. And that just puts us in a terrible place to receive healthcare right now. It’s really, really scary.

MJ:
And you know what’s interesting when you put it that way? In my experience, most people who aren’t doctors or haven’t been through training don’t have a lot of pity for the financial situation of doctors—rightfully so, to a degree. We make a good amount of money when we’re in practice, but there’s this lack of understanding of the debt piece and also the financial situation you’re in while you’re in school and training. It really humanizes it when you read these kinds of quotes. There’s another quote from a resident that says, “The debt makes me feel trapped, like I can’t make any mistakes because I can’t afford to.” So you’re already stressed learning the clinical skills, and then even outside of that, you’re just kind of living on a razor’s edge financially. The implications that has on how you learn and eventually where and how you practice, I think, is tremendous for the rest of us.

NP:
I mean, on the field of medicine—and we’re all impacted by the field of medicine—it’s going to affect the specialties people choose, like you said, where they choose to work, the facilities they choose to work for, whether or not they will or won’t take public payers like Medicare and Medicaid, and whether you can afford to “do the right thing” and take someone on a public insurance plan when reimbursements are so low and debt loads are so high. At a certain point, you have to keep the lights on, put food on your table, and make it to the next paycheck. The concerning part is these stresses start in residency and carry forward. Our residency was four years; I think the median residency time is 4.3 years across all specialties, but obviously some go for five, six, seven, or more years between residency and fellowship. That’s a tremendous amount of time to live under that kind of stress. The chronic stress can’t be overstated—how bad it was. It really is like early aging.

Student Loan Debt Weighs Heavily

MJ:
Yep. And talking about debt—according to the 2025 Resident and Fellow Survey, student loan stress has jumped from 49% to 75% in just one year. What do you think is driving that?

NP:
Uncertainty. Unequivocally, it’s uncertainty. We’re all pretty well-reasoned, scientific-minded people in healthcare, but one thing people look for in their finances is some sense of knowing what tomorrow brings. The debt people are holding, they know they’ll carry it for decades, and the changes we’ve seen in the last five years—initially largely due to COVID—have been completely chaotic. Administrations have shifted student loan policy from one extreme to the next. Multiple cases are at the Supreme Court level. There’s just no understanding of what dollar you owe tomorrow. You can’t forecast how much you owe, whether a forgiveness program you’re paying into will still exist tomorrow. For almost everybody in training, it’s the largest debt they have. Maybe for some, a mortgage is larger, but home buying has certainty for 30 years—you know your payment. With student loans, the chaos creates uncertainty, which drives extreme unhappiness and stress. I had $400,000; you had $300,000 on our shoulders during residency. Not knowing what to do the month after is terrifying, and just waiting for the federal government to mess something up and say, “The bill’s due tomorrow.”

MJ:
Exactly. And the survey talks about how much stress there is with student loans. You mentioned a mortgage—at least with a mortgage, you can call the company and understand how much you owe, when the next bill is due. You can get someone on the phone to answer questions and challenge things if the numbers are wrong. With federal student loans, getting someone to answer the phone is difficult. Getting a correct statement is difficult. Getting an explanation of your IDR plan status is almost impossible. Understanding your status with Public Service Loan Forgiveness is next to impossible. Like you said—it’s the largest debt you have, yet you can’t even access the information you need to plan your whole life around it. That is crazy.

NP:
No, and that’s why that stress level is so extreme—uncertainty is one word, but another is helplessness. There’s $1.7 trillion of student loan debt out there, and there’s no plan for it whatsoever. Every month we’re going in a different direction. There’s no autonomy over what you can do. With a mortgage, you can call, refinance, renegotiate—have a human moment about the debt. With student loans, you’re just carrying a burden by yourself with no clarity about what comes next.

Would Residents & Fellows Choose Medicine Again?

MJ:
So in the 2025 Resident and Fellow Survey, we asked whether someone would choose medicine again. And actually, of those surveyed, one out of three said they would not choose medicine again.

NP:
That hurts. It’s tough to hear. You and I asked each other this question recently when we interviewed each other on this podcast—find it on all your favorite platforms. But we would, and it hurts to hear that a third of people would not. It’s bad for medicine because there’s a concept—I’ll give credit to Dr. Jim Dali, the White Coat Investor; I believe he coined it, I might be wrong—called the “golden handcuffs.”

The debt ties you to the career. So a third of these doctors will graduate from residency wishing they’d gone somewhere else, but now they have three or four hundred thousand dollars of debt. And frankly, what other career can they transition into that pays enough to cover that? You’re probably not going into education, you’re probably not going into food services, you’re probably not going into most other professional careers because you can’t afford to go back to school to be retrained. So you end up with a lot of disaffected and unhappy providers, which is a really unfortunate place for medicine to be in. Do you have comments on that last data point about a third of residents not choosing medicine, MJ?

MJ:
I mean, it stinks.

NP:
I meant from the survey respondents—did they leave comments on why or how?

MJ:
Yes, you can go in and download the survey and see all the comments related to that. I didn’t pull them for this, but the thing I think about is: every system is perfectly designed for the output it produces. And we produce one in three residents and fellows who wish they didn’t do it. Why is that? We’ve already talked about the financial stress and the loans—it’s a complex problem with complex answers, so I don’t want to act like there are simple fix-it actions that could change everything. But at the end of the day, it begs the question: what could we be doing differently in school and training, and what does the future look like in practice to keep people from regretting becoming a doctor? I’d be very interested to know what other occupations have the same rate—like what’s the baseline for other careers where people wish they didn’t do it? Law, finance—pick one.

NP:
Baseline buyer’s remorse in law. I don’t know that. That would be our next survey episode: we’ll talk to a bunch of lawyers about whether they’re happy.

MJ:
That’s a great podcast. Sounds like people would love listening to that. No offense to the attorneys out there.

Which Medical Specialties Feel the Most Burnout?

MJ:
Speaking of not-so-great news, the latest training data also shows that burnout is highest in a few specialties. A few that were highlighted were OB-GYN, family medicine, general surgery, and pediatrics. I don’t know if there’s any correlation, but those are some of the fields most in need—and also some of the most exhausted. Do you see any connection there? Are you surprised by those specialties?

NP:
Yeah, I mean, if I could take a stab at what links all of those—it’s an extrinsic sense of worth. Each one of those specialties is being attacked in one way or another. OB-GYN could be its own podcast about all the changes in the last decade that have severely impacted training. Pediatrics is paid so poorly—it’s a joke how little peds reimburses. And general surgery has had a declining necessity over time. They went from running and leading hospitals to seeing their caseloads chipped away by new medical treatments that reduce the need for surgeries.

Feeling Financially Behind

MJ:
Another quote we got from the Resident and Fellow Survey was from a fifth-year resident who shared an interesting point I related to when I was in training. The quote is: “The most challenging part of residency is feeling financially behind compared to other people my age.”

NP:
Yeah, I distinctly remember this feeling. You leave undergrad and, depending on your path, some people start a professional career at 21, 22, 23 years old. For us, it was four years of med school and four years of residency in Cincinnati, not Cleveland. By that time, we’re 30, 31, 32 before we get our first real adult paycheck. My friends who went straight into tech or professional services or consulting had ten years of experience by then. They’re highly sought-after professionals.

On the first day I was an attending, there was a severe misalignment—like, my gosh, look at everything you’ve been able to do with your adult life so far. You have a house, a family, you’ve built your career—you’re a ten-plus-year professional, and we’re just not there. We spent that decade in training. It really can feel limiting when you look at your future compared to others. It can be disheartening. It’s not, in the end, but it can feel that way.

MJ:
I do think that feeling financially behind your peers can lead to trying to make up for it as soon as you’re done with training. You finally make some money and think, “Oh, now I can catch up and do the vacations, buy the house—all the stuff my friends who’ve been making money for ten or fifteen years are doing.” And that can put doctors in a bad financial spot as well. So there’s that aspect of the stress—comparing yourself to other folks your age while you’re still working eighty hours a week in a hospital and not making very much money.

NP:
Absolutely. Keeping up with the Joneses can put a lot of doctors into worse financial stress than they had in residency.

Practice Ownership Goals

MJ:
Here’s an interesting fact about family medicine residents we picked up in the survey: about 22% of family medicine residents plan to own their own practice. So basically, one in four family medicine residents surveyed said they would own a part of a practice at some point. I was kind of surprised by that—thought it would be less. Are you surprised by that?

NP:
I am surprised. What we’ve seen is a reduction in independent practices over the last ten or fifteen years—a big swing against it. What I hope this means—and this actually gives me a little hope—is that we’re starting to see that swing back a bit. Graduates are looking ahead and saying, “I don’t want to just join another large hospital group. I don’t want to be a W2 cog in a wheel. I want some independence and autonomy. I want to make decisions about my practice and how it’s run.” So I’m going to take that one with hope, MJ.

MJ:
I think if one in four family medicine residents feel like they’ll be an owner or part owner of a practice, that’s great. I also think some of that is probably direct primary care—people see that as an option now, as a way they can practice. There’s good and bad to that, but it gives doctors a path to have more control over how they practice. So maybe that’s part of it too, but I take some hope as well.

NP:
Family Medicine: make us independent again.

Which Specialties Feel Most Prepared for Their Careers?

MJ:
Please, that’s right. In the 2025 Resident and Fellow Survey, a few specialties said they felt the most prepared to practice. The top three were radiology, ortho, and emergency medicine. What do you think it is about those three specialties, Ned, that makes them feel most prepared? Is there anything that could be replicated in other programs? Tough question, isn’t it?

NP:
That’s an incredibly tough question. I had a really good answer—then emergency medicine threw me for a loop.

MJ:
What do you have against emergency medicine?

NP:
I was going to say radiology and orthopedic surgery—both generalists in their own way—are still specialists in their fields. Then emergency medicine is super generalist. Radiology and ortho are organ-specific or imaging-specific, while emergency medicine means you have to know everything. It’s much like family medicine—it’s one of the most diverse areas you need to study and master. So I don’t know if I can tie all three together, but I love that those training programs prepare their residents well enough to step boldly into the world.

MJ:
I don’t know if I have a unified theory either, but I think emergency medicine probably feels that way because of how many clinical reps they get. And maybe I’m biased by where we trained.

NP:
Super busy in our city ER. I get it. Yeah, yeah.

MJ:
Super busy, you see a lot of reps. I know it’s not the same for every program, but that would be my little hypothesis on why that’s the case.

NP:
I like it. It’s almost like I’m going to spend the rest of the episode seeing if there’s a joke answer for that. Like three residents walk into a bar—I don’t know. Maybe an ortho resident…

MJ:
There are a lot of fractures that come in through the ER. So radiology, ortho, and EM work together all the time. Maybe that’s part of it.

NP:
Those three work together a great deal, probably more than most service lines. That’s true.

Is Residency Pay Fair?

MJ:
In our national survey, we asked medical residents and fellows if they thought their pay was fair. We asked them to rate it from 1 to 10—10 being extremely satisfied, 1 being not satisfied at all. It came out smack in the middle at 5.1, a little up from last year. Do you think we’re normalizing low expectations?

NP:
I think we’re normalizing low expectations. People go into it knowing that residency doesn’t pay, so that expectation is already set. It’s also kind of beaten into them—it’s part of the residency asceticism that “it needs to hurt a little bit.” I don’t agree with it. Residents generate a ton of value for health systems and aren’t compensated appropriately. So it hurts me a bit that they don’t have an intrinsically higher sense of value to say, “This is ridiculous—I should be paid more than $49,000 a year in Ohio.” You can’t live off that, not working 80 hours a week. I’d like to see that number actually closer to the unhappy end, because they generate massive value for health systems.

Rapid-Fire Questions

MJ:
All right, I have some rapid-fire quiz questions for you about the amazing Panacea Resident and Fellow Survey of 2025. Some of these we’ve already gone over—so let’s see if you were listening. Ready?

NP:
Okay, this is the toughest quiz.

MJ:
According to the survey, what percent of residents and fellows reported they were very financially stressed?

NP:
53%.

MJ:
Very good—that’s the percentage who are very financially stressed. Of course, many more are stressed in general. You got that one right. Next: outside work decreased in 2025. What do you think the new percentage of residents doing outside work or moonlighting was?

NP:
15%.

MJ:
29%.

NP:
And that’s a decrease from previous years?

MJ:
That’s a decrease. It was higher last year. As you and I know, PGY-1s generally can’t moonlight, so the more advanced you are, the more likely you are to do it. We probably had more fellows in that number, which might have skewed it, but I’m still surprised that one in three were moonlighting.

NP:
Did that line up with our own experience? Would you count internal moonlighting? A lot of our co-residents took extra shifts or night shifts—there was a lot of internal moonlighting versus external, like taking a position at an outside facility. I did that regularly; you did it for one shift.

MJ:
More than one! But if you want to know the answer, Ned, you should download the survey and read it.

NP:
I should. I’d ask you to just send it to me, but I’ll download it.

MJ:
Nope, you have to download it—put in your email, first name, last name… just kidding, I don’t know what we require, but you have to download it. Another question I already asked you: what percent of trainees said they were stressed about student loans?

NP:
Seventy-six percent.

MJ:
Seventy-five percent! Good memory, Dr. Palmer. It’s a depressing stat—three out of four. Interestingly, about 75% of med school grads have debt, so maybe we just got 100% of them saying they’re stressed about it.

NP:
A hundred percent of people with medical school debt have concerns about their debt.

MJ:
Yeah, I get that—I’ve been there. What do you think the average fellow salary was in 2025 according to the survey?

NP:
Eighty thousand?

MJ:
Seventy-nine thousand.

NP:
Okay, good. But a fellow can be anything from a PGY-4 to a PGY-10. The scale kind of curves up. I appreciate our deep PGYs—they do a lot of good work. But $79,000 is hard to live on in most places. In New York, LA, San Francisco—that’s a tough life on that salary.

MJ:
We actually had some quotes from fellows, which I think are interesting. You make more as you progress, but fellows often have more moonlighting opportunities too. One fellow said, “What I like best about fellowship is that we are in a union which protects the rights that we do have.” That opens up a whole different can of worms.

NP:
That warms my Michigan heart. Proud son of a United Auto Worker family—we’re union through and through. I’d like to see more of it in medicine, but that’s probably a bigger topic than this podcast.

MJ:
Probably. I don’t know what the research says about pay in unionized versus non-unionized programs. Do you?

NP:
I don’t think it’s a pay difference, because pay isn’t set locally. It’s more about quality of life, work hours, shift schedules, PTO. Some of the biggest unions are in and around New York—like that groundbreaking NYU case that just unionized recently. It’s mostly about working conditions, similar to traditional union fights—solidarity forever.

MJ:
I figured you’d take it there, so that’s why I asked. It’ll continue—whether people are comfortable with unions or not, that’s the conversation we’re going to have to keep having. At the end of the day, we want a workforce of doctors who aren’t stressed out and can be the best possible versions of themselves. If one out of three residents say they wouldn’t choose medicine again, we’re not doing something right. We should keep innovating and see what works and what doesn’t.

NP:
Yeah, maybe it’s not a union—maybe it’s something else that protects residents at work. But residents get into accidents every year, driving home exhausted. I remember when we were in training, we’d get free cab vouchers that were nearly impossible to get. These are workers harming themselves during training—something needs to change.

MJ:
Did you ever use those cab vouchers?

NP:
Never. Couldn’t figure it out. You had to call three people, go to some hidden basement, call a specific cab company—it was easier to pay $10 for an Uber myself.

MJ:
Yeah, I didn’t even know we had that. I just used Uber—I probably wasn’t listening during that meeting.

NP:
Also true.

MJ:
A hidden basement seems unhelpful.

NP:
Yeah, you’d have to knock on a window: “Do you have the vouchers?” It was like a video game.

MJ:
Sounds like the VA. Was it the VA?

NP:
No, the VA wasn’t even that organized. You had to find one roving person. It really was like a video game.

MJ:
I do love the VA, though. There are things I don’t like everywhere, but I like parts of the VA.

NP:
I miss the VA. Not working at a VA—I just miss the VA. That’s the best way to put it.

MJ:
Yeah. Well, I think we’ve uncovered some interesting points about residents and fellows. All of us should be working to make the system better. I love Panacea’s survey—it really gets a snapshot into the life of a resident and fellow. A lot of other surveys don’t focus on the day-to-day life, especially financial stress. If you want to know more, please go to panaceafinancial.com and download the 2025 Resident and Fellow Survey. It’s great, and as we continue adding more, seeing the trends is really compelling and should inform how we do things better. Dr. Palmer, thank you for joining me on another episode of The Podcast for Doctors, By Doctors.

NP:
Thank you, Dr. Jerkins.

MJ:
Thanks for joining us. You can catch The Podcast for Doctors, By Doctors on Apple, Spotify, YouTube, and all the major podcast platforms. If you enjoyed this episode or learned something, please take a moment to give us a rating and subscribe so you don’t miss an episode. To submit topic suggestions, guest ideas, or questions, reach us at [email protected]. Thanks for listening—and the next time you see a doctor, maybe prescribe them this podcast. See you next time.

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