Resident Physicians: Overworked and Underpaid
Jul 28
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I was recently asked if I believe residents should have a higher salary.
My answer was "abso-fucking-lutely I do."
For those not in this profession, let's first walk through some terminology of roles and a typical path as a doctor in medicine.
First comes medical school, during which most probably know that one is referred to as a medical student. Medical school lasts four years. The structure in those four years will vary between schools, but my experience was two years of mostly classroom-based learning with practical exams and cadaver lab followed by two years of clinical rotations.
Clinical rotations also vary in structure depending on the school. When I was in school, there were core rotations that everyone completed, though at different sites (hospitals). This often meant moving out of the town or state from the medical school. These core rotations included family medicine, internal medicine, obstetrics and gynecology, pediatrics, and general surgery.
After that, students choose elective rotations. These are usually focused on what the student thinks they want to pursue after medical school. For me, I did many obstetrics and gynecology rotations at different hospitals around the country in preparation for residency.
During these rotations, because we are still medical students, we introduce ourselves as Student Doctor. For me, it was "I'm Student Doctor Nazzaro, working with" whoever the supervising team was at the time.
Residency is specialty training after medical school. We now introduce ourselves as "Doctor" though we function under supervision (less as the years go on). The length of residency varies by specialty, but the shortest are family medicine and pediatrics which are both three years. In obstetrics and gynecology, residency lasts four years.
The training will again vary by institution but residency programs are typically following curriculum outlined by ACGME, a non-profit organization.
Fellowship is something that can come after residency to become even more specialized. It's training into a deeper, more specified niche.
Examples of this in obstetrics and gynecology are:
Gynecology Oncology, cancers of the female reproductive tract
Maternal fetal medicine, high risk obstetrics
Urogynecology, urogenital specialists
Upon graduating medical school, the student becomes a doctor. Full stop.
That means a resident is a resident physician.
What is a typical resident salary?
This will vary depending on the institution and geographical location, but not by much. According to the AMA in an article published in 2022, the average first year resident makes about $60,000.
When I was a fourth year resident (my last year), which was 2019 through 2020, I made about $52,000, so that 60k quote was an over estimate for me.
Perspective
In 2020, according to Lending Tree, the average salary in America was $56,310. The median salary was $41,950. They cite the 41% increase in median American salary between 2013 and 2023.
The median salary for an entry-level BSN nurse is $56,421. That's after finishing a four-year nursing program, typically after high school akin to undergraduate education for doctors or other professions.
Now, the peak salary for nurses is lower than physicians but this can still vary widely depending on additional nursing training and various roles. Nurse anesthetists, for example, have a median salary of $174,790.
This brings me to nurse practitioners. Achieving DNP, a Doctor of Nursing Practice, is usually another four years of training, a length of schooling comparable to doctors though without residency training.
According to the Nursing Process website, the entry level salary is expected to be $85,340. This can quickly increase with more years out of DNP school.
That first year out of DNP school is a comparable level to me as a first year resident and I believe the salary should reflect that.
The question here likely becomes the medical license. Resident physicians are practicing under supervision and do not have their own medical licenses (though you can obtain your own during residency, like I did).
How much does a hospital receive for each resident?
This is difficult to find in exact numbers. I believe it's difficult to find on purpose.
Estimates say that hospitals bring in about $150k per resident. With salary and benefits to each resident estimated around $100k, which again is probably generous based on my fourth year salary, that leaves 50k per resident that the hospital gets.
The program I attended was highly autonomous for residents, meaning it's resident-run (with supervision). You feel lucky enough to have attending physicians allow you to attend their surgery for your experience and learning, but the services are managed by residents. first line.
Attending physicians are paid to be in-house as supervisors but we were in the trenches, the Daniel Paull raises a good point that if residents were to be replaced with physician assistants and/or nurse practitioners, this would result in a net loss to hospitals, likely on the order of millions of dollars.
Why? Because residents are expected to work more than PAs or NPs. In fact, resident hours are capped at 80 hours per week as an average over each month. It was my experience that this was frequently violated but never reported. Replacing one resident would require 1.5 PAs or NPs to cover the hours that a resident works.
Why do I think resident pay should be increased?
Everyone thinks doctors make a lot of money. They certainly can. Even the lowest paid specialties earn more than the median American income. But like most things, it's not quite that simple.
The average debt that a graduating medical school student carries out of med school is over $234,000. This does not include debt from other education. If pre-medical school debt is included, that number reaches $264,000. That's an average.
As a reference, in 1978 the average U.S. medical school debt was $13,500. That's the equivalent of $64,534 in 2024 dollars. It pales in comparison to today's ballooned cost. The average DNP student debt is $184,787.
I personally have a 6.5% interest rate on my medical school student loans. That's on par with the mortgage interest rates in 2024 that left everyone aghast.
With a larger student population than ever before in medical school history, this limits the options for a physician practice after residency. Doctors are increasingly being employed by large hospital organizations, often non-profits, for the added benefit of loan forgiveness programs to counteract this debt. This limits how many physicians are able to join private practices, much less start their own. This is smothering small business and even the peak salary of physicians, where practice ownership can lead to higher overall earnings.
Again, I think the argument here is that the eventual salary of physicians will outpace that of other medical professionals including nurse practitioners. That is nothing more than a justification. It's justification for the astronomical medical school debt and inadequate pay as a resident. In my case, the average American salary in 2020 was more than my fourth year residency salary. I don't see that as a good argument for being underpaid for the work you are doing now as a resident.
Anyone who believes that likely still has the mentality that sacrifice in medicine is king. It's my belief that there's a new generation of physicians, not only among my counterparts but in those on my heels, that eventually the sacrifice has to end and it doesn't actually translate into better patient care.
Not to mention the promise of an eventual salary is now blunted by the overwhelming employed model as opposed to practice ownership and increasing trends of cash-based, membership medicine.
The salary and culture of medical training is long overdue for a mentality shift: from sacrificial to elevated.
Resources
Some of the information contained in this article is the result of my training, medical knowledge,
and personal experience without a specific source to be cited.
Disclaimer: This is not medical advice. This is for educational purposes only. Discuss with your
doctor.
What is a nurse practitioner? (2024, February 9). American Nurses Association Nursing Resource Hub. Retrieved from https://www.nursingworld.org/content-hub/resources/becoming-a-nurse/what-is-nurse-practitioner/
What’s the average salary for a nurse? RN vs BSN salary expectations. (n.d.). Drexel University Online. Retrieved from https://www.online.drexel.edu/online-degrees/nursing-degrees/nursing-salary-guide/index.aspx
Cattanach, J. (2024, May 22). Average salary in US, by state, profession, age, sex and more. LendingTree, LLC. Retrieved from https://www.lendingtree.com/debt-consolidation/average-salary-in-us/
Editorial Staff @ NursingProcess.org. (n.d.). Doctor of Nursing Practice (DNP) salary for 2025. NursingProcess.org. Retrieved from https://www.nursingprocess.org/dnp-salary/
Hanson, M. (2024, August 28). Average medical school debt. EducationData.org. Retrieved from https://educationdata.org/average-medical-school-debt
Murphy, B. (2022, June 1). 6 things medical students should know about physician compensation. American Medical Association. Retrieved from https://www.ama-assn.org/medical-students/specialty-profiles/6-things-medical-students-should-know-about-physician
Ostrowski, J. (2025, June 30). Mortgage rate forecast July 2025. Bankrate (edited by C. Jennings). Retrieved from https://www.bankrate.com/mortgages/mortgage-interest-rates-forecast/
The Highway Team. (2025, February 11). Student loan debt among nurses in the US. Highway. Retrieved from https://www.highwaybenefits.com/post/student-loan-debt-among-nurses-in-the-us
Wilcox, L. (2024, July 1). 2024 physician salary report: incomes increase, but many remain unsatisfied. CHG Management, Inc. Retrieved from https://comphealth.com/resources/physician-salary-report-2024