A Resident's Paycheck

Part of The Training Years. Everything else in this section is about what you'll owe. This page is about what actually lands in your account on the fifteenth, which is a different and much smaller number than the one on the contract.

The short version

A first-year resident earns a median of about $67,000.1 About 23% of that never reaches your account, and after the loan payment leaves it too, roughly $4,000 a month is spendable. That's before you've bought a parking pass.

Five things come out between the contract and the bank, and only one of them is the loan payment everybody worries about.

What comes out, and in what order

The figure at the top of this page is one worked case. The order matters, and it isn't obvious.

1. Pre-tax benefits, first. Your share of the health premium comes out before anything is taxed. That's the one piece of good news in the sequence, because it lowers your taxable income and your payroll tax at the same time. A resident's employee share runs in the neighborhood of $150 a month for single coverage, more for a family, and it varies enormously by program.

2. Payroll tax, 7.65%. Social Security and Medicare, taken off almost every dollar. On this salary it is nearly as large as the federal income tax. It's also the one you can do nothing about.

3. Federal income tax. After the standard deduction, a single resident on $67,000 sits in the 12% bracket, so the marginal rate is 12% and the effective rate is about 8%. On this salary it's the largest single subtraction, just ahead of payroll tax.

4. State income tax. Anywhere from $0 to well over $4,000 on this salary, depending entirely on where you match. Nine states have no income tax at all; the highest-rate states take several thousand. This is a real reason a residency in one state pays more than an identical one in another, and it isn't on any published salary table.

5. The loan payment. On RAP, the only income-driven plan open to new borrowers, a resident on the median stipend pays about $335 a month, which is the figure the AAMC publishes against that same stipend.2 It is the third-largest subtraction, behind both taxes.

What that leaves

Around $4,000 a month in a state with income tax, a few hundred more without. Call it a solid working salary in a low-cost city and a tight one in an expensive one.

It is more money than a lot of readers of this site have ever had at once. If you came from a household where $4,000 a month would have changed everything, residency is the first time the arithmetic tips.

And it's a salary for work that runs sixty to eighty hours a week for three to seven years, at an hourly rate below what a lot of jobs pay for forty. Both of those are true.

The costs that are not on the pay stub

These arrive as lump sums against a salary with no slack in it.

  • Step 3, which most residents take in intern year. Around $955 for the exam itself, before any prep.3
  • State licensure, several hundred dollars and rising, plus fingerprinting and verification fees.
  • Board exam and society fees as you go.
  • Moving, twice for some people: to residency, then to fellowship or a first job.
  • Parking, which at a large hospital is a real monthly line and is very rarely free.
  • A car, in most of the country, because call at 5am isn't a bus problem anyone has solved.
  • Interview travel again, if you're applying to fellowship.

None of these is enormous alone. Together they're the reason a resident with a positive monthly balance still ends the year no further ahead, and the reason an emergency fund matters more in these years than in almost any other.

The three decisions worth making in intern year

You'll be too tired to think about money for most of residency. These three are worth doing once, early, and then leaving alone.

Take the retirement match if there is one. Many programs offer a 403(b) or 401(k) with an employer match. A match is the only place money appears from nowhere, and not taking it is the single most expensive passive decision available to you. If you can only contribute enough to get the match and no more, do exactly that.

Certify your income for repayment, every year, on time. Income-driven repayment recalculates from your reported income. Missing the recertification can throw you onto a standard payment your salary can't carry, and for anyone working toward forgiveness it can cost you qualifying months. Put it in a calendar with a reminder, the same way you would a license renewal.

Residency is when the disability question comes up, whichever way you answer it. Your ability to work is the asset the entire plan rests on, it is worth several million dollars over a career, and during training it is uninsured by default. Coverage is cheaper and easier to qualify for while you're young and healthy, and some policies bought in residency let you increase the benefit later without a new medical exam, which is why the timing matters more here than the product does. If you do look, the definition of disability is the line to read, and own-occupation is the term to know. Insuring the Only Asset You Own covers how these work, what they cost, and why some people decide against them.

What this looks like on the other side

The same five subtractions apply to an attending salary. What changes is the rate, not the shape. The marginal federal bracket is far higher. The Social Security half of payroll tax stops at a wage base, which is the one place the burden falls, while the Medicare half never stops and picks up an extra 0.9% above a threshold. And the state you practice in matters far more in absolute dollars than it did on $67,000.

The practical upshot is the one What Doctors Actually Make argues at length: a headline compensation figure and a lived income are different numbers, and the gap widens as the headline grows. A $348,000 offer and a $348,000 offer in a different state aren't the same job.

What belongs to other pages

Which repayment plan you're on and what RAP changed is Loans, in Plain English and The Personal Finance Crash Course. What the job pays after training, and the five levers that set it, is What Doctors Actually Make. Supporting a household on a trainee income is Being a Breadwinner AND a Premed, which is written for the premed years but is about the same collision.

Three things to remember

  1. About a quarter of the salary never reaches your account, in tax and premiums, and the two taxes are close to the same size. The loan payment is not withheld: it leaves afterwards, and you have to move it yourself.
  2. The loan payment isn't the scary line. On an income-driven plan it's about $335 a month, less than either tax, and the exam fees and the move probably cost you more this year.
  3. The retirement match and the disability question are the two worth thinking about while you still have the energy, because both get harder to act on later and one of them is free money you are otherwise declining.

References

Tax rates, brackets, and the standard deduction are set annually. Exam and licensure fees change. Benefit costs, retirement matches, and stipends are set by each residency program and differ substantially. The worked example above is a single illustrative case with every assumption printed, not an estimate of your own pay, and it is educational information rather than tax advice. Last reviewed: 2026-08-06

Footnotes

  1. Median first-year resident stipend, AAMC Medical Student Education: Debt, Costs, and Loan Repayment Fact Card for the Class of 2025, October 2025. https://store.aamc.org/downloadable/download/sample/sample_id/652/ ↩

  2. Repayment Assistance Plan payments are a percentage of total income on a sliding scale, with unpaid interest waived and a minimum of $50 a month applied to principal. Against the AAMC's median first-year stipend this is about $335 a month, which is the figure used throughout this section. Federal Student Aid, repayment plans: https://studentaid.gov/manage-loans/repayment/plans/income-driven · AAMC financial aid resources: https://students-residents.aamc.org/financial-aid-resources ↩

  3. USMLE Step 3 examination fee, which is set annually and is published by the Federation of State Medical Boards rather than on a standing USMLE fee page. Checked 2026-08-03: the usmle.org/bulletin-information/fees URL this footnote used to carry returns 404. https://www.fsmb.org/step-3/step-3-application-fees/ · Step 3 overview: https://www.usmle.org/step-exams/step-3 ↩