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Match Day feels like a major life win, and in many ways, it is. You’ve landed your residency. You’re finally done with med school. You’re about to get paid for doing the job you trained for. And you’re finally an MD.
But most PGY-1s aren’t prepared for how much worse their financial situation is about to get. It gets worse.
Much worse.
We’re talking about debit-card-declined, wish-I-could-drive-Uber level of broke.
It’s true; we talked to three doctors about their first year of residency. Beyond sleeplessness and new-doctor nerves, many common themes emerge.
Here are 10 harsh money lessons that every newly minted MD learns, often the hard way.
1. It’s not the end of the world if you don’t get your first choice
Every med student wants their first choice, but in the long run, your match may not matter all that much.
Dr. Nirav Shah, M.D., neurologist and Physician on FIRE owner, matched into his top choice at the University of Miami in 2011.
Nirav had targeted a large city with a patient population that matched his language skills and clinical interests. But other matches would still have delivered a great experience, says Nirav. “I just wanted to break away from Indiana.”
Dr. Aanika Warner, M.D., a physician and admissions expert at Inspira Advantage, also matched her first choice at Johns Hopkins in 2021. This allowed her to stay in Baltimore, where she already had a home and support systems in place.
But sometimes you land your eighth choice, like Dr. Thomas Pontinen, M.D., a double board-certified anesthesiologist and co-founder of Midwest Anesthesia and Pain Specialists (MAPS).
He was placed at Einstein Medical Center in Philadelphia back in 2008, and that unlikely match ended up reshaping his entire career. Thomas started in general surgery, but quickly realized it wasn’t the right fit. By his second year, he switched specialties to anesthesiology in a pivot he calls “the best decision of my life.”
Your Match Day outcome doesn’t lock you into a lifetime path. Careers evolve, and specialties can change.
2. You’ll start your new “job” in the hole
Between Match Day and Day 1, you’ll hemorrhage a lot of cash. You’ll need to pay the first month’s rent, security deposit, utility hookups, car shipping, licensing applications, new work clothes, medical gear, and furniture.
And depending on where you match, you may need to relocate across the country.
Nirav describes showing up in Miami with only a few days to spare before his residency began. He scrambled to find an apartment and bought furniture one piece at a time, quickly racking up the bills as he settled in.
“You don’t get your first paycheck until much later,” he said. A lot of people take on major credit card debt or private loans to fund their new setup.
3. Virtual interviews can save you thousands
If you’re starting residency in the post-pandemic world, count yourself lucky. You saved a bundle as virtual interviews have become the norm for most specialties.
In 2021, Aanika estimates she spent around $300 total, mainly on a suit, headshots, and lights for a decent virtual interview setup.
That’s a far cry from what previous cohorts faced. Nirav flew to 10–15 interviews, paid for hotels and rental cars, and recalls many peers taking out $10K-plus in loans to cover travel expenses.
Similarly, Thomas estimates that placement interviews cost him about $5,000.
Thanks to the shift toward virtual, most candidates today can expect to spend somewhere between $400 and $7,000 total (depending on specialty), according to AAMC estimates. The median figure is $3,000.
While early interview rounds are often virtual, some travel is often required. Surgical subspecialties, rural programs, or highly competitive fields may require in-person interviews or optional “second look” visits, each one heaping on costs.
4. You may need loans to subsidize your paycheck
After years of living like a student, a PGY-1 salary may feel like big money.
Aanika earned about $68,000 during her first year of residency and says that $65,000–$73,000 is a normal range for Maryland residents.
But taxes, health insurance premiums, union dues, and retirement contributions all take a big bite out of your earnings.
Nirav remembers pocketing about $1,400 per paycheck after deductions during his residency; half of that went straight to rent. And that was back in 2011, before rent inflation took off.
In today’s high-cost cities like San Francisco, New York, or Boston, many residents watch 50–60% of their paycheck disappear into rent before utilities, parking, groceries, or student loan payments even enter the picture.
Technically, you’re earning money. But you may need roommates, private loans, or the Bank of Mom and Dad to keep your secondhand IKEA lifestyle afloat.
5. Your first financial gut punch might happen on a date
There’s broke, and then there’s PGY-1 broke. Thomas shared a moment that sums it up perfectly. “I went on a date the first week I was there, and my card was declined. I had to ask her to pay for lunch.”
You may be a doctor now, but don’t expect your finances to keep pace with your elevated job title, especially in those first few months when your relocation costs, licensing fees, and delayed paychecks hit all at once.
Triple-check your account balance before you go out. Your date may think you’re a pathological liar, escapading in a white doctor coat if your Visa can’t withstand a $40 hit. A fellow PGY-1 might be more sympathetic – but equally unable to pay. Date with caution.
6. Get a roommate before you need one
When you’re earning barely enough to cover rent, splitting costs becomes essential. Roommates aren’t just for undergrads. They’re often the smartest way for PGY-1 residents to make ends meet.
Thomas lucked out by splitting a two-bedroom apartment with a friend who also matched in Philadelphia.
Nirav initially lived solo for convenience, but eventually brought in roommates (other residents and then a physical therapy student) to help cover housing costs. In many cities, even shared housing still costs thousands of dollars each month.
Whether it’s a roommate app or an old med school classmate, sharing rent and utilities is often a survival necessity. Learn to love other people’s dirty dishes.
7. You’ll eat to numb the exhaustion
The physical exhaustion of residency is a big wallet drain. Long shifts, overnight calls, and 30-hour rotations mean skipped meals at home, fast food runs, constant caffeine top-ups, and convenience spending that adds up quickly.
Thomas said exhaustion made him crave simple comfort whenever off-shift, often leading to takeout, delivery apps, or buying whatever helped him function through the next call schedule.
If you’re too tired to cook, you’re probably also too tired to budget or to think strategically about spending. This exhaustion leads to financial leaks that compound as the year wears on.
When you do have a spare window of time, meal prep healthy meals — as many as you can fit in your freezer. Eating chicken and brown rice when you’re sleep deprived is a lot better than a 64-ounce cherry Slurpee and a footlong cheesy burrito.
8. You may need to exercise away the exhaustion
Amid the chaos, there’s still time for exercise. Most buildings and hospitals will have a gym, and many residents need an adrenaline rush to handle the workload.
Nirav said he used exercise to “power through the exhaustion.” He remembers going for runs “just to wake up” because he was so tired after a long night of calls.
So if you’re worried about fatigue, make sure you always know where the nearest treadmill is.
9. You can “sort of” moonlight
It’s tempting to think you’ll pick up extra shifts to pad your income if things get tight. But for most PGY-1s, moonlighting is strictly limited if not outright banned.
Nirav was allowed to moonlight later in residency as a senior, occasionally foregoing sleep to work overnight ICU shifts for around $700 per night. But during PGY-1, other outside work was off the table. Most programs enforce strict limits to ensure residents focus fully on clinical training, especially during their first year.
“I didn’t know freelancing was a thing. I would have tried something if I knew it was a thing,” says Nirav. “Upwork and Uber all came out while I was in residency.”
Driving others around town or assembling IKEA furniture might be hard to balance, but says Nirav, “If you can handle it, do it.”
He notes that writing gigs could be a great hustle for residents who are sitting around in the hospital’s on-call room, and it’s one he wishes he could have done.
10. You’ll wish you saved more
Every doctor we interviewed revealed they wish they had saved more.
It may seem counterintuitive, given how tight budgets already are. But the doctors we talked to all admit that they could have made an effort to set aside something.
Looking back, Nirav says, “If I knew more then, I would have tried to have a lot more saved. When you’re a student, the numbers are all abstract.”
Aanika, who started residency with less financial strain, still said she wishes she had tracked expenses more carefully and started saving for retirement.
While saving for retirement during career training may seem laughable, according to the AMA, many hospital employers offer residents retirement benefits with salary matches of 3–6% and some specialties are especially generous. Among radiology residencies, for example, 76.8% offer access to an employer-sponsored retirement plan.
You don’t want to leave that free money on the table. Saving even $15,000 during residency could grow into a major nest egg.
Left untouched, that $15,000 could double every 9 years (assuming an 8% return and the Rule of 72). That means you’d have $120,000 after 27 years, or a 700% ROI. And in 54 years, you’d have $1 million, or a 6,567% return.
Yes, you can earn more money and invest more later. But you can never recover this lost head-start. Time is a more precious resource than salary because once it’s gone, you can’t get back the power of early compounding
PGY-1 is brutal, but strangely, you might miss it one day
Residency is hard because it’s supposed to be hard. You’re still learning medicine, and real patients depend on you, even when you’re exhausted, overwhelmed, or don’t particularly feel like a “real” doctor.
Thomas notes, “Med school was fun and easy. Becoming a doctor isn’t hard because of med school; it’s because of residency. Just being responsible for someone else’s life when you’re overworked and tired at the end of a 30-hour shift, and someone dies, having to deal with that emotionally is something no other job has to do on a consistent basis.”
But within that brutal learning curve is something most doctors only fully appreciate later: growth, camaraderie, and an accelerated pace of learning.
Dr. Aanika Warner still recalls what her program director told her on her first day. “Your medical schools have ensured you know the basic background knowledge and you are capable to learn, we will teach you the rest.”
PGY-1 can feel like an overwhelming mess of chaos and indecision, but you’ll surprise yourself with how quickly you adapt, how much you absorb, and how capable you become.
Enjoy the moment. You will never again work harder or for less money. The medicine will get easier and the money will get better, but you will never again have the chance to evolve as quickly – professionally, personally, or financially – within a single year.
