Fairness in Residency
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Fairness in Residency

Training allows 80 hours a week. At that cap the stipend is $16 an hour.

Unfair and dangerous. Safety is hours that protect patients and trainees. Fairness is pay that matches the work. The harm shows up in resident distress, in patient errors, and in the cost of a broken workforce.

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Back view of a resident in a white coat walking down a hospital corridor, face unseen

Training cap

80hr/wk

Federal overtime starts at 40 hr/wk

Overtime pay for residents: none[106]

Data table
Same hours as the bars — readable without color.
ScheduleHours
Training cap80 hr/wk
Federal overtime starts40 hr/wk

Eighty hours. Forty is overtime. Residents get none.

Shifts can run 24 hours in a row, plus up to 4 for handoffs[9]. Federal law pays 1.5 times the regular rate past 40 hours[17], but residents are exempt as professionals in training programs[106].

At the 80-hour cap

$16.39/hr

  • If stipend covered 40 hours$32.77
  • Surgery, 83.1 hours$15.77

PGY-1 mean $68,166 / 52 weeks. 96.9% of hospitals pay the same base.

Data table
Same rates as the bars — readable without color.
ScheduleHourly
At the 80-hour cap$16.39
If stipend covered 40 hours$32.77
Surgery, 83.1 hours$15.77

Divide $68,166 by those hours.

The average first-year stipend was $68,166 in the 2025 national survey[1]. Almost every hospital pays the same base across fields: 96.9% of institutions[2].

Real change, 2019–20 → 2025

−5.2%

Nominal first-year mean rose +19.2%[91]

CPI-U rose +25.7% over the same span (2025 CPI partial-year)[91].

The raise that was a pay cut

One window: 2019–20 to 2025. Inside a shorter AAMC table, 2020 to 2023, the inflation-adjusted stipend fell 8.5%[87].

Residents during training

28%

Same-age people in the public: 8%[25]

Data table
Depression episode rates — same figures as the bars.
GroupRate
Residents during training28%
Same-age people in the public8%

Depression vs the public

45.2% of second-year residents reported at least one burnout symptom[22]. About one in three faced depression or depressive symptoms across 54 studies[24]. Sixteen percent of interns reported suicidal thoughts at least once during intern year[26].

If you are thinking about suicide, call or text 988[27].

“Patients deserve doctors who aren’t exhausted and preoccupied by financial stress.”
— Dr. Shreya Amin, endocrinology fellow, KFF Health News, May 2022. Tired doctors make more mistakes. Stressed doctors leave medicine.

Serious ICU errors

35.9% more

24-hour vs 16-hour schedule

136.0 vs 100.1 per 1,000 patient-days, P<0.001.

Depressed residents made 6.2× as many medication errors per resident-month[72].

Tired doctors make more mistakes. Patients carry the risk.

One ICU trial found 35.9% more serious medical errors on 24-hour schedules[66]. Patients deserve doctors who are not exhausted and preoccupied by money stress[36].

Residents, add your voice.

Join a members-only board for residents, message colleagues in other programs, and get a weekly briefing on the bills, lawsuits and ACGME rules that set your hours and pay. Only your email is required.

Joining is legal and private. This is not a union, and we never tell any program who joined. Know your rights.

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What we propose

  • Fair base pay $68,166 a year is $16.39 an hour at 80 hours. Tie raises to inflation at minimum. Recommendation 1
  • A real limit on hours The 80-hour average as a ceiling, never a target. Every hour counted. Recommendation 2
  • Overtime past 40 hours The missing premium runs about $102,248 a year at 80-hour weeks. Recommendation 3
  • Real tax relief on student debt Deduct the interest residents actually pay, not just the first $2,500. Recommendation 4
  • Clear family supports One clear leave policy per program, plus honest childcare math. Recommendation 5

Unfair. Dangerous.

  1. Bad for residents

    45.2%[22]

    Second-year residents with at least one burnout symptom. About one in three faced depression or depressive symptoms[24]; 16% of interns reported suicidal thoughts during intern year[26].

  2. Bad for patients

    35.9%[66]

    More serious ICU errors on 24-hour schedules. Depressed residents made 6.2× as many medication errors per resident-month[72].

  3. Bad for the system

    $4.6B[59]

    Yearly burnout cost estimate for practicing U.S. physicians — not residents specifically. Conditions that break trainees raise error risk and thin the workforce.

Mental health figures · How hours reach patients

Do one thing now

Open the Recommendations. Copy one proposal. Send it to a lawmaker you trust.

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