Medical residents faced a challenging year in 2021; they were called upon to navigate the front lines of a pandemic while working to complete their medical education, with little increase in compensation.

The average salary for all residents was $64,000, up from $55,400 in 2015, according to the Medscape Residents Salary & Debt Report 2021. Resident salaries saw a slow and steady increase in the past seven years, with 3% annual growth from 2017 to 2020. However, salaries generally remained the same as in 2020. Regardless of residency year, men ($64,200) and women ($63,700) are making about the same salary.

Only 43% of residents reported that they felt fairly compensated with their salaries and benefits, similar to 2020. These numbers are down significantly from 2015, when 62% of residents reported an average sense of fair compensation. For the fifth straight year, residents’ chief reasons for dissatisfaction with their salary are that it did not meet the number of hours worked (87%) and it was not comparable to that of other medical staff such as nurses and physician assistants (81%). About three quarters (74%) reported that their compensation did not reflect the required skill level, and 42% reported that it did not meet the cost of living.

COVID Further Strained Pay Disparity

Two thirds (66%) of residents reported that they spend over 50 hours in a hospital during the work week. More than half of residents report spending 1-10 hours per week on scut work (defined as unskilled tasks), and another one quarter spend 11-20 hours on these duties.

Amelia Breyre, who finished her emergency medicine residency in July 2020, said the pandemic further highlighted pay disparity. “For residents, there is no overtime pay or hazard pay,” said Breyre, now an EM fellow. “Residents cannot simply ‘quit’ when faced with adverse working conditions because then they are foregoing years of educational investment and a career in medicine. This past year in particular, residents have not been fairly compensated when considering the demands made of them.”

Nearly 9 out of 10 (88%) residents have been directly caring for COVID-19 patients in person, a sizable increase from last year’s report (54%). Twenty-one percent of them have done so via telemedicine, another increase (11%) from our 2020 data. Nearly 6 in 10 residents (59%) believe that they should be caring for COVID-19 patients, a percentage that has more than doubled since 2020. Among the 41% who felt that medical students should not care for COVID-19 patients, many cited not risking infection for a learning experience. “They are paying to learn, not get sick,” wrote one respondent.

Cherie Fathy, a fourth-year ophthalmology resident, ended up contracting COVID-19 in December 2020, probably during a patient encounter. “I was fine, thankfully, but knowing that I may have exposed those around me was incredibly anxiety-provoking and I was rife with guilt,” she said. In 2021, 91% of residents caring for COVID-19 patients said they feel safer treating COVID patients in recent months, pointing to the vaccine effect.

Half of residents thought their training prepared them for a pandemic of COVID-19’s magnitude, a 10% increase from 2020. Men (56%) were more likely to feel their training prepared them to handle a pandemic than women (42%).

Medical Debt Drives Future Decision-Making

About one quarter (24%) of residents reported having over $300,000 of medical school debt, with 28% saying they have between $200,000 and $300,000 in debt, and 15% reporting between $100,000 and $200,000 in debt. About one fifth of respondents (22%) reported having no debt at all. Just 11% of residents reported having less than $100,000 of medical school debt, distinct from those who had none. According to the Association of American Medical Colleges, 73% of students graduate with debt , with a median of $200,000 in 2019, similar to our findings.

Heavy medical school debts are driving more students to higher-paying specialties. When asked how influential potential earnings were on their choice of specialty, the most popular answer was “somewhat influential” (36% of all residents). About 4 in 10 (41%) reported that it was either “very” or “extremely” influential. Men were more likely than women to report that potential earnings influenced their choice of specialty. Women were almost twice as likely as men to report that potential earning was “not at all” or “slightly” important to their choice of specialty (32%-women; 18%­­-men). Whereas 14% of women residents reported that potential earnings did not influence their choice at all, only 6% of men answered the same.

Around one fifth of residents (22%) say they anticipate becoming a partner or practice owner, while 27% say they anticipate employment. One in five residents (20%) report wanting to do both, and 31% say they are unsure. Male residents (26%) are more likely to anticipate they will become a partner/practice owner than female residents (17%).

Professional Relationships Remain Good

More than four fifths (84%) of residents rated their overall relationships with their attendings as “good” or “very good.” Only 2% say the relationship is poor or very poor, similar to the 2020 report findings. Responses ranged from “it’s a pleasant working relationship” to “[they] use us to do greater than 90% of the work they are being paid to do.”

About three quarters (77%) of residents gave those same “good” or “very good” ratings to their overall relationships with PAs and nurses, with 20% choosing to say “fair.” Responses ranged from “they are professional and cordial” to “nurses don’t understand that resident medical education has been far greater and more in depth than theirs.” “We are taught in medical school to respect nurses and recognize their expertise and experience,” one respondent wrote. “Nurses, on the other hand, are taught none of this in nursing school.”

This report summarizes how more than 1500 residents in more than 29 specialties feel about this past year with regard to salary, debt, COVID-19, and overall work environment.

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