The average household income in the US is currently $55,755 (Census ACS 2016), and the average resident salary is $57,200 (Medscape 2017).

Because those two figures are so close, residents scratch their heads wondering why their cash flow is approaching zero each month.

“Theresa, if other non-medical families can make it, why are we having some trouble?”

Well, I have bad news to bare.

As medical families in training, we have even more expenses than they do.Here are 10 of them.

Ten expenses during medical training

1. Student loans

I’ll start with the biggest one and get it out of the way.

Student loans are residents’ #1 financial worry according to AMA, even over retirement.

Remember that paperwork you signed before you started medical school?  About 6 months after your DrSpouse graduates from medical school, Uncle Sam will start asking you to pay them back via monthly payments at an interest rate that’s higher than most mortgages.

The average medical student loan debt is $189,165 (AAMC October 2016).

2. Boards

There are 3 Board exams you take during residency called Step I, II, and III.

Your DrSpouse takes Step I during second year of medical school, Step II before the end of medical school, and Step III at the end of medical school or start of residency. (This exact timeline varies by specialty.)

Each step exam costs about $900 and study review material around $250-500.

On top of that, there are only a few cities in the US where they’re administered. Don’t live in one of them? He will have to travel.

Three rounds of step exams, prep courses, and travel costs will add up towards $7000 easily.

3. Away and Clinical Rotations

Away and clinical rotations in medical school or residency are great opportunities. They may even be mandatory if your DrSpouse went to a Caribbean or osteopathic school.

If your DrSpouse can’t commute to these rotations daily, you are looking at TWO rents, TWO cars, and TWO living expenses for that entire time.

Serious “dading” during an away rotation in San Diego

4. Residency Interviews

For even a chance to interview at a program, you have to pay an application fee for each one. If your DrSpouse’s step exam scores were low, he should be applying to a ton so he can be sure he will Match.

In 2017, residency applications fees were $99 for up to 10 applications, $13 each from 11-20, $17 each from 21-30, and $26 each for 31 or more (ERAS 2017).

At this point, he hasn’t even left your front desk porch yet and you’re already hundreds or maybe thousands in the hole.

Factor in last-minute travel like flights, car rentals, and hotels.

And when I say last-minute, it’s like this:

”Good morning, Doctor, our interview dates are next Monday and Tuesday. Which do you prefer?”

Aaaand next thing you know, the only flight left available is now $700 when it was $450 last week. Hotel room prices have quadrupled. And all the economy rental cars are taken and the next cheapest available is a luxury sedan.

Suddenly you are $3000-5000 in the hole for the interview season.

5. Fellowship Interviews

If your DrSpouse is thinking fellowship, think of the costs during residency all over again.

On top of that, add another 1-4 years where you will continue to have an income that’s 4-10x less.

6. Childcare

If you are away from family support and your DrSpouse is gone for “80” hours a week, you are a solo parent.

Definition of solo parent:

so·lo par·ent

/ sōlō perənt / (noun): a parent who is married yet does the bulk of parenting.

You need to have babysitters. Even if you are a stay-at-home parent, life throws unexpected curveballs during the roughest rotations.

Here were some real scenarios for us:

  • When we were expecting Baby #3, I wanted my husband to be next to me — holding my hand and helping my breathe — while I delivered. Family was out of town and wouldn’t arrive in time. Kid #1 & Kid #2 weren’t allowed in the room.
  • I took Kid #2 to the ER and had to stay overnight. My husband was working at the time and couldn’t care for our other kids.
  • Some of my husband’s residency programs he interviewed at offered a dinner and invited residents’ spouses. No kids allowed.
Kid #2 not in the ER

I can go on and on. But you get the point. You always need a list of babysitters at hand. (Also pertains to doggy daycare, too.)

7. Services




Those are the words that you and your DrSpouse feel a lot of the time because of the load on both your shoulders.

Outsourcing work could bring you back from the ledge of breakdown. These include a tax preparer, packers/movers, or oil changers.

It’s whatever you can’t stand to do yourself.

After outsourcing, hopefully you would feel more like these instead:


Caught up.


8. Moving

The match requires most of us to move at least 2-5 times during training, some many more times.

I know medical families who spent up towards $10,000 for a cross-country move.

9. Food

Coming up with fast, healthy meals to feed your family every day as a solo parent is no joke.

You buy pre-packaged foods. You eat out at Chick-fil-A. You call for pizza delivery.

Trust me, sometimes spending a little more to have more time elsewhere is exactly what your family needs.

10. Preparing for Attendinghood

We’re not quite at this stage yet ourselves but those who went before us have shared their wisdom.

They told us that just as you see the light when you finish all your training, you aren’t out of the tunnel yet.

You will have to have to pay for licensing, boards, and sometimes COBRA insurance if you are going to have a gap in coverage. You probably want to be attend-ier (yes, that’s a word) and update your work wardrobe, laptop, or cell phone.

Even if some of the costs such as moving will be reimbursed by your employer later, you still have to pay for moving costs up front, and sometimes they take their sweet time (read: months) to reimburse you.

What should you do?

“OK, Theresa, now you’re saying residency is going to suck even more than we thought. What should we do?”

Plan for it.

One of my favorite quotes goes like this:

“Rich People plan for three generations. Poor people plan for Saturday night.” -Gloria Steinem

If you plan, you will not only survive but thrive.

Since you now know you have these expenses coming up, plan now.

What are some ways residency was expensive for you?