A public advocacy project
Medical training can prepare excellent doctors without breaking them.
Residents are licensed doctors with medical degrees and life-and-death caseloads. Our case rests on two pillars: Safety — hours that protect patients and trainees — and Fairness — pay and supports that match the work.
Two pillars
- Pillar 1: Safety Long shifts measurably raise errors and lapses. One ICU trial found 35.9% more serious medical errors on 24-hour schedules[66]. Distress and error travel together: depressed residents made 6.2 times the medication errors of their peers[72]. We report the mortality evidence honestly too, including where reforms did not move it. Hours and safety evidence · Mental health
- Pillar 2: Fairness The average first-year stipend was $68,166 in the 2025 national survey[1] — $16.39 an hour at the 80-hour cap[7] — while graduates averaged $223,130 in education debt[12]. Medicare pays teaching hospitals about $21.2 billion a year to support training[80]. Pay and fairness evidence · Family supports
The picture in brief
Residents are licensed doctors. They finished college and medical school. They now train in hospitals for three to seven years before independent practice[33].
Training rules allow up to 80 hours of clinical plus school work a week, averaged over four weeks[8]. Shifts can run 24 hours in a row, plus up to 4 more for handoffs[9]. After a 24-hour call, rules require at least 14 hours free[10]. Residents must get at least one day in seven free, averaged over four weeks[11].
The average first-year stipend was $68,166 in the 2025 national survey of 350 teaching institutions covering 114,361 residents and fellows[1]. At the 80-hour limit, that stipend works out to $16.39 an hour[7]. Surgery residents reporting 83.1 hours a week land near $15.77 an hour[5].
Most graduates carry large education debt. The class of 2025 averaged $223,130 in total education debt[12]. About 70% of graduates left school with debt[14]. About 28% owed over $300,000[15].
Strain shows in health data. In a 2018 study of 3,588 second-year residents, 45.2% reported at least one burnout symptom[22]. A review of 54 studies covering over 17,000 residents found about one in three faced depression or depressive symptoms[24].
Sources: AMA / AAMC stipend survey · Resident Insider / Panacea hours · Credible / AAMC debt · CMAJ / JAMA burnout · AMA / JAMA depression. Full list on About + Sources.
What we propose
Our proposals cover fair base pay, a real hours limit, overtime past 40 hours, tax relief on student loan interest, and clearer family supports. Details sit on the Recommendations page.
- 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
Why patients sit at the center
Evidence on hours and safety is mixed, and we report both sides. One ICU trial found 35.9% more serious errors on long schedules[66]. System-level reforms since then have not clearly moved mortality. Handoffs and work compression may absorb gains. The Hours page carries the full synthesis.
One fellow stated the shared goal well: patients deserve doctors who are not exhausted and preoccupied by money stress[36].
“Patients deserve doctors who aren’t exhausted and preoccupied by financial stress.”
Do one thing now
Share one finding from this page with a colleague. Send the Recommendations page to a policymaker you trust.