How to Prepare for Residency: Finances, Studying, and Self-Care

After a challenging journey through medical school and the Match process, you’ve finally made it. You’re about to start residency. Residency comes with its own unique challenges, so here are three key areas to focus on as you prepare: personal finance, studying, and self-care.

1 | Residency Financial Planning: What to Do Before July 1st

Why Doctors Struggle With Money (And How to Avoid It)

First, don’t contribute to the stereotype that doctors are clueless about money.

Before we get into specifics: none of this is financial advice. Everyone’s situation is different, and you should do your own research and speak with a financial professional before making any major decisions. For a deeper dive, Dr. James Dahle’s book White Coat Investor is the go-to resource for physicians navigating money for the first time, and our guide to student loans is a good starting point as well.

You have all the excuses in the world to be bad with money. You spent so much time studying and working to become a doctor that you didn’t have the time to learn about finances, or maybe your excuse for the day is that financial literacy should be taught in grade school.

You could compellingly argue those things, or you could take responsibility, own up to the situation, and educate yourself on finances, which I promise are stupidly simple. If you can get into medical school, or if you can just pass the MCAT, you can certainly nail down finances!

Residency marks a significant change in your career, from a student paying for their education to a resident earning money. While doctors are known for making good money, that isn’t the case during residency; the average salary for a new resident is $68,000.

You’re not going to be balling out, but how you handle your finances will set the course for your financial future.

Here’s the hard part about finances: there are few black-and-whites; it’s a lot of gray area and nuance, but the nuance isn’t that difficult to understand.

How to Handle Student Loans During Residency

Take loans, for instance. As a medical student, you’ve probably picked up your fair share of student loans, and most would tell you to pay them off as soon as possible. In reality, your plan will depend on the kinds of loans you have.

For private student loans, you can refinance these loans to lower the interest rates and have lower monthly payments.

For federal loans, you have a variety of programs you can use. Certain school loans will also have deferment, such that you’re not accruing any interest while in medical school, and some even while you’re in residency. That’s a crazy good deal, and while this is not financial advice and is for informational purposes only, I would personally pay these types of loans as slowly as possible, since inflation is eroding their value without me having to pay a cent.

I tend to get passionate about certain hobbies or topics at a time, and when I was first learning about finance, I got really, really into it. I read half a dozen finance books, read White Coat Investor religiously, etc. I actually emailed Jim Dahle from White Coat Investor about my student loan situation, and he essentially said, “Kevin, I help pediatricians with $300,000 in loans. As a future plastic surgeon with $30,000 in loans, why are you wasting my time?”

For those wondering, I had $30,000 in loans between college and medical school during residency because I earned the only merit-based scholarship UCSD offered that year, which covered all my tuition and most of my living expenses.

Loans are offered on a need basis, so if you’re in greater financial need, you’ll be offered school and government loans prior to needing to dip into private loans. They offered me very favorable school loans that I could choose to take if I wanted to max out the budget.

Let’s say tuition was $35,000 per year, and living expenses were another $25,000 or so. I don’t think these are the exact numbers, but just rough estimates. I actually didn’t feel like I needed the full budget that they allocated, but the terms were incredibly favorable for the school loan, as interest was deferred for both medical school and residency.

Therefore, it made complete sense for me to take out all the loans I could that they offered. This is where the nuance comes in with financial optimization.

Why Residents Need Disability Insurance

Other than your loans, start looking into other financial priorities. One of these should be disability insurance.

The point is that you’ve invested so much time and money into becoming a physician with a high earning potential. If something were to happen to you such that you couldn’t practice, let’s say a surgeon who experiences a hand injury, disability insurance will replace some level of your income in the future.

In residency, I stopped doing any work on my car because I realized if I damaged my fingers or hand in any way, I was going to be SOL. I figured it would be worth it to just pay someone else to do my oil changes and brake fluid flush.

By the way, I actually tried getting disability insurance while in residency, but was denied and not even offered any sort of plan because I’m on biologic medication for my inflammatory bowel disease. Medicine is a physically taxing career and can take a toll on your health. As a healthy, young resident, you can get disability insurance at a significantly lower price compared to an older attending.

Retirement Accounts and Saving on a Resident Salary

I remember reading about retirement savings prior to starting residency and thinking, “Who cares? I don’t need to save money for when I’m 65. I’m 25, and I want to save money for a trip or a new computer or car or something!”

The key here is to still take advantage of retirement accounts, since you save a significant portion. Getting into the habit of saving money and understanding how to invest and save money in a protected Roth IRA are things you should definitely consider as well.

Your finances can also include relocation fees if you’ve matched somewhere else. Make sure you have enough time to properly research how much it will cost to move and how much you’ll be paying for your new place.

Ask your co-residents for help, since they recently went through the same process a year ago and know the area better than you do. Ask your program coordinators as well. Some programs offer moving stipends that can help cover hotel costs until you settle in.

2 | Study Smart: Dos and Don’ts to Prepare for Residency

A lot of people will tell you that you shouldn’t waste your last precious months studying and preparing for the intern year, and I’m one of those people.

If you worked hard in medical school, as most people do, there’s little that’s worth your time and effort at this point. Intern year is such an intense learning experience that the few hours of studying here or there that you’ll do the months leading up to July 1st will be close to meaningless.

Others say that certain things are worth brushing up on, and I will say there is some validity here based on your own strengths, weaknesses, and what you’re going into. Sure, your seniors are available to support you and teach you, but you don’t want to be the overly needy intern either. What you brush up on will depend on your specialty and your weaknesses.

As an internal medicine intern, you could refresh your knowledge of EKGs and fluid management. As a surgical intern, you can take some time to practice suturing techniques, particularly if you don’t feel well-versed in your OR skills.

The key is not to spend too much time preparing. Even then, I feel that in the last couple of weeks leading up to residency, a couple of hours here or there will suffice.

Remember, your intern year is an intense learning experience, but it’s also the start of a stepwise training process. You don’t go straight to leading your own surgeries. You are slowly given more responsibility based on your ability. Some programs also offer a boot camp during their orientation period to help prepare incoming residents for the intern year.

If you’re more study-oriented and are willing to dedicate more time to studying before residency, you can take these few months as an opportunity to study for Step 3. Most take it some time during their intern year.

For many specialties, your score doesn’t really matter, and the most important thing is passing. I did 1/3 of the UWorld questions and ended up with around a 240 on Step 3, which made me feel like I over-studied and wasted time on material that didn’t actually benefit me. Obviously, I quit residency, but even if I stayed, my Step 3 score would be close to meaningless for any fellowship opportunities after plastic surgery residency.

Overall, I’d say enjoy your freedom before residency, because you won’t have an extended period of free time and flexibility for the next few years. Only prepare if you feel it will ease your nerves, or if you feel particularly strongly about wanting to. If you are on the fence or simply don’t want to, I think you’ll be better off not doing any prep.

3 | How to Spend Your Time Before Residency Starts

The past four years of medical school have been physically, mentally, and emotionally draining, and match season doesn’t help. You now have a few months before your life changes significantly, and how you spend them matters more than most people give credit for.

In residency, you’ll be working long hours with little free time. Most programs offer only two to three weeks of vacation during intern year, and requesting time off is less straightforward than in most other professions. The people you care about and the things you love doing are going to take a back seat for a while. That’s just the reality.

So use this time to recharge. Travel if you can. See the people you’ve been neglecting. Do the things that fill you up. I’m a big fan of credit card hacking to make travel more affordable, which means signing up for the right cards at the right time, hitting the welcome bonus spend, and turning that into flights and hotels you’d otherwise never be able to justify on a resident salary. It takes some homework upfront, but it’s worth it, and there’s no better time to learn than when you have a few months of breathing room.

Beyond travel and rest, this is also one of the best windows you’ll ever have to build habits you actually want to carry into residency. I know it’s tempting to think, “I’ll start eating better and exercising consistently once I’m in a routine.” But residency doesn’t give you a routine. It gives you a gauntlet. The habits that survive intern year are the ones that were already automatic before it started.

The mistake most people make is trying to build too many habits at once or waiting until residency begins. Both approaches fail. When you’re post-call and exhausted at 8 pm, you default to whatever is already ingrained. If the habit isn’t there yet, it doesn’t happen.

Use these months to build two or three habits that matter most to you, whether that’s exercise, sleep, cooking, journaling, or anything else, and build them deliberately and consistently until they feel non-negotiable. By July 1st, they should be automatic enough that the chaos of intern year doesn’t knock them out entirely.

Residency is a grind, but you don’t have to go into it running on empty. Go in rested, connected to the people you love, and with the habits already in place that will keep you sane on the other side.