As soon as you become a doctor you will be faced with an entire industry encouraging you to take on debt. They rely on the promise of your future high income. And I am not talking about student loans, that is a completely different beast. I am referring to that nice person smiling at you while you ponder whether to buy a brand-new car whose value will melt faster than ice cream under the sun as soon as you leave the dealership. Or perhaps that bank loan officer offering you a “physician loan” to buy a house without a 20 percent down payment or private mortgage insurance (PMI). The list goes on and on.
Because the outside world does not operate like you and me. We are doctors, we are health professionals who put other people’s well-being before our own, working for minimal wage in our twenties to get fair payment for our hard work in our thirties.
The outside world works in a completely different way and one of the convictions in this outside world is that doctors are or will become wealthy. It is an idea that has been fixed in consciousness for generations. But, although it is true that doctors make a lot of money, it doesn’t mean we are rich. And one of the most common reasons is the amount of debt that we take on, and how comfortable we are carrying it for years.
According to Doximity’s 2026 Physician Compensation Report, the average compensation for a doctor in 2025 was $438,269. To put that number into perspective, the U.S. Census Bureau estimated that in 2024 the average household income in the fifth quintile, the top income bracket in the United States, was $315,600. That means the average physician earns roughly $123,000 more than the average American household in the highest income bracket.
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And yet, most of us are not wealthy, and some not even financially stable. One of the main reasons is our debt. Not because we are all irresponsible spenders. The compounding effect of years of financial deprivation, lack of financial education, and our belief in the same societal standards telling us that we will be wealthy no matter what have a lot to do with this situation.
Your net worth is lower than you think
One of the first things most of us should consider when graduating from residency is that our financial net worth is not zero. Think about this. A person who has no debt and no possessions has a net worth of zero. When we graduate from residency owing $200,000, and without major possessions, our financial net worth is negative $200,000. But still, many of us look into buying a new home as soon as we can, considering it an investment or a way to increase our net worth, without fully accounting for the additional debt, interest payments, and expenses we will carry for years to come.
Having a huge boost in your salary as soon as you finish training doesn’t mean much if you incur new high debt without actively addressing the old debt you already had. And although you don’t need to pay an old debt in full before you save enough for goods that make you happy, like a nice car, it is important to be mindful of the fact that interest will erode your income. They will extend payments enough that by the time you finish paying, the principal may have depreciated below the original value of what you bought.
It doesn’t matter if you live in a small rural town where taxes are low, or a buzzing, crowded city where taxes are high; debt should not be standard just because tomorrow’s income will take care of it.
Where the problem starts
For many people, borrowing hundreds of thousands of dollars would be scary. For medical students, it almost feels like part of the curriculum. Tuition. Living expenses. Student loans. Most of this is afforded by assuming debt. So, little by little, debt becomes part of our vocabulary as an acceptable fact, because tomorrow’s income will take care of it. Don’t get me wrong, in many cases tomorrow’s income does take care of it, but at what price? I am not only talking about the financial price but the emotional one as well.
Considering the number of hours we work in residency, our income is low. Residents work up to 80 hours per week, with a salary of about $60,000-$70,000. That is roughly $14-$17 an hour. On an hourly basis, we earn less than many workers keeping the hospital running. And yet, most people in this income range do not assume debt of hundreds of thousands of dollars on a regular basis. But we do. Again, because of the promise of a higher future income.
This debt acceptance mentality follows us way after we finish residency. That is why I advocate for the next generation of doctors to learn about budgeting and wealth management, with the same responsibility and consciousness that we plan the steps of our careers.
Borrowing against the future is not wrong. But it’s important to borrow on future income when you don’t have another choice, or it makes financial sense.
Financial deprivation as a factor
Just like my residents, once I got my first attending salary, something very predictable happened. I started spending more. Some of us spend more abruptly, others for a prolonged time, until some start living above their means. But who can blame us? Delayed gratification may feel unsustainable when the promised future materializes. And little by little, we get pulled into a system targeting the fruit of years of sacrifice.
A solution
So far, I have been describing the waters; now I am going to recommend something. The moment to stop is when your needs are covered and your wants haven’t kicked in yet. If you have the luxury of planning things, create a budget, check your financial net worth (what you owe vs. what you own), pay your debt, invest, and save. Retirement is not light-years away. It will happen tomorrow, before you know it. Many Americans never get that chance. Skip this step, and debt will quietly become part of your lifestyle.
Bruno Casanova is a minimally invasive gynecologic surgeon, department chair, physician leader, and writer in New York City. He is the founder of MD&D (Medicine, Dollars & Decisions), a free educational platform that helps residents, fellows, and early-career physicians navigate their careers, personal finances, and life in medicine.
Drawing on his experience as a practicing surgeon and medical leader, Dr. Casanova recognizes that medical education prepares physicians to care for patients but often offers limited guidance on major career and financial decisions. Through MD&D, he helps bridge that gap by explaining career choices, job offers, employment contracts, physician compensation, relative value units (RVUs), productivity incentives, investing, and personal finances in clear, everyday language.
His writing also explores the human side of medicine, including professional identity, leadership, and the challenge of balancing professional and personal life. Rather than telling physicians what decisions to make, he offers education and perspectives that help them understand their options and make informed choices.
He shares free educational articles and a newsletter, along with podcasts, videos, and The Truth About RVUs Playbook. He is also on Instagram and Doximity.
