Congratulations on moving on to the next stage in your professional career! This article is part of a series called "Transitioning to residency," which is designed to help new interns and subinterns adjust to their new responsibilities. The other articles in this series include:
- “Communication during residency”
- “Daily life of the intern”
- “Navigating stressful situations in residency”
- “Logistics of US health care and hospitals”
This article focuses on moving to a new area, managing student loans, establishing a budget during residency, explaining employer benefits and federal protections, and tips for self-care (managing your weekends, sleep, and mental health considerations).
Prior to starting residency
Residency is an intense period of skill development and personal growth. It will likely be one of the most demanding and rewarding stages in your career. Planning ahead is a vital skill that will help you within your professional life and outside of it. Here are some ideas on how you might approach your personal time before duty hours, night shifts, and the very steep learning curve of your intern year begin to encroach upon it.
- If you can, take some time off before residency. You may wish to:
- Pick up a new hobby.
- Spend time with friends and family.
- Find housing and address the logistics of moving: e.g., decide on a location, whether to rent or buy, whether to hire movers
- Come up with a financial plan: e.g., debt management, loan repayment, budgeting
- Understand employee benefits.
- Take care of yourself.
- If you're starting residency in a new area, give yourself some time to explore.
- Establish care with a primary physician and dentist before starting residency.
- Think about how you would like to spend your time away from the hospital. Consider strategies for:
- Keeping up your social life
- Lightening your load outside of work
- Learn how to prevent and combat fatigue.
- Establish a study plan.
- Know how to recognize when your stress level and worries have become unhealthy.
Moving to a new area
Research and planning
Start planning your move soon after Match Day.
- Research the housing market in the new area.
- Determine when housing supply and demand are highest during the year.
- Explore the housing costs in the area and neighboring areas.
- Consider whether you will be renting or buying.
- Consider hiring a realtor.
- Connect with people at your future institution to learn about the most popular locations to live.
- Get in touch with trainees and administrators in your residency program as well as any contacts who have moved to the new area.
- Senior residents may be vacating their housing.
- Research transportation options in the new area.
- Public transportation: Determine the hours of operation.
- Personal transportation, e.g., cars and bicycles: Determine the ease and availability of parking both at your housing and at your workplace.
- Visit the area to see some potential housing options.
- Prepare for the actual move.
- Set aside at least 1–2 weeks to arrive and get situated (if possible).
- Consider whether you will be using movers or moving your belongings yourself.
- Decide what new items you need to purchase.
Consider the following when selecting a place to live:
- Hospital proximity
- Access to public transportation or parking
- Whether you will be living alone or with a partner or roommate
- Pet policies (if applicable)
- Access to an in-unit or in-building washing machine and/or dryer
Take some time after the move to settle into your new area.
- Take care of logistical details such as:
- Getting a new driver's license/ID
- Changing your address
- Forwarding your mail
- Find nearby dry cleaners, pharmacies, grocery stores, banks/ATM machines, and hair salons/barbershops.
- Explore local dining, parks, museums, and activities.
- Get together with some of your new co-residents! Many of them will also be new to the area and happy to meet outside of work.
Timeline for moving to a new area
3 months before the start of residency
- Research the housing market and contact people who live in your new area.
- Narrow your housing search to a few neighborhoods or neighboring towns.
1–2 months before the start of residency
- Visit the new area to explore potential housing options.
- Find housing and establish a move-in date.
- Start to prepare your belongings for the move, and decide on how you will move your belongings.
1–2 weeks before the start of residency
- Move to your new place!
- Take some time to explore your new area before starting work.
Debt and financial management
Public Service Loan Forgiveness (PSLF) Program: 
In a nutshell: The remaining balance on your federal Direct Loans is forgiven, tax-free, after you make 120 qualifying monthly payments on the loans under a qualifying repayment plan, while employed full-time by a qualifying employer.
- Eligible loans: Only federal Direct Loans are eligible for the program.
- Qualifying payments: You must make payments that cover 120 separate monthly obligations.
- Qualifying repayment plan: An income-driven repayment (IDR) plan
- Qualifying employers
- Government employers
- Nonprofit organization that is tax-exempt under 501(c)(3)
- Nonprofit organization that is not tax-exempt under 501(c)(3), but provides a qualifying public service
- If you are considering PSLF, you should consolidate your loans (see below).
- When you start residency, ask your residency program coordinator to complete the PSLF form to certify your employment (see “Tips & links”). You should aim to submit the PSLF form annually, or when you change employers.
- The National Health Service Corps (NHSC) Loan Repayment Program: a possible alternative to PSLF. In exchange for loan repayment, you serve at least two years of service at an NHSC-approved site in a Health Professional Shortage Area (HPSA). 
Federal loan consolidation 
Consolidation: refers to the process of combining one or more federal student loans into one new federal Direct Consolidation Loan.
- It is done via an online application.
- It is free of charge.
- You will select a repayment plan (see below) at the time of consolidation.
Consequences of consolidation
- Your new interest rate is calculated as the weighted average of all the interest rates on the loans you are consolidating, rounded up the nearest eighth of a percent. This new rate is fixed and won't increase over time.
- Federal loans that otherwise would not be eligible for PSLF (e.g., loans through the Disadvantaged Student program (LDS loans) and the Federal Perkins Loan Program) may become eligible if they are consolidated into a Direct Consolidation Loan.
- Any previous qualifying PSLF payments made on the loans being consolidated are nullified.
- You will only have to make one monthly loan payment.
- You begin repayment immediately, meaning that the 6-month grace period that your loans would otherwise enter after graduation is removed, and any unpaid interest is added to the balance of the loan (capitalization). Beginning repayment immediately is advantageous to you if you plan to do PSLF!
Income-driven repayment (IDR) plans 
Description and requirement
- IDR plans are a type of loan forgiveness program, since the balance of the loan is forgiven after a certain number of years (depending on the type of plan).
- You must recertify your income and family size yearly for your repayment amount to be calculated.
- You will usually end up paying more over time with an IDR plan than with the Standard Repayment Plan.
Options: There are a variety of IDR plans, but most people will choose between the following:
- Pay As You Earn (PAYE) Repayment Plan
- The balance of the loan is forgiven after 20 years.
- If you're married but file taxes separately, your spouse's income will not be considered in the payment calculation.
- Your repayments are capped at the amount you would pay under the 10-year Standard Repayment Plan, no matter how much your income increases.
- Revised Pay As You Earn (REPAYE) Repayment Plan
- The balance of the loan is forgiven after 25 years.
- If you're married, your spouse's income is considered in the calculation for payments.
- There is no cap on your repayments, so the amount may increase significantly if your income increases.
- If your monthly payment doesn't cover the monthly interest charges on your loan, the government will pay 50% of the amount of interest that's not covered.
- Pay As You Earn (PAYE) Repayment Plan
Federal loan deferment and forbearance 
Description: A temporary postponement or reduction in loan payments
- Deferment: interest on your loan balance does NOT accrue
- Forbearance: interest on your loan balance DOES accrue
- Most residents are not eligible for deferment.
- Medical residents are eligible to apply for a mandatory forbearance.
- Types of federal loans eligible for forbearance: Direct Loans, Federal Family Education Loan (FFEL) loans, and Perkins loans
- You will usually need to reapply every 12 months.
- Capitalization of interest is a significant drawback to opting for forbearance.
- Refers to the process of taking out a new loan to pay off a previous loan, which is typically done when the new loan offers a lower interest rate
- Refinancing a federal loan will turn your federal loan into a private loan, which makes you no longer eligible for PSLF or any of the IDR plans!
- Consider refinancing if:
- You have private loans with high interest rates
- You don't need PSLF or another federal loan forgiveness program
- Refinancing requires very good credit, so you may need to wait to refinance until after residency.
- Consider refinancing if:
Student loan interest is deductible on taxes, even if you claim the standard deduction.
The AAMC offers fact sheets for residents on loan repayment and budgeting (see “Tips & links”).
The 50/30/20 budget rule is simple and popular: 
- Spend 50% of your monthly income on needs (i.e., rent, utilities, food, health insurance).
- Spend 30% of your monthly income on “wants” (everything else).
- Put 20% of your monthly income towards financial goals (i.e., savings and debt repayments).
A tracking tool is usually the best way of staying on top of your budget. Some helpful budgeting tools include:
- Mint.com (free)
- You Need a Budget, known as “YNAB” ($84 annual fee)
Plan ahead for the big expenses of residency:
- USMLE Step 3 exam fee
- Medical license application fee
- Study materials
- Board review preparation course fee (if you plan on taking one)
- Board exam application fee
One of your first financial goals should be to establish an emergency savings fund that could cover at least 3 months of expenses.
Benefits and protections
The American Academy of Graduate Medical Education (ACGME) requires that accredited residency programs offer certain benefits to medical residents. Some of these benefits are explained below.
- Policies differ between health insurance providers, states, and regions within a state; there are often designated employees at insurance companies who are available to explain your coverage.
- Vision and dental coverage may not be included and often have to be purchased as supplemental policies.
- See “Health insurance basics” and “Health care payment models and health insurance plans” to better understand your plans.
Consolidated Omnibus Budget Reconciliation Act (COBRA): designed to cover gaps in health insurance coverage while individuals are between jobs (e.g., job loss, changing jobs, reduction in hours) by extending medical coverage that was provided through the previous employer's health plan
- Covers certain qualifying events for the employee and dependents
- More expensive than the premiums you were responsible for paying when employed
- Lasts 18–36 months
- Has an enrollment window
- You may have a waiting period before you can enroll.
- You must enroll within 60 days of the qualifying event.
- Retroactively covers the period starting the day after you lost prior coverage
Life insurance: a contract that establishes that an insurer will pay a certain amount if the insured person dies
- Many residency programs provide a life insurance policy for a specified amount of coverage.
- Life insurance may partially/completely cover any student loan amounts that aren't forgiven upon death.
- Federal Direct Loans and Parent PLUS Loans are forgiven if the insured dies, but not if the loans have been refinanced (have become private).
- Only some private loans are forgiven upon the death of the insured.
- Having a cosigner on loans can often lower your interest rate, but the cosigner may be responsible for paying off any remaining debt should the insured die.
- In community property states, your spouse may be responsible for repaying your student loans if you die if they were taken out while you were married.
Disability insurance: a contract that establishes protections against income loss in the event of a disability that prevents work
- Types of disability insurance
- Long-term disability insurance: income lost as the result of a prolonged inability work and loss of income
- Short-term disability insurance: income lost as the result of a temporary inability to work and loss of income; e.g., 3 months, 6 months, or a year
- Residency programs may provide basic disability insurance or offer coverage for a fee that is deducted from your paycheck.
- Unexpected accidents, injuries, and illnesses do occur. Disability insurance offers a safety net to protect against income loss so that you can continue to pay your living expenses: e.g., rent/mortgage, health insurance, student loans (which are not forgiven if you are disabled).
- Pays ∼ 60–80% of your after-tax income prior to becoming disabled
- Types of disability insurance
Federal Medical Leave Act (FMLA)
Description: a federal law that provides job protection should an employee need to leave work for up to 12 weeks
- Guarantees the same or an equivalent job upon your return from FMLA leave
- Only applicable for certain qualifying events
- The employee must meet eligibility rules.
- Only certain employers must abide by FMLA rules.
- The leave is unpaid.
Implications for residents
- Keep in mind that per ACGME regulations, you may have to make up missed rotations either by replacing electives and/or extending your residency.
- Some employers may require that you use any accrued sick days and vacation days during the covered FMLA time period.
- Some plans allow you to borrow against your savings account as a loan option.
- Taxes are still owed on the money, whether at the time of your contribution or at the time of withdrawal.
- Contributions and accumulated gains can be withdrawn after 59 ½ years of age.
- An employee specifies how much money their employer deducts from their income each month; these contributions are then invested and hopefully accumulate gains.
- The earlier you start investing in a retirement account, the longer it has to compound gains.
- Try to maximize your contributions.
- See if your employer offers a match.
- See “Tips and links” for more information.
Examples of qualified tax-advantaged retirement plans:
- 401(k): provided by for-profit companies
- 403(b): provided by nonprofit companies
- Options that may be added to a 401(k) or a 403(b) plan:
- Traditional option (pretax option): You do not pay taxes on the money you contribute to your investment account, but rather when you withdraw the money.
- Roth options (after-tax option): You pay taxes on your contributions before you invest them and do not have to pay when you withdraw the money.
To provide the best care for your patients, you need to take care of yourself first.
Basic human needs 
- Water and food
- Pack a water bottle and healthy snacks (e.g., protein bars, trail mix, peanut butter sandwiches, crackers).
- Know where to get food and water at work: e.g., resident lounges, vending machines, cafeterias, gift shops
- Clothing: Wear comfortable clothes and shoes. Bring a jacket if work areas are cold.
- Sleep: Prevent and reduce the effects of fatigue by practicing good sleep habits, especially on night shifts and call shifts. Consider taking a blanket and packing an overnight bag.
- Safety and shelter: It is important that you feel safe from perceived threats in both your work and home environments. See “Stressful scenarios.”
- Health: Establish care with a primary care physician and dentist prior to starting residency.
- Water and food
- Having a community and sense of belonging: Socialize and maintain relationships with friends and family.
- Mental health: Educate yourself on ways to prevent, recognize, and combat the negative psychological effects residency may have on you; see “Mental health considerations” below.
- Feeling accomplished: Keep a running list of successes to remind you how you are growing both personally and professionally.
- Achieve your potential.
- Focus on why you went into medicine and frame your learning experiences as ways to achieve those goals.
- Establish a study plan.
- Have creative releases: Find new fun activities that help you to continue to grow as a person. Your whole life doesn't have to be put on hold during residency.
- Achieve your potential.
- Have dedicated time for destressing when you get home: e.g., set a timer for 30 minutes.
- Consider a routine involving one of the following:
- Hot shower/bath and changing into fresh clothes
- Listening to music
- Reading for fun
- Protect your free time.
- Try to avoid working outside of the hospital.
- Smartphones provide easy access to your EMR. Try not to check laboratory results at night.
Weekends: You are guaranteed 1 day off per week averaged over 4 weeks.
- Have a plan for your day off (even if the plan is to do nothing).
- Be realistic about what you can accomplish in one day.
- Plan activities that recharge you physically and mentally.
- Incorporate time for relaxation and to catch up on sleep (nap or go to bed earlier).
- Find residents who live near you to make socializing easier.
- Get together after work near the hospital.
- Follow a local area event calendar for events in your area.
- Maintain relationships with friends and family outside of residency.
- Share in other's life experiences.
Lighten your load
Consider getting outside assistance:
- Housekeeping services
- Wash, dry, fold laundry services
- Dry cleaner that does pickups or has an after-hours drop-box
- Pet walker or neighbor who can help check on your pets during long shifts
- Prepared food services
- Meal prep
- Keep a list of your favorite food places with their hours and phone numbers easily available. Consider using the .
- Consider asking for food delivery service gift cards as gifts from friends and family.
- Online grocery shopping with scheduled pickup or delivery
- Automate shipping for recurrent needs: e.g., toilet paper, paper towels, soap, shampoo, toothbrushes, and pet food.
- Schedule online payments for recurring bills.
Most adults need at least 7 hours of sleep per day to function to the best of their ability. This is not always easy to achieve during residency, but there are steps you can take to prevent and address fatigue. 
Addressing fatigue 
Inadequate sleep in medical professions has been linked to:
- Mental health issues, e.g., generalized anxiety disorder (GAD) and significant anxiety during stressful situations 
- Higher rates of medical errors and serious diagnostic errors 
- A decline in performance 
- An increased risk of car accidents.
Managing night shifts and call shifts 
- Aim to get ≥ 7 hours of sleep per night regularly.
- Bank extra sleep before a shift change occurs. 
- Consider taking melatonin to shift your sleep schedule.
- Sleep before starting a shift, rather than after the shift. 
- Consider using a lightbox for 20–30 minutes just prior to starting a night shift to simulate morning and increase alertness. 
During your night shift or call
- Caffeine can make you more alert, but its effects wear off and it doesn't prevent performance deficits. 
- Take short breaks during downtimes, if possible. 
- Incorporate exercise into your shift to increase alertness: e.g., take the stairs, do lunges or jumping jacks in empty hallways, take stretch breaks.
- Make sure you can get home safely. Sleep in your car or an on-call room if you are too sleepy to drive home.
- Consider wearing sunglasses on your way home to prevent morning light-activated alertness.
- Dedicate time to sleep and aim for at least 9 hours of sleep. 
- Practice good sleep hygiene.
- Develop a calming routine before bed.
- Limit light exposure with blackout curtains.
- Use a white noise machine or fan.
- Keep your bedroom cool (especially when sleeping during the day); around 65°F is ideal.
- Let roommates/neighbors know when your schedule will change, if possible.
- Avoid alcohol and caffeine for 3–4 hours before bed.
Mental health considerations
- Mental health conditions: Physicians have higher rates of certain mental health conditions compared to the general population.
- Relationships 
- Work: mentor and peers
- Personal: friends and family outside of work
- Professional help to address anxiety and depression
- Primary physician or psychiatrist for possible medication
- Talk to your insurance provider about covered virtual mental health options.
- See if your employer participates in an Employee Assistance Program that offers confidential mental health care.
- Relationships 
Create a list of local resources before you start residency and familiarize yourself with your employee assistance program benefits.
Do not attempt to diagnose or treat yourself and do not wait until symptoms are severe to seek help.
Suicide prevention in healthcare professionals 
Suicide risk 
- It is an unfortunate reality that all physicians and other healthcare professionals (e.g., nurses) are at a higher risk of suicide than the general population worldwide.
- This risk appears to be even greater in:
- There are many multifactorial reasons that are thought to underlie these associations. These include but are not limited to:
- Work environment: e.g., chronic exposure to suffering and death, interprofessional conflicts, insufficient teamwork, heavy patient responsibilities, inadequate work-life balance, high expectations and performance requirements, fear of litigation, access to lethal drugs, loneliness
- Professional culture: e.g., always putting others first, reluctance to seek help, stigma around mental health problems and perceived weakness, fear of repercussions from licensing authorities, systemic biases against women and marginalized groups
- Psychosocial factors: e.g., perfectionism, excessive focus on duty and responsibility, additional home stresses
Recognition and prevention
- It is important not to downplay or dismiss suicidal ideation in yourself or your colleagues.
- Be vigilant for symptoms of mental health conditions that can increase the risk of suicide: e.g, depression, anxiety, burnout, substance abuse
- Find out if your university, hospital, or health system offer health professional-specific resources, for example:
- Screening, e.g., interactive screening programs (ISP)
- Crisis resources and counseling services
- Peer and mentor-based support networks
- Confidential text or phone hotlines
- Feedback mechanisms to improve the learning and working environment
- Social support from peers, friends, and family can provide a safety net, both for prevention and crisis intervention.
- Friends and peers are frequently the first to recognize warning signs in each other.
- Do not be afraid to broach these subjects if there is a concern.
- Do not feel ashamed to be vulnerable in sharing your feelings.
- Your close friends and peers may be going through similar struggles which can mitigate feelings of isolation.
- If you require a leave of absence for your mental health, it is better to take it and delay your career than risk suicide.
Coping with a colleague's suicide
- This can be a shocking and traumatizing event to experience, even if you were not close to the individual.
- It is common to have feelings of guilt and responsibility for not being able to intervene or prevent the suicide.
- Do not hesitate to reach out to your program supports and professional counseling.
- If your program does not offer specific opportunities for support and grief counseling, consider reaching out to peers and colleagues to debrief, reflect and cope together.
If you are a resident in the United States having suicidal ideation, do not hesitate to seek care immediately (e.g., call 911, go directly to the ER or a mental health intake facility). If you feel uncomfortable seeking care in your own health system, go to another health facility, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or text the Crisis Text Line (text HELLO to 741741).
- Definition: a constant feeling of overwhelming pressure that lasts weeks to months
Factors: There are many physician and residency-related factors that contribute to chronic stress. Residency is tough.
- Prolonged pressure
- Decision-making fatigue
- High-stakes decisions
- Long work hours
- Inability to escape work: e.g., always thinking about patients, second-guessing your decisions, studying, constant list of to-dos
- Emotional abuse 
- Prolonged pressure
- Associated with:
Imposter syndrome 
- Definition: a condition found in high achievers who feel they do not deserve their achievements or that others will discover they are unqualified or a fraud
Prevalence: 30–45% of medical students and residents report symptoms of imposter syndrome. 
- 40–50% of surveyed women
- ∼ 25% of surveyed men
- Risk factors for physicians 
- Extreme self-doubt
- Anxiety about failure; possible feeling of paralysis
- Tendency to focus more on negative feedback and disregard positive feedback
- Unrealistically high standards for self; expecting nothing less than perfection
- Physical exhaustion from maintaining a facade of success
- Avoiding more visible tasks due to fear of public failure
- Maladaptive behaviors
- Overpreparation: preparation that surpasses the point of diminishing returns
- Can lead to anxiety, depression, and burnout
- Recognize that the thoughts experienced as part of imposter syndrome are inherently irrational.
- Understand how prevalent this syndrome is in the medical profession. You are not alone!
- Ask for objective feedback rather than subjective feedback.
- Keep a “brag book.”
- Have compassion for yourself; curb perfectionism.
- Don't stay silent due to fear of being found out.
- Utilize your support groups.
- Consider seeking professional assistance to learn effective skills, i.e., CBT from a licensed mental health provider.
Clinician burnout 
Definition criteria: All of the following symptoms are involved.
- Emotional exhaustion
- Low sense of personal accomplishment
- Prevalence: ∼ 50% of residents and practicing physicians report at least one major symptom of burnout. 
- Chronic stress
- Lack of control and an inability to effect change
- Inadequate resources, e.g., lack of support at work
- Being overworked, especially with nonclinical tasks
- Moral injury
Risk factors 
- Female gender
- < 55 years of age
- Having a child < 21 years of age
- Having a nonmedical spouse or partner
- Personal negativity: complaining a lot and being cynical
- Difficulty concentrating: taking longer to complete tasks
- Inability to stop thinking about work
- Tension headaches, appetite changes
- Exhaustion/fatigue that doesn’t improve with rest
- Sleep difficulties
- Higher rates of medical errors 
- Higher physician turnover
- Physicians leave the medical profession, which also leads to decreased access to medical care.
- Mindfulness: Focus on things you enjoy about your job and things within your control.
- Stress-management training
- Set boundaries.
- Improving communication (see “Communication during residency” and “Patient counseling and communication”)
- Communication skills training
- Discuss problems before they snowball. If others are having similar problems, a systemic change may be needed.
- Ask others how they have dealt with similar situations or problems.
- Promote a sense of community and connectedness. Consider starting or joining a peer support group.
- See “Self-care” above.
- Recognize your limits and ask for help.
- Reach out to fellow residents, chief residents, the program director, and friends/family.
- Curb perfectionistic habits.
- Talk to your program director about rearranging your blocks or taking time off if needed.
- Consider that you might have an underlying medical condition like anxiety, depression, or ADHD.
- Consider arranging for a diagnostic evaluation and, if an underlying condition is present, treat it with counseling and/or medication. 
- Seek professional help.
Making time to study
Developing a study plan
- During the first 3–4 months of intern year: On-the-job learning should be your priority.
After the initial few months of your intern year: Consider incorporating a more formal study plan.
- Look at the blueprint or content outline for your specialty's board exam.
- Identify board content relevant to your current rotation and use AMBOSS to learn about these subjects.
- Maximizing education time while at work
Make sure your AMBOSS mode is set to “Clinician” in your account profile.