The Cost of a Competitive Edge: Financial Barriers in Research Years for Residency Applicants

Rodriguez, Gabrielle C, et al. “The Cost of a Competitive Edge: Financial Barriers in Research Years for Residency Applicants.” Journal of Surgical Research, vol. 314, 15 Aug. 2025, pp. 393–399, https://doi.org/10.1016/j.jss.2025.06.090.

Research Paper

Background

This study investigated the financial challenges medical students face during dedicated "research years," which are often necessary to get into competitive specialties like plastic surgery. These positions are frequently unpaid or underpaid, creating significant financial strain for students covering living costs, loan interest, and other expenses, especially for those from less privileged backgrounds.

Methods: What Researchers Did

Researchers surveyed 110 students, comparing their compensation to local living costs. The survey also asked about their training, when and where they did research, if they moved, how much money they got, if they had health insurance, and if their research costs were covered.

Results: What They Found:

Out of 110 students asked, 61 answered (55% response rate). These students were from 19 states and 45 different areas, showing the problem is widespread. Most (85%) went to U.S. medical schools. About 4 out of 10 (41%) were already in their first year of plastic surgery residency, and the rest (59%) were applying or interested.

Research Year Income

One out of every five students (20%) doing a research year received no pay at all. The others (80%) did get some money. The pay varied greatly, from $0 to $75,000 per year. This big difference shows there's no set pay for these jobs, which causes a lot of stress for students. Half of the students earned $24,000 or less in a year, and the average pay was $24,445.

Regional Differences in Income

The average cost of living for a single adult where students did research was about $41,980 per year. On average, research students earned $15,529 less than they needed to live. This "money gap" was different in various parts of the country: Northeast ($23,638 less), Midwest ($12,450 less), South ($13,488 less), and West ($10,881 less).

Insurance Gap

About 23% of students got health insurance through their research job, but a worrying 10% had no health insurance at all.Not having health insurance is a big problem because if a student gets sick, they could face huge medical bills, making their financial situation much worse. Most students (nearly 79%) had their research publishing fees fully paid for. Costs for attending medical conferences were also usually fully covered.

How Does Research Year Income Compare to Living Wage?

A striking 95% of research students earned less than the living wage for their area. Also, 51% earned below minimum wage, and 28% earned below the poverty wage. This shows that the pay system for these research years is broken and doesn't meet students' basic needs. When students don't earn enough, they might have to get other jobs, which takes time away from their research.

Funding Sources and Additional Costs

Why This Matters: Socioeconomic Background

Because many research years pay little or nothing, students from wealthier families can more easily afford to do them. This gives them a big advantage in getting into competitive medical jobs that pay well later. This creates a "wealth begets wealth" situation, where those with money can more easily get into high-paying medical fields. This unfair system can limit who becomes a doctor and affects fairness in healthcare.

Building a Path Forward

Conclusion

This study clearly shows that medical students who do research years to get into competitive surgical jobs may face money challenges. This cost makes it very hard for students from less wealthy backgrounds to enter these fields, which goes against fairness in medical education. To make sure all students have a fair chance, we need to fix these money problems by paying students more, finding more ways to fund research, and getting help from medical schools and hospitals, including health insurance.