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Fellowship finances: managing the in-between years

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Fellowship is neither residency nor attending life. Plan the extra training years around real cash flow, benefits, debt strategy, and career value.

THE IDEA

Fellowship often extends trainee-level pay while adding relocation, licensing, board, and interview costs. The AAMC’s 2025 survey reported national average stipends of $77,593 at PGY-4 and $81,807 at PGY-5. Your actual program, city, and benefits matter more than the national average.

Use the fellowship decision to map both money and career value: years of foregone attending income, specialty fit, expected job options, benefits, and any required move. If your employer qualifies for PSLF, fellowship payments can continue the 120-payment count; certify employment annually. Keep federal loans federal while forgiveness or income-driven repayment still has value.

Protect the transitionReview health coverage dates, emergency savings, disability coverage and future-increase options, retirement matching, and moving reimbursements before residency ends. A gap between programs can turn a predictable move into expensive debt.

Your next steps

  1. Build a fellowship-year cash flow using the actual offer and city.
  2. Price the move and any benefits gap before signing.
  3. Record the career value you expect from each additional training year.

Check your understanding

Select each question to reveal the answer.

✓ $77,593.
✓ Yes, if the other PSLF requirements are met.
✓ No. It belongs in the decision alongside career value.
✓ Moving costs, benefits timing, emergency savings, disability coverage, retirement benefits, and loan strategy.

Planning questions

  1. What will your monthly cash flow be in the fellowship city after housing, debt payments, insurance, and moving costs?
  2. What specific career opportunities or compensation gains justify each added year of training for you?

Sources