Residents today earn roughly the same inflation-adjusted salary as residents did decades ago. So why does training feel so much more financially difficult?

In this episode of Cut & Tell, plastic surgery resident Dr. Liz Malphrus explores the economic realities facing modern trainees—from exploding medical school debt and rising housing costs to childcare expenses, delayed financial independence, and the growing gap between resident compensation and the true cost of becoming a physician.

This is the second installment in the "Back in My Day" series, examining how residency has changed over time. Rather than debating which generation had it harder, Dr. Malphrus argues that the conditions surrounding medical training have fundamentally changed—and that understanding those changes is essential if we want to improve graduate medical education.

Topics discussed:

• Resident salaries then vs. now
• Medical school debt and rising education costs
• GME funding and resident compensation
• Housing, childcare, and cost-of-living pressures
• Why many residents struggle financially despite being physicians
• The changing demographics of residency training
• Single-parent households and residency
• Why "back in my day" misses the bigger picture
• Moving beyond the suffering Olympics in medicine

Cut & Tell explores the realities of surgical training, medicine, and the systems shaping physician life today.

Subscribe for new episodes and visit the Hippocratic Collective for more conversations about the future of medicine.

Attendings often tell stories about residency "back in the day" - more autonomy, more responsibility, more independence. But was training really better, or has the entire system changed?

In this episode of Cut & Tell, plastic surgery resident Dr. Liz Malphrus explores why modern residents often report feeling less prepared for independent practice despite performing similar case volumes to previous generations. From duty-hour debates and supervision requirements to RVU-based compensation and the growing pressure for clinical productivity, she examines the structural forces reshaping surgical education.

This isn't a conversation about whether residency is easier or harder. It's about understanding how the training environment has changed, and what that means for autonomy, burnout, and the future of medical education.

Topics discussed:

• Why case numbers don't tell the whole story
• Resident autonomy and surgical confidence
• The impact of RVU-based compensation on teaching
• Academic medicine's productivity pressures
• Why more residents pursue fellowship training
• The relationship between autonomy and burnout
• How surgical education has evolved over the past two decades
• What attendings and residents can learn from each other

Cut & Tell is a podcast exploring the realities of surgical training, medicine, and life beyond the operating room.

Subscribe for new episodes and visit the Hippocratic Collective for more conversations about the culture of medicine.

What if the most important lessons of residency aren't found in a textbook?

With graduation just days away, Liz shares the three pieces of writing that most shaped her understanding of medicine, residency, and life beyond training. From the realities of surgical culture and physician burnout to the hidden history of American healthcare and the power of personal agency, these recommendations offer a framework for understanding not just residency, but your place within the system.

In this episode, Liz discusses:

- Why Surgeon on the Edge by Frances Mei Hardin is the residency memoir she recommends over The House of God

- What The Social Transformation of American Medicine reveals about the forces shaping modern healthcare

- Why the essay How to Be More Agentic by Kate Hall may be the most important 10-minute read for physicians

- How understanding systems can make you a more effective doctor

- The mindset shifts Liz wishes she had before starting residency

Whether you're a medical student, resident, attending physician, or simply interested in the realities of modern medicine, this episode offers a practical reading list for anyone trying to make sense of the profession, and build a career with intention.

🎧 New episodes of Cut & Tell every Thursday.