A while ago, I was speaking with someone who described waking up in the middle of the night thinking about money.
Nothing dramatic had happened to them financially. They were working, paying their bills, and from the outside everything seemed stable. But the uncertainty about the future kept creeping in for them—questions about savings, unexpected expenses, long-term security—until it was 2 or 3 a.m. and they were still awake.
What struck me most was that their stress wasn't really about numbers. It was about the feeling of not being fully in control.
That experience is far more common than we often realize. And in healthcare, it comes layered on top of an already demanding job with long shifts, high stakes, and the weight of caring for others at their most vulnerable. Many healthcare workers we support are carrying a private financial strain that doesn't belong in a handoff, but still follows us onto the floor.
This isn't "generic money stress"
When financial stress comes up in broader conversations, it often gets flattened into universal advice: build an emergency fund, pay down debt, track your spending. But healthcare workers aren't living a generic financial life.
Consider what the data actually shows for healthcare workers:
For residents and fellows: A 2025 survey of U.S. residents and fellows (n=479) found the average financial stress rating was 7.2 out of 10, and 53% rated it 8 or above.
Stress about student loan debt specifically jumped from 49% to 75% in a single year. (Panacea Residents & Fellows Survey, 2025) That's a constant signal running underneath an already grueling training period.
Research also suggests that debt and burnout don't travel separately.
A national study of internal medicine residents published in JAMA found that burnout symptoms were associated with higher educational debt, and that debt (alongside low quality of life and emotional exhaustion) was associated with lower in-training exam scores. (JAMA, 2011) The financial and the clinical are not separate systems.
For nurses: Even among nurses who are highly engaged with their retirement plans—and nursing shows strong plan participation—emergency savings tell a different story.
A 2025 summary of Fidelity research found that 63% of nurses completing a financial wellness checkup reported inadequate emergency savings. (Fidelity/PLANSPONSOR, 2025) Doing the "right" things on paper doesn't always mean the safety net is actually there.
For support staff and direct care roles: A national analysis published as a JAMA research letter, drawing on U.S. Census Bureau data from 2020–2023, found that direct care and healthcare support workers reported food insecurity at 24.5% and housing instability at 13.6%.
Health technologists and technicians reported food insecurity at 11.4%. (JAMA Research Letter, 2025) For many people inside the walls of our healthcare system, this isn't anxiety about the future, it's hardship in the present.
Naming this matters—not to alarm us, but to acknowledge that financial stress in healthcare is both real and deeply uneven across roles.
Why money stress lands emotionally
Our relationship with money usually starts even before we earn our first paycheck. We absorb messages from family, community, and lived experience: “money is scarce;” “money equals success;” “money is something you don't discuss.”
Those beliefs shape how we approach finances as adults, often in ways we can't immediately see.
Add in a stressful job, irregular hours, or a debt load that feels immovable, and what results isn't just "financial anxiety," but rather a prolonged stress response. Your sleep gets lighter, focus at work gets harder, and irritability spills into relationships. People often describe it as a low hum that never fully turns off.
Sound familiar? You're far from alone.
A 2024 analysis using National Health Interview Survey data found that medical financial hardship was associated with higher psychological burden, including serious psychological distress even after accounting for other factors. (PMC/NHIS analysis, 2024).
Financial stress isn't just adjacent to mental health. It's intertwined with it.
The avoidance loop (and why it makes sense)
One of the most common ways people respond to financial stress is avoidance. Don't open the app. Don't look at the statement. Promise yourself you'll deal with it after this stretch of nights, this rotation, this exhausting week.
Avoidance is understandable, because when something feels overwhelming, the brain looks for relief, and not looking often does provide short-term relief.
But over time, avoidance allows uncertainty to grow. The next autopay date approaches like a silent countdown and the stack of unopened bills gets heavier in the peripheral vision. The mental load increases without any new information actually arriving.
Here's the reframe I offer: avoidance isn't a moral failure. It's a signal. It means something feels like too much right now and that's information worth paying attention to.
What actually helps: control, not perfection
Financial well-being isn't about a high income or having it all figured out. Research consistently shows that what matters most is the felt sense of stability, predictability, and options, even when those options are small.
The goal isn't to overhaul your finances in a weekend. It's to reduce uncertainty in one place, this week.
A few micro-actions, sized for healthcare reality:
If debt is the loudest thing in the room: Pick one loan question to clarify this week: your repayment plan, PSLF eligibility, refinancing options, or simply who actually services your loans. Not all of it. One thing. Clarity in one corner reduces cognitive load across the board, regardless of whether you're in training or ten years out.
If you feel like you're always one surprise expense away from the edge: Emergency savings don't have to start big. Even a $25/week automatic transfer builds a real buffer over time, and automating it removes the daily decision. If that still feels out of reach right now, start by naming your stability priorities for this pay period: housing, utilities, food, transit. That's not falling behind. That's triage, and it counts.
If your benefits feel like a second language: Most people in healthcare—at every level—leave money and support on the table simply because the system is confusing. Pick one thing to clarify this week: your retirement match rate and what you're actually contributing, your EAP access, HSA or FSA rules, or what financial hardship assistance might be available to you. One answered question creates real psychological relief.
If your compensation structure feels opaque: Whether it's RVUs, shift differentials, bonus thresholds, or a contract you signed without fully understanding, pick one element to look at this week. Not the whole picture. One line item. Visibility is the first step, and it's available to anyone willing to ask a direct question.
For anyone wondering whether small buffers actually matter: the Federal Reserve's 2024 household survey found that 13% of adults would be unable to cover a $400 emergency expense by any means, and only 55% had three months of rainy-day savings. (Federal Reserve SHED, 2024) The margin many people are working with is thinner than it looks from the outside.
The conversation worth having
Financial well-being doesn't begin when the numbers look right. It begins when we stop avoiding the conversation.
Money influences nearly every part of our lives, from sleep, focus, relationships, to the way we feel walking into a shift. Creating space to talk about financial stress without judgment, and without generic advice that ignores the realities of healthcare work, is part of what it means to support the whole person.
If financial stress has been showing up across your life, you don't have to carry that alone. Confidential support is available through Marvin providers 24/7/365.
Sources
- Panacea Financial. Residents & Fellows Survey Report. 2025. panaceafinancial.com/report
- JAMA Research Letter. Poverty, Food Insecurity, and Housing Instability Among U.S. Health Care Workers. 2025. (SIPP data 2020–2023)
- Shanafelt TD et al. Relationship Between Clerical Burden and Characteristics of the Electronic Environment With Physician Burnout and Professional Satisfaction. JAMA. 2011. jamanetwork.com
- Fidelity Investments/PLANSPONSOR. Despite Strong Participation Rates, Many Nurses Face Savings Shortfall. 2025. plansponsor.com
- Federal Reserve Board. Economic Well-Being of U.S. Households in 2024. 2025. federalreserve.gov
