"I Live Week to Week": Medical Students' Experiences with Financial Burden in Online Discourse

Financial hardship is a significant but underexplored challenge for medical students from lower socioeconomic backgrounds. While the financial barriers to medical school admissions are well-documented, there is limited research on the nuanced financial struggles these students face after matriculation. Traditional qualitative data collection methods often limit students' disclosure of these sensitive experiences. To uncover deeper insights into the experiences of financially disadvantaged medical students, a thematic analysis was conducted in February 2024 using comments from Reddit (r/medicalschool) (from February 2019-2024), a platform that offers anonymous and candid discussions. Three researchers analyzed threads discussing financial burdens in medical training through an inductive coding process. From 9,590 comments across 144 threads, we identified four key themes: personal costs, institutional and systemic barriers, social isolation and peer comparisons, and career trade-offs and professional development. Students described extreme budgeting measures that often led to compromises on basic needs such as food and healthcare. The emotional toll of financial stress was evident in widespread mental health concerns, with many students feeling anxious and inadequate compared to their wealthier peers. Financial disparities also contributed to social isolation and envy, while the need to manage debt heavily shaped career decisions, with many prioritizing high-earning specialties or loan forgiveness opportunities. Interpreted through the complementary frameworks of Bourdieu and Freidson, the findings suggest that financial hardship operates not only as an individual challenge but as a pattern shaped by the institutional organization of medical training. The findings highlight the pervasive financial challenges faced by low-income medical students. Addressing these issues will require greater transparency around the hidden costs of medical education, more comprehensive financial support, and increased institutional empathy toward students' financial difficulties.