To make it worse many of the big name institutions one would aspire to train in (e.g. 10 of the US News top 20 hospitals) are in expensive metros where you don't cross the "low-income line" until the third year of residency.

All the while spending 60-80 hours a week on clinical service and 5-10 hours on research and education so you can maybe get a job somewhere not remote when you're done.