No, you generally do not get paid during clinicals. Nursing, physician assistant, physical therapy, and most other healthcare programs treat clinical rotations as coursework, so you pay tuition for the hours rather than earning a wage. A small number of program structures do pay students during clinical training, and several forms of financial aid and stipends can help cover expenses while you complete unpaid hours.
Why Clinical Rotations Are Unpaid
Clinical hours are a required part of your degree, built into the curriculum the same way a lab course is. The school controls the learning objectives, assigns the site, supervises your progress, and gives you a grade. You register for clinical credit hours and pay tuition for them. Hospitals and clinics that host you dedicate staff time to teaching, reviewing your charting, walking you through procedures, and giving feedback. Under that arrangement, you are a guest learner, not an employee, and the site owes you no wage.
This is the standard model across nearly every accredited healthcare discipline. If you are entering a program that requires clinicals, plan on covering living costs through savings, financial aid, or work outside your clinical schedule.
The Legal Rule Behind Unpaid Clinicals
The Fair Labor Standards Act requires employers to pay at least the federal minimum wage and overtime to covered employees.1Office of the Law Revision Counsel. 29 USC Ch. 8 – Fair Labor Standards Whether a clinical student counts as an employee is decided under what the Department of Labor calls the “primary beneficiary test,” a seven-factor analysis that asks who is getting more out of the arrangement: the student or the facility.2U.S. Department of Labor. Fact Sheet #71: Internship Programs Under the Fair Labor Standards Act
The factors look at whether both sides understood the rotation would be unpaid, whether it is tied to a formal degree program, whether it follows the academic calendar, whether it provides real training rather than filling in for paid staff, and whether it lasts only as long as the learning does. A rotation built into an accredited program, supervised by faculty, and scheduled around your coursework will almost always satisfy the test, which keeps you in the unpaid trainee category.
If a site is using you as free labor instead — assigning you to plug staffing holes without meaningful supervision, or keeping you on indefinitely to avoid hiring — the arrangement can fail the test and you may legally be an employee owed wages. Complaints go to the Department of Labor’s Wage and Hour Division.
When Clinicals Do Pay
A minority of clinical arrangements do come with a paycheck, and they usually fall into two categories.
Dual-Role Jobs
Some facilities hire students as patient care technicians, nursing aides, or similar roles and let those working hours count toward clinical requirements. You hold two roles at once: paid staff member and student. You earn an hourly wage for the work and academic credit for the learning. These positions show up more often at rural hospitals and long-term care facilities that struggle to recruit.
Residency Contracts With Work Commitments
Some hospitals offer a stipend or salary during training in exchange for a promise to work at the facility for a set period after graduation. These are formal contracts, often with repayment clauses. Leaving before your commitment period ends can mean paying back some or all of what you received.
Watch for Training Repayment Clauses
Any paid clinical arrangement can carry a training repayment agreement provision, sometimes called a TRAP. These clauses require you to repay the employer for training costs if you leave before a specified period, and the repayment amount can cover more than tuition assistance — it may include the employer’s claimed cost of onboarding, orientation, or supervision.
The Federal Trade Commission issued a rule in April 2024 that would have banned TRAPs and similar stay-or-pay clauses nationwide as a form of non-compete. A federal court found the FTC lacked authority to issue the rule, and in September 2025 the Commission formally dropped its appeal and accepted the rule’s cancellation.3Federal Trade Commission. Federal Trade Commission Files to Accede to Vacatur of Non-Compete Clause Rule No federal ban is currently in effect. Several states have their own laws restricting these agreements, with more taking effect through 2025 and 2026.
Before signing any clinical contract with a repayment clause, read it carefully and consider having an attorney review it. Pay attention to how “training costs” are defined, how the repayment is calculated, and whether the obligation decreases the longer you stay.
How Money You Do Receive Gets Taxed
If you receive any money during clinical training — a stipend, scholarship, or wage — the tax treatment depends on what the money is for and whether you performed services to earn it.
Scholarship and fellowship money used for tuition, fees, books, supplies, and required equipment is generally excluded from your gross income, as long as you are a degree-seeking student at an eligible institution.4Office of the Law Revision Counsel. 26 U.S. Code 117 – Qualified Scholarships The exclusion applies only to those specific educational expenses.
Money earmarked for room, board, travel, or other personal costs is taxable income, even if the check is labeled “scholarship” or “stipend.”5Internal Revenue Service. Topic No. 421, Scholarships, Fellowship Grants, and Other Grants A monthly housing stipend from a hospital during rotations goes on your tax return.
Any scholarship or fellowship amount that is actually payment for teaching, research, or other services you must perform as a condition of receiving the money is taxable, even if you spend it on tuition.5Internal Revenue Service. Topic No. 421, Scholarships, Fellowship Grants, and Other Grants The IRS treats service-conditioned payments as compensation.6Internal Revenue Service. Employer’s Supplemental Tax Guide A narrow exception exists for certain military health professions scholarships and National Health Service Corps awards, where the service requirement does not trigger taxation.
Costs to Budget For
Unpaid rotations are only part of the financial picture. Several out-of-pocket costs come with clinicals, and programs do not always highlight them during admissions:
- Professional liability insurance. Many programs require students to carry their own malpractice policy before patient contact. Student policies are often under $50 per year. A group policy provided by your school is primarily designed to protect the institution.
- Background checks and drug screenings, which nearly every site requires before you start. These usually run from roughly $80 to $280 depending on the screening and vendor.
- Immunizations, tuberculosis testing, and sometimes a physical exam. If your insurance doesn’t cover them, you pay directly.
- Travel and parking. Sites can be far from campus, and hospital parking fees add up over a semester.
- Uniforms and equipment, including scrubs, a stethoscope, and clinical shoes.
Ways to Cover Expenses During Unpaid Clinicals
Federal financial aid is the most widely available option. Completing the Free Application for Federal Student Aid opens access to federal loans and, for those who qualify, grants like the Pell Grant. Federal loan disbursements can be used for living expenses, which can free you from needing outside work during heavy clinical semesters. Loans have to be repaid with interest.
Some healthcare systems offer clinical stipends — flat payments meant to cover food and housing rather than function as wages. These are more common in rural or underserved areas with high demand for students. Remember that stipends for living expenses are taxable. Travel grants from programs or professional organizations can also help offset commuting costs to distant sites.
If your program offers a paid clinical pathway with a work commitment afterward, weigh the immediate relief against the long-term obligation. Read every contract carefully for repayment clauses, and factor tax on any compensation into your budget.
Your Protections at the Clinical Site
Not getting paid does not mean you lose legal protection at the site.
Title IX prohibits sex discrimination in educational programs that receive federal funding, and the Department of Education has said that coverage extends to training programs a school sponsors at another location, including clinical rotations at hospitals and clinics. Your school must respond to sexual harassment at an off-campus clinical site when it has substantial control over both the person accused and the setting.7U.S. Department of Education. Frequently Asked Questions: Sex Discrimination Report harassment to your school’s Title IX coordinator; the school has to investigate regardless of whether the harasser works for the hospital.
Federal employment discrimination laws covering race, sex, age, disability, and genetic information generally apply to employees, and whether an unpaid clinical student qualifies turns on factors like whether you receive significant benefits beyond academic credit. A separate protection is broader: anyone applying to or participating in a training or apprenticeship program is protected against discrimination in admission and participation, regardless of employee status.8U.S. Equal Employment Opportunity Commission. EEOC Informal Discussion Letter Many states have gone further and extended harassment protections specifically to unpaid interns and trainees.