Resident Salary Compared With Living Wages at US Training Institutions

Objective: To compare living wages and salaries at US residency programs.

Background: It is unknown how resident salary compares to living wages across the United States.

Methods: Cross-sectional analysis of publicly available resident salary affordability from training centers with postgraduate year (PGY)-1 through PGY-7 resident compensation for 2022-2023 was compared with the Massachusetts Institute of Technology Living-Wage Calculator. Resident salary-to-living wage ratios were calculated using PGY-4 salary for each family composition. Univariate and multivariable analysis of PGY-4 salary affordability was performed, accounting for the proportion of expected living wages to taxes, transportation, housing, health care, childcare, and food, as well as unionization and state income tax.

Results: One hundred eighteen residency programs, representing over 60% of US trainees, were included, 20 (17%) of which were unionized. Single-parent families were unable to earn a living wage until PGY-7. Residents with 1 child in 2-adult (single-income) and 2-adult (dual-income) families earn below living wages until PGY-5 and PGY-3, respectively. Residents with more than 1 child never earn a living wage. Multivariable regression analysis using PGY-4 salary: living wage ratios in single-child, 2-parent homes showed food expense and unionization status were consistent predictors of affordability. Unionization was associated with lower affordability prestipend, almost equivalent affordability poststipend, and lower affordability poststipend and union dues.

Conclusions: Resident salaries often preclude residents with children from earning a living wage. Unionization is not associated with increased resident affordability in this cross-sectional analysis. All annual reimbursement data should be centrally compiled, and additional stipends should be considered for residents with children.