Going for Broke The Impact of Cost of Living on Surgery Resident Stipend Value

Objective: The objective of this study was to provide a direct comparison of first-year general surgery resident stipends across states and major cities, using the Cost-of-Living Index (COLI) to determine stipend value. Background: Financial challenges are among residents' top sources of stress, and this may be exacerbated in areas with high costs of living. A 2021 survey found that the mean first-year medical resident stipend increased by 0.6%, or $358, from 2020 to 2021, and only 33% of institutions used cost-of-living to determine annual resident stipend adjustments. Methods: An American Medical Association database was used to identify accredited general surgery residency programs. The 2021-2022 stipend data for first-year general surgery positions were obtained, then data were grouped by state and major city and averaged. Major cities were defined as cities with >4 programs. A direct comparison of stipends was performed using the COLI. Results: Stipend data were available for 337 of 346 general surgery programs. The national average first-year residency stipend was $60,064 +/-$4233. The average COLI-adjusted stipend was $57,090 +/-$5742, with a value loss of -$3493, or 5%. For major cities, the average stipend was $63,383 +/-$4524, and the average COLI-adjusted stipend was $46,929 +/-$8383, with an average value loss of -$16,454, or 26%. Conclusions: The financial burdens that residents face cannot be overlooked, and the cost of living has a meaningful impact on resident stipend value. The current Graduate Medical Education compensation structure limits federal and institutional capacity to adjust for the cost of living and creates an insulated market in which residents are under-compensated.