Resident physician in the big city? You may need a roommate—or four

Brendan Murphy , Senior News Writer

For many resident physicians working long hours to expand their medical knowledge and skills, the hospital may begin to feel like a second home. As for their first home? With resident inflation-adjusted wages remaining relatively stagnant and average rent prices increasing steadily, affordability is a major concern.

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Recent research published in JAMA Network Open, led by Ryan Brewster, MD, a pediatrics resident at Boston Children's Hospital and Boston Medical Center, sheds some light on how big that worry has become. The analysis found that residents at nearly 60% of the 855 residency-sponsoring institutions examined were “rent-burdened,” meeting criteria developed by the U.S. Department of Housing and Urban Development (HUD). That is when rent accounts for 30% or more of the tenant’s monthly take-home pay.

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Between 2000 and 2022, inflation-adjusted first-year resident salaries overall fell slightly—by less than 1%. Meanwhile, inflation-adjusted rental prices rose 17.8%.

When calculating her take home-pay and rent costs, University of California, San Francisco, School of Medicine PGY-3 Christina Wang, MD, doesn’t qualify as rent-burdened.

To make that happen, however, Dr. Wang has four roommates—and one bathroom—in a four-bedroom apartment. Her apartment is within walking distance of the hospital at which she does the bulk of her rotations as an internal medicine resident.

Dr. Wang’s prior apartment, where she lived during medical school and as an intern, had a lower price tag, but she shared it with eight other roommates. In that living arrangement, she didn’t have her own room for portions of her six years living there.

“In general, as a resident or a med student, you have to have a bit of a low threshold for what you’ll accept” with housing, said Dr. Wang, an AMA member. “For me, roommates have obviously been key in making it affordable.”

For trainees, cost of living, and rent prices in general, can be a factor that shapes their decision on where they choose to pursue their graduate medical education, according to John Andrews, MD, vice president, GME Innovations, AMA.

“In evaluating the options throughout the course of your professional career, it’s important to consider cost of living among other factors,” Dr. Andrews said. “So when looking at residency programs, rent prices certainly may factor into applicants’ decisions about where they seek residency training.”

Turn to the AMA Thriving in Residency series for timely guidance on making the most of physician residency. Get resources and tips about navigating the fast-paced demands of training, getting scientific research published, maintaining health and well-being, and handling medical student-loan debt.

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The JAMA Network Open study indicates that support to help residents defray housing costs was generally limited. Moving allowances were available at 28.8% of programs and housing stipends were offered at 13.7%.

Rents tend to be highest in urban settings, researchers found. In metropolitan areas with a population of 250,000–999,999 people, 59.8% of institutions qualified as rent-burdened. In large metropolitan settings—those with more than 1 million residents—83% of institutions were rent-burdened.

About 7 million people live in the San Francisco Bay Area, and its rent prices are among the highest in the nation. Because of that, Dr. Wang had to make sacrifices that extended beyond her living arrangement.

“You really have to work on your budgeting skills,” she said. “People tell you how much you should be saving, and you still want to do things for yourself like go on vacation. You just have a much smaller piece to work with for those things. “I definitely moonlight more than I would because of my rent expenses. When you are picking up these random shifts here and there, you have the unforeseen cost of not spending that time with family and friends.”

Another sacrifice Dr. Wang made was choosing to sell her car. When her shifts are at facilities that are less walkable, she will ride her e-bike. If a shift ends later in the evening, she may use a ride-sharing service to get home, for safety and convenience.

As she enters the final year of her residency, Dr. Wang has her sights set on staying in the Bay Area for the next step in her career. If that happens, she said she isn’t going to rush to find a higher-end apartment.

“I like my roommates,” Dr. Wang said. “So I’m OK staying here for a little while, but that isn’t always the case.

“In my adult life, it took me a long, long time to even move out of a double room, I feel like even having the single room is a win, so I’m still riding that high a little bit.”