How far will your money go during residency?
For residency applicants weighing their options ahead of the Feb. 28 deadline for submitting a rank-order list, that question might be top of mind.
It’s a question that Humam Shahare—a third-year medical student at the University of Arkansas for Medical Sciences—and a group of his peers attempted to shed some light on in a research poster presented at the 2023 AMA Interim Meeting.
The poster examined PGY-1 salaries from integrated plastic surgery residency programs across the U.S and compared them with cost-of-living data. The research’s findings—which can be broadly applied across residency training institutions—were that rather than having the highest salary, geography played a bigger factor in surplus income.
Doing the math
While starting salary may be an incentive residency applicants consider in where they want to train, it is a flawed metric.
Shahare’s research found that first-year integrated plastic surgery residents had an average starting salary of $65,003. The average surplus income, defined as PGY-1 salary minus cost of living, for those residents was $23,632. Residents who trained in areas with lower cost of living had lower salaries, but they also had a higher surplus income.
“It’s not how much you make, it’s how much do you have at the end of the day,” said Shahare, an AMA member. “That’s what is going to answer, are your bills taken care of.”
The study also offered insights on where residents can get the most bang for their buck. Residents training in the Midwest—according to regions defined by the U.S. Census Bureau—had the highest average surplus income at $27,359. Residents training in the West had the lowest average surplus income at $19,785.
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Cost of living and training preferences
About a year away from applying to residency programs, Shahare plans to make cost of living a factor in deciding where to train. He also understands that it’s not going to impact everyone’s plans.
“Medicine is a competitive career path, and understanding that, some people are OK having to stretch and tough it out for a few years in New York to train to be a neurosurgeon,” Shahare said. “At the same time, that person could live that life in Arkansas and have something like 300% more income. It’s different weather and different scenery.”
For example, living in San Franciso, one of the most expensive urban areas in the country, Christian Wang, MD, has had to be strategic about her living expenses. Dr. Wang, a third-year internal medicine resident at the University of California, San Francisco, School of Medicine, has three roommates and 1.5 bathrooms in a four-bedroom apartment.
Even with less surplus income, Dr. Wang said “there are still ways to make it work in a high-cost-of-living city. I was fine with having roommates and a smaller space, recognizing that it was a lot more important for me to be near family and loved ones rather than in a new city with a much more affordable cost of living.”
As far as her advice to residency applicants who may be considering cost of living as a factor in creating a rank-order list, Dr. Wang said it comes down to wellness.
“Think through what factors give you the most wellness and joy in life and … pursue that,” said Dr. Wang, an AMA member. “If it means being in a high-cost-of-living city, that is OK, and there are many ways to make your budget leaner while pursuing the things that are important to you.”
The most important factors in creating a rank-order list will be highly individualized, Dr. Wang added.
“Reflect on what has given you joy and what has been helpful for your mental and physical health during the hardest parts of medical school,” she said. “Envision what would be needed to support you through any similar challenges that would arise in residency and rank based on that.”
