Orthopaedic Residency Compensation and Cost of Living: Are Orthopaedic Residents Financially Strained?

Medical education imposes a financial burden on trainees. Given that cost-of-living varies across geographical regions, understanding its relationship with resident compensation can inform about the finances of residents. We investigated: (1) How does compensation for orthopaedic surgery residents vary across regions? (2) How does compensation for orthopaedic surgery residents vary with respect to cost of living? (3) What is the extent of surplus income for residents after accounting for hours worked? (4) What are the predictors of annual income for orthopaedic residents?

Using the American Medical Association FREIDA database, we collected weekly work hours, location, program type, moonlight allowance, and geographic region for 190 nonmilitary orthopaedic programs. We used institutional websites to collect compensation information. We utilized SmartAsset to estimate take-home pay. We collected reputation ranking from Doximity. Lastly, we collected the Required Annual Income (RAI), a proxy for cost of living, and living hourly wage from the MIT Living Wage database for each program. We estimated Surplus Income (SI) and Hourly Surplus Income (HSI).

Compensation and take-home pay varied significantly across regions (p < 0.001). Additionally, we found a weak positive correlation between RAI and PGY-1 compensation (R² = 0.34). Pretax SI ranged from $24,600 to $35,200, while HSI hours ranged from $0.27 to $2.86 per hour across PGY levels. Standardized to an 80-hour work week, the HSI ranged from -$2.55 to -$0.37 per hour. Doximity reputation ranking, RAI, and region were significant predictors (<0.001).

Despite significant variations across geographic regions, a weak correlation between RAI and compensation indicates that residents in high-cost areas face challenges in offsetting relatively higher expenses. Additionally, our research reveals that orthopaedic residents may be financially strained.