Evaluating Emergency Medicine Resident Salary Adequacy: Inflation Trends and Cost-of-Living Adjustment Across US...

To determine whether US emergency medicine (EM) postgraduate year 1 (PGY-1) resident salaries kept pace with inflation from 2021 and 2022 to 2025 and 2026 and to assess how adjustment for local cost of living altered their relative value.

We conducted cross-sectional and longitudinal analyses of ACGME-accredited EM residency programs. Publicly reported 2025 and 2026 PGY-1 base salaries were collected from program websites, and paired 2021 and 2022 salaries were available for a subset. Salaries were adjusted using the Council for Community and Economic Research Cost of Living Index (C2ER COLI), Quarter 3 2025. Salary growth was compared with the 18.331% increase in CPI-U from July 2021 to July 2025. Regional differences were assessed using Kruskal-Wallis tests, and the relationship between COLI and nominal salary was evaluated using simple linear regression.

Of 295 programs identified, 271 had 2025 and 2026 salary data and 209 had paired salary data. Mean PGY-1 salary increased from $59,115 to $69,184, a mean increase of 17.0%, slightly below cumulative inflation. 70 programs (33.5%) met or exceeded the inflation benchmark, whereas 139 (66.5%) did not. Across all programs, mean nominal salary was $68,839 and mean COL-adjusted salary was $65,100. The West and Northeast had the highest nominal salaries but the lowest COL-adjusted salaries, whereas the Midwest and South showed the opposite pattern. Each 1-point increase in COLI was associated with a $212 increase in nominal salary (95% CI, $188-$236; R ² = 0.53; p < 0.001). Adjusted mean salaries ranged from $37,510 for New York City programs in Manhattan to $82,600 in Akron, Ohio.

Mean EM PGY-1 salary growth slightly lagged inflation, and two-thirds of programs did not meet the inflation benchmark. Although higher-COL markets paid higher nominal salaries, these increases did not fully offset local costs. COL-adjusted salary reporting may improve transparency and support more informed residency selection and compensation review.