As the cost of raising children continues to climb, many resident physicians are confronting a harsh economic truth: child care and other living expenses often outpace their individual earning power, leaving them scrambling to find solutions that work for their families and will not drive their debt load even higher.
A recently published study of 295 surgical residency programs across the country found that trainees in 98.3% of programs had a negative net income—that is, the shortfall an average surgical resident parent would face after subtracting the combined costs of basic living expenses and child care from their residency salary.
The findings, based on a single resident parent’s salary and child-care cost for one child, were true across all U.S. regions and for all child-age groups (infants through school-aged children). With resident physician salaries similar across specialties, the findings—published in JAMA Network Open—are broadly relevant.
With previously reported data indicating that roughly one-quarter of surgical residents have or are expecting children, the study sheds more light on a significant barrier to family building during physician training.
“In totality, surgical residents across the country frequently struggle to cover annual expenses on their salary alone, making the added burden of child care costs unmanageable and potentially deterring individuals from pursuing surgical residencies or starting families during training,” says the study. Notably, the Association of American Medical Colleges reports that about 70% of medical students graduate with an average of more than $212,000 in educational debt.
Regional variations seen
Across all regions, care for children up to 2 years old was the most expensive type of child care, followed by care for toddlers, preschool-aged children, and school-aged children. The data reflects that the situation tends to be most critical in high-cost-of-living metropolitan areas where many teaching hospitals are located.
Parents in the South had the lowest average negative net income. Parents of infants in the West had the highest average negative net income, coming out $21,278 in the red.
Here is how that breaks down. Surgical residents in the West took home $76,576 on average.
But data from the National Database of Childcare Prices showed the average cost per child ranged from $9,936 to $14,538, depending on the age of the child.
And the Bureau of Labor Statistics showed average living expenses of:
- $28,938—housing.
- $15,870—all other living expenses.
- $13,420—transportation.
- $13,064—taxes.
- $10,699—food.
The study data didn’t factor in a resident partner’s income or the cost of child care for residents with multiple children.
The AMA has policy encouraging the provision of on-site or subsidized child care for medical students, residents and fellows that recognizes “the fiscal challenges faced by medical schools and graduate medical education institutions” that make it hard to do so.
Dive deeper:
- Family planning in residency: 3 physicians share their experiences
- How does parental leave affect physician resident performance?
- 4 tips for juggling GME training and becoming a new parent
- Find new ways to help medical students, residents get child care
Subscribe and thrive in residency
Get tips and insider advice from the AMA on navigating and making the most of medical residency—delivered to your inbox.
Finding creative solutions
Jackline Lasola, MD, PhD, ScM, knows firsthand how difficult it is, financially, to make ends meet and afford child care on a resident physician’s salary. Dr. Lasola is a first-year ob-gyn resident in San Francisco and mother of three children, two of whom are not yet school-aged. She and her husband—also a resident physician—are managing careers, child care and long-distance family life on trainee salaries.
“My life ends up being focused on what I need to do for work and then how can I support the kids when I’m off work,” said Dr. Lasola, an AMA member. “I make $90,000-plus as an intern, but what that actually means in terms of whether or not I have any money saved or anything is actually close to zero.”
Dr. Lasola’s salary is higher than the national average for PGY-1 residents, thanks to location-based salary adjustments. But Dr. Lasola’s cost of living is high.
The monthly rent for her four-bedroom apartment near campus is $4,400. She also pays out $1,500 to her aunt, who stays with the family during the week to help care for the children. It is an arrangement that allows Dr. Lasola to work long clinical hours without worrying about gaps in coverage. The average monthly child-care cost—per child—in the West is about $1,000, according to the JAMA Network Open study.
“We’re paying less than market rate, to be honest with you—less than she’s worth in terms of just how many hours she ends up working,” Dr. Lasola said.
For Dr. Lasola, one of the most critical decisions came during the Match. Doing a brief survey of the child-care landscape, she realized that child-care costs for her two daughters (2 and 4 years old) could easily exceed $5,000 a month in certain locations.
Taking that into account, she looked for other options. Although she attended medical school in Baltimore, where her husband—Smirnov Exilus, MD—is completing his otolaryngology residency, she prioritized returning to her home region in the Bay Area to secure consistent, trusted child care from relatives.
“Most of my advisers at my school were like, ‘OK, so you’re going to try and stay with your husband and figure out how to do like two nannies,’” Dr. Exilus said. “But we both came to the realization that it was going to be easier for me to just move away and try and be closer to where I have a lot of family.”
The arrangement isn’t ideal. Her husband remains 3,000 miles away in Baltimore, finishing his fifth and final year of residency. But it’s a tradeoff that makes daily life more manageable for now.
“We’re kind of counting down the days until my partner is an attending,” she said.
The AMA Thriving in Residency series has guidance and resources on navigating the fast-paced demands of training, maintaining health and well-being, handling medical student-loan debt, and other essential tips about succeeding in graduate medical training.
Making it work
Dr. Lasola’s finds that she has had situations arise in which she needs care on short notice, and an on-site child care facility might not be able to meet that need.
“My parents live nearby and are retired,” she said. “I can call them at the very last minute and say, ‘Hey, I really need help.’”
“At the end of the day, you need to have a backup [child care] plan for your backup plan,” she said. “That is one of the biggest lessons I have taken from this experience,” adding that she could not “imagine going through this process without this kind of family support.”
Dr. Lasola finds solace in looking at the calendar, anticipating her husband’s completion of residency training.
“You have to remind yourself that it’s a temporary situation,” she said. “I know I won’t always need this much help.”
