Residents: Will They Ever Pay Off Medical School Debt?

How Much Do Residents Make?

The Medscape 2014 Residents Salary & Debt Report is based on an extensive survey of more than 1200 US residents representing 25 specialties. The focus of the survey was not just on what residents make but also on their debt after medical school. The average resident salary is $55,300, but there is a wide range depending on the specialty chosen. Essentially, the specialty pattern of salary range follows that of physician compensation, with residents in specialties earning the highest salaries, and residents in family and internal medicine at the bottom of the list.

Of course, salaries also increased over time, from an average of $51,000 in the first year after medical school to over $60,000 after the fifth year.

Even with this increase, resident income has not kept pace with rising costs over the past few decades. When adjusted for inflation, resident compensation has been unchanged for 40 years. In fact, given housing costs and debt, salaries are slightly less. Training hospitals share data and use it to set wages, which keeps salaries low and consistent among them, triggering some efforts by residents to take a stand.^[1]

There is also some controversy about how government funds are really used for graduate medical education, specifically for residency training, and whether keeping skilled residents at these low wages actually makes money for academic medical centers.^[2,3,4] Authors of a commentary in the New England Journal of Medicine, however, found no empirical evidence to support this and said, "The cost of training has increased substantially in recent years owing to a series of unfunded mandates, including more stringent educational requirements, decreased duty hours, and strict supervision requirements."^[5]

Gender Disparity Among Residents: Not So Bad

As in most professions, salaries for women in residency are less than those for men ($54,000 and $56,000, respectively). This equates to a 4% disparity, compared with a 24% disparity among all physicians, according to the latest Medscape Physician Compensation report. The much smaller difference among residents is most likely due to their work in the hospital setting, where salaries are consistent. Regardless of any disparities, far more female residents (57%) are satisfied with their compensation compared with their male counterparts (48%). However, Ileana Piña, MD, a Medscape advisor and Associate Chief of Cardiology at Montefiore Einstein Vascular and Cardiac Center in the Bronx, New York, commented, "Women are not happy about salary disparities when they find out. For instance, salaries in universities are often secret, so you may never know. If you don't know, you can't complain. Now, I ask upfront for salary levels."

It appears that once residents have completed training, the disparity in gender compensation increases in some locations. A 2012 article in Health Affairs on New York starting salaries after residency found that newly trained men earned $16,819 more than women, a compensation gap greater than that in 1999, which was only $3600.^[6] One reason given for this increase is that more women are entering primary care, although some statistics dispute that fact.

Given our current cultural environment, the authors of the Health Affairs study did not believe that discrimination plays much of a role in the increasing income disparities that they observed over recent years, writing, "It is possible that the continued influx of women into medicine has reached a tipping point, and physician practices may now be offering greater flexibility and family-friendly attributes that are more appealing to female practitioners but that come at the price of commensurately lower pay."

Location, Location, Location

The highest average resident salary, $71,000, is in the Northwest, with the Northeast and West following at $61,000 and $57,000, respectively. The lowest salaries are found in the Southeast ($50,000) and North Central region ($52,000), with the remaining regions at $54,000, below the general average salary of $55,300. One reason for these regional differences may be Medicare subsidies for graduate medical education (GME), with the states in the Northeast, West, and Northwest being among the largest beneficiaries of resident payments, and those in the Southeast, Southwest, and South Central region, where salaries are below average, receiving lower subsidies for paying residents.^[7] For example, in 2007, the average GME per-resident payment to New Hampshire was $146,499 but was only $43,532 for programs in New Mexico.^[6] The Institute of Medicine issued a report in July intended to overhaul GME. Among its recommendations are reforms in the payment methodology to replace these regional discrepancies with a single national, per resident amount.

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Cite this: Residents: Will They Ever Pay Off Medical School Debt? - Medscape - Aug 05, 2014.