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. 2025 Mar 3;8(3):e250708.
doi: 10.1001/jamanetworkopen.2025.0708.

Affording Childcare on a Surgical Resident's Salary

Margaret G Mercante  1 , Emily G Tocco  1 , Nidhi Kuchimanchi  1 , Mohamad El Moheb  1 , Maria F Nunez  1 , Mackenzie M Mayhew  1 , Susan J Kim  1 , Allan Tsung  1 , Lily S Cheng  1 , Russell G Witt  1
Affiliations

Affording Childcare on a Surgical Resident's Salary

Margaret G Mercante et al. JAMA Netw Open. .

Abstract

Importance: Previously published literature found that 28.6% of surgical residents have or are expecting children, yet little information exists regarding the financial demands of childcare during residency.

Objective: To evaluate surgical residents' net financial balance after childcare costs at various postgraduate years and child ages.

Design, setting, and participants: This cross-sectional study, conducted from June 14 to August 2, 2024, examined surgical residency programs across the US using publicly available data. Programs were categorized into US regions based on the Association of American Medical Colleges classifications: Northeast, Midwest, South, and West. Childcare costs were obtained from the National Database of Childcare Prices, and annual expenditure data came from the Bureau of Labor Statistics.

Main outcomes and measures: The primary outcome was residents' net income by year of residency, calculated using salaries and expenditures. To compare costs by region and child age, net income was determined by subtracting mean expenditures and childcare costs from residency salaries. Calculations were validated using the Massachusetts Institute of Technology Living Wage Calculator.

Results: Of 351 US surgical residency programs, 295 with publicly available salaries for postgraduate years 1 through 5 met inclusion criteria. A total of 290 programs (98.3%) showed a negative net income when expenditures and childcare costs were deducted. This finding held true across all child age groups and US regions. The West had the most negative mean net income (-$18 852 [range, -$35 726 to $766]), followed by the Northeast (-$15 878 [range, -$37 310 to $3589]), Midwest (-$12 067 [range, -$26 111 to $1614]), and South (-$8636 [range, -$18 740 to $4826]). Parents of school-aged children in the South had the lowest mean negative net income (-$8453 [range, -$16 377 to $3417]), while parents of infants in the West had the highest mean negative net income (-$21 278 [range, -$35 726 to -$5112]).

Conclusions and relevance: This cross-sectional study of surgical residents' net income found that, after accounting for mean annual expenditures and childcare costs, a surgical resident's salary was insufficient to cover living expenses and childcare costs for single resident parents. This financial obstacle may deter individuals from pursuing surgical residency or from starting families as surgical residents.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Cheng reported receiving a grant from the National Institute of Diabetes and Digestive and Kidney Diseases. Dr Witt reported being an iTHRIV Scholar, which is supported in part by the National Center for Advancing Translational Sciences of the National Institutes of Health, and receiving support from the National Cancer Institute Early Surgeon Scientist Program. No other disclosures were reported.

Figures

Figure.
Figure.. Net Income for Parents With Children Categorized as Infants (Birth to 23 Months), Toddlers (24-35 Months), Preschool Aged (36-54 Months), and School Aged (≥55 Months) Across General Surgery Residency Programs in the US
aP ≤ .01. bP < .001. cP ≤ .001. dP = .08. eP ≤ .05.
See this image and copyright information in PMC

Comment in

  • doi: 10.1001/jamanetworkopen.2025.0712

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