‘Virtually impossible to afford childcare’ on single-parent resident salary
Key takeaways:
- Most surgical resident programs led to negative net income among residents after accounting for annual expenses and childcare costs.
- Researchers observed the highest negative mean net income in the West.
Combined living expenses and childcare costs could not be sustained on the salary of a single-parent surgical resident, according to study results published in JAMA Network Open.
Individuals may be deterred from pursuing surgical residency or from starting families as surgical residents due to the financial obstacle, researchers concluded.
‘Mind-blowing’
“We had our first child the year after I finished fellowship and while my husband was still in fellowship,” Lily S. Cheng, MD, pediatric surgeon at UVA Health, told Healio. “When we were doing our taxes that year and calculated how much we spent on childcare, it was mind-blowing.
“I remember thinking that we would not have been able to afford this if we were both still residents and fellows,” she added. “There has been a lot of great research in the last few years on pregnancy and infertility in residency that has sparked some positive policy changes, but we felt like no one had looked at the financial burden of having a child during training, which is also really challenging.”
For this reason, Cheng and colleagues sought to evaluate surgical residents’ net financial balance after childcare costs at various postgraduate years and child ages.
The cross-sectional study included data from 351 U.S. surgical residency programs, including 295 with publicly available salaries for postgraduate years 1 through 5. Researchers categorized programs into U.S. regions based on the AMA Colleges classifications — Northeast, Midwest, South and West — and obtained childcare costs from the National Database of Childcare Prices and annual expenditure data from the Bureau of Labor Statistics.
They determined net income by subtracting mean expenditures and childcare costs from residency salaries to compare costs by region and child age.
Residents’ net income by year of residency served as the primary outcome.
Negative net income
Results showed that after deducting expenditures and childcare costs, 98.3% of programs left residents with a negative net income. Results remained consistent across all U.S. regions and child age groups.
“We were surprised that nearly all programs, out of 295 that we looked at, left residents with a negative income after annual cost-of-living expenses and childcare costs,” Cheng told Healio. “It’s virtually impossible to afford childcare on a resident’s salary alone.”
In addition, researchers observed the highest negative mean net income in the West (–$18,852), followed by the Northeast (–$15,878), Midwest (–$12,067) and South (–$8,636).
Moreover, parents of infants in the West experienced the highest mean negative net income (–$21,278), whereas parents of school-aged children in the South experienced the lowest mean negative net income (–$8,453).
“Our findings underscore that if you’re going to have a child in residency, you need help — either in the form of another income stream and/or partner who can care for the children,” Cheng said. “The hope is that these findings spark conversation about how we can better support residents who choose to start families during training.
“We’ve seen some important policy changes as a result of the growing body of literature on infertility, pregnancy and parenthood in surgical trainees,” she added. “I hope that continues, because there is more that we can do.”
For more information:
Lily S. Cheng, MD, can be reached at lilycheng@virginia.edu.
Perspective
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There has been rising concern about burnout interfering with physicians’ capacity to provide the highest quality of care. Studies evaluating the quality of life for physicians in specialty training have been increasing over time.
This study is important, because we can tie the highest care delivery outcomes in patients to the healthiest, best educated and most supported medical staff. By looking at all aspects of training and the practice of medicine, we can better serve our patients.
The researchers found that the vast majority of residents couldn’t afford to pay their own living expenses and also pay for childcare.
Surgical residencies are intensive training — 5 years, and often prolonged by additional subspecialty training — and occur during the time that most people outside of medicine are having children.
The study data showed that 98% of programs produced a net negative income for those trainees who wanted to build a family. Trainees make large sacrifices to receive training to provide the superlative medical care we have in the United States.
Alongside the solutions the researchers provided, which include stipends and onsite childcare, Erika Rangel, MD, of Massachusetts General Hospital, wrote a wonderful commentary in which she suggests institutional support that aligns with that seen in the private sector.
Thinking about health care as a business, we want to make sure we provide benefits to our staff — in this case, physicians — to help them succeed in their role. A company that invests in their staff will receive better productivity, better service and, I anticipate in this scenario, better care for patients.
How can we invest in our staff — and therefore get better outcomes and less physician turnover? Things like subsidies for childcare are certainly one potential solution.
National investments to make childcare more affordable is another; paid family leave could also help. Considering the different aspects of how we support our trainees is critical to achieve that elusive work-life balance.
This study confirms what some of my own research has shown — that it can be very challenging for people in training to have children, despite our desires when faced with concerns from the “biological clock.”
This may disproportionately affect trainees who are either single parents or living in high- cost areas. The downstream effect of that is that there could be repercussions within the workforce, meaning less people of a certain group — like women — who want to go into surgery. It can also mean there might be less access to surgeons within certain areas, because we’re just not sufficiently filling the workforce pipeline.
It goes back to this idea that if we invest in our workforce, we can get better outcomes for our patients and improve the quality of life for everyone.
We really are seeing an increased focus on some of these issues, which is fantastic, because it means that research is helping drive the movement toward positive change. We are trying to improve medicine to make sure physicians are able to have a family and be successful in their careers, and also achieve important personal and professional metrics.
It is amazing that we are making progress toward our goal of having excellent medical care — and also healthy and happy physicians to provide it.
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