Affordability of Childbearing During Emergency Medicine Residency: A Cost-of-Living Analysis

Many EM residents complete training during prime childbearing years, making postponing family planning difficult. High living and childcare costs may create substantial financial barriers for residents starting a family. The objective is to evaluate the affordability of having a child during EM residency by comparing PGY-1 salaries with required annual income (RAI) across household structures.

Publicly available 2025 PGY-1 salaries were collected for 271 EM programs. Cost-of-living (COL) indices were obtained from the Council for Community and Economic Research (C2ER) 2025 Quarter 3 database, covering 272 U.S. urban areas, and applied when the program’s city was included. RAI, the minimum income required to meet basic living expenses in the program’s county, was subtracted from salary to calculate annual income surplus for three household structures: single adult, single adult with one child, and two working adults with one child.

The mean PGY-1 stipend was $69,095 (SD = $7,952; range $56,707–$101,200). Surplus for a single adult without children averaged $19,762 (SD = $6,745; range −$2,059–$44,315). For a single-income household with one child, the mean surplus was −$17,466 (SD = $10,724; range −$66,291–$5,729); only 5 of 271 programs provided a positive surplus. Dual-income households with one child had a mean surplus of −$27,601 (SD = $10,616; range −$74,888–−$5,679). Over 95% of programs did not meet RAI for a single parent supporting a child. COL was negatively correlated with surplus for single adults with one child (r = −.379, p < .001), highlighting greater financial strain in higher-cost areas.

Most EM PGY-1 salaries are insufficient to support a child, even with dual incomes, particularly in high-COL regions. These findings highlight the financial challenges of childbearing during residency and support the need for program-level interventions, including childcare assistance and regionally adjusted compensation, to promote resident well-being and financial stability.