Geographic Trends in Ophthalmology Resident Physician Compensation and Cost-of-Living Expenses

IMPORTANCE: Given that resident physician financial strain has been associated with poor outcomes, objective metrics to forecast financial well-being may be useful to (1) applicants when evaluating ophthalmology residency programs and (2) programs when determining resident benefits. OBJECTIVES: To determine and compare the relative value of ophthalmology resident stipends plus benefits when adjusted for cost-of-living expenses and to analyze program characteristics associated with greater resident net incomes. DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, the American Medical Association’s Fellowship and Residency Electronic Interactive Database was used to identify US Accreditation Council for Graduate Medical Education–accredited ophthalmology residency programs. Resident physician stipends and stipends plus benefits as well as residency program characteristics from the 2023-2024 academic year were noted for all eligible programs. The Massachusetts Institute of Technology’s Living Wage Calculator’s required annual income (RAI) was selected as a surrogate to approximate cost-of-living expenses. EXPOSURE: Residency program characteristics, including affiliation, size, ranking, presence of housing benefit, and training year. MAIN OUTCOMES AND MEASURES: The primary outcome was the annual stipend plus benefits income surplus (SPBIS) for each residency program, defined as the resident’s stipend plus benefits (SPB) minus the RAI for the county in which the residency program is located. Secondary outcomes included income surplus variation by program characteristics. RESULTS: Of 116 ophthalmology residency programs analyzed, 37 (31.9%) were located in the Northeast, 36 (31.0%) in the South, 29 (25.0%) in the Midwest, and 14 (12.1%) in the West. The mean (SD) postgraduate year 1 resident annual SPB was $65 397 ($8205), and the median (IQR) was $63 986 ($59 992-$69 698). After adjusting for the cost of living, the mean (SD) SPBIS was $27 459 ($5734) and the median (IQR) was $27 380 ($23 625-$31 796). Annual cost-of-living expenses varied by as much as $8628 (95% CI, $6310-$10 947) and SPBIS varied by as much as $6283 (95% CI, $3367-$9198) between regions. Resident SPB increased by a mean (SD) of 3.97% (0.98%) for each subsequent training year (range, 0.93%-7.26%). Annual SPBIS increased by a mean (SD) of 9.48% (3.60%) for each subsequent training year. CONCLUSIONS AND RELEVANCE: After adjusting for living costs, intraregional and interregional differences in SPBIS among ophthalmology residents can vary by thousands of dollars, impacting residents’ financial security. Further discussion regarding compensation may lead to innovative strategies that aim to improve resident well-being and performance.