Regional Variations in Diagnostic Radiology Residency Stipends Are Accentuated When Correlated With Cost of Living

Objectives: To determine and compare the relative value of diagnostic radiology resident stipends when adjusted for regional cost of living. Methods: The ACGME database was queried for a list of accredited allopathic diagnostic radiology residency programs for academic year 2017-2018. Stipend information for R1 positions (post-graduate year 2) was identified through each program's website. Data was grouped and analyzed by city, state, and geographical region. Stipends were then correlated with the 2017 annual region-specific average cost of living index (COLI). Results: There were 194 programs identified, of which 118 (60.8%) were analyzed after exclusions for lack of stipend or corresponding COLI data. The average annual stipend was $57,161 +/-$4,242 (range, $49,547-$72,000). The COLI-adjusted value was $51,357 +/-$9,927 (range, $26,915-$68,827). The average difference between stipend and cost-of-living adjusted value was -$5,804 +/-$12,610 (range, -$40,953-$10,958), corresponding to an average -9.1% stipend value loss (range, -58.1%-21.7%, P = .00000004). Value loss in large metropolitan cities was as high as 53.8%. Discussion: Financial issues are one of the biggest challenges faced by trainees and have been correlated with increased stress as well as poor academic performance. The pressures of debt can also play a significant role in ultimate subspecialty career choice. Discrepancies between resident stipends, which are not adjusted based on the local COLI, are exacerbated by large regional variations in cost of living. Residency applicants should not discount regional cost of living when deciding where to train, and training programs should consider cost of living when setting stipend levels for their trainees.