(0320) Navigating the Discrepancy: How Cost of Living Adjustments Impact Otolaryngology Residents' Salaries

Introduction: Otolaryngology (ENT) residents in certain cities and states face significant financial stress due to elevated cost of living (COL). While the mean annual resident salary has risen by 3% over the past decade, these salary increases have not matched escalating inflation rates and overall cost of living.

Methods: Accredited US ENT residency programs were included if salary information and the N of filled residency positions annually were found online in December 2023. Salary data from each program was grouped by state, by cities with ≥ 100K population, and by cities with ≥ 2 programs. The weighted salary by state and cities for PGY-1 to PGY-5 combined is expressed as median (25th to 75th interquartile range). Salaries before and after adjustment for the cost of living (COL) were compared.

Results: Out of 131, 122 ENT programs met the inclusion criteria. The national median ENT residency salary by state was $68K (65K-73K) (n = 1,785) and for all cities with ≥ 100K population $69K (63K-74K) (n = 1,290). After cost of living index (COLI) adjustment (national median COLI = 100, >100 indicating above-median COLI and < 100 indicating lower COLI), the national median salary by state was $68K (60K-73K; p < 0.001) (median COLI = 95; 92-116) and the median ENT residency salary by cities with ≥ 100K population decreased to $67K (59K-71K; p < 0.001) (median COLI = 100; 93-118). In cities with ≥ 2 programs, median salary was $73K (67K-77K) (n = 602), and after adjustment, it reduced to $65K (55K-71K; p<.001). The state of MA had the biggest decline after adjustment (n = 66, $98K to $66K, -33%; p < 0.001), while MS had the largest gain (n = 15, $58K to $67K, +16%; p < 0.001). The most significant loss for bigger cities after adjustment was observed in NYC-Manhattan programs (n = 70, $89K to $39K, -56%; p < 0.001), whereas Augusta had the most substantial gain (n = 13, $61K to $74K, +21%; p < 0.001).

Conclusions: This study reveals statistically significant changes in salary following COL adjustments. ENT residents in expensive cities and states will experience greater financial stress due to salaries falling behind living costs.