What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Anesthesiology residency programs (n=118). Intervention: High Cost-of-Living Index (COLI) areas vs. Low Cost-of-Living Index (COLI) areas. Primary outcome: CA-1 anesthesiology resident stipend (median difference $7,909, 95% CI 5,969-12,728, p=<0.001).

What does this research mean for the field?

Anesthesiology residency stipends averaged $70,757 but decreased by 21.8% to $59,499 after cost of living adjustments in major cities (p < 0.001). Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The study aims to evaluate how regional cost of living affects anesthesiology resident stipends across the U.S.

January 20, 2026Open Access

Cost of living and its effect on anesthesiology resident stipends across the United States

Q: What are the key findings of this study?

High cost-of-living areas provided a median CA-1 anesthesiology resident stipend of $74,046 compared to $66,137 in low-cost areas, but resulted in marked reductions in real purchasing power after adjustment.

Q: What does this research mean for the field?

Anesthesiology residency stipends averaged $70,757 but decreased by 21.8% to $59,499 after cost of living adjustments in major cities (p < 0.001). Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

The study aims to evaluate how regional cost of living affects anesthesiology resident stipends across the U.S.

BCBenjamin H. P. CormanRhode Island Hospital MKMark C. Kendall CMChristopher J. MalgieriRhode Island Hospital

Key Result

High cost-of-living areas provided a median CA-1 anesthesiology resident stipend of $74,046 compared to $66,137 in low-cost areas, but resulted in marked reductions in real purchasing power after adjustment.

Key Points

The study aims to evaluate how regional cost of living affects anesthesiology resident stipends across the U.S.
Queried AAMC directory for anesthesiology residency programs for 2024-2025.
Collected CA1 stipend data via internet search and assigned programs to metro areas based on COLI metrics.
Recorded city, state, geographic region, and reputation ranking to calculate discrepancies.
National average CA-1 stipend is $70,757, varying significantly by cost of living.
California showed the largest adjusted deficit at -$26,969, while Oklahoma had a surplus of $13,096.
After COLI adjustment, stipends in major cities dropped by 21.8% on average.

Study Design

Type

Cross-Sectional (n=118)

Structured PICO

Population

118 accredited anesthesiology residency programs in the United States with published CA-1 stipends and available COLI data for the 2024-2025 academic year.

Outcome

Absolute and relative discrepancies in CA1 (post graduate year 2) stipends using Cost-of-Living Index (COLI)

Anesthesiology residency stipends show substantial variation after adjusting for regional cost of living, with high COLI areas experiencing marked reductions in real purchasing power.

Main Result

Mean Difference: 7909 (95% CI 5969–12728)

Absolute Event Rate: 74046% vs 66137%

p-value: p=<0.001

Limitations

Did not include non-stipend benefits such as meal stipends, housing subsidies, health insurance coverage, moonlighting opportunities, and wellness or educational funds.
Some rural programs were excluded due to lack of published salaries or COLI data, limiting generalizability to rural training environments.
COLI index reflects relative rather than longitudinal cost changes at a single point in time.
Unable to calculate state or local tax burdens reliably.

Abstract

Background Cost of living is one of the key factors in residency selection among U. S. medical graduates, given rising student loan debt. No studies have investigated anesthesiology stipends relative to regional cost of living. This study aimed to compare anesthesiology resident stipends nationwide using the Cost-of-Living Index (COLI) to assess purchasing power. Methods The AAMC directory was queried to obtain accredited anesthesiology residency programs for the 2024–2025 academic year. CA1 (post graduate year 2) stipends were collected via internet search and residency programs were assigned to metro areas using region specific COLI metrics. City, state, geographic region, and reputation ranking were recorded and absolute and relative discrepancies were calculated. Results Of 174 anesthesiology residency programs, 118 (67. 8%) were analyzed. The national average CA-1 stipend was 70, 757 ± 9, 718, with medians of 66, 137 in low COLI areas and 74, 046 in high COLI areas (median difference 7, 909, [95% CI 5, 969-12, 728, p 30% loss after COLI adjustment. Conclusions Anesthesiology residency stipends showed substantial variation after adjusting for regional cost of living, with many high COLI areas experiencing marked reductions in real purchasing power. Given rising educational debt, applicants should consider COLI adjusted stipends when evaluating programs to better assess regional affordability and financial impact. Trial registration N/A.

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