Beyond the Paycheck: Real Salary Growth and Regional Differences in Integrated Plastic Surgery Residencies

Introduction: Resident salaries influence recruitment, retention, and overall physician well-being. For integrated plastic surgery programs, compensation varies depending on program funding, institutional size, and regional costs. While prior studies have described nominal differences in pay, less is known about salary increases throughout residency after accounting for inflation and cost of living. This study investigates year-to-year wage growth after accounting for inflation and regional salary differences among integrated plastic surgery programs. Methods: Resident salary data were collected from the 2025 AAMC Residency Explorer Tool for integrated plastic surgery (PRS) residency programs in the U.S. Programs without available data were excluded. Programs were then divided into four CDC regions (Midwest, Northeast, South, and West). Annual salary increases were calculated within each program and adjusted for inflation using the regional consumer price index (CPI) as a surrogate for inflation. Additionally, wages were adjusted for cost of living using regional price parity by urban city and state relevant to each program. Mean salaries and mean percentage changes were calculated by region. Kruskal-Wallis and One-Way ANOVA tests were used to test differences between groups with post-hoc tests adjusted by Bonferroni correction were used to assess significance (p<0.05). Results: Seventy-seven of the 89 PRS programs were included in the study. The West offers the highest RPP-adjusted mean salary ($81,817.31) amongst PRS programs while the South offers the lowest ($75,046.20). The South offers significantly less salary than Midwest ($79,324.53, p<0.001), Northeast ($80,352.40, p<0.001), and West (p<0.001). Interestingly, the South has the greatest mean growth after inflation (1.66%) amongst all regions while the West demonstrated the lowest (1.12%). Significant differences in mean adjusted salary growth exist between the South and the Midwest (1.27%, p=0.003), South and Northeast (1.16%, p<0.001), and South and West (p<0.001). Discussion: Although the South trails in absolute pay for residents in integrated plastic surgery programs compared to other regions, it demonstrates the greatest year-to-year salary growth above inflation, which may help lower financial strain as responsibilities increase over training. In contrast, the West demonstrates the opposite trend, where higher entry salary but slower growth may cause undue stress from lack of perceived financial growth These trends highlight the need to not only continually renew baseline salaries, but also salary trajectories relative to ever-increasing inflation and cost of living. Programs and policymakers should consider both cost-of-living adjustments and long-term salary trajectories when addressing resident financial well-being.