News Release

Study: Childcare is unaffordable for U.S. medical residents

Findings revealed at the Pediatric Academic Societies 2024 Meeting

Reports and Proceedings

Pediatric Academic Societies

Resident physicians at more than 98% of U.S. training programs aren’t paid enough to afford childcare, according to a new national study. The research will be presented at the Pediatric Academic Societies (PAS) 2024 Meeting, held May 3-6 in Toronto. 

Childcare remains unaffordable even at most programs that subsidize childcare or offer it onsite, the examination of data from the Labor Department and the U.S. Census Bureau’s American Community Survey (ACS) revealed.

“People in the United States from many walks of life struggle to pay for childcare, and resident physicians are no exception,” said Ryan Brewster, MD, resident physician at Boston Children’s Hospital and presenting author. “If we want to address this country’s physician shortage, we need to ensure that talented, motivated residents of all backgrounds—who already work long hours and, all too often, carry huge student loan debts—earn enough for basic childcare.”

The study of second-year residents at 935 accredited residency programs found that childcare is less likely to be affordable in urban areas and in the Mid-Atlantic, New England, and on the West Coast. Researchers found that childcare has become less affordable over the last two decades. Resident physician salaries fell by 0.23% while childcare costs rose by 44.7% between 2000 and 2022, according to the study.

Childcare becomes unaffordable when it consumes more than 7% of household income, according to the Department of Health and Human Services.

These findings underscore the need for multilevel advocacy for graduate medical compensation, according to the authors.

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Dr. Ryan Brewster will present “Childcare Affordability and Benefits Amongst U.S. Resident Physicians” on Friday, May 3 from 3:45-4:00 PM E.T.

Reporters interested in an interview with Dr. Brewster should contact Amber Fraley at

The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information, please visit

About the Pediatric Academic Societies Meeting

Pediatric Academic Societies (PAS) Meeting connects thousands of leading pediatric researchers, clinicians, and medical educators worldwide united by a common mission: Connecting the global academic pediatric community to advance scientific discovery and promote innovation in child and adolescent health. The PAS Meeting is produced through the partnership of four leading pediatric associations; the American Academy of Pediatrics (AAP), the Academic Pediatric Association (APA), the American Pediatric Society (APS), and the Society for Pediatric Research (SPR). For more information, please visit Follow us on X @PASMeeting and like us on Facebook PASMeeting.

Abstract: Childcare Affordability and Benefits Amongst U.S. Resident Physicians

Presenting Author: Ryan Brewster, MD

Organization: Boston Children's Hospital


Medical Education: Resident


Many resident physicians have children during their training years. Access to childcare and institutional parental benefits may impact financial health and professional development. The extent to which graduate medical education (GME) salary and benefits addresses the burdens associated with parenthood have not been well defined.


Describe childcare affordability and associated benefits available across ACGME-accredited residency training programs in the United States.


We conducted a cross-sectional analysis of 2023-2024 PGY-2 salaries relative to childcare costs across institutions sponsoring ACGME-accredited residency programs nationally and the availability of childcare benefits (childcare subsidies, on-site childcare). Institutional characteristics were obtained from the AMA FREIDA program. We used the U.S. Department of Labor to calculate county-level infant childcare cost and the American Community Survey to estimate a resident partner’s income. Per the Department of Health and Human Services, annual childcare cost as a proportion of household income (childcare affordability index) >7% is considered unaffordable. We used multiple linear regression to assess the association between institutional characteristics and the childcare affordability index. Temporal trends in inflation-adjusted childcare cost and resident salary from 2000-2022 were obtained from the Consumer Price Index for childcare and the Association of American Medical Colleges, respectively, and evaluated with the Mann-Kendall trend test.


Childcare was unaffordable for 98.2% of the 935 included sponsoring institutions with a median childcare affordability index of 12.7% (IQR 10.5-15.4%) (Table 1, Figure 1). Childcare subsidies and on-site childcare were offered by 111 (11.9%) and 239 (25.6%) sponsoring institutions, respectively. The childcare affordability index was significantly associated with geography - particularly the Pacific (aOR 12.36, 95% confidence interval 6.22-24.53), Mid-Atlantic (aOR 3.91, 95% CI 2.04-7.50), and New England (aOR 23.95, 95% CI 10.65-53.86) regions – and urbanicity (aOR 22.84, 95% CI 15.29-34.11). Between 2000-2022, childcare cost increased by 44.7% overall (p< 0.001), while resident salaries decreased by 0.23% (p=0.004) (Figure 2). 


Childcare has become progressively unaffordable for residents, with significant regional variation and a widening gap between childcare costs and trainee salaries over time. Yet, childcare subsidies and on-site childcare are limited. Multilevel advocacy is needed to ensure GME compensation reflects the needs of resident parents.

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