The cost of raising children in the US has outpaced wages across most professions, but for medical residents, the gap between what they earn and what it costs to care for a family is stark. Consider some numbers:

Resident pay rose a meager 2.2% in 2025, the slowest rate of pay growth in 4 years. That trails the US inflation rate hovering around 3%.

The cost of childcare has increased 220% in the past three decades.

Medical school graduates carry an average of nearly $250,000 in student debt, including undergraduate loans.

Add it all up and you get this: Childcare is unaffordable for residents in 98% of programs, according to a 2024 nationwide study.

The researchers found that even when childcare subsidies or on-site services were available, the median childcare affordability index remained far above the federal threshold of affordability as defined by the US Department of Health and Human Services. In most programs included in the study, childcare consumed more than 12% of income.

The gulf between resident pay and childcare costs isn’t just an abstract statistic. It has consequences for where residents train, how they juggle family life with an already punishing schedule, or whether they decide to have children at all.

Parenting Across Time Zones

Jackline Joy Martín Lasola, MD, PhD, ScM, a second-year ob/gyn resident, confronts these challenges every day. While her partner, Smirnov Exilus, MD, is in his last year of otolaryngology residency in Baltimore, Lasola made the difficult decision to relocate to San Francisco with their three children.

Not because the Bay Area is more affordable — Lasola’s 1100-square-foot apartment costs roughly $4400 — but because that was the only place family was available to lend a hand. Last year, her aunt moved in to care for the children, but she was unable to continue this year. So Lasola had to pivot in order to arrange care for her two youngest children, 3 and 5 (her oldest is 17), during her often 12-plus-hour shifts at the hospital.

Full-day care wasn’t an option. “We considered employer-sponsored care through Bright Horizons, but for a toddler it was over $1000 a month and for an infant it could be $2000-$3000,” she said.

Despite combining incomes with her partner, the math didn’t add up. “It would be like the equivalent of two Bay Area mortgages.”

Lasola also looked at nannies, but finding someone willing to work 12-hour shifts, overnight coverage, or unpredictable hospital schedules was nearly impossible without hiring multiple sitters — something two resident salaries couldn’t realistically support.

Thankfully, Lasola’s parents offered to take the youngest children into their home. “I had to figure out a system, and I’m grateful for my parents,” she said. “But I will say they weren’t particularly happy about it. They’re both retired. They weren’t intending on taking care of toddlers.”

Lasola visits the children when she has at least 2 days off. Exilus sees the family for three vacation weeks out of the year, though they plan to be reunited when he enters his final year. “It’s been an adjustment for all of us,” Lasola said.

A Career and a Family at Odds

Lasola’s journey through training and parenthood also touches on another dilemma: fertility and family planning in medicine. Many physician trainees delay having children until their careers are more established, often until after residency or fellowship training, when hours ease and pay improves. But with delays come the added risk for infertility and pregnancy complications. Some institutions offer fertility benefits such as embryo freezing to preserve options, but this poses a subtle contradiction.

“I was at a place in my life where I wasn’t going to delay extending my family for training,” Lasola said. Yet she pointed out that even in her ob/gyn community — where one might expect strong support for family building — the system sends mixed messages. “We’re promoting people having children at an age where it may be more challenging,” she noted, reflecting on how structural and cultural pressures can influence choices about when to start a family.

This echoes a broader sentiment among residents: Medicine’s demanding training often operates as if family is a distraction rather than an intrinsic part of many physicians’ lives.

Stacked Struggles

The cost is just one piece of a bigger puzzle, said resident Ryan Brewster, MD, who co-authored the 2024 study on childcare affordability and presented the research at the 2024 Pediatric Academic Societies meeting.

“When I moved to Boston for my residency training, which is one of the highest cost-of-living cities in the country, I found that there was a disconnect between the compensation and policies of the program and the lived experiences of the trainees,” he said. Consequently, before the study on the affordability of childcare, he conducted one that looked at the affordability of housing based on residents’ salaries around the country. 

“It really established the patterns that every resident knows intuitively — which is to say there is a mismatch between our payment and cost of living, particularly in coastal metropolitan areas,” Brewster said.

When he and his team started discovering similar patterns with childcare, he realized that all these factors — childcare, housing costs, limited benefits, and the cultural expectation that residents should put training first — need to be considered together. “We also have to overcome the cultural and social stigma against starting a family in medicine,” he added.

Brewster and his partner, both physicians, began the in vitro fertilization process with out-of-pocket costs not covered by their benefits at the time, another example of how trainees absorb the financial risk of family planning amid intense work demands. “Both of us are in our early thirties and don’t anticipate being in a stable position to start a family soon, so we made that investment,” he said. “And it’s illustrative of that conflict between what is expected of you as a physician and your family-building goals.”

“Medicine is such a unique beast,” he added. “We as the healthcare professional community are required to complete years, oftentimes decades, of training that involves deferring retirement benefits, savings, and fair income.”

Though Brewster does believe things are improving, he said, it’s vital to include residents and trainees in discussions about compensation and benefits. And to keep the research going. “One of the drivers behind the study was to put the data behind what we already know and to create momentum for that structural change at a programmatic level,” he said. “And, more broadly, to revise how our residents’ compensation model is framed.”

When Geography Shapes Family Decisions

“California is out. Boston is out. New York is out,” said Erin Wildermuth, MD, PhD, an MS4 with three children and another on the way, describing how cost of living is influencing her residency applications.

Bottom line, expensive housing and childcare shut the door on many top-tier programs. “It’s not just childcare,” she said. “It’s the whole housing situation when you need more bedrooms.” And with preschool slots competitive and deposits required before match results arrive, the administrative and financial burden begins before training even starts.

“I feel like the childcare and the schooling piece of this residency puzzle has caused as [much] if not more stress than the actual application for myself,” Wildermuth said.

Wildermuth has narrowed her focus to programs in locations that meet her family’s cost-of-living criteria and provide support for nontraditional students. She acknowledged the advantage of having a partner who “makes real money.”

“I genuinely do not know how a single parent could make residency work financially, given the hours required and the cost of childcare,” she said. “As a married resident-to-be, I am already feeling the strain even with a partner who earns comparatively well as a web developer.”

Nonetheless, Wildermuth has invested a great deal of time into researching and sharing information with others on a variety of family-focused topics, such as creative childcare options, growing a family while in medical school, and even how to cut costs as a pre-med — providing “hacks” within a system that seems increasingly unresponsive to the feasibility of raising a family while in training.

Changing Cultures and Emerging Solutions 

Across the country, some medical schools, student groups, and advocacy coalitions are pushing for change, even while acknowledging how entrenched the problem is.

At the UNC School of Medicine, Chapel Hill, North Carolina, the Family Support Initiative interest group — led by Lindsey “Lou” Gaghan, MD, and Bao-Tran “BT” Parker, MD — helped develop a New Child Adjustment Policy. Passed in 2019, this policy creates structured support for students when a new child enters their lives, outlining options for time away from the curriculum while maintaining benefits such as health insurance and financial aid.

Neither Gaghan nor Parker had children at the time they were drafting the policy, but they knew starting a family was an issue they would face in the future. “[Parker and I] knew we wanted to have kids, but we also knew there were all these obstacles in the way,” said Gaghan.

Sue E. Estroff, PhD, served as Gaghan and Parker’s faculty mentor. She acknowledged that some national guidelines exist, but the culture of residency programs and internships remains quite local. Estroff said that the UNC initiative wasn’t met with any resistance.

“In my position as faculty chair, I knew how the administrative and policy processes at the university and med school worked,” Estroff said. “I also had personally worked with decision-makers in various committees and other venues while in that role. As a known quantity, I could bring credibility, connections, and support.”

Gaghan, now a mother of two young children with a third on the way, noted that support networks — such as resident parent listservs and community groups — have become critical sources of advice. But she also recognized the gaps that still exist: complicated health insurance rules surrounding dependents, outdated parental leave policies, and a lack of widespread childcare support.

Building Parent Advocacy

On a broader advocacy front, the Parent Resources in Medical Education (PRIME) initiative has emerged as a platform for medical students and trainees to organize around parental support.

Created by medical students at the University of Chicago Pritzker School of Medicine, Chicago, PRIME seeks to build community among parent trainees, advocate for policy changes that support parents, and provide resources and tool kits for students to start local chapters.

National associations such as the American Medical Association (AMA) have also weighed in, adopting policy recommendations aimed at increasing on-site or subsidized childcare for medical trainees. The AMA policy highlights how childcare costs and training demands compound stress for residents, and it calls on medical schools to find innovative solutions.

While some institutions have begun offering childcare subsidies, emergency backup care, or on-site centers, these remain exceptions rather than the rule. In some residency programs, childcare discounts offered through hospital employee services are modest, and on-site daycare spots have year-long waiting lists.

A Culture Shift Under Way — Slowly

Obviously, residency training wasn’t originally designed around the needs of family life. Historically, it either assumed a trainee workforce without dependents or, when the field was male-dominated, that there were stay-at-home wives providing childcare. That assumption no longer fits the landscape of modern medicine, where women now make up a majority of incoming medical students and many trainees pursue parenthood during training.

Change is slow, and solutions remain uneven. But pockets of progress — from student-driven policies like the one at UNC to national advocacy networks — signal that the conversation is shifting. These efforts, combined with data showing the extent of the affordability gap, are forcing medical schools to face some difficult questions.

Can they attract and retain the best talent if trainees feel they must choose between family and career? Are the top-tier schools in metro, high-cost-of-living cities getting passed over for programs in more affordable locations?

“I think as more women and more nontraditional candidates are going into medicine, the need to address these issues has become more apparent,” said Gaghan. “But the dial doesn’t move on its own. The dial moves because people move it.”