Robert Florin, MD Resident Award: The Cost of Neurosurgical Training: A Net Present Value and Opportunity Cost Analysis

Introduction: Neurosurgical training requires high financial sacrifice compared to other high-earning careers such as engineering. It is unknown what neurosurgical residents make per post-graduate year (PGY) and how the net present value (NPV) of neurosurgical training compares to their initial investment (loans) and alternative careers such as engineering.

Methods: PGY 1-7 salaries were recorded from each neurosurgical training institution’s parent GME website for the 2022-2023 year and weighted by trainees for each parent institution. Medical school debt was derived from annual AAMC medical school graduate surveys. Loan repayment was based on the SAVE/Repay plan. Federal, state, and employee FICA taxes were subtracted from each resident’s salary using the NBER Taxism database. Living expenses were derived from each city’s validated MIT Living Wage Index. 10% of residual income was assumed to be invested in a Roth IRA earning the average long-term S&P 500 return. Weighted-average engineering salary for each city was obtained from the annual BLS Occupational Employment and Wage Statistics (OEWS) Survey for each city and adjusted for experience. Average long-term inflation was used to discount future cash flows.

Results: 118 PGY 1-7 programs were studied, providing salary information for 100% of neurosurgical trainees and 61% of total US trainees. Weighted-average resident salary by post-graduate year was $63,992 (PGY-1) to $80,693 (PGY-7). Compared to engineering salary, after taxes, loan principal, and loan payments, the average neurosurgical graduate has $532,278 less total wealth (net present value) than similarly aged engineers ($140,479 compared to $672,757). After removing living expenses, recent Neurosurgical graduates after PGY-7 year failed to break-even (-$64,717 vs. $325,443 for engineering).

Conclusion : The opportunity cost of neurosurgical training is extremely high compared to alternative careers using matched, validated metrics for living cost, loans, loan repayment, and taxes for each neurosurgical resident. Neurosurgeons deserve high compensation given the high actual and opportunity costs of training.