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The Debt and the Cash Flow of Residents: I. The Grim Present

James Loehr
JAMA. 1990;264(10):1248. doi:10.1001/jama.1990.03450100037010.
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To the Editor.—  As a fourth-year medical student, I read with interest the article by Hernried et al,1 which concluded that a "typical" house officer, with extreme indebtedness, might accumulate over $75 000 of additional debt during a 5-year residency program.I have several objections to their model. First, while the authors use cost-of-living indexes to differentiate between expenses in more vs less expensive cities, they neglect to note that salaries also differ between these areas. Using information gathered on my recent residency interviews, I compared salaries from 6 California programs with those from 12 programs in seven other states. The California house officers consistently received higher salaries, ranging from 7.5% more for the first year to 22.4% more in the third year. While this would not completely make up for the difference in cost of living between California and the other states, it would help substantially.Second,


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