Which Residency Cities Make the Most Financial Sense?
A Practical Guide to Comparing Training Locations Before Match Day
Updated: December 2025 • 4 Minute Read
- Not all residency cities are financially equal — the same salary can go much further in one city than another.
- Housing affordability depends on more than rent alone: salaries, cost of living, taxes, home prices, and appreciation trends all matter.
- Two free tools — the Resident Housing Affordability Index™ and the Residency City Comparison Worksheet — can help you make a confident, data-driven decision.
- Preparing now will make Match Week less stressful and help you stay in control when everyone else is scrambling.
Introduction
Why Compare Residency Cities Now?
As Match Day approaches, you’re likely narrowing down your list of potential residency cities. It’s tempting to focus on where you’d like to live — sunshine, big city energy, great restaurants — but the smartest move is to ask:
Which city will actually work best for me financially during residency?
A little preparation now means:
- less stress later
- clearer expectations
- and a far more confident decision once Match results are released.
That’s exactly why we created two companion resources to help you compare your top options the right way. Even if you don’t have immediate access to the tools, this article will walk you through the logic and process so you can make an informed decision.
Step 1. Understand How Your Salary Might Actually Feel in Each City
Not all $60–70K PGY-1 salaries are equal.
A resident earning $64K in Houston experiences something very different than a resident earning $64K in Boston. Between state taxes, cost-of-living differences, housing costs, and rent vs. buy dynamics, two cities with the same income can deliver radically different lifestyles and financial outcomes.
This is where the Resident Housing Affordability Index™ comes in. This professionally researched tool analyzes 50 major residency cities and ranks them based on:
- PGY-1 salary levels
- Cost of living adjustments
- Median home prices
- Rental market conditions
- State income taxes
- And even market appreciation trends
It gives you a simple, one-number comparison score so you can see which cities stretch resident income the farthest — and which cities will require tighter budgeting. See the full breakdown and rankings inside the index. If you don’t have the index handy, consider using online cost-of-living calculators or salary comparison tools as a starting point.
Step 2. Compare Your Top Cities Side-by-Side
Once you understand how each city ranks financially in general, it’s time to zoom in on your specific situation.
That’s where the Residency City Comparison Worksheet becomes incredibly powerful. This isn’t a generic checklist. It helps you compare up to four residency cities side-by-side across the things that actually matter to you, including:
Program & Income Factors
- Salary
- Annual increases
- Moonlighting
- Fellowship plans
- State taxes
- Adjusted take-home pay
Housing & Cost Factors
- Expected home prices
- Physician mortgage payment estimates (Use Steth MD for more information)
- Property taxes
- Rent pricing near the hospital
- Utilities and parking
- Rent vs. Own cost comparison
Lifestyle & Quality-of-Life Factors
- Commute time
- Public transit
- Walkability & safety
- School districts
- Airport access
- Partner job market
- Support network proximity
It even includes a decision matrix, letting you score each city and see which one honestly comes out ahead instead of guessing. If you don’t have the worksheet, you can create a simple table or spreadsheet to compare these factors for your top cities.
How These Tools Work Together
Think of it this way:
- Housing Affordability Index™: Big picture — where resident life is financially easier vs. harder; data-driven market insight.
- City Comparison Worksheet: Personal picture — how your life may look in each city; financial + lifestyle clarity.
Together, they move you from:
“I think this city might be better…”
to:
“This city actually makes the most financial and lifestyle sense — and here’s why.”
If your financial and lifestyle priorities point to different cities, take a moment to weigh what matters most to you. Sometimes, a city that’s slightly less affordable may offer a better support network or job market for your partner, and vice versa. Use your decision matrix to clarify your priorities and make a balanced choice.
Where Physician Mortgages Fit Into This Decision
If one of your potential residency cities scores well financially, buying a home may be more financially advantageous than renting — especially if you’ll be there at least three years.
Physician mortgage programs can help make ownership possible sooner than most residents expect, often with:
- Little or no down payment
- No PMI
- Flexibility around student loans
- And the ability to qualify using your residency offer letter before your first paycheck
The key is timing, understanding eligibility, and running numbers early enough to have options instead of scrambling. However, remember that homeownership comes with risks, such as market volatility and the possibility of needing to move after residency. Make sure to consider your long-term plans and risk tolerance before deciding to buy.
Your Next Step
If you’re a 4th-year medical student or current resident with 2–4 cities in mind, don’t leave this to guesswork:
- Review the Resident Housing Affordability Index™ to see how your cities stack up
- Fill out the Residency City Comparison Worksheet to personalize the analysis
- When you’re ready, connect with a physician mortgage specialist.
They can help you evaluate whether renting or buying makes more sense in each of your potential cities — and when it might make sense to move forward.
If you’d like help walking through your comparison or want a personalized affordability assessment, our physician-focused mortgage team is here when you need us.
3 Simple Options
to Get Started
Interactive Assessment
Chat with Steth, our Physician Loan Assistant, to quickly explore your options and get immediate answers.
Custom Recommendation
Receive options tailored to your specialty, career stage, and financial objectives.
Do Your Own Research
Check our FAQ and our pages for every stage of your career.