Background The present study aims to quantify the opportunity cost of training residents and fellows for head and neck surgery. Methods A 2005–2015 review of ablative head and neck surgical procedures was performed using the National Surgical Quality Improvement Program (NSQIP). Work relative value units (wRVU) generated per hour were compared among procedures performed by attendings alone, attendings with residents, and attendings with fellows. Results Among 34,078 ablative procedures, the rate of wRVU generation per hour was greatest for attendings alone (10.3), followed by attendings with residents (8.9) and attendings with fellows (7.0, p < 0.001). Resident and fellow involvement was associated with opportunity costs of $60.44 per hour (95% CI: $50.21–$70.66/h) and $78.98 per hour ($63.10–$94.87/h, 95% CI), respectively. Conclusion wRVU‐based physician reimbursement does not consider or adjust for the extra effort involved in training future head and neck surgeons. Level of Evidence NA Laryngoscope, 134:113–119, 2024 We investigated the relative value unit opportunity cost of including residents and fellow trainees in common head and neck surgical procedures sing the National Surgical Quality Improvement Program (NSQIP). Inclusion of residents and fellows in head and neck surgical procedures was associated with opportunity costs of $60.44 per hour (95% CI: $50.21–$70.66/h) and $78.98 per hour ($63.10–$94.87/h, 95% CI), respectively.