Exploring the 5 Lowest-Paid Medical Specialties: Career Impact Explained

Top 5 Lowest-Paid Medical Specialties: What It Really Means for Your Career

In conversations about Medical Careers, salary comes up early and often—especially for students and residents facing six-figure debt. While medicine is rarely chosen only for income, the reality of loans, cost of living, and long training years makes Healthcare Salary an important part of specialty decision-making.

At the same time, some of the most meaningful, relationship-based fields in medicine consistently appear at the bottom of salary surveys. This raises a difficult question: how much should income influence your specialty choice?

This guide walks through the top five lowest-paid medical specialties, explores why their salaries tend to be lower, and offers a practical framework to help you decide whether that should matter for your life and career.

Note: Salary numbers are approximate and vary by region, practice setting, years of experience, and source of data. Focus on relative trends, not exact figures.

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Understanding Physician Salaries: Beyond the Headline Numbers

How Salary Data Is Typically Reported

Reports from sources like Medscape, Doximity, and MGMA commonly rank specialties by average or median income. They often separate:

• Primary Care (e.g., Family Medicine, Pediatrics, General Internal Medicine)
• Specialty Care (e.g., Cardiology, Orthopedics, Dermatology)

Across multiple reports, the same pattern holds: primary care and certain cognitive specialties cluster at the lower end of the income spectrum.

Average annual income ranges (very approximate, pre-tax, full-time, U.S.) often look like this:

• High-earning procedural specialties: $500,000–$800,000+
• Middle-range specialties: $300,000–$450,000
• Lower-end specialties (many primary care and cognitive fields): $190,000–$260,000

The specialties in this article sit in that lower band, although their non-financial rewards can be substantial.

Why Salary Doesn’t Tell the Whole Story

Pure income figures miss several critical dimensions of Career Choices in medicine:

• Job Satisfaction and Meaning

  • Continuity with patients
  • Sense of impact on individuals, families, or communities
  • Alignment with your values (e.g., health equity, prevention, mental health)

• Work–Life Balance

  • Predictability of schedule
  • Call burden and overnight work
  • Flexibility for part-time or non-traditional paths

• Training Length and Opportunity Cost

  • Additional 1–3 years of fellowship to reach a higher-paying specialty
  • Delayed full attending income and life milestones

• Geographic and Practice Flexibility

  • Ability to work in urban, suburban, and rural settings
  • Options in academic centers, community hospitals, private practice, telemedicine, etc.

• Burnout Risk

  • Even high-income fields can have high burnout if misaligned with your personality or priorities.

You are not choosing only an income bracket—you are choosing an everyday life, a set of patients, a culture, and a professional identity.

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The 5 Lowest-Paid Medical Specialties (and Why They’re Still Worth Considering)

Across multiple annual surveys, the same five specialties consistently appear near the bottom of the pay scale:

1. Family Medicine
2. Pediatrics
3. Psychiatry
4. General Internal Medicine
5. Geriatric Medicine

We’ll explore each field with a focus on:

• Typical salary range (approximate U.S. averages)
• Why compensation tends to be lower
• Lifestyle and intangible benefits
• Concrete strategies to improve both income and satisfaction

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1. Family Medicine: Comprehensive Care for Every Stage of Life

Family Medicine is often described as the backbone of primary care. Family physicians provide longitudinal, holistic care across the lifespan—from newborns to older adults—often becoming “the doctor for the whole family.”

Typical Salary and Trends

• Average annual salary: commonly reported around $190,000–$230,000
• Among the lowest-paying specialties in most national surveys
• Income can vary significantly by:
  • Rural vs urban
  • Employed vs private practice
  • Additional services (procedures, urgent care coverage, direct primary care models)

Why Family Medicine Salaries Tend to Be Lower

1. Reimbursement Structure

   • Payment in the U.S. is heavily procedure-centered.
   • Family physicians do a lot of cognitive work—history-taking, counseling, chronic disease management—which is reimbursed less than procedural interventions.

2. Short Visit Times, High Volume

   • Typical visit lengths: 10–20 minutes.
   • To maintain revenue, many practices rely on high patient volumes.
   • This can contribute to documentation burden and burnout.

3. Primary Care Underinvestment

   • Despite strong evidence that robust primary care improves population health and lowers system costs, primary care historically receives a smaller share of healthcare dollars.

Lifestyle, Job Satisfaction, and Career Flexibility

For many physicians, these non-financial advantages more than compensate for lower salaries:

• Longitudinal Relationships
  • You might care for a patient from their 20s into their 70s, then care for their children and parents.
• Breadth of Practice
  • Manage diabetes, prenatal care, depression, minor procedures, and preventive counseling in the same day.
• Practice Variety
  • Outpatient clinic, hospitalist-type roles, urgent care, sports medicine, academic teaching, global health.
• Geographic Options
  • High demand everywhere, particularly in underserved or rural areas (often with loan repayment incentives).

How to Enhance Income in Family Medicine

• Add in-office procedures (skin procedures, joint injections, IUD insertions).
• Explore direct primary care (DPC) or concierge models that reduce insurer dependence.
• Work in rural or underserved regions offering higher salaries or federal/state loan repayment.
• Take on medical director roles for nursing homes, clinics, or public health departments.
• Combine outpatient care with urgent care shifts, telemedicine, or hospitalist work.

If you value variety, continuity, and community impact, Family Medicine can offer outstanding Job Satisfaction, even if it’s not at the top of the Healthcare Salary scale.

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2. Pediatrics: Caring for the Next Generation

Pediatrics focuses on the health of infants, children, and adolescents—a population that often can’t fully advocate for itself. Many pediatricians are drawn not only by clinical interest, but by a deep sense of mission.

Typical Salary and Trends

• Average annual salary: often cited around $180,000–$230,000
• Almost always among the lowest-paid specialties
• Subspecialists (e.g., pediatric cardiology, NICU) may earn more, but often still less than adult counterparts.

Why Pediatric Salaries Are Lower

1. Insurance Mix

   • A large portion of pediatric patients are covered by Medicaid or CHIP, which tend to reimburse less than commercial insurance.
   • Practices serving low-income communities may face particularly tight margins.

2. Time Intensity

   • Communicating with both child and caregiver.
   • Frequent preventive visits (well-child checks, vaccines) that are necessary but not highly reimbursed.
   • Developmental assessments and counseling require extensive time.

3. Higher Overhead

   • Vaccine storage and inventory.
   • Kid-friendly equipment and facilities.
   • Time spent on school forms, sports clearances, and parental communication.

Lifestyle and Non-Financial Rewards

• Generally Predictable Hours (Outpatient)
  • Many outpatient pediatricians have limited overnight work, though call and after-hours advice can be substantial.
• Profound Emotional Rewards
  • Supporting children and families through milestones and crises.
  • Advocating for vulnerable child populations, including those with complex social needs.
• Preventive Impact
  • Vaccination, early intervention, and developmental screening can shape an entire life trajectory.

Strategies to Improve Income in Pediatrics

• Join or build larger group practices that spread overhead and negotiate better payer contracts.
• Provide in-clinic procedures (e.g., minor procedures, circumcisions where appropriate).
• Develop niche skills: behavioral pediatrics, breastfeeding support, adolescent medicine.
• Consider leadership roles (medical director, quality improvement lead, health system positions).
• Explore telehealth, especially for follow-up and behavioral/ADHD management.

If your primary drive in medicine is to support children and families, Pediatrics can offer exceptional meaning—even if it remains on the lower end of the physician pay scale.

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3. Psychiatry: The Front Line of Mental Health Care

Psychiatry addresses the diagnosis, treatment, and prevention of mental, emotional, and behavioral disorders. As mental health needs grow globally, the importance of this specialty is clearer than ever.

Typical Salary and Trends

• Average annual salary: commonly around $230,000–$280,000 for general psychiatry
• Still on the lower-to-mid side compared with many procedural fields, but has increased in recent years.
• Significant variability by:
  • Outpatient vs inpatient
  • Academic vs private practice
  • Urban vs rural; telepsychiatry vs in-person

Why Psychiatry Has Historically Been Lower-Paid

1. Insurance Limitations and Parity Issues

   • Historically, mental health services were not reimbursed on par with physical health services.
   • Some insurers tightly limit therapy or psychiatric visit coverage.

2. Cognitive, Not Procedural

   • Similar to other cognitive specialties, reimbursement for time-intensive, conversation-based visits is lower than for procedures.

3. Underdiagnosis and Stigma

   • Social stigma can delay care, reduce referrals, or limit open discussion of mental health needs—though this is improving.

Lifestyle, Flexibility, and Job Satisfaction

Psychiatry offers some of the most flexible career paths in medicine:

• Schedule Control
  • Outpatient psychiatry often allows for highly controlled hours.
  • Telepsychiatry can enable location independence and flexible scheduling.
• Intellectual Depth
  • Integration of neuroscience, pharmacology, psychotherapy, and social determinants of health.
• Varied Practice Settings
  • Outpatient clinics, inpatient units, emergency services, addiction centers, academic research, consultation-liaison roles.
• High Demand
  • Many areas have a significant shortage of psychiatrists, enabling strong job security and negotiation leverage.

How Psychiatrists Increase Income

• Work in high-demand settings (correctional facilities, rural areas, inpatient units).
• Incorporate telepsychiatry to expand reach and efficiency.
• Develop a niche: addiction, child and adolescent psychiatry, forensics, consultation-liaison.
• Combine clinical work with consulting, expert witness work, or industry roles (e.g., pharma, digital mental health startups).
• Consider cash-pay private practices in certain markets, which can avoid insurance constraints.

If you are passionate about mental health, the opportunity to dramatically change patients’ lives can far outweigh salary differentials when compared to high-income procedural fields.

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4. General Internal Medicine: The Subspecialists’ Gateway and a Career in Its Own Right

General Internal Medicine (GIM) focuses on adult patients and often serves as the primary care provider for individuals with complex, chronic diseases. Many internists go on to subspecialty fellowships, but generalists are essential to the healthcare system.

Typical Salary and Trends

• Average annual salary: typically around $200,000–$250,000 for outpatient general internal medicine
• Hospitalists (also under the internal medicine umbrella) often earn somewhat more, depending on shift structure and region.

Why General Internal Medicine Incomes Are Lower

1. Primary Care Payment Model

   • General internists in outpatient settings face similar reimbursement challenges as Family Medicine—cognitive, time-intensive care that is undervalued relative to procedures.

2. High Complexity, Limited Time

   • Adults with multiple comorbidities (e.g., diabetes, CHF, CKD, COPD) require extensive management and coordination.
   • Short visit times make it challenging to address all patient needs.

3. Regional Market Saturation

   • In some urban and suburban regions, high numbers of internal medicine physicians can hold down salaries.

Lifestyle and Career Options

• Outpatient General Internal Medicine
  • Regular office hours, variable call responsibility, strong continuity of care.
• Hospital Medicine
  • Shift-based work (7-on/7-off is common), higher intensity during shifts but more consolidated time off.
• Academic Internal Medicine
  • Mix of teaching, research, and clinical care; typically lower pay than private practice but higher intellectual and career development benefits.

Improving Income and Career Satisfaction in Internal Medicine

• Consider hospitalist roles or hybrid outpatient–inpatient models.
• Pursue leadership positions (medical director, quality improvement, hospital administration).
• Offer in-office procedures (e.g., joint injections, skin biopsies).
• Explore value-based care organizations that reward quality and cost-effective management.
• If aligned with your interests, pursue a subspecialty fellowship (e.g., cardiology, GI, pulmonary/critical care), recognizing this extends training but often significantly increases income.

For those who enjoy adult medicine’s complexity and the detective work of diagnosis, General Internal Medicine can be rich in intellectual challenge and continuity, even if not at the top of the earnings chart.

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5. Geriatric Medicine: Expert Care for an Aging Population

Geriatric Medicine focuses on the unique needs of older adults, especially those with frailty, multiple comorbidities, and functional or cognitive decline. As populations age, the demand for geriatricians is growing rapidly.

Typical Salary and Trends

• Average annual salary: frequently reported around $200,000–$240,000
• Often similar to or slightly above general primary care, but below many subspecialties that require comparable training length.

Why Geriatrics Compensation Is Relatively Low

1. Medicare-Based Reimbursement

   • Most older adults are covered by Medicare, which reimburses at lower rates than some commercial plans, particularly for evaluation and management services.

2. Time-Heavy, Complexity-Heavy Visits

   • Polypharmacy, mobility issues, caregiver dynamics, cognitive assessment, and advanced care planning all demand time—and systems frequently undervalue that time.

3. Limited Procedure Revenue

   • Much of geriatrics is cognitive rather than procedural, again disadvantaged by current payment models.

Lifestyle, Mission, and Fulfillment

• Interdisciplinary Care
  • Work closely with nurses, therapists, social workers, and caregivers—ideal for those who appreciate team-based approaches.
• Impact on Quality of Life
  • Small changes (e.g., medication adjustments, home safety evaluations) can dramatically affect independence and dignity.
• Varied Practice Settings
  • Outpatient geriatric clinics, long-term care facilities, home visits, hospital consult services, palliative care overlap.

Enhancing Income and Opportunities in Geriatrics

• Combine geriatrics with roles in palliative care, hospital medicine, or medical directorships for nursing homes and assisted-living facilities.
• Pursue administrative or leadership positions focused on aging populations (health system leadership, ACOs, value-based care).
• Engage in research or quality improvement targeting high-cost, high-need older patients—often funded and valued by health systems.

If you are drawn to complex, person-centered care and the ethical dimensions of medicine near the end of life, Geriatric Medicine offers profound meaning despite relatively modest income.

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Should You Care About Being in a Lower-Paid Specialty?

A Practical Framework for Weighing Salary vs. Satisfaction

When considering Career Choices in these lower-paid specialties, try asking yourself:

1. What type of day-to-day work energizes me?

   • Short, procedure-focused encounters?
   • Longer visits with more counseling and relationship-building?

2. How important is schedule control and flexibility?

   • Some lower-paid specialties offer excellent control over hours and practice style.

3. What level of debt and financial obligation am I facing?

   • High debt is manageable even in lower-paid fields, but may require more intentional financial planning (e.g., loan repayment programs, cost-of-living decisions).

4. How central is income to my sense of success?

   • Be honest with yourself. There is no wrong answer—only what fits your values.

5. Where do I derive meaning and Job Satisfaction?

   • Preventive care?
   • Child and family advocacy?
   • Mental health?
   • Geriatric and end-of-life care?

Strategies to Make Lower-Paid Specialties Financially Viable

• Loan Forgiveness and Repayment Programs

  • Public Service Loan Forgiveness (PSLF)
  • National Health Service Corps (NHSC)
  • State-specific rural or primary care loan repayment programs

• Location Choices

  • Salaries in rural or underserved areas can be significantly higher.
  • Lower cost-of-living regions can make a “lower” salary go much further.

• Side Income Streams

  • Telemedicine
  • Locum tenens
  • Consulting, teaching, or non-clinical roles (writing, medical education, informatics)

• Financial Literacy

  • Early budgeting, aggressive loan repayment strategy, and responsible investing can compensate for income differences over time.

The Reality: No Specialty Is Truly “Low Paid”

Even at the bottom of physician salary surveys, these fields still provide incomes well above the national average. The larger difference often lies in:

• Lifestyle
• Training duration
• Daily work activities
• Emotional rewards

If you choose a specialty that fits who you are, Job Satisfaction and longevity in your career can easily outweigh a pay gap between one field and another.

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Frequently Asked Questions About Low-Paid Medical Specialties

Q1: Are there real opportunities to increase income in lower-paying specialties like Family Medicine or Pediatrics?
Yes. Physicians in these fields routinely enhance income through:

• In-office procedures (e.g., skin procedures, joint injections, IUDs, circumcisions where appropriate)
• Extra clinical work (urgent care, hospitalist shifts, telemedicine)
• Rural/underserved practice with higher base pay or loan repayment
• Leadership roles (medical director, quality improvement, population health)
• Practice models like direct primary care that emphasize value over volume

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Q2: How can I know if a lower-paying specialty will still be financially sustainable for me?
Run the numbers early:

• Estimate your total loan burden and projected monthly payments under different repayment plans.
• Compare typical salaries by region and setting for your specialty of interest.
• Factor in cost of living, family plans, and lifestyle goals.
• Talk to practicing physicians in those fields about their financial realities, including housing, childcare, and retirement savings.

A specialty you love plus a clear financial plan is often more sustainable than a high-income specialty that leads to burnout.

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Q3: What if I enjoy a low-paid specialty but still care significantly about income?
You’re not alone, and that’s not a contradiction. Consider:

• Combining your clinical specialty with administration, informatics, or business roles.
• Pursuing subspecialty training (e.g., in pediatrics: cardiology, critical care; in psychiatry: interventional, forensic, addiction).
• Working in higher-paying practice environments (e.g., certain hospital-employed roles, rural or high-demand markets).
• Building non-clinical skills (data science, leadership, policy, medical education) that open doors to better-compensated hybrid roles.

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Q4: Are these “lowest-paid” specialties likely to remain at the bottom of the salary rankings?
Not necessarily. Trends change due to:

• Policy shifts (e.g., better payment for primary care and mental health)
• Growing demand (especially in psychiatry, geriatrics, and primary care)
• New care models (value-based care, team-based care, virtual care) While the relative ranking may persist in the short term, there is increasing recognition—and some movement—toward more equitable compensation for cognitive and primary care specialties.

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Q5: How should I ultimately choose a specialty when income, interests, and lifestyle all matter?
Use a structured approach:

1. Experience widely: Seek electives and shadowing experiences in different fields.
2. Reflect deeply: Journal or talk with mentors about what brings you energy during rotations.
3. Research carefully: Look at data on salary, burnout, job satisfaction, and work–life balance.
4. Plan realistically: Map out financial scenarios for each specialty, including training length and likely income.
5. Decide holistically: Choose the field where your interests, values, lifestyle goals, and financial realities align best, not perfectly.

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In the end, the “lowest-paid” specialties are often those with the closest, longest, and most human relationships with patients and communities. If that is what called you to medicine in the first place, these paths may still be the richest choice you can make—financially sufficient, professionally meaningful, and personally sustainable over a lifetime in medicine.