Pediatrics Residency Guide: Physician Salary by Specialty Revealed

Physician compensation is a major consideration for residency applicants, especially in fields like pediatrics where lifestyle, mission, and income must all be carefully balanced. Understanding physician salary by specialty within pediatrics—and how it compares to other fields—is essential for making informed career decisions and setting realistic expectations for your future.

Below is a comprehensive guide to pediatric physician salary by specialty, how peds compares to other fields in terms of doctor salary by specialty, and what factors affect your earning potential before and after the peds match.

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Understanding the Big Picture: Where Pediatrics Fits in Physician Salaries

When students think about physician salary by specialty, they often hear two messages:

1. Pediatrics is one of the lower-paying specialties.
2. Pediatrics offers excellent lifestyle and high job satisfaction.

Both are generally true, especially compared with the highest paid specialties such as orthopedic surgery, plastic surgery, or interventional cardiology.

General Salary Position of Pediatrics

In most national compensation surveys (e.g., Medscape, Doximity, MGMA):

• Pediatrics (general) typically ranks in the lower third of all medical specialties.
• Pediatric subspecialties often earn more than general pediatrics, but still usually less than adult procedural subspecialties.
• Lifestyle and work culture in pediatrics often score above average in job satisfaction and burnout measures despite the lower pay.

Approximate relative position (conceptual, not exact dollar figures):

• Highest paid specialties: Orthopedic surgery, plastic surgery, cardiology (interventional), dermatology, radiology, gastroenterology, some surgical subspecialties.
• Mid-range specialties: Internal medicine subspecialties, emergency medicine, anesthesiology, hospitalist medicine, OB/GYN.
• Lower-range specialties: Family medicine, general pediatrics, psychiatry, some non-procedural internal medicine subspecialties.

Pediatrics attracts many applicants who place a high value on:

• Working with children and families
• Collaborative, team-based care
• Predictable schedules in many practice settings
• Strong sense of mission and meaning in daily work

The key is to understand the trade-offs within pediatrics—between general peds and subspecialties—and between pediatrics and other specialties you may be considering for the peds match.

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Pediatric Salary Basics: Training Path, Early Career, and Growth

Before diving into pediatric subspecialties, it helps to understand the typical training path and what that means for your income trajectory.

Training Timeline and Income Milestones

1. Medical School (4 years)

   • Income: $0 (or negative, if loans are accruing interest)
   • Decision point: Choosing pediatrics vs other specialties.

2. Pediatrics Residency (3 years)

   • Income: Standard resident salary, typically $60,000–$75,000 per year depending on region and PGY level.
   • Work hours: Often 60–80 hours/week, though this varies by program.
   • You are not yet in the physician salary by specialty range—this is training pay, not attending compensation.

3. Fellowship (0–3+ years, depending on subspecialty)

   • Optional for general pediatrics; required for subspecialties.
   • Income: Usually slightly above residency but still modest, often $70,000–$85,000 per year.
   • This is a critical trade-off: additional years of lower pay in exchange for higher long-term earning potential.

4. Attending Physician (Post-training)

   • This is where physician salary by specialty really diverges.
   • General pediatrics: Shortest path to attending status (3 years after med school).
   • Subspecialties: Longer path, but often higher salaries.

Factors That Drive Pediatric Physician Salaries

Several factors influence pediatric income regardless of subspecialty:

• Practice setting
  • Academic medical center vs community hospital vs private practice vs multispecialty group.
• Geography
  • Urban vs rural, high cost-of-living vs low cost-of-living states, and regional market demand.
• Employment model
  • Employed by hospital/health system vs independent private practice vs large corporate group.
• Clinical vs non-clinical mix
  • Percentage of time in direct patient care vs research/teaching/administration.
• Procedural intensity
  • Subspecialties that perform procedures (e.g., pediatric cardiology, gastroenterology) typically earn more.
• Call burden and shifts
  • Nights, weekends, and in-house call may lead to higher compensation.

Understanding these levers will help you interpret how pediatric physician salary by specialty varies even within the same field and location.

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General Pediatrics: Compensation, Lifestyle, and Career Trajectory

For many applicants, general pediatrics is the default pathway after the peds match. It’s important to know what to expect in terms of income, job prospects, and day-to-day life.

General Pediatrics Salary Overview

While exact numbers vary by region and year, typical early-career general pediatrician compensation in the U.S. often falls roughly into the following ranges:

• Starting salary (first 1–3 years in practice):
  Roughly $160,000–$220,000 per year in many markets.
• Established pediatricians (5–10+ years):
  Often $190,000–$260,000+, depending on productivity, partnership track, and practice type.
• Rural or high-demand areas may offer:
  • Signing bonuses
  • Loan repayment incentives
  • Higher base salaries to attract candidates

Academic positions in general pediatrics often start lower (to reflect research/teaching emphasis) but may offer:

• More predictable schedules
• Strong benefits and retirement plans
• Opportunities for academic promotion, leadership, and niche specialization

Practice Settings and Impact on Pay

1. Private Practice (Solo or Small Group)

   • Potential for higher earnings with partnership/ownership.
   • Income tied more directly to volume and overhead.
   • Typically more business responsibilities.

2. Large Multispecialty or Hospital-Employed Practice

   • Stable salary or salary-plus-bonus structure.
   • Less independent control, but less business risk.
   • Often standardized compensation packages.

3. Academic Pediatrics

   • Lower average salary than private/community practice.
   • Strong emphasis on teaching, research, and scholarly work.
   • Attractive for those who enjoy mentoring and academic leadership.

Lifestyle Considerations

General pediatrics is often chosen for lifestyle reasons:

• Clinic-based work: Many jobs are primarily outpatient, weekday-based.
• Predictable schedules: Many practices have limited nights/weekends.
• Lower procedural intensity: Less OR time, more cognitive and family-centered care.

That said, some general pediatricians:

• Take call for newborn nursery or inpatient pediatrics.
• Work urgent care or after-hours clinics to supplement income.

For many, the combination of meaningful work, reasonable hours, and steady income is worth the trade-off compared with the highest paid specialties.

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Pediatric Subspecialties: Which Paths Pay More (and Why)

Within pediatrics, there’s substantial variation in physician salary by specialty. Subspecialization usually requires a 3-year fellowship after residency, extending training but potentially increasing your earning potential.

Below are broad trends commonly seen across pediatric subspecialties; actual salaries will vary significantly by region and practice type.

Higher-Earning Pediatric Subspecialties

These often sit toward the top for pediatric physician salaries:

1. Pediatric Cardiology

   • Work: Congenital heart disease, echocardiography, cath lab, advanced imaging.
   • Compensation: Typically above general pediatrics—often $250,000–$400,000+, with procedural cardiologists tending toward the higher end.
   • Factors: Procedural intensity, call burden, and specialized skillset.

2. Pediatric Gastroenterology (GI)

   • Work: Endoscopy, inflammatory bowel disease, feeding disorders, liver disease.
   • Compensation: Frequently $250,000–$400,000+ depending on procedures and practice setting.
   • Procedures: Upper and lower endoscopies, PEG placements in some settings.

3. Pediatric Critical Care (PICU)

   • Work: Management of critically ill children in intensive care units.
   • Compensation: Often $260,000–$400,000+, with variability based on shift work, academic vs community, and call.
   • Lifestyle: Intense, shift-based, high acuity; often associated with strong compensation relative to other peds subspecialties.

4. Pediatric Emergency Medicine

   • Work: ED shifts, procedural care, trauma, acute illness.
   • Compensation: Typically $250,000–$350,000+, depending on shift volume and site.
   • Schedule: Shift-based (nights/weekends/holidays), which can pay more but may challenge work–life balance.

5. Neonatology (NICU)

   • Work: Premature infants, high-risk newborns, level III/IV NICUs.
   • Compensation: Commonly $250,000–$380,000+.
   • Structure: Often in blocks of service weeks, sometimes with in-house or home call.

These subspecialties move you closer to mid-range or even higher-range incomes compared to average physician salary by specialty, but most still fall below the highest paid specialties like adult cardiology or orthopedic surgery.

Mid-Range Pediatric Subspecialties

These may provide a moderate salary boost relative to general pediatrics, often balanced with specific lifestyle advantages:

1. Pediatric Endocrinology

   • Work: Diabetes, growth disorders, thyroid disease, hormone-related conditions.
   • Compensation: Often $200,000–$280,000+.
   • Lifestyle: Largely outpatient, relatively predictable call in many settings.

2. Pediatric Hematology/Oncology

   • Work: Childhood cancers, sickle cell disease, bleeding disorders.
   • Compensation: Typically $220,000–$320,000+, with variation by academic vs private setting.
   • Considerations: Emotional intensity but often deeply meaningful work.

3. Pediatric Pulmonology

   • Work: Asthma, cystic fibrosis, chronic lung disease, sleep disorders.
   • Compensation: Commonly $220,000–$320,000+.
   • Mix: Combination of outpatient, inpatient consults, procedures (e.g., bronchoscopies).

4. Pediatric Nephrology

   • Work: Renal failure, dialysis, transplant medicine, complex electrolyte issues.
   • Compensation: Often $210,000–$300,000+.
   • Demand: Subspecialty with fewer graduates; job demand can be favorable.

Subspecialties with Smaller Financial Gain Over General Pediatrics

Some pediatric subspecialties involve longer training without a dramatically higher salary compared to general pediatrics:

• Pediatric Rheumatology
• Pediatric Infectious Diseases
• Developmental-Behavioral Pediatrics
• Child Abuse Pediatrics
• Pediatric Genetics/Metabolism

These fields often fall in ranges like $190,000–$260,000+, sometimes overlapping significantly with or only modestly exceeding general pediatric salaries, especially in academic settings. Many trainees choose these areas primarily for intellectual interest and passion for the patient population, rather than for income.

Academic vs Community Subspecialty Pay

Across almost all pediatric subspecialties:

• Academic roles often pay less than purely clinical community positions, especially early on.
• However, academic physicians may:
  • Hold leadership roles that come with stipends.
  • Receive funded research time or grants.
  • Gain prestige and influence within their field.

When thinking about physician salary by specialty in pediatrics, clarify whether you picture yourself in a research-intensive academic career or a clinically focused community/hospital role. The same subspecialty can have very different compensation profiles in each context.

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Pediatrics vs Other Specialties: Income Trade-offs in the Peds Match

When preparing for the peds match, you may also be weighing pediatrics against other fields like family medicine, internal medicine, emergency medicine, or even higher-paying surgical specialties.

Comparing Pediatrics to Other Primary Care Fields

Family Medicine vs General Pediatrics

• Salaries for family medicine and general pediatrics are often similar, with family medicine sometimes slightly higher depending on the market.
• Family medicine may have:
  • Broader patient age range.
  • More minor procedures in some settings.
  • Opportunities for urgent care shifts or inpatient work to boost pay.
• Pediatrics:
  • Focused exclusively on children and adolescents.
  • Often seen as more “niche” and mission-driven.
  • May have somewhat lighter adult-style chronic disease management (e.g., less multi-morbidity).

Internal Medicine (General) vs General Pediatrics

• General internal medicine (adult) often earns more on average than general pediatrics.
• However, many IM residents go on to subspecialize, increasing their income further.

Pediatrics vs the Highest Paid Specialties

Compared with the highest paid specialties (e.g., orthopedic surgery, neurosurgery, cardiology, dermatology, radiology):

• Pediatrics (even high-paying subspecialties) usually earns significantly less.
• The trade-off:
  • Fewer middle-of-the-night emergency surgeries.
  • Less physically demanding procedural work in many peds specialties.
  • Often more predictable clinic-based schedules.
  • Profoundly meaningful interactions with children and families.

If maximizing income is your primary goal, pediatrics is typically not the most lucrative field. But if you value mission, fit with patient population, and a collaborative work culture, the relative physician salary by specialty may feel like a fair trade.

The Role of Non-Clinical Income

Some pediatricians supplement clinical income with:

• Medical directorships and leadership roles
• Consulting (e.g., guidelines development, pharma/biotech, digital health)
• Medical education (course development, board review, speaking)
• Telemedicine (after-hours urgent care, second opinions)
• Entrepreneurship (startups, apps, side businesses)

While this isn’t unique to pediatrics, peds physicians often find creative ways to expand their impact and income beyond direct patient care.

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Practical Advice for Residency Applicants: Balancing Passion, Pay, and Long-Term Planning

As you consider a pediatrics residency and eventual subspecialty, it’s important to think strategically about physician salary by specialty without letting it dominate your decision.

1. Start with Fit and Interest

Ask yourself:

• Do I truly enjoy working with children and their families?
• Can I see myself handling the emotional weight of caring for sick kids?
• Do I prefer cognitive, relationship-based care or procedurally oriented work?
• Where do I see myself in 10–15 years: clinic, hospital, academic center, or mixed roles?

If you don’t enjoy the core work, a higher salary in another field won’t fix long-term dissatisfaction or burnout.

2. Understand Your Financial Needs and Goals

Consider:

• Educational debt load.
• Desired lifestyle (housing, family plans, major expenses).
• Geographic preferences (HCOL vs LCOL areas).
• Willingness to moonlight or take call-heavy positions for higher pay.

You can make pediatrics work financially, but it may require:

• Strategic loan repayment plans (e.g., income-driven repayment, PSLF).
• Thoughtful choices on practice setting and location.
• Realistic expectations about income growth and timeline.

3. Explore Subspecialties Early and Honestly

During residency:

• Seek electives in subspecialties you find interesting.
• Talk openly with attendings about:
  • Their typical schedule.
  • Actual compensation ranges in their region.
  • Pros and cons of academic vs private practice.
• Ask fellows about:
  • Job market conditions.
  • Hours worked and call frequency.
  • How they feel about the balance between training length and earning potential.

Your interest may evolve. Exposure helps avoid surprises later.

4. Evaluate Job Offers Holistically, Not Just by Salary

When comparing offers after training, look beyond the headline physician salary:

• Base pay vs bonus structure
• RVU targets and how realistic they are
• Benefits: health, malpractice coverage, retirement match, CME funds
• Call schedule and weekend coverage
• Vacation time and parental leave
• Loan repayment or signing bonuses
• Partnership track or promotion pathways

A slightly lower base salary in a supportive practice with growth opportunities may be better than a “high” salary with unsustainable workload.

5. Stay Informed: Compensation Changes Over Time

The landscape of doctor salary by specialty is not static. Monitor:

• Annual compensation reports from major physician surveys.
• Local and regional job postings.
• Trends in telemedicine, value-based care, and pediatric reimbursement.

As healthcare economics shift, some subspecialties’ relative compensation may rise or fall. Being informed helps you negotiate and plan your career smarter.

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FAQs: Pediatric Physician Salary by Specialty and the Peds Match

1. Is general pediatrics a financially viable career given medical school debt?

Yes, general pediatrics can be financially viable, but it often requires:

• Thoughtful use of income-driven repayment plans.
• Considering Public Service Loan Forgiveness (PSLF) if you work for non-profit or academic institutions.
• Budgeting realistically in early career years.
• Potentially choosing regions or jobs with loan repayment incentives.

While general pediatrics earns less than many specialties, stable employment, strong benefits, and strategic financial planning can support a comfortable lifestyle for most physicians.

2. Which pediatric subspecialties are closest to the highest paid specialties?

Within pediatrics, the higher-earning subspecialties often include:

• Pediatric cardiology
• Pediatric gastroenterology
• Neonatology
• Pediatric critical care
• Pediatric emergency medicine

These generally still earn less than the absolute highest paid specialties like orthopedic surgery or interventional adult cardiology, but they may move you into the middle of the overall physician salary by specialty spectrum.

3. Does doing a fellowship always mean I’ll earn more than a general pediatrician?

Not always. Some peds subspecialties do not provide a large income boost over general pediatrics—especially when you account for:

• Extra years of lower-paid training.
• Academic vs community salary differences.
• Limited procedural revenue in certain subspecialties.

Fields like pediatric rheumatology, infectious diseases, or developmental-behavioral pediatrics may earn only modestly more—or sometimes similar amounts—to general pediatrics, particularly in academic roles. Choose a fellowship for genuine interest, not solely for income.

4. How much should salary influence my choice of pediatrics during the peds match?

Salary should be one factor, but not the only one. Consider:

• Your genuine interest in the patient population and type of work.
• Your tolerance for workload, call, and training length.
• Long-term lifestyle goals and family considerations.
• Financial needs and debt management strategies.

If you love working with children and families, pediatrics can be an extremely rewarding career—even if it isn’t among the highest paid specialties. Being realistic about physician salary by specialty in pediatrics will help you plan, but passion, fit, and sustainability should guide your ultimate decision.