The Complete Guide to Physician Salary by Specialty for Medical Residents

Understanding Physician Salary by Specialty: Why It Matters for Applicants

Choosing a specialty is one of the most consequential decisions you’ll make in your medical career. Passion, aptitude, lifestyle, and training length should all weigh heavily—but for most applicants, compensation is also a crucial piece of the puzzle. Understanding physician salary by specialty, what influences those numbers, and how they evolve over time will help you make more informed, realistic career decisions.

This guide is written specifically for medical students and residents thinking about their futures—especially those in the thick of the residency application and Match process. We will not tell you to “pick solely based on salary” (you shouldn’t), but you should understand the economics you’re stepping into.

We’ll cover:

• How physician compensation actually works (base, bonuses, RVUs)
• Doctor salary by specialty: broad trends and the highest paid specialties
• Factors that explain differences in pay between specialties
• Practical advice for integrating salary data into your specialty choice
• Key concepts for negotiating your first contract and beyond

Throughout, remember: reported salaries are averages and ranges, not guarantees. They’re one data point—important, but not definitive.

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How Physician Compensation Works: Beyond the Headline Number

To interpret salary reports intelligently, you need to understand how most physicians actually get paid. Compensation is usually a mix of several components.

1. Base Salary

Most physicians—especially early in their careers—start with a base salary guaranteed for 1–3 years. This:

• Provides financial stability as you build a patient panel or procedure volume
• Is often lower than your eventual earning potential
• May be adjusted annually based on performance or market trends

Academic positions often have lower base salaries but offer non-monetary benefits (protected time, research resources, prestige, better hours in some fields).

2. Productivity-Based Pay (RVUs, Collections, or Encounters)

Once you’re out of training and past any initial guarantee period, a higher fraction of your income is often tied to productivity. Common models include:

• wRVU-based: You earn a set dollar amount per work Relative Value Unit (wRVU), which reflects the complexity, time, and intensity of services.
• Collections-based: You receive a percentage of the revenue you generate after billing and collections.
• Encounter-based or capitation: Less common but used in some systems; compensation tied to number of visits or patients on a panel rather than volume of procedures.

Implication for specialty choice:

• Procedure-heavy specialties often generate more wRVUs or collections per hour, helping explain why they top doctor salary by specialty lists.
• Cognitive specialties, pediatrics, and psychiatry often generate fewer billable units per visit and may be reimbursed at lower rates.

3. Bonuses and Incentives

Modern contracts frequently include:

• Quality or value-based bonuses (meeting specific clinical or patient satisfaction metrics)
• Signing bonuses (commonly in the tens of thousands)
• Retention bonuses (extra pay for staying a certain number of years)
• Leadership stipends (medical director, program director roles)

These can substantially impact your total annual compensation—especially in competitive or shortage areas like rural primary care or certain surgical subspecialties.

4. Benefits and Non-Salary Compensation

Total compensation is more than just your paycheck. You should consider:

• Health, dental, and vision insurance
• Retirement contributions (401(k), 403(b), pension plans)
• Malpractice coverage (claims-made vs. occurrence, tail coverage)
• CME funds and time
• Vacation and sick leave
• Loan repayment programs (employer-based or federal/state)

A job with a slightly lower nominal physician salary but generous benefits and loan repayment can be financially superior over time.

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Doctor Salary by Specialty: Overall Trends and Highest Paid Specialties

Exact dollar amounts shift year to year and vary by data source, but the relative ranking of specialties has been remarkably stable. Below is a conceptual overview of doctor salary by specialty to help frame expectations. (Note: figures are rounded, approximate, and can vary significantly by region, employer, and experience.)

1. Highest Paid Specialties

Procedural and surgical subspecialties consistently top the highest paid specialties lists. Examples (ranges approximate for full-time attendings, not fellows):

• Neurosurgery: Often $800,000+; high-stakes, long training, intense call
• Orthopedic Surgery: ~$600,000–$800,000+; procedures are highly reimbursed
• Cardiology (Invasive/Interventional): ~$600,000–$800,000+
• Plastic Surgery: ~$500,000–$700,000+ (can be higher with a strong cosmetic practice)
• Gastroenterology: ~$500,000–$650,000+ (high procedure volume: colonoscopies, EGDs)
• Radiology (Interventional): ~$500,000–$700,000+
• Dermatology: ~$450,000–$600,000+ (especially with procedures and cosmetic work)

Factors driving these high salaries:

• High reimbursement per procedure
• Long, intensive training (and fewer trainees)
• High demand and constrained supply
• Willingness to work demanding hours and take complex call

2. High-Mid Earning Specialties

These fields often offer strong compensation with relatively better work-life balance compared to some surgical subspecialties:

• Emergency Medicine: Roughly ~$350,000–$500,000+ depending on region and practice model
• Anesthesiology: ~$400,000–$550,000+
• Radiology (Diagnostic): ~$400,000–$550,000+
• Cardiology (Non-invasive): ~$450,000–$600,000+
• Urology: ~$450,000–$600,000+
• Otolaryngology (ENT): ~$400,000–$550,000+

These specialties typically balance procedural work with shifts or call-based models, often with less continuity of care but more schedule flexibility.

3. Middle-Range Earning Specialties

Many residents gravitate to these “core” specialties, which combine reasonable pay, diverse career paths, and more predictable lifestyles in certain practice settings:

• Internal Medicine (General, Outpatient): ~ $250,000–$325,000+ (higher in hospitalist or rural roles)
• Hospitalist Medicine: ~$280,000–$350,000+
• Family Medicine: ~$230,000–$300,000+ (rural or high-need areas may pay more)
• Obstetrics & Gynecology: ~$300,000–$400,000+
• General Surgery: ~$350,000–$500,000+ depending on call, trauma, and practice type
• Physical Medicine & Rehabilitation (PM&R): ~$275,000–$375,000+
• Neurology: ~$275,000–$350,000+
• Psychiatry: ~$275,000–$375,000+ (locum tenens and telepsychiatry can push higher)

IM and FM salaries often jump when physicians move into hospital-employed, rural, or urgent care roles, or when they add procedures (e.g., endoscopies, joint injections).

4. Lower-Paid Clinical Specialties (Still Six Figures)

Even the “lower tier” for physician salary remains high relative to most professions, but debt and training length make these distinctions meaningful:

• Pediatrics (General): ~$220,000–$275,000+
• Pediatric Subspecialties (e.g., endocrinology, infectious disease): often ~$220,000–$300,000+
• Adolescent Medicine, Pediatric Rheumatology, etc.: frequently on the lower side of the range
• Academic positions in many specialties: typically lower than private practice equivalents

Reasons for lower pay include:

• Lower reimbursement rates for pediatric care
• Less procedural or procedure-reimbursed work
• Heavy concentration in academic and large health systems with standardized pay scales

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Why Some Specialties Earn More: Key Drivers of Physician Salary

Understanding why there are large salary differences can help you interpret the numbers more thoughtfully.

1. Procedure vs. Cognitive Emphasis

Insurance reimbursement historically tends to pay more for:

• Procedures (surgery, endoscopy, cardiac caths, interventional radiology)
• Imaging interpretation
• Invasive interventions

Compared with:

• Time spent counseling, coordinating care, and managing chronic disease
• Preventive care and behavioral health

Specialties built around procedures or interventions naturally fall among the highest paid specialties. Cognitive fields, despite their complexity and importance, are valued lower in current payment structures.

2. Supply and Demand

Specialty compensation responds sharply to workforce supply and patient demand:

• Fewer training spots (e.g., neurosurgery) + high community need → high salaries
• Expanding residency positions (e.g., some primary care fields) may moderate salary growth
• Underserved regions (rural, inner-city) often pay a premium, especially for primary care, psychiatry, and emergency medicine

Workforce projections also matter. For example:

• Aging populations → increased demand in cardiology, oncology, orthopedics, and geriatrics
• Mental health crisis → strong demand and rising salaries in psychiatry

3. Training Length and Opportunity Cost

When you compare physician salary by specialty, factor in:

• Residency length: 3 years (IM, peds, FM) vs. 5–7+ years (surgery, neurosurgery)
• Fellowships: Additional 1–3 years of lower trainee pay
• Delayed earning: The more years you train, the fewer years you’ll earn attending-level income

Highly paid surgical subspecialties often require 5–7 years of residency plus 1–2 years of fellowship—leading to a later start but higher eventual earnings.

4. Lifestyle, Risk, and “Hidden Costs”

Salary levels also reflect:

• Malpractice risk: OB/GYN, neurosurgery, orthopedic surgery, and some procedural fields face higher malpractice exposure, often baked into pay premiums (but also higher insurance costs).
• Call intensity and hours: 24/7 emergency availability, trauma call, or frequent overnight work typically drives up compensation.
• Burnout risk: Fields with challenging workloads, high emotional burden, or difficult schedules sometimes offer higher pay to attract and retain physicians.

5. Practice Setting and Ownership

Where and how you practice can sometimes matter more than the specialty label:

• Private practice or group ownership: Higher earning potential, but more financial risk and management responsibilities.
• Hospital-employed: More stable, often slightly lower but predictable salary with benefits and administrative support.
• Academic medicine: Lower pay but access to research, teaching, prestige, and (sometimes) more predictable work hours.
• Locum tenens: Higher hourly pay in exchange for temporary assignments, often in underserved areas and without long-term stability.

Within the same specialty, a physician in a rural, hospital-employed role with a robust call schedule may earn significantly more than an academic colleague in a major metropolitan center.

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Integrating Salary Data into Your Specialty Choice

Raw numbers don’t tell the whole story. Here’s how to use physician salary data wisely when you’re choosing a specialty or planning your post-residency path.

1. Start with Fit: Interests, Strengths, and Daily Work

Identify:

• What kind of problems you enjoy (procedural vs. diagnostic puzzles vs. longitudinal care)
• Your tolerance for high acuity, emergencies, and stress
• Preference for continuity of care vs. episodic care
• Comfort with hands-on procedures vs. cognitive, discussion-based work

Salary can’t compensate for daily dissatisfaction. A neurosurgeon earning $900k but dreading every call night is not “better off” than a fulfilled pediatrician at $240k.

Actionable step:
During clinical rotations, write down what you liked and disliked about the daily work in each specialty—not just your impression of the residents’ lifestyles.

2. Run the Numbers for Your Debt and Lifestyle Goals

High student loan balances make physician salary by specialty more consequential. Consider:

• Your total projected educational debt at graduation
• Desired timeline for repayment (10 vs. 20+ years)
• Whether you will pursue loan forgiveness programs (PSLF, NHSC, state programs)
• Personal financial goals (home purchase, family plans, geographic preferences)

Example:

• Student A: $400k debt, drawn to pediatrics and cardiology.
• Cardiology may offer $500k+ after training vs. $240k–$280k in general pediatrics.
• But cardiology also means 3 years IM + 3 years fellowship vs. 3 years pediatrics.
  You must balance earlier earning potential in pediatrics vs. higher but delayed earnings in cardiology.

3. Understand the Range Within Each Specialty

Almost every specialty contains:

• High-earning niches (rural, private practice, high call, procedural-heavy roles)
• Moderate-earning but lifestyle-favorable jobs (outpatient-only, part-time, academic)

For instance:

• Family Medicine:

  • Urban academic clinic: lower salary, more teaching and research opportunities
  • Rural hospital-employed with inpatient/outpatient mix: significantly higher salary, loan repayment, housing incentives

• Psychiatry:

  • Academic outpatient clinic: moderate salary, stable hours
  • Telepsychiatry or locum work: higher hourly rates, flexibility, but less stability

Actionable step:
When reviewing doctor salary by specialty data, look for ranges and quartiles (25th–75th percentile), not just average values, and think about where you might realistically land based on your preferences.

4. Anticipate Burnout and Sustainability

Some specialties with high compensation are also known for high burnout rates. Before chasing the highest paid specialties solely for income:

• Talk to attendings 10+ years into their careers about sustainability
• Ask residents how they feel about call burden, administrative workload, and emotional toll
• Consider how your values might shift over time (family, health, hobbies)

Long-term satisfaction will likely matter more than squeezing out the last dollar of salary.

5. Use Salary Data for Negotiation, Not Just Selection

Even during residency applications and early training, start building the habit of using compensation data as a negotiation tool:

• Understand typical starting physician salary ranges for your chosen specialty and desired region
• Know what benefits and incentives are “standard” and what’s negotiable
• Learn how practice setting affects pay in your specialty (academic vs. private vs. employed)

This knowledge will serve you well when you sign your first contract.

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Planning Ahead: From Residency Match to Your First Contract

As you move from the residency Match toward your first attending role, your relationship with physician salary data will change—from curiosity to negotiation.

1. During Residency and Fellowship

Key tasks:

• Track how your chosen specialty is trending in physician salary reports over several years
• Observe how attendings at your training institution discuss productivity, RVUs, and compensation
• Attend any GME-organized seminars on contracts, negotiation, and practice management
• Talk to recently graduated alumni about what they’re actually seeing in their first jobs

Use elective time to rotate at different practice types (academic, community, private, rural) within your specialty to see how work and compensation differ.

2. Before Job Search: Clarify Your Priorities

Rank the following for yourself:

• Location (specific city vs. open to many regions)
• Practice type (academic vs. private vs. employed)
• Income level and growth potential
• Lifestyle (hours, call, vacation)
• Teaching/research opportunities
• Loan repayment or signing bonus

Understanding which trade-offs you’re willing to make will guide your negotiations more than any fixed salary target.

3. Interpreting Offers: Look at Total Value

When comparing offers, don’t fixate solely on base physician salary. Build a simple comparison table for:

• Base salary and length of guarantee
• Productivity model (RVU or collections rate, thresholds, caps)
• Call pay, overtime, and shift differentials
• Signing and retention bonuses (and payback terms)
• Retirement contributions and vesting schedule
• Loan repayment, relocation assistance, and CME support
• Non-compete clauses and geographic restrictions

A slightly lower base salary with a strong productivity model, good benefits, and no onerous non-compete may be much more valuable than a superficially higher number.

4. Negotiate Strategically

Even first-time attendings have room to negotiate. You can often ask for (politely and with data):

• Higher base salary or a mid-point between their offer and your request
• Larger signing bonus or relocation assistance
• RVU rate or thresholds that are closer to regional norms
• Additional CME funds or protected time
• Adjustments to non-compete radius or duration

Use up-to-date doctor salary by specialty reports (MGMA, specialty society data, Doximity, Medscape) to support your asks—never just “I want more money.”

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FAQs: Physician Salary by Specialty for Residency Applicants

1. How much should physician salary influence my choice of specialty?
It should be a factor, not the factor. Aim for a specialty where you enjoy the daily work, can see yourself thriving for decades, and where the financial picture is compatible with your debt and life goals. Use salary data to avoid major surprises and to plan realistically—but don’t choose a high-paying specialty you dislike just for the income.

2. Are salary numbers I see online accurate for what I’ll make as a new attending?
Most reported physician salaries are for physicians several years into practice, not fresh out of training. New attendings may start lower, especially if they have a guaranteed salary before transitioning to full productivity-based models. Use the numbers as directional guidelines and expect a ramp-up period over the first 2–5 years.

3. Do academic physicians always earn less than private practice doctors?
Generally yes, but not always. Academic roles often pay less in base salary, but may offer additional income via administrative stipends, consulting, or moonlighting, plus non-financial rewards like research, teaching, and prestige. Some subspecialties in high-demand markets can have academic salaries that approach or match community positions, especially with significant call or procedural workloads.

4. Can I significantly change my earning potential after choosing a lower-paying specialty?
Yes, within limits. Even in lower-paying fields, you can increase income by:

• Practicing in high-need or rural areas
• Adding reimbursable procedures to your scope
• Taking on leadership roles or administrative responsibilities
• Working extra shifts, telemedicine, or locum tenens
• Transitioning into related higher-paying niches (e.g., pain management for PM&R, sleep medicine for pulmonology/psychiatry)
  You likely won’t match top neurosurgery or orthopedic incomes without retraining, but you can meaningfully move your earnings upward through strategic career choices.

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Understanding physician salary by specialty is part of being an informed, empowered future attending. Use these data alongside your values, interests, and long-term goals to craft a career that is both financially sustainable and personally fulfilling.