Physician Salary by Specialty: Your Guide to Preliminary Surgery Year

Understanding Physician Salary by Specialty in the Context of a Preliminary Surgery Year

When you’re planning a preliminary surgery year, the question “What will I earn in the long run?” naturally comes up. You’re investing one of the most demanding years of your life. How that year positions you within the broader landscape of physician salary by specialty matters—for both your career strategy and your financial planning.

This guide explains:

• How pay works during a prelim surgery residency compared with categorical spots
• How different specialties (surgical and non-surgical) pay over a career
• Where surgery falls among the highest paid specialties
• How to think strategically about a prelim year if long-term compensation is a factor

Throughout, keep in mind: a preliminary surgery year is usually a temporary training status, not a terminal destination. Its impact on your earning potential is mostly indirect—through which specialty you ultimately match into, how competitive your application becomes, and what doors it opens or closes.

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1. How a Preliminary Surgery Year Fits Into the Salary Landscape

1.1 What a Preliminary Surgery Year Actually Is

A preliminary surgery residency is typically a one-year, non-categorical PGY-1 position in general surgery. You’re doing the same—or very similar—clinical work as categorical interns but without guaranteed continuation to PGY-2 and beyond in that program.

Common pathways into a prelim surgery spot:

• Unmatched or partially matched applicants in the NRMP Main Match
• Those planning to transition into another specialty (e.g., radiology, anesthesiology, urology, PM&R, dermatology) that requires or prefers a strong clinical base year
• IMGs seeking U.S. clinical experience who plan to re-apply into categorical positions

Key point for salary:
Your income during a prelim year is essentially the same as any PGY-1 in that hospital—regardless of specialty. Where salary differences really appear is after training, when you’re a fully practicing attending physician.

1.2 Resident Salary vs. Attending Physician Salary

It’s crucial to separate:

• Resident salary (including prelim surgery):
  • Based primarily on PGY level and institution, not on specialty
  • Differences between prelim and categorical PGY-1 are usually negligible or nonexistent
• Attending physician salary by specialty:
  • Varies dramatically based on specialty, practice setting, geography, and subspecialty training
  • This is where you see big differences between general surgery, orthopedics, radiology, psychiatry, etc.

During your preliminary surgery year, your salary is typically:

• A fixed PGY-1 range (often roughly $60,000–$75,000 per year in the U.S., depending on cost of living and institution, sometimes higher in very expensive metros)
• Accompanied by benefits (health insurance, sometimes housing stipends, meal money, etc.)
• Unaffected by your future career plans (you get paid as a surgery intern whether you later match into radiology, anesthesia, or family medicine)

1.3 Why Salary by Specialty Matters Even During Your Prelim Year

Even though your prelim surgery residency pay is standardized, long-term physician salary by specialty should influence how you:

• Choose a target specialty (if you are undecided)
• Decide whether to pursue a second preliminary year vs. re-tooling your application and changing fields
• Balance passion vs. financial sustainability
• Plan for loan repayment and lifestyle expectations

You’re about to work 60–80+ hours/week in one of the most intense training environments—understanding how that effort might translate into future income (and whether that future is in surgery or another field) is part of making a well-informed decision.

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2. Big Picture: Physician Salary by Specialty

2.1 General Patterns in Compensation

While exact numbers vary year-to-year and by survey, several broad patterns consistently emerge in doctor salary by specialty:

1. Procedural and surgical specialties tend to earn more than cognitive, non-procedural specialties.
2. Lifestyle specialties (e.g., dermatology, radiology, ophthalmology, anesthesia) often combine strong compensation with more predictable schedules.
3. Primary care specialties frequently earn less than many subspecialties, but there’s rising emphasis on value-based pay, loan repayment, and incentives.
4. Subspecialization (fellowship training) usually increases earning potential within a field (e.g., interventional cardiology vs. general cardiology; vascular vs. general surgery).

In many surveys, highest paid specialties often include:

• Orthopedic surgery
• Plastic surgery
• Neurosurgery
• Cardiology (especially interventional)
• Gastroenterology
• Radiology
• Dermatology
• Some procedural subspecialties within anesthesiology and urology

General surgery is usually in the upper-middle tier: significantly higher than primary care but not always at the very top compared with the most lucrative procedural subspecialties.

2.2 Representative Ranges (High-Level Overview)

Exact numbers fluctuate, but to give approximate attending-level ballpark (full-time, U.S., pre-tax, not adjusted for region):

• Primary Care (FM, IM, Pediatrics): often in the low-to-mid $200,000s
• General Internal Medicine subspecialties (e.g., endocrinology, rheumatology): location- and field-dependent, typically mid $200,000s
• Hospital-based specialties (radiology, anesthesia, EM): often mid $300,000s and up, with substantial variation
• General Surgery: commonly mid-to-high $300,000s, sometimes higher depending on practice model and call
• Surgical subspecialties (ortho, neurosurgery, plastics, vascular, ENT, urology): frequently mid $400,000s to $700,000+ at the high end

Your preliminary surgery year is the gateway into (or near) some of these high-earning fields—but it’s not itself a determinant of your future salary. The specialty you ultimately complete determines your long-term income trajectory.

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3. Where Surgery Fits: Salary Within and Beyond General Surgery

3.1 General Surgery: A Baseline for Surgical Pay

As someone in a prelim surgery residency, you’re exposed to the culture and workload of general surgery. As an attending, general surgeons typically:

• Perform a broad mix of operations (hernia, cholecystectomy, colorectal, trauma, emergency surgeries)
• Take significant call (often nights, weekends, trauma, emergent cases)
• Have high responsibility and medicolegal risk

In most compensation surveys, general surgery:

• Pays substantially more than primary care and many cognitive subspecialties
• Usually sits below the upper echelon of the highest paid specialties such as neurosurgery, orthopedic surgery, and some interventional fields
• Has substantial variation based on:
  • Trauma vs. elective practice
  • Academic vs. private practice vs. employed models
  • Geographic area (rural and underserved areas often pay more)

3.2 Surgical Subspecialties and Their Earnings

Many who start in preliminary surgery hope to transition into categorical surgery and later subspecialize. Some high-level patterns:

• Orthopedic surgery & neurosurgery: Repeatedly near the top in doctor salary by specialty; heavy call, high stakes, very intensive training.
• Plastic surgery: Among the highest paid specialties, especially in cosmetic-heavy private practices.
• Vascular surgery, cardiothoracic surgery: High compensation; significant call and complexity.
• ENT (otolaryngology), urology: Typically strong earnings with a mix of clinic and OR, often high but somewhat more lifestyle-friendly depending on practice.
• Surgical oncology, colorectal, minimally invasive/foregut: Compensation varies widely (academic vs. private), but often competitive.

From the vantage point of a prelim surgery resident, these fields may feel out of reach; however, some prelims do ultimately move into categorical surgery and later fellowship. The key is to understand both:

• The training cost (years, call, emotional/physical toll)
• The earning potential relative to other specialties you might pivot into

3.3 Non-Surgical Routes After a Preliminary Surgery Year

A preliminary surgery year can also be a springboard to non-surgical specialties with very good earning potential:

• Anesthesiology: Frequently strong compensation; OR-based; good mix of procedures and physiology; often appealing to residents who enjoy the OR but not surgical lifestyle.
• Diagnostic radiology or interventional radiology: Among the higher-paying “lifestyle” fields; IR is very procedure-heavy and often near the top of earnings.
• Emergency medicine: Historically well-compensated; shift-based work; current job market somewhat tighter in some regions but still solid in many areas.
• PM&R with interventional pain: Can be highly lucrative for those who subspecialize in procedural pain management.
• Dermatology: Involves a re-application and is highly competitive, but combines some of the best physician salary by specialty profiles with strong lifestyle.

Whether these are viable for you depends on board scores, research, networking, visa status (for IMGs), and program relationships—but a prelim surgery residency does build a strong “clinical currency” that you can leverage.

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4. Using a Preliminary Surgery Year Strategically If Salary Matters

4.1 Clarify Your Priorities: Passion, Lifestyle, and Pay

Salary should be one factor—not the only factor—in your decision-making. Ask yourself:

• Am I willing to accept long hours, frequent call, and surgical stress for surgical-level pay?
• Would I be happier in a high-paying but more controlled-lifestyle specialty (e.g., radiology, anesthesia)?
• How does my debt load compare to my anticipated earnings and lifestyle expectations?

If you’re already in a preliminary surgery year, this is a natural time to reassess. You’re experiencing the workload and culture firsthand while still having some flexibility to pivot.

4.2 Step 1: Get Clear on the Salary Profiles of Your Target Choices

During your prelim year, spend deliberate time researching:

• Average starting salaries and mid-career income for:
  • General surgery
  • Surgical subspecialties you’re interested in
  • Non-surgical fields you’re considering
• Regional differences: salaries in rural vs. urban; community vs. academic centers
• Trends: Are certain specialties facing oversupply in particular regions? Is telehealth or technology changing the market?

Use:

• Specialty society resources (e.g., ACS, ASA, ACR)
• Major physician compensation surveys (e.g., MGMA, Medscape, Doximity)
• Faculty mentors who can share real-world numbers (within reason)

4.3 Step 2: Evaluate How Your Prelim Year Positions You

A prelim surgery residency can help or hinder your trajectory depending on how you use it:

Helps you if you:

• Secure strong letters from surgical and non-surgical faculty
• Demonstrate reliability, work ethic, and team skills under pressure
• Seek out cases and rotations that align with your future target specialty (e.g., ICU and anesthesia exposure if considering anesthesiology; trauma and EM if exploring emergency medicine)
• Engage in research or QI projects tied to your intended field

May hinder your options if you:

• Burn bridges or get poor evaluations
• Fail Step 3 / COMLEX 3 or postpone it unnecessarily
• Don’t use the year to strategically network and explore alternatives

This matters for physician salary by specialty in the long run: a strong prelim performance increases your odds of successfully entering one of the more competitive or higher-paying specialties.

4.4 Step 3: Consider the Timeline and Opportunity Cost

Think about:

• Total years of training:
  • Preliminary year + categorical surgery (5 years total, maybe 7+ with fellowship)
  • Preliminary year + new residency in a non-surgical field (3–4 more years)
• Delayed attending-level income:
  • Extra years in training mean additional resident-level salaries instead of earning as an attending.
• Burnout risk:
  • Taking on very long, intense training for higher pay may backfire if you’re not well-matched to the specialty.

Sometimes, choosing a moderately paid but shorter training pathway with fewer extra years can yield earlier financial stability—even if the eventual annual salary is lower than the very top highest paid specialties.

4.5 Step 4: Align Your Debt Strategy With Your Career Path

During your prelim year:

• Review your loan repayment strategy:
  • Income-Driven Repayment (IDR)
  • Public Service Loan Forgiveness (PSLF) possibilities
  • Refinancing (usually after training, once income is stable)
• Think about how your likely specialty influences:
  • How quickly you can pay down debt
  • Your tolerance for additional fellowship years
  • Whether you prioritize academic vs. private practice (often lower vs. higher pay)

A clear financial plan can make it easier to choose a specialty that’s not at the very top in physician salary by specialty but still meets your needs.

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5. Practical Examples: How a Prelim Surgery Year Intersects With Salary Outcomes

5.1 Example 1: The Future General Surgeon

• Profile: U.S. MD, did not match categorical General Surgery; matched into a preliminary surgery residency.
• Goal: Secure a categorical general surgery spot and later consider surgical oncology fellowship.
• Strategy:
  • Focus intensely on performance: excellent evaluations, strong LORs from key attendings.
  • Seek early meetings with program leadership about transitioning into an open categorical position or re-applying broadly.
  • Participate in research, morbidity & mortality conferences, and quality improvement.
• Salary trajectory:
  • PGY-1 prelim salary: similar to categorical PGY-1
  • If matched into categorical surgery: total 5+ years of residency, possibly fellowship (2–3 years)
  • Attending general surgeon: commonly in mid-to-high $300,000s or beyond, depending on practice and region; potentially more after subspecialization

5.2 Example 2: The Pivot to Anesthesiology

• Profile: IMG matched prelim surgery after not matching into anesthesiology.
• Goal: Use the prelim year to re-apply to anesthesia, possibly leveraging OR experience.
• Strategy:
  • Request rotations with anesthesia and ICU to demonstrate interest and ability.
  • Obtain LORs from anesthesiologists and intensivists.
  • Highlight procedural skills and hemodynamic management in the new application.
• Salary trajectory:
  • Extra year in training as prelim
  • 3–4 years anesthesiology residency
  • Attending anesthesiologist: often strong compensation, typically mid $300,000s or higher depending on group, region, and call obligations

5.3 Example 3: Re-Orienting Toward a Cognitive Specialty

• Profile: DO student in prelim surgery year, realizing the OR and surgical lifestyle are not a good fit.
• Goal: Switch to internal medicine or psychiatry with an eye toward a sustainable lifestyle, accepting lower long-term income.
• Strategy:
  • Meet early with program director and mentors to discuss performance and references.
  • Apply to open PGY-1 or PGY-2 spots in medicine/psychiatry through SOAP or off-cycle openings.
  • Describe the prelim year as proof of resilience, clinical competence, and procedural experience.
• Salary trajectory:
  • PGY-1 surgery + 3 years internal medicine or psychiatry
  • Attending internist or psychiatrist: typically lower income than surgical or anesthesiology fields, but may still allow comfortable lifestyle and earlier stability

In each example, the prelim year’s direct salary is similar. The indirect effect—what specialty you end up in—has massive implications for lifetime earnings, lifestyle, and satisfaction.

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6. Actionable Advice for Prelim Surgery Residents Focused on Salary

6.1 While You’re in Your Prelim Year

1. Track your performance

   • Ask for feedback early and often
   • Identify weaknesses (documentation, OR efficiency, communication) and fix them quickly

2. Maximize networking

   • Build genuine relationships with faculty in both surgery and fields you’re considering
   • Let mentors know your long-term goals; they can steer you toward opportunities

3. Targeted rotations

   • If exploring non-surgical pathways, negotiate for rotations in ICU, anesthesia, radiology, EM, or medicine where possible
   • Showcase your work ethic and competence in those rotations for strong letters

4. Use data when deciding on your specialty

   • Compare physician salary by specialty with lifestyle, your aptitude, and your interests
   • Don’t chase the highest paid specialties blindly; factor in training length, burnout risks, and job market realities

5. Start financial planning now

   • Create a basic budget that acknowledges resident salary constraints
   • Understand your loan details and repayment options

6.2 As You Approach the End of the Prelim Year

1. Clarify your target specialty (surgery vs. non-surgery)
2. Line up letters from the specialties you’re aiming at
3. Update your application:
   • Reflect your clinical growth from the prelim year
   • Highlight procedural and acute care skills that are attractive across many specialties
4. Apply broadly and realistically:
   • Be strategic about how competitive your profile is for each specialty
   • Consider geography and visa considerations (if applicable)

Remember: the preliminary surgery year is a tool; how you use it determines which rung of the physician salary by specialty ladder you ultimately stand on.

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FAQs: Physician Salary by Specialty and Preliminary Surgery

1. Does a preliminary surgery year pay less than a categorical surgery PGY‑1?
Generally, no. At most institutions, prelim surgery residents and categorical surgery interns receive the same PGY‑1 salary and benefits. The distinction is in the contract length and guarantee of continued training, not in pay.

2. Will doing a preliminary surgery year increase my eventual salary?
Indirectly at best. The prelim year itself does not raise your pay scale. However, it can improve your chances of entering a higher-paying specialty (e.g., surgery, anesthesia, radiology) if you perform well, secure strong letters, and strategically re-apply. The specialty you ultimately complete, not the prelim year, drives your attending-level income.

3. Is surgery one of the highest paid specialties?
General surgery is well-compensated compared with primary care and many cognitive subspecialties but is usually below the very top earners like orthopedics, neurosurgery, and some interventional subspecialties. Many surgical subspecialties, however, are among the highest paid specialties. Your decision to pursue additional fellowship training will significantly influence your long-term earnings.

4. Should I choose a specialty based mostly on physician salary by specialty?
It’s risky to do so. While salary is an important factor—especially with large educational debt—choosing a field misaligned with your interests, temperament, and desired lifestyle can lead to burnout and dissatisfaction. Use salary data as one input among many: consider your clinical passions, work–life balance needs, training length, job market, and personal values alongside potential earnings.

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Category: RESIDENCY_APPLICATIONS
Phase: RESIDENCY_MATCH_AND_APPLICATIONS