Physician Salary by Specialty in Internal Medicine: Ultimate Guide

Physician compensation is one of the most common—and most sensitive—topics for medical students and residents planning a career in internal medicine. Understanding physician salary by specialty within internal medicine is critical not only for financial planning, but also for setting realistic expectations, negotiating contracts, and aligning your career path with your values and interests.

This guide focuses on how internal medicine physicians are paid across general internal medicine and major IM subspecialties, factors that drive income differences, and how your choices during training (such as fellowship or practice setting) can influence your long‑term earning potential.

Note: Salary figures mentioned are approximate, based on recent surveys up to 2024 (e.g., Medscape, AMGA, MGMA, Doximity reports). Actual compensation varies significantly by region, setting, and individual contracts.

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The Big Picture: Internal Medicine and Physician Salary

Internal medicine is one of the most versatile specialties in medicine. It offers:

• Broad clinical scope
• Numerous subspecialty options
• Flexibility in practice setting (academic, community, hospital-employed, private practice, telemedicine, industry, etc.)

From a compensation standpoint, internal medicine sits in the middle of the overall physician salary spectrum:

• General internal medicine (outpatient or hospitalist) typically sits below surgical fields and procedural subspecialties.
• Procedural internal medicine subspecialties (like cardiology and gastroenterology) are among the highest paid specialties in medicine overall.
• Cognitive subspecialties (like endocrinology, rheumatology, infectious disease) often earn less than procedural counterparts, though factors like lifestyle, call burden, and job satisfaction may be more favorable.

Understanding this landscape early in the IM match process can help you think strategically about your training and long‑term career.

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Core Internal Medicine Pathways and Typical Salary Ranges

Before diving into each subspecialty, it helps to understand the main “macro-pathways” internal medicine residents can pursue after completing an internal medicine residency.

1. General Internal Medicine (Outpatient Adult Primary Care)

• Training: 3 years of internal medicine residency; no fellowship required
• Scope: Chronic disease management, preventive care, complex multimorbidity in adults
• Typical total compensation range (base + bonus):
  • About $220,000–$280,000 in many regions
  • Higher in rural/underserved areas or high-cost-of-living markets with aggressive recruitment
• Key income drivers:
  • RVU production (especially for high-volume primary care clinics)
  • Quality metrics/bonuses (e.g., value-based care, panel size management)
  • Incentives for extended hours, leadership roles, or medical directorships

General internists in outpatient settings often trail procedural specialties in pure physician salary, but may benefit from more predictable schedules and longitudinal relationships with patients. Compensation gaps can be partially narrowed by productivity and quality incentives, particularly in integrated health systems.

2. Hospitalist Medicine

• Training: 3-year internal medicine residency; optional hospitalist-focused tracks but no additional fellowship required
• Scope: Inpatient general medicine, admissions, consults, comanagement
• Typical total compensation range:
  • Often $260,000–$330,000 for full-time work
  • Nocturnists (night-focused hospitalists) frequently earn $20,000–$50,000 more than daytime counterparts
• Schedule:
  • Common models: 7-on/7-off, block scheduling, swing shifts
  • Increased pay for nights, weekends, high census, or higher-acuity facilities

Hospitalist careers are a major draw for internal medicine residency graduates because they combine relatively high earnings with block scheduling and no outpatient panel management. That said, pace and intensity can be high, and compensation can be volume-sensitive (admissions, encounters, relative value units).

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Physician Salary by Internal Medicine Subspecialty

Internal medicine offers a wide spectrum of subspecialties with very different earning profiles. Below is an overview of major IM subspecialties, their training path, and typical compensation patterns.

Salary ranges below are approximate national averages. Regional demand, practice type, and years in practice can shift figures significantly.

Cardiology

• Training: 3 years IM + 3 years cardiology fellowship; optional 1–2 additional years (interventional, EP, advanced imaging)
• Nature of work: Combination of cognitive and procedural; cath lab, imaging, clinic, inpatient consults
• Typical total compensation:
  • General/non-invasive cardiology: $450,000–$600,000+
  • Interventional cardiology: $600,000–$900,000+
  • Electrophysiology (EP): often similar to or higher than interventional in high-volume markets
• Key factors:
  • High RVU-generating procedures (caths, PCI, ablations, device placements)
  • Emergency and STEMI call often adds income but increases lifestyle strain
  • Private practice and cardiology groups may share in ancillary revenue

Cardiology consistently ranks among the highest paid specialties within internal medicine and medicine overall. However, it involves long training, demanding call, and high-acuity patients.

Gastroenterology (GI)

• Training: 3 years IM + 3 years GI fellowship; optional 1-year advanced endoscopy
• Nature of work: Endoscopy (EGD, colonoscopy), advanced procedures (ERCP, EUS), clinic, inpatient consults
• Typical total compensation:
  • $500,000–$750,000+; higher for advanced endoscopy and high-volume private practices
• Key factors:
  • Procedural intensity and endoscopy volume drive earnings
  • Ownership stakes in endoscopy centers or ancillary services can substantially increase income
  • Call burden varies by practice and hospital coverage patterns

GI is often cited in surveys as one of the highest-earning internal medicine subspecialties, frequently comparable to or exceeding cardiology in some markets.

Pulmonary and Critical Care Medicine (PCCM)

• Training: Common combined track: 3 years IM + 3 years Pulm/Critical Care
• Nature of work: ICU care, ventilator management, procedures (bronchoscopy, lines, thoracentesis), outpatient pulmonary clinics, sleep medicine options
• Typical total compensation:
  • $350,000–$550,000+, higher for intensivist-heavy or nocturnist roles
• Key factors:
  • Proportion of ICU vs clinic work (ICU shifts often command higher pay)
  • Geography: rural or high-need areas often offer significant salary premiums
  • Additional sleep medicine or interventional pulmonology may boost income

PCCM blends high-acuity inpatient care with longitudinal pulmonary follow-up. Earnings are generally strong but can be tempered by demanding schedules and night/weekend critical care coverage.

Hematology/Oncology (Hem/Onc)

• Training: 3 years IM + 3 years Hem/Onc or separate Heme/Onc tracks
• Nature of work: Cancer care, chemotherapy management, benign hematology, inpatient consults, outpatient infusion clinics, clinical trials
• Typical total compensation:
  • $400,000–$600,000+, often higher in private practice or community cancer centers
• Key factors:
  • Productivity bonuses tied to chemotherapy administration, infusions, and patient volume
  • Opportunities for clinical research and leadership roles in cancer centers
  • Emotional intensity and longitudinal relationships with seriously ill patients

Hem/Onc offers high earning potential and opportunities in both community and academic settings, balanced by a heavy cognitive and emotional workload.

Nephrology

• Training: 3 years IM + 2 years nephrology fellowship
• Nature of work: Chronic kidney disease, dialysis management, inpatient consults, transplant medicine (in some group structures)
• Typical total compensation:
  • $260,000–$350,000+; some regions and private nephrology groups exceed this range
• Key factors:
  • Dialysis unit affiliations and medical directorships can increase physician salary
  • High call burden and multiple site coverage (hospitals + dialysis centers)
  • Market saturation in some urban areas can exert downward pressure on compensation

Nephrology has seen variable compensation trends; while not among the top-earning IM subspecialties, business-savvy nephrologists in the right markets can earn above the average range.

Endocrinology

• Training: 3 years IM + 2 years endocrinology fellowship
• Nature of work: Diabetes, thyroid disorders, bone metabolism, pituitary/adrenal diseases, endocrine tumors
• Typical total compensation:
  • Often $220,000–$280,000, sometimes slightly higher in high-demand markets
• Key factors:
  • Primarily cognitive specialty with limited procedural revenue
  • Growing need for diabetes care offers stable demand
  • Academic jobs traditionally pay less but may offer research and teaching opportunities

Endocrinology is frequently cited as a “lower-paid” internal medicine subspecialty relative to length of training, but many physicians value its manageable lifestyle, clinic-based work, and strong patient relationships.

Rheumatology

• Training: 3 years IM + 2 years rheumatology fellowship
• Nature of work: Autoimmune disorders, inflammatory arthritis, connective tissue diseases
• Typical total compensation:
  • $250,000–$330,000+
• Key factors:
  • Cognitive specialty; income often tied to visit volume and infusion center services
  • Substantial demand in many regions; ability to build long-term outpatient panels
  • Less procedural revenue than GI/Cardiology but often better hours and call

Rheumatology combines intellectually challenging diagnostics with chronic disease management. While not among the highest paying subspecialties, lifestyle and work satisfaction rates are often strong.

Infectious Disease (ID)

• Training: 3 years IM + 2 years ID fellowship
• Nature of work: Complex infections, HIV, transplant ID, inpatient consultations, antimicrobial stewardship, public health involvement
• Typical total compensation:
  • $220,000–$270,000+ in many settings; can be higher with leadership roles or specialized niches
• Key factors:
  • Largely cognitive; lower RVU production compared to procedural fields
  • Strong presence in academic centers and hospital employment
  • Opportunities in global health, public health agencies, infection control, and hospital leadership

ID is often below the median physician salary by specialty, but offers rewarding intellectual challenges, system-level impact, and non-clinical role options.

Allergy & Immunology

• Training: 3 years IM (or Pediatrics) + 2 years Allergy/Immunology
• Nature of work: Allergic rhinitis, asthma, immunodeficiencies, food and drug allergies, outpatient-focused
• Typical total compensation:
  • $260,000–$340,000+; private practice can exceed this range
• Key factors:
  • Outpatient, largely daytime work with limited call
  • Income driven by visit volume, allergy testing, and immunotherapy
  • Attractive lifestyle with fewer hospital responsibilities

Allergy & Immunology is often seen as a high-lifestyle, moderate-compensation subspecialty that balances clinic work with relatively low-intensity call.

Geriatrics and Palliative Care

• Training:
  • Geriatrics: 3 years IM + 1 year geriatrics
  • Hospice & Palliative Medicine: 3 years IM + 1 year HPM (or via other primary specialties)
• Nature of work: Frailty, multimorbidity, goals-of-care discussions, symptom management, hospice, and long-term care
• Typical total compensation:
  • Often $220,000–$270,000, similar to or slightly above general internal medicine
• Key factors:
  • High value to healthcare systems, but reimbursement still catching up to importance
  • Opportunities for medical directorships in nursing homes, hospice agencies, and health systems
  • Frequently integrated with academic or system leadership roles

Compensation in geriatrics and palliative care often does not reflect the complexity and societal importance of the work, but these fields can be deeply meaningful and aligned with mission-driven careers.

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Factors That Drive Physician Salary Within Internal Medicine

Beyond specialty choice, multiple variables influence physician salary by specialty in internal medicine. Understanding these will help you interpret offers and plan your post-residency path.

1. Procedural vs Cognitive Practice

The single biggest driver of doctor salary by specialty in IM is whether a field is:

• Procedural (e.g., GI, interventional cardiology, EP, some pulmonary, advanced endoscopy)

  • Higher RVUs per encounter
  • Facility fees, equipment utilization, and ancillary revenue streams
  • Higher compensation but often more intense schedules and call

• Cognitive (e.g., endocrinology, rheumatology, ID, geriatrics)

  • Mostly evaluation and management (E/M) billing
  • Lower RVUs per visit and fewer billable procedures
  • Compensation lags behind procedural fields despite similar training lengths

2. Practice Setting

Common settings and how they affect income:

• Private practice (solo or group)

  • Potential for higher physician salary, especially when sharing in practice profits and ancillaries
  • Greater financial risk, business overhead, and administrative responsibilities

• Hospital-employed / health system-employed

  • More predictable salary, benefits, and support staff
  • Income often based on salary + RVU/quality bonus
  • Less direct exposure to business risk but also less upside

• Academic medicine

  • Typically lower base salary than community settings
  • Compensation supplemented by incentives, grants, administrative roles
  • Tradeoffs include teaching, research, prestige, and academic career growth

• Government / VA

  • Stable government pay scales and strong benefits
  • Often lower than private sector for subspecialists, but predictable workload and good retirement packages

3. Geography and Market Demand

Location exerts a powerful influence on physician salary:

• Rural or underserved regions often:

  • Offer higher salaries, sign-on bonuses, and loan repayment
  • Have fewer competing physicians, boosting negotiating power

• Urban and coastal areas may:

  • Pay less in pure salary due to high competition and desirable locations
  • Offer non-monetary advantages like academic affiliation, research, and lifestyle amenities

4. Call Burden and Schedule

• Specialties with heavy night and weekend call (cardiology, GI, PCCM) often pay more but can impact lifestyle and burnout risk.
• Hospitalist nocturnists usually earn a premium for dedicated night shifts.
• Outpatient-focused fields (allergy, endocrinology, geriatrics) often trade some salary for more predictable hours and lighter call.

5. Experience and Partnership Track

Early-career vs seasoned physicians:

• New graduates starting salaries may:

  • Be lower in private groups with a partnership track but ramp up considerably after partnership
  • Be relatively flat in hospital-employed or academic positions

• Partnership in private practice may:

  • Offer sharing of profits, facility fees, ancillary services, or real estate
  • Boost total compensation significantly above base salary figures, especially in high-volume procedural subspecialties

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Planning Your Career: Balancing Salary, Lifestyle, and Fit

As you navigate the IM match and consider subspecialty training, it’s essential to look beyond raw numbers.

1. Don’t Choose Solely Based on the Highest Paid Specialties

While GI, cardiology, and other procedural subspecialties offer strong earning potential, choosing a field purely based on income can backfire if:

• You dislike the core clinical work (e.g., procedural intensity, high-stakes emergencies)
• You find the lifestyle unsustainable (e.g., frequent night/weekend call, long hours in the cath lab or endoscopy suite)
• You’re drawn more to longitudinal cognitive care, complex diagnostics, or relationship-focused practice

Burnout rates are high in many high-paying specialties; alignment with your interests and strengths matters as much as physician salary.

2. Understand the Full Compensation Package

When comparing offers or specialties, look at:

• Base salary
• Productivity bonus structure (RVU thresholds, conversion factors)
• Sign-on bonuses and relocation packages
• Loan repayment or forgiveness options
• Benefits (health insurance, retirement match, CME funds, disability insurance)
• Non-clinical compensation (medical directorships, administrative stipends, academic titles)

Total compensation can vary widely even within the same specialty and city.

3. Consider Long-Term Flexibility

Internal medicine is uniquely flexible. Over a 30–40 year career, you may:

• Shift between hospitalist and outpatient roles
• Split time between clinical practice and administration (CMO, quality, informatics)
• Move into industry (pharma, biotech, medical devices) or consulting
• Transition into public health, policy, or global health

Income may rise or fall as you change roles, but your IM foundation will remain valuable.

4. Use Salary Data Wisely in Contract Negotiations

As a new attending:

• Research regional benchmarks for your specialty through MGMA, Doximity, Medscape, and specialty societies.
• Understand your expected RVU targets and what typical physicians in the group actually produce.
• Negotiate not only base salary, but also sign-on bonuses, moving allowances, and forgiveness clauses on bonuses if the practice situation changes.

For residents and fellows, this groundwork pays off when transitioning from training to your first attending job.

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Frequently Asked Questions (FAQ)

1. How does internal medicine residency choice affect future doctor salary by specialty?

Your internal medicine residency program itself (university vs community, location, prestige) has much less direct impact on your long-term salary than:

• The subspecialty you choose (or choice to remain in general IM or hospitalist medicine)
• Your eventual practice setting and geographical location
• Whether you pursue procedural or cognitive tracks

However, certain residencies may have stronger pipelines into competitive fellowships (cardiology, GI, PCCM), which can indirectly influence your eventual earning potential by improving your fellowship match chances.

2. Is hospitalist medicine financially better than outpatient internal medicine?

In many markets:

• Hospitalist physicians generally earn more than outpatient general internists, especially when factoring in nocturnist differentials, shift differentials, and limited non-billable time.
• Outpatient internists may have more predictable daytime hours and less intense clinical pace, but often at lower compensation.

That said, outpatient IM in high-demand or rural areas, or with strong productivity incentives, can approach or exceed some hospitalist roles. Lifestyle preferences and burnout risk should be central to your decision, not just salary.

3. Which internal medicine subspecialties are considered the highest paid specialties?

Within internal medicine, subspecialties that frequently lead the doctor salary by specialty lists include:

• Gastroenterology (particularly with advanced endoscopy and ASC ownership)
• Cardiology (especially interventional and electrophysiology)
• Pulmonary/Critical Care Medicine (in high-intensity, high-demand markets)
• Hematology/Oncology (especially community-based, high-volume practices)

These often rival or exceed the incomes of many surgical specialties, but with substantial training time and demanding clinical responsibilities.

4. Are lower-paying subspecialties like endocrinology or infectious disease “bad financial decisions”?

Not necessarily. While average salaries in endocrinology, infectious disease, geriatrics, and palliative care may be closer to or only slightly above general internal medicine levels, several points matter:

• Many physicians in these fields report high professional satisfaction and manageable lifestyles.
• Leadership roles, administrative positions, and niche areas (e.g., transplant ID, endocrine oncology, medical directorships) can significantly supplement income.
• Over a multi-decade career, work satisfaction, burnout risk, and flexibility can be as important as initial salary differentials.

Ultimately, the “best” financial decision is one that balances sustainable income with a career you can maintain enthusiastically over time.

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Understanding physician salary by specialty within internal medicine is an important piece of planning your career, but it should be considered alongside lifestyle, personal interests, and long-term goals. Internal medicine offers one of the broadest ranges of pathways in medicine—use your residency and early career years to explore these options, speak with mentors, and define what success looks like for you, both professionally and financially.