Physician Salary by Specialty in Preliminary Medicine: An Essential Guide

Understanding Physician Salary by Specialty During a Preliminary Medicine Year

When you’re applying for a preliminary medicine year (prelim IM), you’re really planning for two things at once: a single year of internal medicine training and the start of a longer specialty career. Naturally, questions about physician salary by specialty, doctor salary by specialty, and the highest paid specialties come up early—often even before ERAS is submitted.

This guide explains how a prelim IM year fits into long‑term earning potential, how compensation varies between specialties, and how to think strategically about salary when planning your career. It is written for medical students and international graduates considering or already pursuing a preliminary medicine year.

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1. What a Preliminary Medicine Year Is (and Why Salary Matters Early)

A preliminary medicine year is a one‑year, non‑categorical internal medicine internship. Unlike a categorical IM position (which leads to full internal medicine board eligibility in 3 years), a prelim IM year is designed to be your PGY‑1 base for another specialty.

Common Specialties Requiring or Accepting a Prelim IM Year

Many competitive fields either require or accept a preliminary medicine year as the clinical foundation:

• Neurology (often accept either prelim IM or transitional year)
• Anesthesiology
• Radiology (Diagnostic & Interventional) – often TY or prelim IM
• Radiation oncology
• Physical medicine & rehabilitation (PM&R)
• Dermatology (sometimes TY or prelim; depends on program)
• Ophthalmology (often TY or prelim IM)
• Some subspecialty tracks that pair with a PGY‑2 position

In each of these, the prelim year salary will be essentially the same as other interns at your institution—determined by PGY level and institution pay scale, not by your future specialty. The real salary differentiation happens after residency and fellowship, when you are practicing as an attending.

Still, you’re choosing a pathway now that determines your long‑term income trajectory, lifestyle, and career satisfaction. That’s why understanding physician salary by specialty is important even at the prelim IM application stage.

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2. How Physician Salaries Are Structured in the U.S.

Before comparing doctor salary by specialty, it helps to understand how compensation is typically structured.

Key Components of Physician Compensation

1. Base Salary

   • Fixed annual amount guaranteed by contract.
   • Common in large health systems, academic centers, and early practice years.

2. Productivity Bonuses

   • Often based on wRVUs (work relative value units), collections, or number of clinical sessions.
   • Specialties with procedure-based care (e.g., interventional cardiology, orthopedic surgery) may have higher bonus potential.

3. Quality or Value-Based Incentives

   • Performance on quality metrics, patient satisfaction, readmission rates, etc.
   • Usually a smaller portion but increasingly common.

4. Call Pay / Stipends

   • Extra pay for taking call beyond normal expectations.
   • Relevant for hospital‑based and procedural fields.

5. Benefits

   • Retirement contributions, CME funds, health/dental/vision insurance, disability insurance, malpractice coverage.
   • Sometimes include signing bonuses, relocation assistance, and student loan repayment.

Resident vs. Attending Salary

• Residents, including prelim IM interns

  • Paid by PGY level and institution, not by specialty.
  • Typical PGY‑1 salary: often $60,000–$75,000 depending on region and hospital.
  • Overtime is rarely paid separately; salary is considered inclusive despite 60–80 hour weeks in many programs.

• Attendings

  • Salaries vary widely by specialty, practice setting, geography, and academic vs. private practice roles.
  • The term “doctor salary by specialty” usually refers to post‑training attending compensation, not residency pay.

Understanding this distinction can help you avoid misconception: taking a prelim IM year does not limit or cap your long‑term earnings; it simply serves as your internship on the way to your ultimate field.

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3. Physician Salary by Specialty: Broad Overview

All numbers below are approximate ballparks based on recent major physician compensation surveys (MGMA, Medscape, AMGA) as of the early‑mid 2020s. Actual figures vary by location, practice type, and experience.

3.1 Primary Care and Generalist Specialties

These are common end‑points for those who complete a categorical internal medicine or family medicine residency (not just a prelim IM year).

Internal Medicine (General, Outpatient or Hospitalist)

• Typical range: ~$250,000–$320,000
• Hospitalists: Often in the higher end of that range; some hospitalist groups surpass it with nocturnist roles or high‑volume work.
• Factors influencing pay:
  • Geographic region (rural/underserved often pay more)
  • Shift‑based vs. clinic‑based roles
  • Academic vs. private practice (academics often pay less but offer stability and teaching opportunities)

Family Medicine

• Typical range: ~$240,000–$300,000
• Similar to internal medicine, with some primary care‑focused compensation models and incentives.

Pediatrics (General)

• Typical range: ~$200,000–$250,000
• One of the lowest paid major clinical specialties in raw dollar terms, often offset by high job satisfaction and more manageable lifestyle in many settings.

3.2 Cognitive Subspecialties of Internal Medicine

These usually require a 3‑year IM residency after which you can do a 1–3 year fellowship.

Cardiology (Non‑interventional, General)

• Typical range: ~$450,000–$600,000+
• Strong earning potential; imaging and consultative work can be very lucrative.

Gastroenterology (GI)

• Typical range: ~$500,000–$650,000+
• Procedures like colonoscopy and endoscopy drive higher compensation, particularly in private practice.

Hematology/Oncology

• Typical range: ~$400,000–$550,000
• Often a mix of inpatient consults, outpatient clinics, infusion center oversight, and sometimes clinical trials.

Pulmonary/Critical Care

• Typical range: ~$380,000–$500,000
• ICU coverage can contribute substantially; night shifts and high‑acuity care often increase compensation.

Endocrinology, Rheumatology, Infectious Disease, Nephrology

• Endocrinology: ~$230,000–$280,000
• Rheumatology: ~$260,000–$340,000
• Infectious Disease: ~$230,000–$300,000
• Nephrology: ~$270,000–$350,000
• These fields often offer lifestyle, intellectual engagement, and longitudinal patient relationships but are not among the highest paid specialties.

3.3 Surgical and Procedure‑Heavy Specialties (Often Among the Highest Paid Specialties)

Many of the generally highest paid specialties tend to be procedure‑based:

• Orthopedic Surgery

  • Typical range: ~$550,000–$800,000+
  • Subspecialties like spine, sports medicine, joints can be at the high end.

• Neurosurgery

  • Typical range: ~$650,000–$900,000+
  • Among the top tier in doctor salary by specialty, but with extremely long training and demanding call.

• Cardiothoracic Surgery

  • Typical range: ~$600,000–$800,000+

• Interventional Cardiology (after Cardiology fellowship)

  • Often similar to or above general cardiology, e.g., $600,000–$800,000+ in high‑volume private settings.

• Interventional Radiology

  • Typical range: ~$500,000–$700,000+

• Radiation Oncology

  • Typical range: ~$450,000–$600,000** in many markets, though subject to shifting reimbursement trends.

• Dermatology

  • Typical range: ~$400,000–$650,000+
  • Cosmetic work and private practice can significantly increase income.

These fields often require a preliminary year (medicine or surgery) or a transitional year prior to entering specialty training, making prelim IM an important entry path.

3.4 Other High‑Earning, Non‑Surgical Specialties

Some specialties that commonly follow a prelim IM year (or a transitional year) also rank high in physician salary by specialty:

• Anesthesiology

  • Typical range: ~$400,000–$550,000+
  • Pain management subspecialization can push compensation even higher.

• Diagnostic Radiology

  • Typical range: ~$450,000–$600,000+
  • Overnight and teleradiology roles, or high‑volume private practices, may exceed this.

• Emergency Medicine

  • Typical range: ~$350,000–$450,000**, sometimes higher with rural/locum work
  • Comp pressure and contract uncertainty are increasing in certain markets.

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4. How a Preliminary Medicine Year Fits into Long‑Term Income Planning

Your prelim IM year does not directly dictate your attending income, but it influences your path toward your ultimate specialty and may shape your CV, skills, and networking during a critical year.

4.1 Prelim IM vs. Transitional Year vs. Prelim Surgery

Many advanced specialties accept more than one type of PGY‑1 year:

• Prelim Internal Medicine

  • Strong medical foundation: inpatient medicine, ICU exposure, consults.
  • Favors specialties that are medicine‑adjacent (neurology, PM&R, radiation oncology, some anesthesiology and radiology programs).
  • Helpful if you want flexibility to pivot later into a categorical IM spot (leading to IM subspecialties).

• Transitional Year (TY)

  • Generally more flexible, slightly lighter inpatient load (varies widely by program).
  • Attractive for those strongly committed to a specialty already secured (e.g., dermatology, ophthalmology).

• Prelim Surgery

  • Better match for surgical trajectories (orthopedics, ENT, neurosurgery, urology, etc.).

From a physician salary by specialty standpoint, what matters most is where you land after all training, not which intern year you did. But your choice of prelim structure can impact:

• The competitiveness of your residency application for a given field.
• Your alignment with the clinical skills and culture of your target specialty.
• Your ability to pivot if you don’t match into or change your mind about your intended specialty.

4.2 Timing and Opportunity Cost

Different specialties require different lengths of training:

• Shortest paths (3–4 years total after med school)
  • Family medicine, internal medicine, pediatrics (3 years)
  • Psychiatry (4 years)
• Intermediate (4–5 years)
  • Emergency medicine, anesthesiology, diagnostic radiology, neurology, PM&R, ophthalmology, dermatology
• Longer (6–7+ years with fellowships)
  • Surgical subspecialties, cardiology, GI, interventional radiology, neurosurgery, CT surgery, interventional cardiology

The opportunity cost of extra years in training is real: each additional fellowship year postpones earning an attending salary and may add more lifestyle strain. However, those additional years often open doors to the highest paid specialties.

A typical thought process might be:

“If I do 1 year prelim IM + 3 years neurology = 4 years, then I’m an attending neurologist at ~$300k–$350k.
If I instead do 1 year prelim IM + 4 years radiology = 5 years, I might be at $450k–$600k.
Does the extra year and different nature of the work justify that change?”

Thinking explicitly about time‑to‑attending and long‑term salary can help align your preliminary medicine year choices with your financial goals.

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5. Highest Paid Specialties and How Prelim IM Connects to Them

Some of the highest paid specialties in modern U.S. medicine either require or commonly accept a prelim IM year or a similar internship.

5.1 Specialties Commonly Connected to a Prelim Medicine Year

While specific program requirements vary, many residents who complete a preliminary medicine year go on to:

• Anesthesiology

  • Strong path for those who enjoy physiology, acute care, OR environment.
  • Frequently ranked among higher‑income non‑surgical fields.

• Diagnostic Radiology / Interventional Radiology

  • Radiology residency may be preceded by a prelim IM or transitional year.
  • Interventional radiology, in particular, is highly procedural and often well‑compensated.

• Radiation Oncology

  • Often preceded by a transitional or prelim year with strong internal medicine exposure.
  • Among higher earning cognitive/non‑surgical specialties, though market dynamics are evolving.

• Neurology

  • May not be top tier in raw salary compared to ortho or neurosurgery but can be very competitive with other cognitive specialties.
  • Neurocritical care, epilepsy, and interventional neurology can increase compensation.

• Dermatology (for some program structures)

  • Some residents do a prelim medicine year before entering derm.
  • Historically among the top in doctor salary by specialty with relatively favorable lifestyle options.

Thinking strategically, a well‑chosen preliminary medicine year at a reputable academic or large community program can:

• Provide strong letters of recommendation and clinical experience.
• Offer connections to departments like anesthesia, radiology, and neurology.
• Build your procedural and acute care skillset, which is valued in many high‑earning specialties.

5.2 Does Picking a “Lower‑Pay” Specialty Mean a Bad Financial Choice?

Not necessarily. Consider:

• Geographic arbitrage: Practicing in underserved or rural regions often boosts income substantially, even in primary care.
• Hospitalist vs. clinic work: Hospitalist roles in internal medicine can push compensation upward, especially with nocturnist pay or higher shift volume.
• Leadership, administration, and niche expertise: Becoming a medical director, program director, or subspecialist in a “lower‑pay” field can meaningfully increase income.
• Side ventures: Telemedicine, consulting, medical writing, or entrepreneurship can add to your base compensation.

The prelim IM year keeps the door open to categorical IM and its subspecialties, allowing you to adjust your path if needed.

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6. Practical Strategies for Residency Applicants: Balancing Salary, Specialty, and Fit

6.1 How Much Weight Should Salary Have in Choosing a Specialty?

Reasonable considerations about physician salary by specialty are appropriate, especially given:

• High student loan burdens.
• Long training periods.
• Opportunity costs vs. other careers.

But salary should not be the only factor. Consider:

• Day‑to‑day work: Do you enjoy clinic, procedures, imaging, acute care, long‑term follow‑up?
• Tolerance for call and emergencies: Many high‑earning specialties carry significant nighttime and weekend responsibilities.
• Personality fit: Collaborative vs. solitary work, pace, stress tolerance, need for hands‑on interfaces vs. cognitive puzzle‑solving.

A realistic framework:

• Salary: Important
• Lifestyle and fit: Equally or more important
• Prestige alone: Least important (rarely sustains happiness long term)

6.2 Using Your Prelim IM Year to Clarify Your Path

If you are not already locked into a PGY‑2 specialty position, your preliminary medicine year can be an invaluable “test bed”:

• Rotate on ICU, cards, pulm, neuro, oncology to see what resonates.
• Seek mentorship from attendings in multiple fields:
  • Ask about their day‑to‑day, not just their income.
  • Inquire about schedule, documentation burden, and long‑term satisfaction.
• Attend departmental conferences:
  • Radiology noon conferences, neurology grand rounds, anesthesia M&M.
• Use electives to explore:
  • Outpatient subspecialty clinics.
  • Procedural rotations (endoscopy, interventional radiology, cath lab).

As you gather exposure, keep a running list:

• What do you look forward to on the schedule?
• What drains you the most?
• Which attendings’ lifestyle and career type do you realistically want?

6.3 Negotiating and Understanding Salary Later in Your Career

Though this comes later, awareness during training helps:

• Learn the basics of:
  • wRVU compensation models
  • Non‑compete clauses
  • Partnership tracks in private practice
• Talk to senior residents and fellows about:
  • Offers they receive.
  • Urban vs. rural differences.
  • Academic vs. community compensation.
• Remember that starting salaries are not your final destination:
  • Income typically rises with experience, productivity, and subspecialization.
  • Your first job is often a stepping stone, not your final practice.

The key point: a preliminary medicine year is just the foundation. The major salary differences come from your eventual specialty and practice choices—but the decisions you make during this year strongly influence those outcomes.

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FAQs: Physician Salary by Specialty and the Preliminary Medicine Year

1. Does doing a preliminary medicine year reduce my eventual physician salary?

No. Your eventual doctor salary by specialty depends on the specialty you complete and your practice setting, not on whether your PGY‑1 year was prelim IM, transitional, or categorical. A prelim IM year is simply your internship and will not cap your long‑term earnings. What it does affect is your pathway and your competitiveness for certain specialties.

2. Are the highest paid specialties always the best choice financially?

Not always. While the highest paid specialties (neurosurgery, ortho, CT surgery, interventional fields) can offer very high incomes, they also involve:

• Longer and more intense training.
• Higher malpractice premiums in some cases.
• More demanding call and lifestyle.
• Increased burnout risk for some physicians.

Over a lifetime, a high‑earning but unsustainable career can be less favorable than a slightly lower‑paid, sustainable specialty you enjoy and can practice for decades.

3. How much will I earn during my preliminary medicine year?

Your preliminary medicine year salary will be equivalent to other PGY‑1 residents at your institution, typically around $60,000–$75,000 annually in many U.S. programs, plus benefits. This is independent of your future specialty and similar whether you are in prelim IM, categorical IM, surgery prelim, or a transitional year.

4. If I’m undecided, is prelim IM a good choice for keeping options open?

Often yes. A prelim IM year gives broad exposure to inpatient medicine, ICU care, consult services, and subspecialties. It can keep doors open for:

• Transitioning into categorical internal medicine (and thus IM subspecialties).
• Applying to neurology, anesthesiology, radiology, PM&R, and other fields that accept an IM‑based internship.
• Building a strong CV with letters from well‑known internists and subspecialists.

However, you should verify specific PGY‑1 requirements for any target specialty and programs, since some prefer or require a transitional year or a surgical preliminary year.

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By understanding physician salary by specialty early—alongside lifestyle, training duration, and your own personal fit—you can use your preliminary medicine year strategically. View it not as a detour, but as a deliberate stepping stone toward a career that balances financial stability, professional fulfillment, and a sustainable life outside of medicine.