Physician Salary by Specialty in Transitional Year: A Complete Guide

Resident pay is the same across specialties during training, but the salary differences you’ll see after your Transitional Year (TY) can be dramatic. Understanding physician salary by specialty while you’re still deciding on your next step after TY is one of the most practical ways to plan your career, lifestyle, and finances.

Below is a comprehensive, data‑driven look at how salaries vary by specialty, how a Transitional Year fits into that picture, and how to think strategically about income, training length, and career satisfaction.

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Understanding the Transitional Year and Where Salary Fits In

A Transitional Year residency is a one‑year, broad‑based internship that fulfills the PGY‑1 requirement for several advanced specialties (e.g., radiology, anesthesiology, dermatology, PM&R, radiation oncology). It can also be used by undecided graduates who want more clinical exposure before committing.

What a TY Program Is (and Is Not)

• What it is:

  • A PGY‑1 year with diverse rotations (IM, surgery, ED, electives).
  • A stepping stone to advanced specialties.
  • Often chosen for its flexibility, stronger elective time, and more balanced workload than some categorical programs.

• What it is not:

  • It does not lead to board certification by itself.
  • It does not directly alter your resident salary—TY resident pay is determined by the institution and PGY level, not by future specialty choice.

Where Salary Enters the Picture

During your Transitional Year, your take‑home pay will be similar to peers in prelim or categorical PGY‑1 positions at the same institution. The real salary divergence happens:

1. After residency training (as an attending).
2. Within the same specialty based on practice setting (academic vs private), geography, and productivity models.
3. Over time as you build seniority, subspecialize, or assume leadership roles.

Knowing the doctor salary by specialty landscape while you’re in a Transitional Year can:

• Help you evaluate whether the training length and workload of a specialty are worth the ultimate compensation.
• Guide your approach to debt repayment and financial planning.
• Set realistic expectations about lifestyle vs income trade‑offs.

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Resident Salary vs Attending Salary: Clarifying the Basics

Before we dive into physician salary by specialty, it’s important to distinguish between:

1. Resident / fellow compensation
2. Attending physician compensation

What Residents in TY Programs Typically Earn

Resident salaries vary by region, hospital system, and PGY level, but ranges are broadly similar.

For most Transitional Year residents in the U.S.:

• PGY‑1 salary: Approximately $60,000–$75,000 base annually (2024–2025 ballpark).
• Benefits:
  • Health, dental, disability insurance.
  • Retirement account (often with minimal or no match).
  • Educational stipend, meal allowance, parking (varies widely).
• Overtime: Not typically paid; compensation is usually fixed, regardless of hours worked.

Your TY program itself doesn’t carry a different salary scale from other intern‑year tracks. You’re paid as a PGY‑1, period.

Attending Physician Salaries: Where Specialties Diverge

Once board‑certified and practicing independently, salaries diverge sharply. Comparing doctor salary by specialty:

• Primary care fields (e.g., internal medicine, pediatrics, family medicine) sit on the lower end of the attending pay spectrum.
• Procedure‑heavy or highly specialized fields (e.g., orthopedics, cardiology, dermatology, radiology, neurosurgery) are typically among the highest paid specialties.
• Hospital‑employed vs private practice vs academic roles can change income substantially—hundreds of thousands of dollars over a career.

Your Transitional Year is often the launchpad to these higher‑earning, specialized fields, and that makes this year a crucial time to understand the downstream financial implications of your choice.

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Physician Salary by Specialty: Big-Picture Patterns

Exact numbers vary by source (e.g., Medscape, Doximity, MGMA, institutional reports) and by year, but the patterns are consistent. The list below uses approximate ranges in U.S. dollars for full‑time attendings, focusing on broad trends rather than granular data.

Highest Paid Specialties (Procedure‑Heavy & Subspecialized)

Commonly reported highest paid specialties:

• Orthopedic Surgery: ~$600,000–$800,000+
• Neurosurgery: ~$650,000–$900,000+
• Cardiology (Invasive / Interventional): ~$550,000–$800,000+
• Radiology (Diagnostic, Interventional): ~$450,000–$750,000+
• Gastroenterology: ~$500,000–$700,000+
• Dermatology: ~$400,000–$650,000+
• Otolaryngology (ENT): ~$450,000–$650,000+
• Urology: ~$450,000–$650,000+
• Anesthesiology: ~$400,000–$600,000+

Key features:

• Procedural intensity and RVU generation drive income.
• Many are accessible through a Transitional Year, especially radiology, anesthesiology, PM&R, and radiation oncology.
• Often longer training (5–7+ years including fellowship) but higher lifetime earnings.

Mid‑Range Earning Specialties

These usually involve a mix of cognitive and procedural work:

• Emergency Medicine: ~$350,000–$500,000+
• Hospitalist Internal Medicine: ~$275,000–$375,000+
• Psychiatry: ~$275,000–$400,000+
• Obstetrics & Gynecology: ~$325,000–$450,000+
• PM&R (Physiatry): ~$300,000–$450,000+ (can be higher with interventional pain)
• Rheumatology / Endocrinology / Infectious Disease: ~$250,000–$400,000 (varies, often higher in private practice or with procedures)

These fields can offer:

• Reasonable balance between length of training, lifestyle, and income.
• Opportunities to increase income through call coverage, procedures, or private practice.

Lower Paid (But Essential) Specialties

Often primary‑care focused and more cognitive:

• General Internal Medicine (Outpatient): ~$230,000–$300,000+
• Family Medicine: ~$230,000–$300,000+
• Pediatrics (General): ~$210,000–$275,000+
• Geriatrics: Often similar or slightly above general internal medicine, varies.

Despite lower compensation:

• These specialties can offer strong job stability and geographic flexibility.
• They’re critical for the healthcare system and can be highly fulfilling.

How TY Residents Fit In

Many specialties that require a preliminary or Transitional Year fall into the middle to upper salary tiers.

Common TY‑linked advanced specialties and approximate salary ranges:

• Diagnostic Radiology: ~$450,000–$700,000
• Interventional Radiology: ~$550,000–$800,000+
• Anesthesiology: ~$400,000–$600,000+
• Radiation Oncology: ~$400,000–$600,000+
• Dermatology: ~$400,000–$650,000+
• PM&R: ~$300,000–$450,000+ (more for interventional pain)
• Neurology (some routes use TY/Prelim): ~$275,000–$400,000+ (higher in subspecialties like stroke, epilepsy, neurocritical care in some markets)

For TY residents, this is the crucial connection: while your intern salary is similar to peers, the post‑training income potential in the advanced specialties you’re aiming for is often disproportionately high compared with the length of your residency.

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Translating Salary Data into Strategy During Your TY Year

You don’t pick a specialty by salary alone—but ignoring compensation entirely isn’t realistic when you’re staring down six‑figure student debt. Here’s how to use doctor salary by specialty information productively during your Transitional Year.

1. Weigh Training Length vs Future Income

Longer training delays attending‑level income, but may offer much higher long‑term pay. For example:

• Dermatology: TY or prelim + 3 years derm = ~4 years total.
  • High median income, strong lifestyle, outpatient.
• Anesthesia / Radiology: TY + 3–4 years core training (+ fellowship optional).
  • High pay, some call/shift work, technical skill set.
• PM&R: TY or prelim + 3 years PM&R (+ optional fellowship).
  • Upper mid‑range salary with opportunities to move higher via interventional pain or sports.

Compare those with:

• General Internal Medicine: 3 years categorical IM.
  • Lower income ceiling but simpler path and strong job demand.

Ask yourself:

• How many extra years of training am I willing to invest?
• Do I want to start earning as an attending earlier, even if at a lower peak salary?

A Transitional Year gives you flexibility and time to make this calculation with more clinical experience under your belt.

2. Match Salary Profiles to Your Lifestyle Priorities

Salary ranges correlate not just with specialization but often with lifestyle factors:

• Higher‑paying specialties often involve:
  • More call, OR time, nights, or high‑stakes decision‑making.
  • Greater RVU pressure in some practice models.
• Moderate‑paying and primary care specialties may offer:
  • More stable hours, predictable outpatient schedules, or shift‑based work (e.g., hospitalist).
  • More opportunities for part‑time work or non‑clinical roles (admin, QI, teaching).

During your TY program:

• Pay attention to your energy levels on different rotations.
• Notice whether you thrive in procedural environments (OR, IR suite, cath lab) or more cognitive, longitudinal care settings.

Plan to:

• Shadow attendings in specialties you’re considering and ask candid questions about lifestyle, schedule, burnout, and compensation models.
• Talk to recent graduates who’ve just finished fellowship—what do their first contracts look like?

3. Integrate Physician Salary with Your Debt and Financial Goals

Your choice of specialty strongly influences your timeline for debt repayment and long‑term financial freedom.

Examples:

• A TY resident going into dermatology or radiology:

  • May graduate with similar debt as a future pediatrician.
  • But with significantly higher lifetime income potential and faster capacity to pay off loans aggressively if desired.

• A TY resident undecided between PM&R vs internal medicine:

  • PM&R often delivers higher average income, particularly with interventional pain.
  • But may require additional fellowship training and can have higher malpractice costs depending on subspecialty.

Key questions:

• Do you want to pay off loans as fast as possible, or are you comfortable with a slower, PSLF‑oriented path?
• How important are future flexibility and part‑time options?
• Are you open to working in rural or underserved areas, which often pay more regardless of specialty?

Use your Transitional Year to:

• Meet with a financial counselor if your institution offers one.
• Run back‑of‑the‑envelope simulations:
  • “If I match into specialty X with a typical that‑specialty physician salary, how quickly could I pay off $250k in loans?”
  • “How would that change if I choose specialty Y with lower but still solid pay?”

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Practical Tips: Using Your Transitional Year to Explore Salary-Linked Specialties

Your TY year can do more than fulfill your PGY‑1 requirement—it can actively shape your understanding of income, lifestyle, and fit across specialties.

1. Choose Electives Strategically

If your TY program allows significant elective time, prioritize rotations that:

• Represent potential long‑term career options (e.g., radiology, anesthesia, PM&R, dermatology, neurology, radiation oncology).
• Show you a range of income and lifestyle profiles.
• Allow you tosee both academic and community practice if possible.

Questions to ask attendings on elective:

• “How is your compensation structured? Salary, RVU‑based, partnership track?”
• “What’s a realistic range for income early vs mid‑career in this specialty?”
• “What trade‑offs do you feel you made compared to other specialties you considered?”

2. Analyze Salary in Context of Non‑Financial Factors

High pay doesn’t guarantee satisfaction. During your TY rotations, note:

• Do you enjoy the patient population?
• How does the stress level feel during a typical day?
• Are you drawn to the procedural vs cognitive orientation?
• How does burnout manifest among attendings and senior residents in that field?

Create a personal decision matrix:

• Columns: Interest, Lifestyle, Training length, Physician salary by specialty, Geographic flexibility, Burnout risk.
• Rows: Each specialty you’re seriously considering.

Rank each specialty honestly. Salary should be a column—not the column.

3. Build a Realistic Post‑Residency Financial Picture

As you evaluate the doctor salary by specialty landscape, try to understand your net picture:

• Use estimated:
  • Starting attending salary (first 1–3 years).
  • Loan repayment plan (standard, PAYE/REPAYE/SAVE, PSLF, private refinancing).
  • Anticipated cost of living in your preferred cities.
• Factor in:
  • Malpractice premiums (may be included in employed roles).
  • Retirement benefits and potential employer matching.
  • Opportunities for side income (locums, telemedicine, consulting, teaching, research stipends).

This exercise can clarify, for example, why a “mid‑range” specialty in a low cost‑of‑living area may deliver a better real lifestyle than a “top‑paying” specialty in a very expensive city.

4. Avoid Common Pitfalls When Thinking About Salary

During your TY year, watch out for:

• Chasing the top line only:
  • A $700k salary doesn’t help if you feel miserable, burned out, or trapped in a job you hate.
• Underestimating training fatigue:
  • Longer, intense training (e.g., neurosurgery) can be incredibly rewarding but is not for everyone.
• Ignoring geographic dependency:
  • A specialty’s “average” salary may hide big differences between urban academic centers vs rural community practices.
• Overvaluing short‑term resident experience:
  • A tough or easy rotation doesn’t always predict long‑term satisfaction in that field; try to see the attending perspective as well.

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FAQs: Physician Salary by Specialty and the Transitional Year

1. Does doing a Transitional Year change my salary compared with a categorical intern year?
No. As a PGY‑1, your TY residency salary is typically the same as other interns at your institution, regardless of whether you’re in a Transitional Year, preliminary year, or categorical program. The differences in physician salary by specialty emerge later—after you complete core residency (and any fellowship) and begin working as an attending.

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2. Are specialties that require a Transitional Year generally higher paying?
Many advanced specialties that commonly pair with a TY program—such as radiology, anesthesiology, dermatology, radiation oncology, and PM&R—do tend to fall into the middle to upper tiers of physician compensation. However, there’s variation within each field (academic vs private, geographic region, subspecialty). A TY doesn’t automatically guarantee a higher doctor salary—it just keeps the door open to several high‑earning specialties.

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3. Should I pick my specialty based mainly on which is the highest paid?
It’s rarely wise to base your choice on highest paid specialties alone. Salary matters—especially with significant educational debt—but so do:

• Your genuine interest in the work
• Tolerance for training length and workload
• Preferred lifestyle and schedule
• Burnout risk and job satisfaction
• Geographic and practice‑type flexibility

A balanced approach is to treat salary as a major factor, not the only factor. During your TY program, use your rotations to realistically assess both fit and financial trajectory.

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4. If I change my mind during my Transitional Year, can I still move into a lower‑ or higher‑paying field easily?
It depends on timing and available positions, but one of the advantages of a TY program is flexibility. Many TY residents successfully pivot—toward both higher‑paying and lower‑paying fields—based on what they discover during the year. The main constraints are:

• Match timelines and application cycles.
• Availability of categorical positions (e.g., internal medicine, family medicine, neurology).
• Your overall application strength (scores, letters, evaluations).

However, it’s much easier to make an informed switch during your Transitional Year, when you can still tailor electives and secure strong specialty‑specific letters.

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Bottom line: Your Transitional Year is the bridge between medical school and your long‑term career. Resident pay won’t differ by specialty during this year, but the choices you make—about which advanced specialty to pursue, how long you’re willing to train, and what lifestyle you want—will determine the physician salary, flexibility, and satisfaction you experience for decades. Use this year intentionally: study the doctor salary by specialty data, but just as importantly, pay attention to who you are when you’re actually doing the work.