Urology Residency Salary Insights: The Ultimate Physician Guide

Urology is consistently listed among the highest paid specialties in medicine—but what does that actually mean for someone planning their career, negotiating a contract, or entering the urology match? This guide breaks down physician salary by specialty with a focus on urology: where it stands, why it’s well compensated, how salaries vary, and what you can realistically expect at different stages of training and practice.

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Understanding Where Urology Fits in Physician Salary by Specialty

When applicants search for “doctor salary by specialty” or “highest paid specialties,” urology almost always appears near the top. To understand why, it helps to look at the broader compensation landscape.

How Urology Compares to Other Specialties

Public surveys and compensation reports (e.g., Medscape, MGMA, Doximity) consistently show urology as one of the highest paid specialties. While exact numbers shift year to year and depend on practice setting and region, a general relative hierarchy often looks like this:

• Top-tier / highest paid specialties

  • Neurosurgery
  • Orthopedic surgery
  • Interventional cardiology
  • Plastic surgery
  • Urology
  • Gastroenterology
  • Dermatology
  • Radiology
  • Anesthesiology

• Mid-to-high compensation specialties

  • General surgery
  • Emergency medicine
  • Cardiology (non-interventional)
  • Critical care
  • Oncology
  • Ob/Gyn
  • ENT

• Primary care and cognitive specialties (typically lower average pay)

  • Internal medicine
  • Family medicine
  • Pediatrics
  • Psychiatry
  • Neurology
  • Endocrinology
  • Rheumatology

While specific numbers vary, it’s common for urology to rank within the top 5–8 specialties in average total compensation. It is often ahead of many other surgical fields and most non-surgical specialties.

Why Urology Is So Well Compensated

Several drivers explain why the urology residency pipeline leads to one of the highest paid specialties:

1. Procedural intensity
   Urology is heavily procedural: cystoscopies, TURPs, ureteroscopies, robotic prostatectomies, nephrectomies, stone procedures, in-office procedures (vasectomies, biopsies), and more. Procedures usually reimburse better than purely cognitive visits.

2. Aging population and high demand
   Urologic conditions (BPH, prostate cancer, incontinence) are strongly age-related. As populations age, demand for urologists increases—outpacing the supply of new graduates.

3. Limited workforce
   Urology has relatively few residency spots compared to the overall demand for urologists. This supply–demand imbalance supports higher compensation.

4. Blend of outpatient and surgical revenue
   Urologists can derive income from clinic visits, surgeries, endoscopic procedures, minor in-office procedures, and ancillary services (e.g., imaging, sometimes infusion or advanced diagnostics depending on practice).

5. Call and procedural responsibility
   Urology call can be intense and often includes urgent issues—stones, urinary retention, trauma, post-op complications. Compensation reflects this responsibility and lifestyle burden.

6. Subspecialty opportunities
   Many urology fellowships (uro-oncology, endourology, female pelvic medicine, pediatrics, reconstructive urology, andrology) allow for niche practice models that can enhance earning potential.

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Urology Compensation Across Career Stages

To make salary data meaningful, it’s important to look at compensation in context: training level, practice setting, and geography.

1. Medical School and the Urology Match

The urology match is separate from the main NRMP match and is highly competitive. At this stage, you’re not earning a urology-specific salary yet, but the future earning potential of urology is one reason it’s so attractive.

Key points during this phase:

• No salary yet as an attending, but you should:
  • Understand the long-term earning trajectory versus other specialties you’re considering.
  • Factor in the length and intensity of training (urology residency is typically 5–6 years).
  • Consider the trade‑off between competitive entry and eventual compensation.

This is the time to learn the language of compensation—RVUs, base salary, bonuses, call pay—so you’re prepared for negotiations later.

2. Urology Residency Salary

During urology residency, pay is similar to other surgical residencies at the same institution. Compensation is typically determined by PGY level, not specialty.

Typical ranges (approximate, pre-tax, in USD, varying by region and institution):

• PGY-1 (Intern): ~$60,000–$70,000
• PGY-2 to PGY-3: ~$63,000–$75,000
• PGY-4 to PGY-6: ~$67,000–$80,000

Additional income streams may include:

• Moonlighting (where allowed): Inpatient shifts, ED consult coverage, or affiliated clinics can add several thousand to tens of thousands per year for senior residents.
• Call stipends: Some programs provide supplemental pay for extra call coverage.
• Academic stipends: Small bonuses for chief residents, research tracks, or administrative duties.

Even though this is nowhere near an attending physician salary, residency is the time to:

• Build procedural skill and efficiency (which later links to RVU productivity).
• Observe attendings’ practice models and income streams.
• Learn billing and documentation practices early.

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3. Fellowship Training in Urology

Many urologists pursue fellowship in:

• Urologic oncology
• Endourology/stone disease
• Pediatric urology
• Female pelvic medicine and reconstructive surgery (FPMRS)
• Andrology/infertility
• Reconstruction and trauma

Fellowship salary is similar to senior residency pay or slightly higher—usually in the $70,000–$90,000 range, depending on the institution and whether the fellow has independent practice responsibilities.

From a long-term doctor salary by specialty perspective:

• Some fellowships may increase earning potential (e.g., uro-oncology with complex robotic surgery in a high-demand region).
• Others may be more lifestyle or interest-driven, with variable impact on income (e.g., some academic pediatric urology positions).

Your primary financial decision is weighing an extra 1–2 years of trainee-level salary against potential future income, practice focus, and job satisfaction.

4. Early Attending Urologist Salary

First-year attending urology salaries vary significantly based on:

• Practice type (private practice, hospital-employed, academic)
• Geographic region (coastal urban vs. Midwest vs. rural)
• Call responsibilities and schedule
• Negotiation and contract terms

Rough early-career figures (again approximate and variable):

• Academic urology (assistant professor)

  • Base salary: ~$250,000–$375,000
  • Total comp (with incentives): ~$275,000–$425,000
  • Benefits may be strong (retirement contributions, loan repayment, protected research time), but clinical pay can be lower than private settings.

• Hospital-employed urology

  • Guaranteed base: ~$350,000–$500,000 for new grads
  • Bonuses for productivity or quality metrics can push total comp toward ~$400,000–$600,000 in high-demand markets.

• Private practice (single or multi-specialty group)

  • Starting guarantees: often ~$350,000–$500,000 with a path to partnership.
  • Once partnership is reached (typically 2–5 years), income can rise substantially, sometimes into the upper six figures or beyond, depending on ancillary income and practice volume.

For new attendings, urology often enters the range typical of highest paid specialties, especially after the early ramp-up years.

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Factors That Influence Urology Physician Salary

Your individual urology salary won’t just be “the urology average.” It will depend on multiple interacting variables.

1. Practice Type and Ownership

Academic Medicine

• Pros:
  • Intellectual environment, research, teaching.
  • Often more predictable daytime schedule.
  • Strong benefits, retirement, and job security.
• Cons:
  • Generally lower clinical income compared to private practice.
  • Compensation often structured around rank and institutional scales.
• Best for:
  • Those prioritizing research, education, niche subspecialization, or complex tertiary/quaternary care.

Hospital-Employed / Health System

• Pros:
  • Stable base salary with RVU or quality bonuses.
  • Less administrative burden; hospital handles billing, staffing.
  • Good for new grads seeking security and support.
• Cons:
  • Less control over schedule, staffing, and strategic decisions.
  • Potential RVU pressure to maintain high productivity.
• Best for:
  • Physicians seeking balance of income and job stability without entrepreneurial risk.

Private Practice

• Pros:
  • Highest upside for total compensation, especially in partnership.
  • More autonomy over clinical practice, ancillary services, and staffing.
  • Opportunity to build equity in the practice.
• Cons:
  • Business risk, overhead, and administrative responsibilities.
  • Income variability early on; partnership terms can be complex.
• Best for:
  • Those comfortable with a business mindset and seeking top-tier earning potential.

Employment Model and Salary Mechanics

Common mechanisms that affect income:

• Base salary plus RVU bonus (hospital systems, some academics).
• Collections-based compensation (private practice, especially post-partnership).
• Profit-sharing or equity distributions (groups with imaging centers, surgery centers, labs, etc.).

Understanding how you are paid—not just how much—is crucial.

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2. Geographic Variation

Geography is one of the most powerful variables in physician salary by specialty, especially for urology:

• Rural and underserved areas

  • Often significantly higher salaries or signing bonuses.
  • Loan repayment programs and generous relocation packages.
  • Less competition; high patient volume quickly.

• Suburban and mid-sized cities

  • Strong balance of income and lifestyle.
  • Solid demand with reasonable cost of living.

• Large coastal or “desirable” urban centers

  • Often lower base salaries relative to national averages.
  • Compensated by lifestyle amenities, academic prestige, or family considerations.
  • Higher cost of living can eat into real take-home pay.

When evaluating offers, consider cost of living adjusted income, not just the headline number. A $450,000 salary in a low-cost Midwest city may stretch further than $550,000 in a high-cost coastal market.

3. Subspecialization Within Urology

Different subspecialties can have distinct earning patterns:

• Endourology/stone disease

  • High procedural volume; strong revenue from stones and minimally invasive procedures.
  • Often in community or hospital-based practices.
  • Typically in line with or above general urology income.

• Urologic oncology

  • Complex robotic surgeries and oncologic procedures.
  • Academic settings may pay less per RVU, but demand is strong.
  • Highly variable depending on academic vs. community practice.

• Pediatric urology

  • Often academic or children’s hospital-based.
  • Compensation may be lower than adult urology, offset by unique practice satisfaction and schedule differences.

• Female pelvic medicine & reconstructive surgery (FPMRS)

  • Mix of clinic, reconstructive surgery, and pelvic floor procedures.
  • Income often tied to procedure mix and payer base.

• Andrology/infertility

  • May involve a mix of cash-based services, fertility center affiliations, and elective procedures.
  • High upside in some markets; more niche in others.

Subspecialization can increase your marketability and negotiate leverage, even if the subspecialty’s average income is similar to general urology.

4. Workload, Call, and Productivity

Your work hours, call burden, and clinical efficiency directly influence income:

• More clinic and OR time → higher RVUs or collections.
• Heavier call schedules → more consults and procedures (and sometimes explicit call pay).
• Efficient documentation and coding → more accurate billing and less revenue loss.
• Use of advanced practice providers (APPs) → can expand clinic capacity and OR efficiency.

Two urologists in the same city and practice type can earn very different incomes depending on:

• How many days per week they operate.
• Whether they perform high-RVU procedures (major cases, robotics).
• Their comfort with long or frequent call commitments.

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How Urology Compares to Other High-Earning Specialties

For someone deciding between high-earning fields, it’s useful to compare urology to other highest paid specialties along more than just income.

Urology vs. Orthopedic Surgery

• Both are typically in the top tier for doctor salary by specialty.
• Orthopedics may have slightly higher average income, especially in private practice.
• Urology:
  • Smaller, more intimate field; easier to “know everyone” nationally.
  • Mix of open, endoscopic, and robotic surgery.
  • More chronic disease management and long-term patient relationships.
• Orthopedics:
  • Larger volume of trauma and sports injuries; frequent musculoskeletal surgeries.
  • Physical demands in the OR (e.g., joint replacements) can be substantial.

Urology vs. Interventional Cardiology

• Both procedural and high-income.
• Interventional cardiology often requires lengthy, intense call with STEMIs, emergencies, and night procedures.
• Urology emergencies (stones, obstruction, trauma) are significant but may have more variability in call structure.

Urology vs. Radiology / Anesthesiology

• Radiology and anesthesiology can also be high-earning, but the nature of work differs:
  • Less direct clinic-based patient continuity.
  • Different malpractice profiles and call structures.
• Urology offers:
  • Direct patient relationships.
  • Mixture of clinic and OR.
  • Hands-on management of acute and chronic problems.

Urology vs. Dermatology

• Dermatology is among the highest paid specialties, particularly with cosmetic practice.
• Lifestyle and schedule in dermatology can be very favorable.
• Urology is more surgically intensive, hospital-based, and call-heavy, but also has robust earning potential without needing a purely cosmetic or cash-pay model.

When choosing between highest paid specialties, consider:

• Your tolerance for call and acute emergencies.
• Desire for surgery vs. clinic.
• Interest in long-term relationships vs. episodic care.
• Comfort with urine, catheters, and genitourinary anatomy—urology has its own unique culture.

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Practical Advice: Maximizing Your Future Urology Income (Without Sacrificing Your Life)

Even as a student or resident targeting the urology match, you can take steps to position yourself for a healthy financial future.

1. Start Financial Education Early

• Learn basic concepts:
  • W‑2 vs. 1099.
  • RVUs, collections, payer mix.
  • 401(k)/403(b), Roth IRA, backdoor Roth, HSA.
• Understand the impact of student loans and strategies for repayment (standard, IDR plans, PSLF, private refinancing).

2. During Residency and Fellowship

• Observe attendings:
  • Who seems burned out vs. balanced?
  • Who is in academic vs. private vs. hospital-employed models?
  • How do their lifestyles differ?
• Ask about:
  • How they negotiated their first contract.
  • What they wish they’d known about physician salary or practice models.
• Consider moonlighting if allowed and sustainable—extra earnings can reduce high-interest debt and build an emergency fund.

3. When Evaluating Job Offers

Look beyond the headline salary:

• Base salary and duration of guarantee (1 year vs. 3+ years).
• Bonus structure:
  • RVU thresholds and payout rates.
  • Quality or patient satisfaction metrics.
• Call burden:
  • How often? In-house vs. beeper? Post-call days off?
  • Is there additional compensation for extra call or covering partners?
• Partnership track:
  • Timeline, buy-in cost, and what you’re actually buying (building, ancillaries, goodwill).
• Benefits:
  • Retirement matching, health insurance, CME funds, malpractice coverage (occurrence vs. claims-made, tail coverage).
  • Loan repayment or signing bonus.

It’s wise to use a healthcare attorney or contract review service for any major contract, particularly in private practice or complex hospital systems.

4. Balancing Income and Burnout Risk

Short-term, you can dramatically increase revenue by:

• Taking more call.
• Working more weekends.
• Compressing your schedule.

Long-term, though, this can lead to burnout, strained relationships, and health issues. A sustainable approach:

• Aim for efficient, not excessive, productivity.
• Delegate appropriately to APPs and staff to focus on higher-level tasks.
• Set boundaries early (clinic templates, OR block time, protected off days).

The goal is to leverage the strong earning potential of urology to build financial security and freedom, not to maximize short-term income at any cost.

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FAQs: Urology Salary and Career Planning

1. Is urology really one of the highest paid specialties?

Yes. Across multiple national surveys, urology consistently ranks among the highest paid specialties, often in the top 5–8 for average compensation. While neurosurgery, orthopedics, and some cardiology subspecialties may edge it out on average, urology typically out-earns most other surgical and medical specialties, especially after partnership or in high-demand regions.

2. How much does a new urologist typically earn?

Newly graduated urologists often see:

• Academic starting salaries: roughly $250,000–$375,000 base, with potential bonuses.
• Hospital-employed positions: around $350,000–$500,000 guaranteed for the first 1–3 years, plus incentives.
• Private practice guarantees: similar or slightly higher, with a path to partnership where income may significantly increase.

Exact figures will depend heavily on location, call burden, and contract structure.

3. Does fellowship training increase or decrease urology salary?

It depends on the fellowship and practice setting:

• Some subspecialties (e.g., uro-oncology, endourology) may lead to equal or higher income due to complex, high-RVU procedures and strong demand.
• Others (e.g., pediatric urology, some academic-focused tracks) may carry lower average salaries compared to high-volume general urology in private practice.
• Fellowship is often more about practice fit, interest, and lifestyle than guaranteed higher income.

4. Is urology a good choice if I care about both income and lifestyle?

For many physicians, yes. Urology offers:

• High earning potential—clearly among the strongest in physician salary by specialty.
• A blend of clinic, OR, and procedures.
• Variability in call and hours, allowing you to choose roles that match your lifestyle priorities (academic vs. community vs. private practice vs. rural vs. urban).

However, it is still a surgical specialty with real call responsibilities and physically and emotionally demanding work. The best outcomes usually come when you choose urology because you’re genuinely interested in the field—and then strategically structure your career to leverage its strong income potential in a sustainable way.

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Understanding where urology sits in the broader doctor salary by specialty landscape can help you make informed decisions—from the urology residency and match process to choosing your first job and beyond. With thoughtful planning, urology offers not only a fascinating and impactful clinical career, but also a financial trajectory that can support long-term security, flexibility, and satisfaction.