As a medical student, I couldn’t wait for my first real paycheck. School was so long that I wasn’t sure when it would come. I learned that I would get paid in residency, but when and how much?
Physicians do get paid throughout residency training. In 2020, the average starting salary for resident physicians in the USA was $63,400, according to the 2020 Medscape Residents Salary and Debt Report. Salaries increase every year as residents progress from post graduate year 1 to post graduate year 2 and beyond.
There’s a lot more to know about residency salaries. The average is $63,400, but does every resident physician make that much? Do salaries vary by specialty or by location? And who actually determines these salaries, anyway?
How Much Doctors Get Paid In Residency
When I was a resident, I was so excited for my first paycheck. After four years in medical school making no money and having to borrow massive amount of student loan debt to survive, that residency paycheck was special. With a paycheck in hand, I could finally say that I was an actual professional doctor!
But then I heard about friends in other specialities, in other areas of the country and saw that our paychecks were different. So I looked up the average resident salary for that year and saw I was being paid less. Not much less, but it was different. Why was that?
As it turns out, resident salaries don’t only vary based on PGY year, but also by location. As you progress through residency from your first year to your second year and beyond, you’ll get a small bump in your salary. Usually around $2000 to $3000 per year.
How much exactly depends on a few things that are determined by your specific training hospital. Did they generate more funding or revenue this year? Are they located in a higher cost of living area? Or are there other reasons to give a higher salary this year?
To better understand how PGY year can affect residency salaries, here is a list of average salaries by residency year, according to the Medscape survey.
| Residency Post Graduate Year | Salary |
| PGY-1 | $57,100 |
| PGY-2 | $58,800 |
| PGY-3 | $61,000 |
| PGY-4 | $64,500 |
| PGY-5 | $66,800 |
As you can see, every year resident physicians get a small pay bump. While the raise each year isn’t very big compared to the bump in salary you’ll get when you become an attending physician, it can feel significant when you’re a resident. That’s an extra $2000-$3000 you can put toward living expenses, student loans, or even to fund a ROTH IRA.
Aside from PGY year, the other major factor that determines residency salaries is location. The Medscape survey doesn’t break down its data by region, but thankfully the AAMC also collects residency salary data and they do.
Here is resident salary average for PGY-1 year by region according to the AAMC Survey of Resident/Fellow Stipends and Benefits is:
| Region | PGY-1 Salary Average |
| Northeast | $63,565 |
| West | $60,596 |
| Midwest | $58,026 |
| South | $55,862 |
So you might make a whole $8000 more by going to residency in the northeast instead of the south. Well, sort of. Salaries do vary by region, but they also change significantly within a region. To prove this, I pulled salaries from 18 different residency programs across the country. Salaries within a region were as low as $47,500 to as high as $66,500.
While it’s interesting to see general differences in salary trends by region, the reality is that neither regions nor specific states decide residency salaries. Individual programs do. If you want to find the specific salary data for a residency program you’re interested in, you’ll have to go to their website. It’s easy, though. All you need to do is search for that residency program followed by “PGY salary” on google and you’ll find the information.
Medical Resident Salary By Specialty
Because physician salaries can vary so widely by specialty, you might also think that residency salaries do the same. It is true that some specialties do get paid more than others, but this difference is typically based on internal moonlighting agreements that some specialties may have with their programs. Otherwise, it’s a pretty standard number based on PGY year regardless of specialty.
Interestingly, the Medscape report does provide data on differences in resident salary by specialty, with numbers ranging from $58,500 to $69,500. However, it’s important to realize that this data includes survey results from fellows, residents in longer residencies, and residents in shorter residencies. It doesn’t separate out average salaries by specialty by PGY year. So even though it suggests differences in salaries by specialty, it’s not a very reliable data source for that answer.
If you’re thinking about choosing a specialty based on how much more money you think you’ll make in residency, I’d ask you to reconsider. First, the difference in residency pay between specialties is essentially zero aside from a few moderate differences for specific programs. And secondly, residency salary just doesn’t have a huge impact on uour career, so it’s not a great tool for specialty choice.
There are a number of other, vastly more important reasons to decide which specialty is the right one for you. A topic we’ll get into in more detail in another article.
Why Is Residency Salary So Low
One thing most residents physicians will realize is that despite getting paid to train unlike medical school, resident pay is very low. It’s especially low, about $12/hr, when accounting for 60-80 hour work weeks during training. But residents are an essential member of the medical teams at training facilities. And they provide some of the best care in those facilities. So why is their pay so low?
There are two main drivers of resident salaries. The first is medicare. The second is the teaching hospital.
In 1965, medicare was established. Through the congressional hearings that established medicare, they decided to provide funding for residency positions throughout the country. More specifically, they said this:
“Educational activities enhance the quality of care in an institution, and it is intended, until the community undertakes to bear such education costs in some other way, that a part of the net cost of such activities (including stipends of trainees, as well as compensation of teachers and other costs) should be borne to an appropriate extent by the hospital insurance program.”
(House Report, Number 213, 89th Congress, 1st session 32 (1965) and Senate Report, Number 404, Pt. 1 89th Congress 1 Session 36 (1965))
When medicare was signed into law, it provided about $10 billion for medical training, with approximately $5 billion set aside for resident salaries. Not too shabby, especially considering how little resident physicians got paid before medicare.
However, a few more things happened. In 1997, through the Balanced Budget Act, congress put a cap on the number of residents it was willing to fund through medicare. Then, in 1999, with the Balanced Budget Refinement act, they set limits to the per-resident amount of funding and eliminated inflation adjustment for some facilities through 2013.
Without getting too much further into the weeds of legislation, the bottom line is this. Graduate medical education (GME) is primarily funded through medicare. Congress determines the per resident amount of GME funding which does change over time, but has not kept pace with inflation. As of 2017, the per resident amount for primary care was $102,875 and for other residents was $100,956.
Now, residents do get some funding from their individual hospitals, whether through non-medicare patient revenue, fundraising and donations, or other sources. But not all of this goes into resident salaries. In the end, the hospitals are the ones who collect money from medicare and other sources, and they’re the ones who determine resident salaries.
Without significant changes to medicare that would increase funding for resident physicians or major new sources of revenue for training hospitals, it not likely for residents to make significantly higher salaries any time soon.
However, it’s not all bad. Average resident salaries have increased from $55,400 in 2015 to it’s current average of $63,400 in 2020. While nowhere near what other members of the healthcare team with similar levels of training make, it’s still moving in the right direction.
How Long Is Residency For Doctors
I’ll leave you with this. Because resident salaries are closely associated with post-graduate training year, I think it’s important to know how long training can be for the different specialties. You can find a list of residency specialties by training length here:
| Specialty | Length of Training |
| Neurosurgery | 7 years |
| Plastic Surgery | 6 years |
| Orthopedic Surgery | 5 years |
| General Surgery | 5 years |
| Otolaryngology | 5 years |
| ENT | 5 years |
| Radiation Oncology | 4 years plus PGY-1 transition year |
| Diagnostic Radiology | 4 years plus PGY-1 transition year |
| Obstetrics/Gynecology | 4 years |
| Pathology | 4 years |
| Psyschiatry | 4 years |
| Emergency Medicine | 3-4 years |
| Physical Medicine | 3-4 years |
| Anesthesiology | 3 years plus PGY-1 transition year |
| Dermatology | 3 years plus PGY-1 transition year |
| Neurology | 3 years plus PGY-1 transition year |
| Ophthalmology | 3 years plus PGY-1 transition year |
| Internal Medicine | 3 years |
| Family Medicine | 3 years |
| Pediatrics | 3 years |
