How much do residents make? Given the staggering cost of medical school it’s quite understandable for both DO and MD students to wonder how much residents make. Whether you are considering the most competitive or the least competitive residencies, we are here to help you learn how much residents make and why their pay is structured the way it is.
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Do You Get Paid During Residency?
Acceptance into a Graduate Medical Education (GME) program is a prestigious achievement in the career of a young doctor. The thrill of specialization is now a reality, and you now get to focus almost all of your time and energy on developing your skills as a medical practitioner. But medical school, whether a standard MD program or a combined MD PhD program, likely brought with it the most rapid development of debt you’ve ever experienced. Furthermore, you were almost assuredly unable to maintain even a part-time job as an MD or DO student, and so have been wholly dependent on loans, medical school scholarships, and institutional funding for most of the last 4 or so years. The possibility of having a wage of any kind is likely so alluring that it feels like a dream. And so, as you being your ERAS or CaRMS applications, you’re assuredly wondering: will I get paid as a resident?
The immediate answer, fortunately, is yes. Think of residency in terms of other forms of graduate education: students in academic PhD programs almost never get admitted without some sort of offer of funding, whether it be teaching, research assistantships, or just plain old grants. There are many reasons for this, but the biggest is that high-level education like a PhD or medical residency is truly elite—statistically very few people pursue this work, and in so doing, they contribute significantly to the institution training them. This is especially true of medical residents, who often staff clinics, teach, and most of all, perform rotations in hospitals. Residents are undergoing graduate education, but they are in many senses no longer students, but trainee physicians. As such, they are, rightly, paid for the broad spectrum of services they provide to the institutions and people around them.
However, unlike most other occupations and paid graduate positions, pay structures for medical residents aren’t negotiated on a person-by-person basis, nor do they vary all that much by their chosen medical specialty)—although there is some variation here. Rather, how much residents make is largely determined by two factors: institution and seniority. To understand how these two dimensions of residency shape salaries, let’s start digging into the specifics of residency pay structures.
Are you wondering how doctors get paid? Check out our video about the highest paid doctors in the US and Canada:
Residency Pay Structures
It’s important to note right off the bat that residency pay structures differ between the US and Canada. While both countries have pay structures that increase salary for each year in residency, the general difference is that US resident pay varies by individual institution, whereas Canadian resident pay differs based on the province in which one works.
Without getting too far into the weeds, it’s worth noting that part of this difference lies in the type of healthcare system each country utilizes. The US uses a private, for-profit system in which many aspects of cost are determined by hospitals and institutions, and Canada utilizes a network of provincially-administered systems, similar—but not identical—to what is often called a single-payer structure. As such, it makes sense that there’s a more highly regulated and top-down residency pay structure in the country that utilizes greater governmental power to organize its healthcare, and vice versa. It’s also one of the reasons why practicing physicians in the US are among the highest paid doctors in the world.
Let’s turn our sights away from the political economy of health care generally, and back to the nitty-gritty of resident pay.
Check out how much residents make on average:
How Much Do Residents Make in the US?
There are two main sources for resident pay information in the US. One is the AMA’s FREIDA database, which includes average first-year compensation numbers in a wide array of specialties. An important caveat though is that FREIDA also includes fellowships in their overall list, and so the information can be deceiving. For instance, looking at abdominal radiology, FREIDA lists the average first-year salary as $72,038.27, which would indeed be incredibly high for someone in their first post-graduate year (PGY1). However, abdominal radiology is trained in subspecialty fellowships after an initial residency in general radiology, and so this number is in fact reflective of a PGY4 or PGY5 wage.
The other main source for residency compensation is Medscape’s annual Residents Salary & Debt Report, which includes greater contextual information like breakdowns by years beyond PGY1, gender, and, of course, medical school debt. Medscape’s sample size is ostensibly smaller than that of FREIDA, however—the most recent survey counted 1600 respondents in approximately 30 specialties, so these numbers will somewhat vary, as mentioned, by institution. Additionally, some of Medscape’s calculations like overall compensation averages are, like FREIDA, inclusive of fellowship programs as well, so when considering the higher end of these averages it’s important to remember that they’re not pay rates for people fresh out of medical school, but rather doctors in a later PGY.
The Medscape survey also includes survey data on resident satisfaction with their pay, and average hours/shifts worked. We’ll discuss some of this information in a moment, but much of this is more granular than we need to address here. Nonetheless, to get a more detailed picture of your would-be residency we greatly recommend carefully reading each section of the Medscape survey, and then contemplating if the logistical aspects of your plans suit your larger desires and needs.
Average Resident Pay in the US
To begin, there’s very little variation in PGY1 for most residencies in the US—pay ranges from around $57,000 to $62,000. Overall averages are then inclusive of a range of years and programs, and so it’s important to understand that average compensation for family medicine, which is short and ranks somewhat low on the list, is calculated from PGY1-3 numbers only. In contrast, hematology’s average compensation is ultimately an average of PGY4-5, so would necessarily be higher for that reason alone.
With this context in mind, let’s look at Medscape’s numbers on average salary ranges by specialty:
Important to contextualize this first list is that of average salary by residency year:
Overall Average - $63,400
PGY1 - $57,100
PGY2 - $58,800
PGY3 - $61,000
PGY4 - $64,500
PGY5 - $66,800
PGY6-8 - $68,500
There are a few points to make just from this information. The first is to identify a kind of hierarchy. Residency programs available to recent MD or DO graduates don’t appear on this specialty average list until the $64,600 category, with the notable exception of pathology. This connects to our point above that overall averages like this must be followed by identifying the type of program—i.e., whether it’s a true PGY1+ program or a fellowship or combined program. For the most part, the former category begins at the $64,600 level, and the latter is represented by the top 4 categories.
The second point is that so-called “early match” specialties—neurology, neurosurgery, ophthalmology, and urology—have higher average compensation than those of normal match residencies. There are a few reasons for this, but the most relevant point is that each of these residency programs are typically quite long. Neurosurgery, for instance, ranks among the longest residency program types, ranging from 6 to nearly 10 years in some cases. And so, the compensation average of a program that includes a PGY5, 6 or even 8 and onward, will necessarily be higher than that of, say, family medicine’s 3 year data set.
US Resident Pay – Other Dimensions
The Medscape survey provides some other relevant information for MD and DO students preparing for residency interview.
One is that the pay gap between men and women is far smaller in residency—about $700—than it is among practicing primary care physicians—a jaw-dropping 25%. A $700 average is beyond the margin of error, but it is at least somewhat more egalitarian than the post-residency landscape.
Another point worth mentioning is that resident satisfaction with compensation is greatest in PGY1, which Medscape’s survey has at around 49%. This drops off significantly in PGY2 and PGY3, whose respondent satisfaction average was around 37% and 43% respectively. It’s hard to pull much insight from this, but it’s interesting to consider in relation to our earlier point about the relief many PGY1 residents feel following admission to a paid residency program. That first year of no longer going further into debt, and getting to practice and training for your specific desired specialty, may be the happiest you feel for a while before the incredibly demanding schedule of residency really kicks in through the latter years of your program.
The majority of residents in the US also receive added benefits like health insurance, paid time off, and dental insurance among other perks. Due to the nature of the US healthcare system and medical union activity, these perks vary quite widely by institution, but they are common to at least three quarters of residency programs.
Lastly, it’s worth mentioning that there are quite a few options for non-salary compensation in US residency programs, like on-call assistant shifts, moonlighting, and hospital coverage shifts. Given the volume of mandated work in residency programs these one-off or occasional opportunities won’t make too much of a difference in one’s overall annual income, but they can help offset any surprise expenses you may encounter during residency.
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How Much Do Residents Make in Canada?
If the above discussion of how much residents make in the US felt confusing, we’ve got great news for you: things are a lot more straightforward in Canada. Resident compensation is typically negotiated between residency associations or unions and the provinces. As such, average resident compensation is easy to chart and understand. Our numbers come from CaRMS.
Average Resident Pay in Canada
While these pay structures are typically reported by province, it may be more illuminating and easier to compare if we examine each year of residency and fellowship across provinces. All numbers refer to gross annual salary guidelines:
Patterns here are fairly obvious. On average, residents in Nova Scotia/NB/PEI are the highest paid, while residents in Quebec are the lowest-compensated. Additionally, the increase from year to year is about the same in each province—about $5000.
Canadian Resident Pay – Other Dimensions
In addition to annual salary, resident associations also negotiate the amount or scale of other benefits like vacation time, call stipends, conference leave, educational leave, and parental leave. Additionally, resident associations and unions will negotiate for a greater array of benefits. Some agreements include meal allowances, dental coverage, and even wedding leave. The point is that each province offers a slightly different residency experience that isn’t totally captured by its gross annual salary numbers. If you’re looking to apply to residency programs in Canada, we greatly recommend examining the full chart on CaRMS’ website to understand the way these additional benefits affect your quality of life during residency.
Going back to the Medscape survey again, it’s worth noting a couple non-monetary measurements of resident life. The first is that of the 1600 respondents surveyed the vast majority—77%—reported being satisfied with their learning experience. Furthermore, 88% reported having good-to-very-good relationships with their attending physicians, and 82% reporting the same with the nurses and PAs they work with. Overall, residents are quite happy with their programs, and while compensation may vary somewhat the experience and structure of these programs continues to be enlightening and transformative for each successive cohort.
You’ll have plenty of time and the means to pay off your medical school debt after finishing residency, so as long as you can afford the basics during this time, you should try to enjoy it as a once-in-a-lifetime experience and not mere wage labor. Plus, as nice as it is to make the jump from growing debt to moderate pay, the next jump up to physician salary—often 4 or 5 times what you’ve earned as a resident—will feel like winning the lottery.
1. What are the highest paid residencies in the US?
Allergy & immunology, hematology, medical geneticists, rheumatology, and most forms of specialized surgery top the list. However, it’s important to remember that these are subspecialty residencies, aka fellowships, and so are effectively PGY4+ residencies.
2. Do residents make more in the US or Canada?
This is somewhat hard to answer, but on average residents in both countries enjoy about the same initial pay, with similar yearly increases. There are two very important distinctions though. The first is that the average medical school debt for Canadian graduates is around $100k, while in the US this amount is more than double—$215,900! Residents aren’t paying off their debt until after residency in either country, but it’s important to factor in the truly cosmic levels of student debt involved when talking about salaries in medicine.
The other factor is that residency compensation agreements in Canada are usually much more comprehensive, including dental care, more time off, and more, whereas in the US these added benefits are inconsistent from program to program at best. So: you may make slightly more money in some US residency programs, but odds are the supplementary benefits in Canadian programs will be far greater.
3. What are the highest paid doctors?
Specialized surgery disciplines are always among the highest-paid doctors, with recent numbers singling out orthopedic and plastic surgeons as the highest earners in medicine—$511k and $479k average salary, respectively. If you’re concerned about making $60k during residency in either of these specialties don’t worry, you’ll be able to afford a down payment on a house quite quickly after you become a fully independent physician.
4. Is there a link between residency competitiveness and pay?
Yes! There is to some extent, though as we’ve explained above these variations aren’t especially large in the grand scheme of things. Plastic surgery and neurosurgery, for instance, are among the most competitive programs year after year, and also top the list of average resident salaries above. There are exceptions to this though. Dermatology, for instance, is extremely competitive, and sits right around average in resident pay. The important factor to consider is when these programs occur in a medical career though. Average salary for the aforementioned specialized surgery disciplines includes advanced periods like PGY5 and 6, whereas dermatology is an early match specialty open to recent MD or DO graduates—and so inclusive of lower-pay years like PGY1 and 2. Averages, as ever, need context for full understanding.
5. Are there other opportunities for compensation during residency?
Yes, although these vary by institution and can be hard to manage during the busy years of residency. Additional call shifts, assistantships, moonlighting at clinics, and grant-backed research positions are all common for residents to pursue, and while their compensation levels vary they can definitely help.
6. Why do family medicine residents get paid so little?
This is a bit of mathematical sleight-of-hand—they don’t, really. The average for Family Medicine is smaller than most other types of residency because these programs are shorter, and so the average is inclusive of data only up to PGY3 or 4, whereas the higher averages usually correlate to longer programs.
7. Will I go back to a PGY1 salary if I switch residencies?
In many cases yes, unfortunately. Especially in Canada, a first-year resident is a first-year resident, no matter what the specialty. In the US, this is more complicated, but if you switch from one normal match residency to another one—say, from internal medicine to family medicine—you’ll likely experience a slight pay cut or “reset.” The big exception to this is when moving from a generalized residency like the aforementioned two specialties to a more specialized one. For instance, a resident who has completed a 2-year general training residency in internal medicine will not go back to a PGY1 salary if they move into a hematology program.
8. How much more do fellows make than residents?
The answer to this connects to the previous question—think of fellowships not as standalone programs, but as residency programs that begin at PGY4+. As such, the pay for a subspecialty fellowship is at least what a later PGY residency salary would be, and is often quite a lot more. The national average salary for a Hematology-Oncology fellow is around $133k per year, which is more than double what an average Internal Medicine resident makes. Harder work requiring more training = more money. In many cases it’s as simple as that.
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