Resident Doctor Salaries: How Much Do You Really Earn?

According to the 2023 Medscape Resident Salary and Debt Report, the average annual salary for a resident doctor was $67,400. At first glance, that might seem like a decent amount. However, when you break it down by hour, the reality is quite different. If a resident is working 80 hours a week, which is the maximum allowed by the Accreditation Council of Graduate Medical Education (ACGME), their hourly wage comes out to around $15 per hour. That’s less than what some fast-food workers make.

This is despite the fact that residents have already completed eight years of higher education. The pay disparity is stark when compared to other professions. For instance:

• Plumbers earn an average salary of around $60,000, with an hourly rate of approximately $29 per hour. Additionally, many make extra income in cash, potentially doubling or tripling their recorded earnings.

• HVAC technicians earn about $24 per hour.

• Electricians make around $60,000 per year, though, like plumbers, they often receive cash payments that don’t always reflect in reported income.

Of course, these professions are essential, and workers in these fields deserve fair pay. But it’s striking to see that those responsible for saving lives earn less per hour than those fixing utilities.

State-by-State Variations in Resident Salaries

Resident salaries vary across the United States. Some states pay more, while others pay less, and salary differences often correlate with the cost of living.

For example, according to Panacea Financial, first-year resident (PGY1) salaries in 2023 were:

• Alabama: $52,000

• Florida: $54,000

• New York: $61,000

• Texas: $51,000 (but with no state income tax, making take-home pay higher)

States with large metropolitan areas, such as California and New York, tend to offer higher salaries. A resident in San Francisco, for example, might earn around $70,000 per year, while a resident in the Midwest could be making closer to $55,000 per year. However, these higher salaries often come with a higher cost of living, meaning that real earnings may not be as advantageous as they seem.

Institutional Differences in Salary

Where you train also impacts how much you earn. Residents at prestigious institutions like the Mayo Clinic or Johns Hopkins often earn more than those at smaller community hospitals. These institutions have larger budgets and can afford to pay their residents more. However, the true value of training at a top-tier institution often lies in the career opportunities and professional connections it provides, rather than just the salary.

The Gender Pay Gap in Residency

There is a gender pay gap in residency, with female residents earning roughly 1% less than their male counterparts. While 1% might not seem like much, it accumulates over time, especially considering the massive student loan debt that many residents carry. This gap often widens as doctors move into their attending years.

One factor contributing to this disparity is that women tend to enter lower-paying specialties at higher rates than men. Additionally, studies suggest that female physicians may work fewer hours on average than male physicians due to various life circumstances. Nonetheless, the principle of equal pay for equal work remains critical in the medical field.

Union Representation and Resident Salaries

Resident unions are becoming more common. For example, residents at Cleveland Clinic have unionized, and unionized residents often negotiate for higher pay and better benefits. If you're considering residency programs, it may be worth looking into whether your prospective institution has a union and what that could mean for your compensation and working conditions.

Which Specialties Pay the Most?

Not all residency programs pay the same. Certain specialties offer higher salaries, both in residency and as an attending physician. According to MedEdits, the highest-paid residents include:

• Plastic Surgery: Among the highest-earning residents, with salaries continuing to increase as they progress.

• Radiology: Offers relatively high pay starting in PGY1.

• General Surgery: Pays less in residency but has strong earning potential as an attending.

• Family Medicine: Among the lowest-paid, averaging around $58,500 per year.

As residents advance through their training, their salaries also increase. For example:

• PGY1 (First Year): ~$61,000

• PGY2 (Second Year): ~$63,000

• PGY3 (Third Year): ~$65,000+

• Fellows (PGY4-7): Higher salaries, especially in subspecialties.

By the time residents reach fellowship years, they often have additional financial responsibilities, such as supporting a family, making salary progression an important consideration.

The Light at the End of the Tunnel: Attending Salaries

Once residency and fellowship training are complete, doctors see a significant increase in earnings. According to Doximity, attending physician salaries vary widely by specialty:

• Neurosurgery: $700,000+

• Cardiothoracic Surgery: $650,000+

• Orthopedics: $600,000+

• Cardiology: $500,000+

• Radiology, GI, Anesthesiology, Oncology: ~$400,000–500,000

• Emergency Medicine: ~$400,000

• Internal Medicine, Infectious Disease, Pediatrics: ~$300,000

Surgical specialties tend to pay significantly more than non-surgical specialties. Pediatric specialties often earn the least, likely due to lower reimbursement rates and less opportunity for multiple

billing codes per patient compared to adult medicine.

The Reality of Medical Training

While the earning potential for doctors is high, the road to financial security is long. Burnout is a real issue, and many residents leave the field before ever seeing the multiple six-figure paychecks of attending physicians. The combination of long hours, massive student debt, and relatively low pay during training can make residency one of the most financially challenging periods of a doctor’s career.

That being said, those who persevere through residency often find themselves in a financially rewarding position, with a salary that finally reflects their years of hard work and sacrifice.

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