Updated January 2026 — Comprehensive guide to medical residency salaries across all specialties, including PGY-level pay scales, highest and lowest-paid programs, and how resident compensation compares to hours worked.
Key Takeaways
- Average residency salary in 2026: $64,000 - $78,000 per year
- Salary increases ~$3,000-$5,000 per PGY year
- Highest-paid residencies: Neurosurgery, Orthopedic Surgery ($70,000+)
- Lowest-paid residencies: Family Medicine, Pediatrics (~$60,000)
- Real hourly rate: $16-$22/hour when accounting for 60-80 hour weeks
- Salary differences between specialties are small during residency—the big differences come after
How Much Do Medical Residents Make in 2026?
The average medical resident salary in 2026 ranges from $64,000 to $78,000 per year, depending on specialty, geographic location, PGY level, and hospital system. This represents a steady increase from $63,400 in 2020, though when adjusted for inflation, residents have actually lost purchasing power over the past decade.
Resident salaries are largely standardized because most residency programs receive funding through Medicare's Graduate Medical Education (GME) program. This means a PGY-1 in family medicine often earns similarly to a PGY-1 in neurosurgery—the major pay differences between specialties come after residency completion.
Residency Salary by PGY Year (2026)
Resident pay follows a predictable step-wise increase each year of training:
| Training Year | Average Annual Salary | Monthly Take-Home (Est.) |
|---|---|---|
| PGY-1 (Intern Year) | $60,000 - $65,000 | $3,800 - $4,100 |
| PGY-2 | $63,000 - $68,000 | $4,000 - $4,300 |
| PGY-3 | $66,000 - $71,000 | $4,200 - $4,500 |
| PGY-4 | $69,000 - $74,000 | $4,400 - $4,700 |
| PGY-5 | $72,000 - $77,000 | $4,600 - $4,900 |
| PGY-6 | $75,000 - $80,000 | $4,800 - $5,100 |
| PGY-7+ (Fellowship) | $78,000 - $85,000 | $5,000 - $5,400 |
Note: Monthly take-home estimates assume standard tax withholdings and do not account for state income tax variations, retirement contributions, or health insurance deductions.
Residency Salary by Specialty (2026)
While resident salaries are relatively uniform compared to attending physician salaries, there are meaningful differences between specialties—particularly for longer training programs where residents reach higher PGY levels.
Surgical Specialties
| Specialty | Training Length | PGY-1 Salary | Final Year Salary |
|---|---|---|---|
| Neurosurgery | 7 years | $62,000 | $82,000 |
| Orthopedic Surgery | 5 years | $63,000 | $77,000 |
| Cardiothoracic Surgery | 6-7 years | $62,000 | $80,000 |
| Plastic Surgery | 6 years | $62,000 | $78,000 |
| Vascular Surgery | 5-7 years | $62,000 | $78,000 |
| General Surgery | 5 years | $61,000 | $75,000 |
| Urology | 5-6 years | $61,000 | $76,000 |
| ENT (Otolaryngology) | 5 years | $61,000 | $75,000 |
Medical Specialties
| Specialty | Training Length | PGY-1 Salary | Final Year Salary |
|---|---|---|---|
| Interventional Cardiology | 6-7 years | $61,000 | $79,000 |
| Gastroenterology | 6 years | $61,000 | $77,000 |
| Pulmonology/Critical Care | 6 years | $61,000 | $77,000 |
| Hematology/Oncology | 6 years | $61,000 | $77,000 |
| Rheumatology | 5 years | $61,000 | $74,000 |
| Nephrology | 5 years | $61,000 | $74,000 |
| Endocrinology | 5 years | $61,000 | $74,000 |
| Infectious Disease | 5 years | $61,000 | $74,000 |
| Internal Medicine | 3 years | $61,000 | $67,000 |
| Family Medicine | 3 years | $60,000 | $66,000 |
Other Specialties
| Specialty | Training Length | PGY-1 Salary | Final Year Salary |
|---|---|---|---|
| Dermatology | 4 years | $61,000 | $72,000 |
| Radiology | 5 years | $61,000 | $75,000 |
| Interventional Radiology | 6 years | $61,000 | $77,000 |
| Anesthesiology | 4 years | $61,000 | $72,000 |
| Emergency Medicine | 3-4 years | $61,000 | $70,000 |
| Psychiatry | 4 years | $60,000 | $70,000 |
| Neurology | 4 years | $61,000 | $71,000 |
| Pathology | 4 years | $60,000 | $70,000 |
| Physical Medicine & Rehab | 4 years | $60,000 | $70,000 |
| Pediatrics | 3 years | $60,000 | $66,000 |
Highest and Lowest Paid Residencies
Highest-Paid Residency Programs
The highest-paid residencies are typically longer surgical programs where residents reach PGY-6 or PGY-7:
- Neurosurgery: $75,000 - $85,000 (PGY-7)
- Cardiothoracic Surgery: $73,000 - $82,000 (PGY-6/7)
- Orthopedic Surgery: $70,000 - $78,000 (PGY-5)
- Plastic Surgery: $70,000 - $78,000 (PGY-6)
- Interventional Cardiology: $70,000 - $79,000 (PGY-7)
Lowest-Paid Residency Programs
Shorter residency programs have lower final-year salaries simply because residents don't progress to higher PGY levels:
- Family Medicine: $60,000 - $66,000 (3 years)
- Pediatrics: $60,000 - $66,000 (3 years)
- Internal Medicine: $61,000 - $67,000 (3 years)
- Emergency Medicine: $61,000 - $70,000 (3-4 years)
- Psychiatry: $60,000 - $70,000 (4 years)
Important: Don't choose a specialty based on residency salary. The $10,000-$20,000 difference during training is negligible compared to the $200,000-$500,000+ difference in attending salaries between specialties.
What Residents Actually Earn Per Hour
Residency salaries look reasonable until you calculate the hourly rate. ACGME limits residents to 80 hours per week (averaged over 4 weeks), but many residents work close to this limit—and some exceed it.
| Hours/Week | Annual Hours | Effective Hourly Rate |
|---|---|---|
| 50 hours | 2,600 | $24 - $30 |
| 60 hours | 3,120 | $20 - $25 |
| 70 hours | 3,640 | $17 - $21 |
| 80 hours | 4,160 | $15 - $19 |
For context, the federal minimum wage is $7.25/hour, and many retail and food service jobs pay $15-$20/hour. After 11+ years of education (4 years undergrad + 4 years medical school + residency), residents often earn less per hour than entry-level workers in other fields.
Factors That Affect Residency Salary
Geographic Location: Residencies in high cost-of-living areas (NYC, San Francisco, Boston) typically pay $5,000-$15,000 more than programs in lower-cost regions. However, this rarely fully compensates for housing costs.
Hospital System: Large academic medical centers and prestigious institutions sometimes pay less than community hospitals, trading prestige for salary.
Moonlighting: Some programs allow residents to work extra shifts (moonlighting) for additional income, typically $75-$150/hour. This can add $10,000-$30,000+ annually for motivated residents.
Cost of Living Stipends: Some programs in expensive cities offer housing stipends, meal allowances, or parking subsidies worth $2,000-$10,000 annually.
Unionization: Resident unions have successfully negotiated higher wages at some institutions. Unionized programs may pay $3,000-$8,000 more than non-unionized counterparts.
Residency Benefits Beyond Salary
Total compensation includes more than base salary. Most residency programs offer:
- Health insurance (medical, dental, vision) - often covering dependents
- Malpractice insurance - required and always provided
- Disability insurance - short and long-term coverage
- Life insurance - typically 1-2x annual salary
- 401(k) or 403(b) retirement plans - some with employer matching
- CME (Continuing Medical Education) allowance - $1,000-$3,000/year
- Meal stipends or free meals during shifts
- Parking or transit subsidies
- Paid time off - typically 2-4 weeks vacation + sick leave
- Parental leave - varies widely by program
Residency Salary vs. Attending Physician Salary
The financial picture changes dramatically after residency. Here's how resident pay compares to what you can expect as an attending:
| Specialty | Final Year Resident | Attending (Year 1) |
|---|---|---|
| Neurosurgery | $82,000 | $650,000+ |
| Orthopedic Surgery | $77,000 | $550,000+ |
| Cardiology | $79,000 | $500,000+ |
| Gastroenterology | $77,000 | $450,000+ |
| Dermatology | $72,000 | $400,000+ |
| Radiology | $75,000 | $400,000+ |
| Anesthesiology | $72,000 | $380,000+ |
| Emergency Medicine | $70,000 | $320,000+ |
| Internal Medicine | $67,000 | $260,000+ |
| Family Medicine | $66,000 | $230,000+ |
As you can see, the relatively small $15,000-$20,000 difference in residency salaries between specialties becomes a $200,000-$400,000 difference as an attending physician.
Frequently Asked Questions
How much do first-year residents make?
PGY-1 residents (interns) typically earn $60,000-$65,000 per year in 2026, regardless of specialty.
Do surgical residents make more than medical residents?
At the PGY-1 level, salaries are nearly identical. Surgical residents earn more overall because their programs are longer, allowing them to reach higher PGY levels.
Can residents negotiate salary?
Generally no. Resident salaries are set by the hospital/program and funded largely through Medicare GME. However, you may be able to negotiate moonlighting privileges or sign-on bonuses.
Do residents get paid during fellowship?
Yes. Fellows are typically paid at PGY-4 through PGY-7 levels, depending on their prior training. Fellowship salaries range from $70,000-$85,000.
Is residency salary enough to live on?
It depends on location. In low cost-of-living areas, resident salary is adequate. In expensive cities like New York or San Francisco, many residents struggle financially or rely on dual incomes.
Do residents get overtime pay?
No. Residents are classified as exempt employees and do not receive overtime, regardless of hours worked.
How much do residents pay in taxes?
Residents typically pay 22-24% federal tax plus state taxes. Effective tax rates range from 25-35% depending on state of residence and filing status.
Bottom Line
Residency salaries in 2026 range from $60,000 to $85,000 depending on PGY level and program length. While surgical and subspecialty residencies pay more in absolute terms, this is primarily because they're longer programs—not because residents are compensated at higher rates.
The key insight: Don't let residency salary influence your specialty choice. The $15,000 difference during training is insignificant compared to the $200,000+ difference you'll see as an attending. Choose based on what you want to do for the next 30+ years of your career, not what pays slightly more during 3-7 years of training.
Data Sources: AAMC, Medscape Resident Salary Report, MGMA, individual program salary disclosures. Salary figures are estimates based on 2025-2026 data and vary by institution and region.