Resident Physician Salary (2026): What You Actually Make by Year, Specialty, and Location

Resident Salary by PGY Year: The Complete 2026 Data

The 2025 AAMC survey found that the nationwide, unweighted average stipends for residents and fellows were as follows:

*Take-home estimates based on 22% federal marginal rate, no state income tax (Texas/Florida), single filer, standard deductions. State income tax reduces these figures by $200 to $600/month in high-tax states.

The median PGY-1 salary is $66,986, with a 75th percentile of $71,657. That spread means some programs pay meaningfully more than the average — but most residents fall within $5,000 to $6,000 of the national mean at the same PGY level regardless of where they trained or what specialty they chose.

Why Your Specialty Does Not Change Your Resident Salary

This surprises nearly every medical student researching residency compensation: a PGY-1 internal medicine resident and a PGY-1 neurosurgery resident at the same hospital earn essentially the same salary.

In most programs, all residents at the same PGY level within the same institution are paid the same rate, regardless of medical specialty. These salary rates are determined primarily by cost of living.

The apparent salary differences between specialties in residency salary tables come entirely from program length — not from higher per-year compensation. A 7-year neurosurgery residency program has residents earning PGY-1 through PGY-7 salaries, producing a higher average when all years are combined. A 3-year family medicine residency averages only PGY-1 through PGY-3 salaries. When compared year-for-year, the difference is negligible.

The practical implication: 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.

A neurosurgery resident enduring 7 years at $68,000 to $89,000 per year is building toward a $750,000+ attending salary. A family medicine resident finishing in 3 years enters a $290,000 to $350,000 market. The attending income gap matters infinitely more than the residency stipend difference.

Resident Salary by Institution Type

The unweighted averages for each type of training institution, from the first year of training to the eighth, were:

• •Medical schools: $67,899 to $90,855
• •General hospitals and specialty hospitals: $68,308 to $96,112
• •Health systems and consortiums: $67,657 to $94,009

General and specialty hospitals pay slightly more at the higher training years — likely because these programs include more senior residents in procedural and surgical specialties with longer training periods. The differences at the PGY-1 and PGY-2 levels between institution types are minimal — typically under $1,000 annually.

The more important institutional variable: Benefits packages. An institution offering a generous 403(b) match, free health insurance for dependents, and a meal stipend provides materially more total compensation than one offering the same base salary with bare-bones benefits. Always calculate total package value — not just the stipend number — when comparing programs.

Resident Salary by Region: The Geography That Actually Matters

Regional variation in resident salaries is real but partially offset by cost-of-living differences in the same direction.

PGY-1 salaries in the West average around $75,000, the highest regionally. Central region programs average around $65,000, closer to the national mean. Cost of living often cancels out these differences. Regions with the lowest adjusted physician salaries include Boston, Washington DC, Seattle, Denver, and San Francisco — also among the most expensive cities in the country. Cities like Rochester MN, St. Louis, Oklahoma City, and Omaha consistently show some of the strongest adjusted compensation for physicians and trainees.

The counterintuitive insight: A resident earning $65,000 in Oklahoma City paying $1,200 per month in rent has more disposable income than a resident earning $75,000 in San Francisco paying $3,200 per month in rent. The nominal salary advantage of West Coast programs evaporates when housing costs are factored in.

What Residents Actually Take Home: The Tax Math

This is what most residency salary discussions skip entirely — and where residents get the biggest shock when their first paycheck arrives.

For a single PGY-1 resident earning $68,166 per year:

The effective hourly rate reality: A PGY-1 working 60 hours per week across 50 weeks earns $68,166 on 3,000 clinical hours — $22.72 per hour gross, approximately $16 to $17 per hour after taxes. A resident working 80 hours per week earns $17 per hour gross. Residents are exempt employees — there is no overtime regardless of hours worked.

This is not a complaint lodged here. It is the financial reality that every resident needs to understand so they can plan their budget, their loan strategy, and their moonlighting decisions with accurate numbers rather than assumptions.

Resident Benefits: The Non-Salary Compensation Worth Quantifying

Most residency salary comparisons focus exclusively on the stipend and ignore the benefits package — which in many cases is worth $15,000 to $30,000 in annual economic value.

Most U.S. residency programs include standard benefits such as health insurance (medical, dental, vision) — often covering dependents — malpractice insurance, and 2–4 weeks of paid time off.

Benefit components and their dollar values:

Health insurance: A family health insurance policy that would cost $800 to $2,000 per month on the private market is typically provided to residents at heavily subsidized premiums. A resident with a spouse and child receiving employer-subsidized family health coverage at $200 per month saves $600 to $1,800 per month compared to purchasing equivalent coverage independently.

Malpractice insurance: Required by law and always provided. Individual physician malpractice insurance would cost $5,000 to $15,000 annually depending on specialty. The program provides it at zero cost to the resident — a real economic benefit that does not appear in any stipend comparison.

Meal stipend: Most programs offer some form of meal allowance or free meals while on call. Estimated value: $1,000 to $3,000 annually.

CME and board expenses: Many programs reimburse Step 3 exam fees, licensing fees, and medical conference attendance. Value: $2,000 to $5,000 annually.

Retirement plan: Some programs offer 403(b) or 401(k) plans with institutional matching. A program matching 4% of a $68,000 stipend contributes $2,720 annually — a real economic benefit even at modest income levels. At 7% annual return, that $2,720 employer contribution compounds to approximately $40,000 over 15 years — not trivial.

Disability insurance: Programs provide short-term and long-term disability through the hospital's group plan. This group coverage is important to understand — it is typically any-occupation after 24 months and non-portable. It is not a substitute for individual own-occupation disability insurance, but its existence means residents have some protection before their individual policy is secured.

The Attending Salary Leap: What You're Building Toward

The jump from residency to attending is the single largest salary increase of any career path in the United States. Understanding the magnitude of that jump — and how it differs by specialty — is the most important financial context for a resident evaluating their training years.

The jump from residency to attending-level income is the single largest salary increase in a physician's career. The gap varies significantly by specialty.

The compounding effect: A resident who survives residency on their stipend without accumulating lifestyle debt — no car loan, no lifestyle inflation, modest rent — enters attending practice with every future dollar available for wealth building. A resident who takes on $40,000 in consumer debt during training enters attending practice with a hole to dig out of before wealth accumulation begins.

Residency is a financial sacrifice. The data makes clear it is a temporary one. The attending income that follows — regardless of specialty — produces compensation that objectively justifies the training years. The physicians who build the most wealth from attending practice are those who maintained discipline during residency.

The Resident Salary Factors You Can Actually Control

Most residents cannot negotiate their base stipend. Unlike physicians, residents typically cannot negotiate salary increases. The stipend is set by the institution and applied uniformly to all residents at the same PGY level. What residents can control:

1. Moonlighting Income

The most powerful income lever available during residency. A resident picking up 2 external moonlighting shifts per month at $120 to $200 per hour adds $12,000 to $28,000 in annual gross income on top of their stipend.

The critical caveats: Program director approval is required at most programs. ACGME duty hour limits — 80 hours per week averaged over 4 weeks — apply to moonlighting hours. Moonlighting income is 1099 self-employment income subject to a 15.3% self-employment tax on top of income taxes. A resident who earns $20,000 in moonlighting income nets approximately $12,000 to $14,000 after all taxes — not $20,000.

The Solo 401(k) that self-employment income unlocks is the most underutilized resident financial tool: up to $24,500 in pre-tax contributions from moonlighting income that reduces your AGI, your income tax, and your self-employment tax simultaneously.

For the complete moonlighting tax and income analysis, see our Moonlighting as a Resident guide.

2. State Income Tax Optimization

A resident who matches into a Texas, Florida, Tennessee, Nevada, or Washington program and a comparable resident who matches into California or New York have a $3,000 to $6,000 annual after-tax income difference on the same stipend. On a $68,000 stipend, that is meaningful — and for the resident who also chooses to marry during training, the combined state tax impact on a dual-income household compounds further.

This is not a reason to rank programs based on state income tax — but it is a real financial variable that residents in high-tax states should account for in their budget planning.

3. Student Loan Strategy During Residency

The most financially consequential decision a resident makes is not about their salary — it is about their student loans. A resident who enrolls in IBR from day one, certifies PSLF employment at a qualifying nonprofit hospital, and accumulates qualifying payments during training is building forgiveness value that can be worth $200,000 to $350,000 in tax-free loan forgiveness.

IBR payment at $68,000 resident salary, single filer:

• •AGI after retirement contributions: approximately $63,000
• •Discretionary income: $63,000 − $22,590 = $40,410
• •Annual IBR payment: $40,410 × 10% = $4,041 = $337 per month

That $337 per month counts as a qualifying PSLF payment at most nonprofit training programs. A 3-year residency generates 36 qualifying payments. A 7-year combined residency and fellowship generates 84 qualifying payments — leaving only 36 remaining payments (3 years) to reach PSLF forgiveness as an attending.

For the complete PSLF strategy for residents, see our What Happens to Your Student Loans During Residency guide and our PSLF vs. Refinancing guide.

4. Disability Insurance — The GSI Window

The most underutilized resident financial decision is purchasing disability insurance during training. Residency is the lowest-risk underwriting period of a physician's career — you are young, healthy, and pre-clinical-injury. GSI (Guaranteed Standard Issue) programs at most major training institutions allow residents to purchase individual own-occupation disability insurance without medical underwriting — meaning any health condition that develops during residency cannot affect your policy.

A resident who purchases a $3,000/month benefit with a Future Increase Option (FIO) rider during PGY-1 locks in:

• •Individually owned, portable coverage that travels with them regardless of employer changes
• •The FIO rider that allows expanding to $10,000 to $20,000/month as attending income grows — guaranteed, regardless of health changes during training
• •Non-cancelable, guaranteed renewable protection at the lowest premium available in their career

The GSI window is open for a defined enrollment period — typically during orientation week or within the first 30 to 60 days of training. Missing it means individual medical underwriting that may exclude conditions developed during residency.

See our Guardian DI Review, Principal DI Review, and Ameritas DI Review for a comparison of which carriers have the most widely available GSI programs at residency training institutions.

The Chief Resident Premium and Other Stipend Add-Ons

71.1% of residency programs pay chief residents a higher stipend than the rest of the residents in the program. The average additional salary amount was $5,071. 13.5% of residency programs reported paying additional salary to residents other than chief residents.

Chief residents at the PGY-3 or PGY-4 level who receive the chief resident premium earn approximately $78,000 to $84,000 — a meaningful increase from the standard PGY-3 or PGY-4 rate.

Unionized programs pay more. Resident unions have successfully negotiated higher wages at some institutions. Unionized programs may pay $3,000–$8,000 more than non-unionized counterparts. Resident unions have been organizing at increasing rates at major academic medical centers — a trend that is slowly moving the floor of resident compensation upward in markets where collective bargaining is active.

Building Your Resident Budget: The Real Numbers

A resident earning $68,166 annually ($5,680/month gross, approximately $4,200/month take-home in a no-income-tax state) needs a budget that covers living expenses, student loan payments, emergency fund building, and ideally some retirement savings.

Sample monthly budget for a single PGY-1 in a moderate cost-of-living city:

At $4,200 in monthly take-home, this budget is tight but executable — particularly if rent can be kept below $1,400. The residents who struggle financially during training are those who sign leases at $2,000+ per month, finance new cars, or carry credit card balances. The residents who emerge from training in the strongest financial position are those who spent below their take-home, let their IBR payment accumulate PSLF credit, and used any moonlighting income for emergency fund and Roth IRA contributions.

For the complete residency budget breakdown with city-specific rent data, see our PGY-1 Financial Checklist.

The Roth IRA Opportunity Most Residents Miss

Residency is the only period in a physician's career when Roth IRA contributions are straightforwardly optimal. Here is why that window matters:

At $68,000 in resident income, your federal marginal tax rate is 22 percent. Every Roth IRA contribution costs you 22 cents in foregone tax savings per dollar contributed.

When you become an attending at $380,000, your marginal rate will be 32 to 37 percent. Roth contributions at that income level cost 32 to 37 cents per dollar in foregone savings — and you cannot make direct Roth IRA contributions at all above the income threshold ($168,000 single, $252,000 married in 2026). You must use the backdoor Roth.

A resident who contributes $7,500 per year to a Roth IRA for 4 years of training invests $30,000 at a 22% tax rate. That $30,000, growing at 7% for 35 years, becomes approximately $320,000 in completely tax-free wealth at retirement — money that will never be taxed again regardless of how much it grows.

The Roth IRA 2026 contribution limit is $7,500. A resident earning $68,000 falls well below the income limit for direct contributions. This is one of the few genuine timing advantages that residency provides — maximize it before attending income eliminates direct access.

For the complete Roth IRA strategy for physicians, see our Backdoor Roth IRA for Physicians guide.