Resident Physician Salary (2026): What Doctors Make in Residency, by Year, Specialty, and Location

Resident Salary by PGY Year: The Latest AAMC Data

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

*Take-home estimates: single filer, 2026 federal tax brackets and standard deduction, Social Security and Medicare taxes, a $100 to $300 monthly health premium, no state income tax (e.g., Texas or Florida), and no retirement contributions. State income and payroll taxes reduce these figures where wages are taxed: in California, income tax takes an estimated $177/month at PGY-1 rising to about $364/month at PGY-8 (2026 California brackets, standard deduction and exemption credit, single filer), plus State Disability Insurance of 1.3% of wages (about $74 to $102/month), and more in higher-tax places such as New York City.

The median PGY-1 salary is $66,986, with a 25th percentile of $62,830 and a 75th percentile of $71,657. That spread means some programs pay meaningfully more than the average — but the middle half of institutions pay PGY-1s within about $5,300 below to $3,500 above the national mean.

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. In the 2025 AAMC survey, 96.9% of institutions with more than one specialty reported paying the same base stipend at each level across all specialties. Stipend levels vary mainly by institution and region.

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. Averaged across training, a 5-year program pays about $3,600 a year more than a 3-year program at AAMC 2025 means ($74,273 versus $70,655), which is small next to differences of $200,000 or more between specialties 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 specialty that averaged $829,161 in Doximity's 2026 Physician Compensation Report. A family medicine resident finishing in 3 years enters a specialty that averaged $325,040. 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.

These are the AAMC's 2025 unweighted mean PGY-1 stipends by region. The West ($73,190) and Northeast ($72,749) pay the most, the Central region ($67,191) sits just below the national mean, and the South ($63,160) pays the least. Weighted by the number of residents, the gaps are a bit wider: $77,649 in the West, $74,994 in the Northeast, $68,580 in the Central region, and $65,076 in the South. Cost of living often cancels out these differences — the highest-paying regions include many of the country's most expensive cities.

Individual programs vary more than the regional averages. For 2025–26, UCSF listed a PGY-1 salary of $96,953 on the University of California scale (effective October 1, 2025, and including a housing allowance), while OU Health in Oklahoma City listed $62,731. Some high-cost programs pay enough to offset much of the rent difference and others do not, so compare each program's published stipend with what an apartment near the hospital actually costs.

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, using the 2026 federal brackets and $16,100 standard deduction and the 2026 Social Security wage base:

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 $17 to $19 per hour after taxes and health premiums. A resident working 80 hours per week earns $17 per hour gross. Residents are exempt professionals under federal overtime rules — 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, for a resident with family health coverage, can be worth more than $20,000 a year in employer-paid premiums alone.

The ACGME Institutional Requirements make several benefits mandatory: sponsoring institutions must provide residents with health insurance for themselves and eligible dependents, disability insurance, and professional liability coverage, plus at least six weeks of approved medical, parental, and caregiver leave once during training. Most programs also offer dental and vision coverage and several weeks of paid vacation.

Benefit components and their dollar values:

Health insurance: Family coverage is expensive — total premiums for employer-sponsored family coverage averaged $26,993 a year in 2025 (about $2,250 a month), according to KFF's Employer Health Benefits Survey, with employers paying most of it. Residents typically pay a subsidized share, so a resident with a spouse and child paying $200 per month for family coverage is receiving well over $1,000 a month of employer-paid premium.

Malpractice insurance: ACGME requires the sponsoring institution to provide professional liability coverage, including legal defense, for residents' work within the program. An individual policy would cost thousands of dollars a year, and more in high-risk specialties. The program provides it at no cost to the resident — a real economic benefit that does not appear in any stipend comparison.

Meal stipend: Many programs offer some form of meal allowance or free meals while on call. Ask for the annual amount; its value depends on how many call shifts you work.

CME and board expenses: Many programs reimburse Step 3 exam fees, licensing fees, and medical conference attendance. Ask each program for its education allowance in dollars.

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 a 7% annual return, three years of that match (about $8,160) grows to roughly $21,000 fifteen years after the first contribution — not trivial.

Disability insurance: ACGME requires sponsoring institutions to provide disability insurance, usually through the hospital's group plan. This group coverage is important to understand — group policies often switch to an any-occupation definition after a set period and usually end when you leave the program; read the plan summary. 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 in a physician's career. 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 gap varies significantly by specialty. In the table below, the residency figure averages the AAMC's 2025 mean stipends across each program's length, and the attending figure is the specialty average from Doximity's 2026 Physician Compensation Report.

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. Rates vary by specialty, market and role; at an assumed $120 to $200 per hour, a resident working two 5-hour moonlighting shifts a month (120 hours a year) adds $14,400 to $24,000 in annual gross income on top of their stipend.

The critical caveats: Under the ACGME Common Program Requirements, PGY-1 residents are not permitted to moonlight, and internal and external moonlighting hours count toward the 80-hour weekly limit (averaged over four weeks). Program director approval is required at most programs. External moonlighting income is usually 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: pre-tax employee deferrals up to the 2026 limit of $24,500 (shared with any 403(b) or 401(k) deferrals you make at your program) reduce your AGI and income tax. They do not reduce self-employment tax.

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 have an estimated $3,000 annual after-tax income difference on a $68,166 stipend (about $2,100 of state income tax at 2026 California brackets, single filer, plus about $900 of State Disability Insurance), and the gap is wider in higher-tax places such as New York City. 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 toward tax-free forgiveness that, for a typical medical school balance, can run well into six figures.

One caveat: IBR is only available for federal loans disbursed before July 1, 2026. Under the 2025 reconciliation law, a borrower who takes out a new federal loan or consolidates on or after that date must repay all of their Direct Loans under the Repayment Assistance Plan (RAP) or the Tiered Standard Plan, according to the Federal Student Aid IDR plan request form. If that applies to you, see our IBR vs. RAP for Medical Residents guide.

IBR payment at $68,000 resident salary, single filer, for a borrower who is a "new borrower" under IBR rules (no federal loan balance before July 1, 2014 — borrowers with older loans pay 15% instead of 10%):

• •AGI after retirement contributions: approximately $63,000
• •Discretionary income: $63,000 − $23,940 (150% of the 2026 poverty guideline of $15,960 for a one-person household) = $39,060
• •Annual IBR payment: $39,060 × 10% = $3,906 = $326 per month

That $326 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 the 120 qualifying payments PSLF requires 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 modest monthly 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, which lets them raise the benefit as attending income grows (up to the carrier's limits) without new medical underwriting
• •Non-cancelable, guaranteed renewable protection at the lowest premium available in their career

The GSI window is open for a defined enrollment period that varies by program and carrier, often around orientation — ask your GME office when it closes. Missing it means individual medical underwriting that may exclude conditions developed during residency.

See our Guardian DI Review and Principal DI Review for a comparison of which carriers have the most widely available GSI programs at residency training institutions, or read our complete Own-Occupation Disability Insurance guide.

The Chief Resident Premium and Other Stipend Add-Ons

In the 2025 AAMC survey, 71.1% of institutions paid chief residents a higher stipend than other residents. Among institutions that add a set dollar amount for chiefs, the mean addition was $5,071 (median $2,500). 13.5% of institutions reported paying higher stipends to residents other than chief residents.

Chief residents at the PGY-3 or PGY-4 level who receive the chief resident premium earn roughly $76,000 to $83,000 based on those averages — a meaningful increase from the standard PGY-3 or PGY-4 rate.

Unionized programs can pay more. Resident unions have negotiated higher wages at some institutions, though the size of the increase varies by contract. In the 2025 AAMC survey, 12.3% of responding institutions reported that their residents are unionized. Resident unions have been organizing at major academic medical centers — a trend that is 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, roughly $4,700/month after federal income and payroll taxes in a no-income-tax state, before health insurance and other deductions) 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 roughly $4,700 a month after taxes, 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 (12 percent if pre-tax retirement contributions bring taxable income under $50,400, under the 2026 brackets). Every Roth IRA contribution costs you at most 22 cents in foregone tax savings per dollar contributed.

When you become an attending at $380,000, your federal marginal rate will be 24 to 35 percent, depending on filing status. Roth contributions at that income level cost 24 to 35 cents per dollar in foregone savings — and you cannot make direct Roth IRA contributions at all above the income limit ($168,000 single, $252,000 married filing jointly 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.