The Best-Paid Specialties Take the Fewest International Graduates: US Doctor Salary by Specialty (2026)

Published 13 November 2026 · Luke, co-founder of OET BANK and USMLE BANK · 13 min read

A US resident's pay hardly depends on the specialty. An attending physician's depends on it heavily. In Doximity's 2026 report, built on nearly 23,000 surveys in which full-time US physicians reported their own pay during 2025, neurosurgeons averaged $829,161 and orthopaedic surgeons $696,852, against $339,274 in internal medicine and $273,665 in general pediatrics. The best-paid fields are also the ones international graduates rarely enter. In the 2024–25 academic year, graduates of medical schools outside the US and Canada made up 1.4% of orthopaedic surgery residents and 2.5% of dermatology residents, against 41.2% in internal medicine. The well-paid route that stays open runs through internal medicine: 37.3% of cardiology fellows had graduated from medical schools abroad, and cardiologists averaged $604,635. This article sets out what attendings earn by specialty, why the government's figures are lower, what employers offered physicians on H-1B visas from April to June 2026, and how much is left after tax, as things stand on 13 November 2026.

1. What attendings earn, specialty by specialty

An attending is a physician who has finished training and practices without supervision. In residency, as our article on what US residents earn explains, almost every hospital pays the same in every specialty. After training, the specialty decides much of the pay, and it also decides how likely you are to get in as an international graduate. This table puts Doximity's 2025 averages next to the share of each specialty's residents in 2024–25 who had graduated from a medical school outside the US and Canada:

The pattern is plain. In the six best-paid fields in the table, from neurosurgery to dermatology, international graduates made up at most 16.2% of residents, and in orthopaedic surgery and dermatology fewer than 3%. The four fields with the largest shares, pathology, internal medicine, neurology and family medicine (29% to 44%), averaged $325,040 to $410,039. Pathology is the exception worth knowing: it had the largest share of international graduates in the table, 43.9%, and its average of $410,039 was close to obstetrics and gynecology's.

The gap between fields is widening. Doximity found that physician pay rose 2% overall in 2025, and that surgical specialists earned 90.1% more than primary care physicians, up from 87.3% in 2024.

2. The route through internal medicine

Internal medicine trains more international graduates than any other specialty: 14,048 of its 34,086 residents in 2024–25. Its residency takes three years, and many internists then train for two or three more in a fellowship. The ACGME counts fellows the same way:

Cardiology is where high pay and a large share of international graduates meet: six years of training in all, three in internal medicine and three in the fellowship, then an average of $604,635. In interventional cardiology, a further fellowship after that, half the fellows (50.1%) had graduated abroad. Gastroenterology, hematology and oncology, and pulmonary disease and critical care are also three-year fellowships, with averages above $440,000 and international graduates making up 29% to 38% of fellows.

A fellowship does not always raise pay. The two most open to international graduates, nephrology (61.9%) and endocrinology (56.3%), averaged $385,965 and $309,782: nephrology somewhat above general internal medicine, endocrinology below it. Infectious disease, at 40.8%, averaged $337,353, about the same as internal medicine. All three take two years. Pick a fellowship for the work you want to do for decades, but know before you add the years which ones change the pay.

3. Why the government's figures are lower

Search for doctors' pay and you will also meet the US Bureau of Labor Statistics. Its figures for May 2025 are lower: by 18% to 31% in most of these specialties, and by about half in orthopaedic surgery:

They differ in four ways:

• Residents are in the BLS figures. Under the federal occupation rules, trainees are classified with the occupation they are training for, and in 2016 the committee that maintains the rules declined to create a separate occupation for residents and fellows. The ACGME counted 167,083 residents and fellows in 2024–25; the BLS counted 804,140 physicians and surgeons on payrolls in May 2025. If residents are coded as the rules say, roughly one in five of the people behind the BLS figures is still in training. The low end fits: the bottom 10% of family physicians earned $76,830 or less, about what a resident is paid.
• The self-employed are not. The BLS counts employees only, so self-employed doctors, and owners and partners of unincorporated practices, are left out. Its wages also exclude what it calls nonproduction bonuses.
• Part-time doctors are in. The BLS covers part-time as well as full-time employees. Doximity's averages come only from physicians working at least 40 hours a week.
• A median is not an average. A few very high earners lift an average more than they lift a median.

Neither source is wrong. The BLS tells you what people on medical payrolls are paid, trainees included; Doximity tells you what full-time doctors say they earn. For a job after training, Doximity is the closer guide, and the written offer is the only exact one.

4. Why procedures pay more

Part of the gap between fields comes from how US medicine is priced. Medicare, the federal insurance mainly for people aged 65 and over, pays physicians from a fee schedule. Each service has relative value units (RVUs) for the physician's work, the practice's costs and malpractice insurance; the total is multiplied by a conversion factor and adjusted for the area. On 4 November 2026 the Centers for Medicare & Medicaid Services (CMS) set the main 2027 conversion factor at $32.63, 2.31% lower than in 2026, mainly because a one-year 2.5% increase written into law for 2026 runs out. Physicians in certain alternative payment models get $32.95 in 2027.

CMS's own 2027 files show the difference. A moderately complex office visit with an established patient (code 99214) carries 1.92 work RVUs, and CMS assumes 47 minutes of the physician's time for it. Placing a stent in one coronary artery (code 92928) carries 9.75 work RVUs for 134.5 minutes. Minute for minute, the stent is valued about 1.8 times as highly. Before the adjustment for area, the Medicare fee is about $131 for the visit in an office and about $454 for the stent. A specialty that fills its day with procedures tends to earn more from the same scale than one that spends it talking with patients.

5. Where and for whom you work

Beyond the specialty, the place and the employer also move pay, often by tens of thousands of dollars or more:

• The city. Among the 60 metro areas in Doximity's report, average physician pay in 2025 was highest in Oklahoma City ($495,617) and lowest in Durham–Chapel Hill ($381,424). New York averaged $438,060. Adjusted for the cost of living, Boston, Washington DC and Baltimore came out lowest, and New York sixth lowest.
• The state. In the BLS state figures for family medicine, the mean was highest in Rhode Island ($365,960), while New York ($211,570) ranked 49th of the 52 areas listed. New York also has more residents than any other state, 20,376 in 2024–25; if the BLS counts them as the rules say, they may pull its figures down. Several of the best-paid places for family physicians in the BLS lists are small cities and rural areas, such as the nonmetropolitan areas of northeast Nebraska ($410,430) and east-central Montana ($382,030).
• The employer. By practice setting, Doximity's averages were highest in single-specialty groups ($480,961) and multi-specialty groups ($477,033), then hospitals ($454,440), and lowest in academic medicine ($389,591) and government ($311,502).

This matters on a visa. A university, or a non-profit affiliated with one, is exempt from the annual H-1B cap, so academic jobs are often easier to reach on an H-1B; they are also among the lower-paid settings. A J-1 waiver through Conrad 30 usually places you for three years in an area short of doctors, often outside the big cities. Our article on residency visas explains both.

6. What employers offer physicians on an H-1B

Before an employer can file an H-1B petition, it must file a Labor Condition Application (LCA) with the Department of Labor, stating the wage it will pay. The wage must be at least the prevailing wage for that job and area, or the employer's own wage for similar workers if that is higher, and the Department publishes the applications. We took every LCA for a physician occupation certified from 1 April to 30 June 2026 for a full-time H-1B job, and set aside the 916 whose job titles named a resident, fellow or other trainee. That left 3,571 applications, with a median wage of $293,000:

A quarter of the applications, 888, were for hospitalists: internists who look after patients admitted to hospital. Their median was $284,980. Most applications came from physician practices (1,540) and hospitals (1,269), followed by universities (504). New York (305), Florida (196) and Pennsylvania (167) had the most applications.

Three cautions. An LCA states the wage the employer commits to, not necessarily everything the doctor will earn. A certified application does not mean someone was hired. And these are three months of data. Even so, the picture is consistent. For the seven occupations that also appear in the table in section 3, the H-1B median falls between the BLS median and Doximity's average in all but radiology, where it is just below the BLS figure; and cardiologists were offered the most and pediatricians the least.

7. Before and after tax

Every figure above is before tax. As a rough example, take a salary equal to the internal medicine average, $339,274, paid in 2026 to a single person with no other income who takes the standard deduction ($16,100) and lives in a state with no income tax, such as Texas or Florida:

• Federal income tax: about $81,880. The last dollars are taxed at 35%.
• Social Security: 6.2% of the first $184,500 of wages, $11,439.
• Medicare: 1.45% of all wages plus 0.9% of wages over $200,000, $6,173.

That leaves about $239,800, roughly 71%, or about $20,000 a month. States such as California and New York add their own income tax, and contributions to a retirement plan and health insurance come out of the same pay. Your own tax depends on your family, your state and your tax residency status, so check it with a tax adviser before you compare offers.

Count the years as well as the dollars. A hospitalist job can start after a three-year internal medicine residency, paid at a resident's salary (the PGY-1 mean was $68,166 in 2025); a cardiologist starts after six years of training.

The procedures behind a cardiologist's pay are also where Step 1 finds its anatomy questions. A coronary stent can be placed through the femoral artery in the groin, and where the needle enters decides what can go wrong. Try this USMLE BANK question:

Frequently asked questions

How much does a doctor make in the US?

It depends on the specialty. In Doximity's 2026 report, full-time physicians' average pay in 2025 ranged from $217,819 in pediatric infectious disease to $829,161 in neurosurgery, with general pediatrics at $273,665 and internal medicine at $339,274. The BLS median for physicians on payrolls in May 2025, not counting surgeons, was $271,090, but that figure includes residents and leaves out the self-employed.

Which medical specialty pays the most in the US?

In Doximity's 2025 figures, neurosurgery ($829,161), thoracic surgery ($749,707) and orthopaedic surgery ($696,852). Neurosurgery and orthopaedic surgery take few international graduates: in 2024–25 they were 7.6% and 1.4% of their residents.

Which well-paid specialties are open to international medical graduates?

The fellowships after internal medicine. In 2024–25, international graduates were 37.3% of cardiology fellows, 36.6% in hematology and oncology, 38.4% in pulmonary disease and critical care and 28.9% in gastroenterology, fields that averaged $441,472 to $604,635 in 2025. Pathology, at 43.9%, averaged $410,039.

How much are doctors on an H-1B visa paid?

In the Labor Condition Applications for full-time physician jobs certified from April to June 2026, leaving out trainee positions, the median wage was $293,000 across 3,571 applications: $500,000 for cardiologists, $265,000 for general internists, $284,980 for hospitalists and $235,000 for pediatricians.

How much of a US doctor's salary is left after tax?

As a rough 2026 example, a single internist paid $339,274 in a state with no income tax, taking the standard deduction, pays about $81,880 in federal income tax and $17,612 in Social Security and Medicare, leaving about $239,800, roughly 71%. State income tax, retirement contributions and insurance reduce it further.