Your Specialty Doesn't Set Your Pay: What US Residents Earn (2026–27)

Published 12 November 2026 · Luke, co-founder of OET BANK and USMLE BANK · 12 min read

In a US residency, your specialty does not set your pay. Your year of training does. In the AAMC's 2025 survey, 96.9% of the institutions that answered the question paid the same base salary at each level in every specialty, so at nearly every hospital a first-year surgery resident and a first-year psychiatry resident are paid the same. The mean first-year salary was $68,166 on 1 July 2025, about a quarter of the median wage of US physicians, and it varied more with the region than with the field: weighted by the number of residents, from $65,076 in the South to $77,649 in the West. This article sets out what residents are paid and how it rises, what hospitals pay in 2026–27, the hours and the benefits, and what a J-1 or H-1B visa changes about the money, as things stand on 12 November 2026.

1. How residents are paid

A resident is an employee of the hospital, university or health system that sponsors the program, and is paid a salary. The ACGME and the AAMC call it a stipend, and the ACGME says the two words mean the same thing. The salary is set by postgraduate year, or PGY: PGY-1 is the first year of residency, often called the intern year, PGY-2 the second, and so on. Fellows usually continue the count, so a fellow who starts after a three-year residency is typically paid at PGY-4.

• Almost always the same in every specialty. Of the 290 institutions that answered the AAMC's question, 96.9% paid the same base salary at each level across all specialties. Longer programs reach higher levels, so the total you earn depends on how many years you train, not on what the field pays later.
• Usually raised each year. 71.9% of institutions had adjusted their salaries on 1 July 2025. To decide the size of a raise, institutions most often used the GME office's recommendation (64.9%), other market data (62.6%), the AAMC's own report (59.2%) and the cost of living (42.8%).
• Sometimes set by a union. 12.3% of institutions said their residents were unionized, nearly all through a larger union. There, pay and benefits come from a contract negotiated for the institution's residents.

2. What residents earn, year by year

These are the AAMC's national figures for 1 July 2025. Each institution counts once, whatever its size:

The middle half of institutions paid a PGY-1 between $62,830 and $71,657. Weighted by the number of residents, the PGY-1 mean was higher, $70,684, because large institutions tend to pay more. At these means, three years of internal medicine come to about $212,000 before tax.

The raise from 2024 to 2025 was $1,453, or 2.2%, slightly less than consumer prices rose. Over a longer span the gap is wider: the first-year mean rose from $54,127 in 2016–17 to $68,166 in 2025, but after inflation the AAMC's figure fell by about 6%. Each year's figure comes from a different set of institutions, so read this as a trend, not an exact measure: in real terms, first-year pay has slipped.

One limit of the survey: it reports non-profit institutions only. Programs run by for-profit hospitals are not in these figures.

3. Where you train

The region moves pay more than the specialty does. The AAMC's figures below are weighted by the number of residents:

The regions that pay the most include many of the most expensive cities, so a higher salary does not always leave more after rent. Individual hospitals publish their own scales. Some examples for 2026–27:

Three things stand out. First, pay differs within one city: among the three New York examples, the first-year salary runs from $81,238 at the city's public hospitals to $96,600 at NewYork-Presbyterian. Second, the AAMC survey is a yardstick: 59.2% of institutions said they use it to decide their raises, and UT Southwestern's 2026–27 scale matches the survey's 75th percentile at every level, to the dollar. Third, the base salary is not the whole package. NewYork-Presbyterian adds a $7,500 living supplement and $2,160 a year on a meal card; Stanford's figures already include a $12,000 housing allowance; UCLA pays every resident an $8,000 enhancement fund each year and up to $1,500 for relocation; NYC Health + Hospitals pays up to $3,800 a year for meals.

Contracts also move the dates. The University of California's first system-wide contract for residents, effective from 30 July 2026, starts its new pay table on 1 September 2026, and Stanford is paying its 2025–26 rates while a new contract is negotiated.

Taxes also depend on where you live: state income tax differs from state to state, some states have none, and a few cities add their own.

4. The hours behind the salary

The ACGME, which accredits US residencies, limits the hours. Under its 2026 requirements:

• 80 hours a week at most, averaged over four weeks. The count includes clinical work done from home and all moonlighting.
• One day in seven free, also averaged over four weeks, with no at-home call on those days.
• 24 hours of continuous duty at most, plus up to four hours for handover and education, with no new patients in that time. After 24 hours of in-house call, at least 14 hours off.
• No moonlighting in PGY-1. After that, it must not interfere with training or patient safety, and it counts towards the 80 hours.

Because the limit is an average, a single week can run past 80 hours. As rough arithmetic: if a PGY-1 earning $68,166 worked 80 hours every week of the year, that would be about $16 an hour; at 60 hours, about $22.

5. Leave, insurance and the written terms

The ACGME's Institutional Requirements set a floor for leave. Every sponsoring institution must give each resident, once during the program, at least six weeks of approved medical, parental or caregiver leave, paid at no less than 100% of salary, plus at least one more week of paid time off kept for use outside those six weeks. Health and disability insurance must continue during the leave.

Above that floor, benefits vary. The AAMC asks about them every other year; its 2024 survey (as of 1 July 2024) found:

• Vacation: 16 to 21 days a year was the most common amount (45.2% of institutions), followed by 11 to 15 days (28.2%).
• Paid medical, parental or caregiver leave: a median of 42 days.
• Health insurance: 30% of institutions paid the full premium for a resident's own cover, and 64% shared the cost.
• Retirement plan: offered by 80.5%.

You can compare all of this before you rank. The ACGME requires that an applicant invited to interview be told, in writing or electronically, the terms of appointment: salary, benefits, professional liability cover, disability insurance, health insurance and the leave policies. Read them with the city's rent in mind.

6. What J-1 and H-1B change about the money

Many international graduates train on a J-1 visa sponsored by Intealth (ECFMG), others on an H-1B. Our article on residency visas explains the choice. Four things about the money differ:

• Extra work. A J-1 physician may not work outside the approved program, paid or unpaid. Since September 2025, Intealth has allowed supplemental clinical work at the training site itself, with the program director's approval and a form the hospital files with Intealth. Work anywhere else stays off limits.
• Social Security and Medicare. A J-1 trainee who is a nonresident alien for tax purposes does not pay these taxes, 7.65% of pay, or about $5,200 a year on $68,166. For tax purposes, J-1 trainees do not count their days in the US for two calendar years (fewer if they held J, F, M or Q status in any of the previous six), so the exemption usually covers the year you arrive and the next. On an H-1B, the taxes are withheld from the start.
• Income tax. Federal income tax applies on either visa. As a nonresident alien, a J-1 resident cannot take the standard deduction, so more of the salary is taxed. The two effects partly cancel out.
• A second income. A J-2 spouse can apply to USCIS for permission to work, though that income may not be used to support the J-1 physician. An H-4 spouse can work only if the H-1B holder has an approved immigrant petition (Form I-140) or certain extensions, so in residency an H-4 spouse usually cannot.

Check the visa before the salary. Some of the programs above take international graduates on a J-1 only. The internal medicine programs at NewYork-Presbyterian/Weill Cornell and at Henry Ford say they do not sponsor H-1B visas, and UCLA's GME office considers an H-1B only in limited cases, such as graduates of US or Canadian medical schools. Each program's own page says which visas it sponsors.

Tax rules depend on your own history and on any tax treaty with your country. Ask your hospital's payroll or international office which forms they need from you when you start.

7. After residency

The jump comes at the end. The US Bureau of Labor Statistics put the median annual wage of physicians and surgeons at $275,930 in May 2025, about four times the mean PGY-1 salary. Fellowship, if you take one, keeps you on the PGY scale for one to three more years.

The salary in training is not small because the work is. On a night on call, the resident covering the cardiology ward may be the first doctor to see a patient who suddenly deteriorates days after a heart attack. Step 1 asks why it happens. Try this USMLE BANK question:

Frequently asked questions

How much does a first-year resident make in the US?

In the AAMC's 2025 survey, the mean PGY-1 salary was $68,166 (median $66,986) on 1 July 2025, at 350 non-profit institutions. By region, weighted by the number of residents, it ranged from $65,076 in the South to $77,649 in the West.

Do surgery residents earn more than other residents?

Not at the same institution, as a rule. 96.9% of the institutions that answered the AAMC's question paid the same base salary at each year of training in every specialty. Surgical residencies are longer, so surgeons in training reach higher PGY levels, but the rate for each year is the same.

How many hours do US residents work?

The ACGME allows at most 80 hours a week, averaged over four weeks, including moonlighting and clinical work from home, with one day in seven free and continuous duty of no more than 24 hours plus up to four hours for handover and education.

Can residents on a J-1 visa moonlight?

Not outside their program. Intealth does not allow J-1 physicians to work outside the approved training, paid or unpaid. Since September 2025, supplemental clinical work at the training site is allowed with the program director's approval and a form the hospital files with Intealth. The ACGME also bars all PGY-1 residents from moonlighting.

Do J-1 residents pay Social Security and Medicare taxes?

Not while they are nonresident aliens for tax purposes, which for a J-1 resident with no earlier years in the US in J, F, M or Q status usually means the calendar year they arrive and the next. After that they are taxed as residents and the 7.65% is withheld. H-1B residents pay it from the start.