If you're preparing for residency, you're probably wondering what your income will actually look like. Residency salary is one of the most important (yet least transparent) topics for new doctors entering graduate medical education. While the title “resident doctor” may suggest a high paycheck, the reality is that residency wages reflect your training status, not your final earning potential.
At OnlineMedEd, we understand that financial clarity is just as important as clinical competence. That's why we provide practical tools to help you confidently manage both your education and life logistics, including what to expect financially during training.
Researching the financial realities of residency is essential for every medical trainee. While the demands of training are steep, residency pay rarely reflects the scope of the responsibility. Still, knowing what to expect can help you plan wisely.
Across the U.S., the average residency salary ranges from $60,000 to $70,000 per year. First-year residents (PGY-1), often referred to as interns, typically earn on the lower end of that scale, with annual stipends averaging $58,000 to $61,000. Each year, residents usually receive modest raises (typically $1,500 to $2,500), but these increases often lag behind inflation and student loan interest accrual.
Where you train significantly influences how far your salary stretches. Residency programs in high-cost cities like New York, San Francisco, or Los Angeles may offer stipends on the higher end—sometimes approaching $75,000 for senior residents—but steep housing costs and transportation expenses can erode that apparent advantage. In contrast, residents in smaller cities or more rural areas may earn slightly less but often enjoy a better quality of life due to lower living costs.
Your chosen specialty also plays a role, though not as dramatically as in post-residency earnings. Surgical and subspecialty residents may receive slightly higher stipends or additional pay for longer hours and overnight call shifts, but these increases are typically small. Ultimately, residency pay is structured more by institutional budgets and GME funding than specialty-specific demand.
While residency salaries represent a clear step up from medical school (especially for those with little or no income during training), they still require strategic budgeting and long-term planning. This is particularly true for residents supporting their families or managing significant student loan debt. That’s why we highly recommend that you establish smart financial habits early on and seek guidance from trusted mentors or financial advisors.
For extra support, we offer a free financial wellness program led by Hope Steele, MAcc, a seasoned financial coach and tax expert. The program includes a class on common financial pitfalls, tools for budgeting and saving, and even a free eBook and one-on-one coaching—all designed to help medical professionals build financial stability from the ground up. All you have to do is sign up for ClubMedEd to gain access!
Residency salaries might seem straightforward on paper, but in reality, they’re shaped by multiple interlocking factors. What a resident earns depends on more than just their PGY (post-graduate year) status. Here’s what to keep in mind when evaluating or negotiating what you’ll earn as a resident.
Where you train significantly impacts your take-home pay. Programs in high-cost cities like NYC or San Francisco often offer higher base salaries (e.g., $67,000 or more), but steep housing and living expenses may offset any perceived financial advantage. In contrast, programs in cities like Memphis may offer salaries closer to $56,000, but your money may stretch further with lower rent and living costs.
With each passing year, most residents receive incremental salary bumps—typically ranging from $1,500 to $2,500 annually. While these increases reflect growing responsibility and clinical independence, they don’t always keep pace with rising costs or lifestyle demands.
While most salaries are tied to PGY rather than specialty, surgical and procedural specialties may offer slightly higher stipends due to increased hours or funding models. Military residencies, funded fellowships, and certain public service programs may also have alternative compensation structures.\
Academic centers and teaching hospitals—especially those with strong resident unions—often provide more competitive salaries, childcare assistance, and contractually guaranteed benefits. At smaller or non-unionized hospitals, raises may barely outpace inflation. The presence (or absence) of a union can affect everything from stipends to parental leave policies.
Salary isn’t just about your paycheck. Some programs offer bonuses for relocation, sign-on incentives, CME allowances, subsidized meals, housing assistance, or scrubs and pager stipends. These non-salary perks can materially affect your quality of life during training.
The bottom line is that a residency salary is rarely just a single figure. It’s shaped by locality, specialty, institution, benefits, and where you are on your training path. Understanding these variables equips you to plan ahead, advocate for what you need, and approach this next chapter with greater confidence.
For residents trying to stretch a limited salary, moonlighting—taking on paid work outside of your residency training—can seem like an appealing way to boost income. Whether it’s to chip away at student loans, build financial security, or simply afford some breathing room, moonlighting offers both opportunity and complexity.
Not every residency program allows moonlighting, and those that do typically set firm guardrails. Many institutions require residents to be in good academic standing and often restrict moonlighting to those in PGY-2 or above. Programs may also require written permission from your program director. Most importantly, moonlighting must comply with ACGME work-hour limits, which cap total weekly hours at 80, including all clinical duties and moonlighting shifts. Violating this limit can put both your training and your program’s accreditation at risk.
Moonlighting comes in two primary forms:
Telemedicine, in particular, is growing in popularity among residents looking for flexible, remote work options that better fit their schedules.
Moonlighting doesn’t just pad your bank account; it can also enhance your clinical confidence and efficiency. Working in new environments exposes you to different workflows, patient populations, and clinical responsibilities. This can accelerate your transition to independent practice, making you more adaptable and resourceful. For many, the financial benefits are tangible, allowing for faster loan repayment, emergency fund building, or reduced financial stress.
Still, moonlighting isn’t for everyone. Residency already demands long hours, emotional endurance, and constant learning, and adding extra shifts can tip the balance toward burnout. It’s important to assess whether the additional workload supports your goals or stretches you too thin. Pay attention to signs of fatigue or stress, and prioritize your well-being just as much as your paycheck. Open conversations with program leadership and trusted mentors can help guide your decision.
If you find yourself overwhelmed, remember that support is available. OnlineMedEd’s partnership with Rula Mental Health through ClubMedEd offers free access to personalized mental health care designed for the unique pressures of medical training. Whether you’re managing anxiety, stress, or just need someone to talk to, Rula creates a safe space to strengthen your resilience, so you can continue showing up as the clinician you aim to become.
Ultimately, moonlighting is a personal and professional decision. Done thoughtfully, it can be an empowering way to ease financial pressure while expanding your clinical exposure. But it requires careful planning, boundary-setting, and a clear understanding of institutional policies. Residency is a demanding chapter, but your well-being and long-term success should always come first.
Residency is a time of transformation, but it can also come with a ton of financial pressure. The long hours and intense demands of training don’t leave much space for personal finance deep-dives, but simple, mindful budgeting can make all the difference. Here are some actionable ways that you can make the most of each dollar and reclaim a sense of control over your financial life:
With just a little structure, your budget can become one more skill you master in this demanding phase of training. Plus, OnlineMedEd’s Residency Prep resources offer real-world tools and guidance to help you think holistically, not just clinically. From time management and communication tips to leadership strategies, this bundle helps residents build a well-rounded foundation, both inside and outside the hospital.
Residency is a time of profound professional growth, but it also comes with real financial challenges that require intention, planning, and self-awareness. While salaries may not reflect the full weight of your contributions, understanding how compensation works—and how to stretch it—can empower you to make thoughtful decisions that support your well-being and long-term goals. From evaluating moonlighting opportunities to building better budgeting habits with ClubMedEd’s free financial tools, you have everything you need to thrive during your residency. With knowledge and resilience, you can meet residency demands while laying the groundwork for a healthier financial future.
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Student loans weigh heavily on most residents’ financial outlook. With average debt often exceeding $200,000, the typical residency salary—while steady—is rarely enough to comfortably cover living expenses, loan payments, and personal needs. That’s why many residents rely on income-driven repayment plans or explore loan deferment options during training. It’s not easy, but it is manageable. With a realistic budget, supportive mentors, and access to free resources like ClubMedEd, you can stay on track and avoid financial burnout.
Yes, and they can make a real difference. Some hospitals offer loan repayment support, relocation stipends, or sign-on bonuses. On a national scale, programs like Public Service Loan Forgiveness (PSLF) provide long-term relief for physicians in qualifying roles. States may also offer loan repayment incentives for working in underserved areas. Be proactive! Don’t be afraid to ask your GME office or look into state-level opportunities.
Geography matters—sometimes a lot. While urban programs in places like New York City or San Francisco may offer higher salaries, the cost of living can offset those gains. In contrast, residents in smaller cities or rural areas often earn less nominally but may stretch their salary further thanks to lower housing and living expenses. Don’t just look at the paycheck; evaluate how far it goes in the context of your lifestyle and financial goals.
There’s no universal pay scale for residency. Each institution sets its own salary, typically based on PGY level. Most PGY-1 residents earn between $58,000 and $70,000 annually, with small increases each year. While base pay is fairly consistent nationwide, the real variation comes from benefits, institutional perks, and the local economy—factors that can greatly influence quality of life.
In most cases, no. Residency programs follow ACGME work hour guidelines, which cap weekly hours but don’t come with traditional overtime pay. Instead, residents receive a fixed annual salary, regardless of fluctuations in workload. Some institutions offer additional stipends for moonlighting or intense rotations, but “time and a half” is not part of the equation. The hours are demanding—your compensation simply reflects the role, not the clock.
Direct salary negotiation is rare. Resident pay is typically set by GME offices and, in unionized programs, by contract. However, there’s room to ask about fringe benefits like relocation assistance, housing stipends, or educational funds. These extras can have a meaningful impact on your financial well-being. When comparing programs, look at the full package—not just the base salary—and don’t hesitate to ask thoughtful questions before signing on.