Lowest Paid Medical Residencies: What to Expect and How to Survive

The Truth Behind Medical Residency Salaries

Most people think doctors start raking in money the day they get their white coat. But here’s the shocker: medical residents are some of the most hardworking, underpaid folks in the hospital. Medical residency salary is basically a polite way of saying, “Congrats on your degree—now live like a broke college student, just with a lot less sleep.” The numbers don’t lie. According to the 2024 Medscape Residents Salary & Debt Report, the average annual residency salary in the U.S. is about $64,000. But that’s just the average. Some residents take home way less, and the reasons are frustratingly complicated.

The pay gap between specialties is real, and it’s not always based on workload or hours. For example, internal medicine, pediatrics, and family medicine consistently rank as the lowest paid residencies, hovering around $58,000-$60,000 a year. On the other end, some surgical and specialized residencies break the $70,000 mark. That might sound like a lot, until you realize many residents are working 60-80 hours a week, sometimes more, all while still repaying massive student loans and dealing with the cost-of-living in cities where rent is sky-high.

One of the most common questions med students have is, “Does the hospital or the specialty determine how much I’ll make?” It’s a little bit of both. Hospital budgets, funding type (private vs. public), location, and the specific specialty all play a part. Urban teaching hospitals, especially in places like New York City and California, often pay less than rural programs, even though city life is far more expensive. So not only do some residents make less—they often have to make it work in pricier environments.

Here’s the irony: the lowest paid specialties usually have the most direct patient care and are crucial for underserved populations. If you pick family medicine or pediatrics because you want to help people, you’re often rewarded by being at the bottom of the residency program salary ladder. The whole situation leaves a lot of future doctors scratching their heads, wondering if passion for the job is enough to weather three to five years of tight budgets and ramen dinners.

Did you know some residents actually moonlight (take extra medical shifts) just to make ends meet? That’s not a loophole, it’s a coping strategy, especially for those in low-paying primary care fields. But not every residency allows it, and some specialties leave you so exhausted there’s barely time for sleep, let alone another shift. The reality is, medical training is tough, and for the lowest paid residents, it’s basically a marathon where the water stations are sometimes empty.

Which Specialties Earn the Least in Residency?

If you ask around, there are always rumors—“Psych gets paid more,” “Surgery is best,” and so on. But hard data points to three clear losers in the pay race: family medicine, internal medicine, and pediatrics. They cut close on salary, with small variances depending on hospital and location, but year after year, they end up at the bottom.

Family medicine residents typically earn about $58,000 to $60,000 annually in the first postgraduate year. Internal medicine comes in at around the same mark, sometimes just a few hundred dollars higher. Pediatrics, despite the emotional intensity and long hours, doesn’t fare better—expect somewhere just under $60,000.

Check out this quick salary comparison table for 2024 first-year residents in the U.S.:

What about “prestige” specialties like dermatology or radiology? Oddly, their starting pay isn’t much higher during residency—it’s the attending salaries that skyrocket afterward. Residency pay is structured more by hospital policy and residency year (Post-Graduate Year, or PGY), so specialties requiring extra years might finish slightly higher but rarely make up for lower pay in early years.

Why do the lowest paid resident physician pay fields always seem to be the “people-focused” ones? A big chunk of it comes down to how Medicare funds hospitals and residency positions. Primary care programs usually receive less direct hospital revenue, so there’s less incentive (and cash) to pay residents more. Surgical programs can bill more for procedures—hence, more cash flowing in and (sometimes) more available for trainees.

This dynamic isn’t unique to the U.S., by the way. In Canada and parts of Europe, primary care residents also land near the bottom of the pay scale, though government health funding changes the equation a bit. The pattern sticks: if your work is holistic and low-margin, you get paid less during training.

Inside the Daily Life of Low-Paid Residents

Picture this: you’re up before dawn, snatching coffee from the hospital vending machine, hoping it’s not the flavorless sludge it usually is. Rounds start early, and you’ll barely have time to check your phone, let alone eat a real meal. Now, stack that kind of day 28 times a month, add a pile of student debt, and know you’ll get paid about as much as your college grad friends who work desk jobs.

Living on a medical residency salary means adapting to a lifestyle some call “functionally broke.” Residents learn to stretch every dollar. They track discounted grocery store days, split rent with roommates (sometimes cramming into tiny apartments just to save $200 a month), and scout for free lunch at every hospital lecture. A running joke among residents: the most important part of any medical conference is the buffet.

Here’s where it gets even more interesting (and, let’s be honest, frustrating): call shifts don’t come with massive overtime. Most residents are considered “exempt” from hourly wage laws, thanks to an old legal loophole that treats them as trainees, not employees. In real life, this means you’re paid a flat salary, whether you work 40 hours or 100. Ever wondered how long this has been going on? Since the early 20th century, when residency training first took root in teaching hospitals, this pay model hasn’t changed much. The 80-hour workweek limit (set by ACGME) is still the law—but ask any honest resident, and they’ll tell you there are weeks that edge above it.

Stepping out of the hospital doesn’t get you off the hook. Bills keep coming—student loans (sometimes $200,000 or more), car payments, rent, groceries, and let’s not forget the cost of keeping those white coats clean (hospital laundry services aren’t free, sadly). Those who manage without breaking down have a special cocktail of stubbornness, resourcefulness, and mutual support from fellow residents.

So why stick with these “lowest paid” specialties if the lifestyle is such a grind? Some say it’s because they want to make a difference. Others mention having a genuine love for the work, the patients, or the community. And, let’s be real, some landed in these specialties because they didn’t want to take on the competitive stress (and length) of more lucrative surgical residencies. When you see residents celebrating payday by treating themselves to $5 takeout, remember—they’re in it for the bigger picture.

How to Survive (and Even Thrive) on a Resident’s Salary

If you ask any low-paid resident their secret to surviving, you’ll usually get equal parts sarcasm (“Don’t buy anything ever again”) and surprisingly practical advice. The first rule? Budgeting is your life raft. Forget winging it—residents who last learn to create a spreadsheet for everything: groceries, utilities, gas, even coffee runs. Some use popular budgeting apps like You Need a Budget or Mint to keep every dollar accounted for.

One strategy that comes up a lot is living with multiple roommates. Sure, you’ll sacrifice privacy, but splitting rent three or four ways in a big city can free up hundreds each month. Many residents also swap cars for public transportation or bikes, which not only saves on parking and gas but can cut a chunk off your insurance bill, too. A lot of hospital systems throw in free or discounted transit passes—snag one if you can.

Want free food? Get involved with hospital committees, wellness events, or lunchtime lectures—they usually come with snacks or whole meals. It sounds silly, but when you’re counting pennies, a free plate of pasta can make your day. Some residency programs also quietly keep “resident pantries” or food banks stocked for those tough weeks.

Is it possible to side-hustle during residency? Yes, but it’s tricky. Some residents sign up for short online surveys, tutoring, or even freelance writing. A few squeeze out extra cash from moonlighting (once program rules allow it, usually in the second or third year). Just be sure you don’t violate your program’s policy—getting caught can mean big trouble.

For those with crushing student loans, look into income-driven repayment plans or public service loan forgiveness (PSLF). Primary care residents especially might qualify, as they often work in nonprofits or government-run hospitals. It won’t erase debt overnight, but it can keep payments manageable while you work toward eventual loan forgiveness.

Here’s a tip you won’t find in official brochures: buddy up with senior residents. They’ve seen it all—cheap rental tricks, best grocery deals, which departments share leftover conference food, how to stretch a scrubs allowance. Don’t try to reinvent the wheel; learn from those who survived before you and build your own mini support crew. Residency is all about teamwork anyway—why not use it for your wallet, too?

Does Low Pay in Residency Really Matter in the Long Run?

If you’ve read this far, you’re probably wondering whether all this penny-pinching actually pays off down the line. The answer is: it depends on what you mean by "pay off." After residency, salaries jump. New attendings in internal medicine might start at $200,000 a year or more, with family medicine and pediatrics close behind. The “low pay” years don’t last forever, but they can be tough enough to shade your whole outlook on medicine if you’re not prepared.

Low residency pay has real consequences. It drives some talented doctors away from crucial fields like primary care and rural health, where doctors are needed most. It can delay life milestones—buying a house, saving for kids’ education, even taking vacations. And for some, the stress of scraping by adds another layer to an already intense training period, risking burnout before they even finish. There’s growing talk about raising resident salaries, but change, as usual, is slow and tangled in bureaucracy.

But here’s the thing: every seasoned doc will tell you those years, tough as they are, teach you creativity, grit, and a kind of street smarts money can’t buy. That desperate coffee at 4 am during a night shift, the high-fives after surviving a rough week, and the joy of actually making a difference for a struggling patient—those are the moments that stick around way after paychecks start to climb. And when you look back, you realize working a lowest paid residency did more than just pay the bills; it built the foundation for the kind of doctor—and person—you’ll become.