Residency and fellowship represent consecutive stages of physician training, each with distinct responsibilities, compensation structures, and career implications.
You've matched into residency. You've survived the 80-hour weeks, the overnight calls, an intensive period of clinical training. Now you're considering fellowship - another one to three years of training before you can finally practice independently.
The question is inevitable: A common question is how compensation changes between residency and fellowship.
The short answer: Yes, fellows generally earn more than residents - but the gap is smaller than you might expect, and it varies significantly by program, location, and specialty.
Some fellows earn just a few thousand dollars more than senior residents. Others - particularly in high-demand specialties at unionized programs - see jumps of $20,000 or more . And in some cases, fellows actually earn less than residents when you factor in the lost opportunity cost of attending-level pay.
This 2025 guide breaks down the real differences between resident and fellow salaries. We'll look at actual program data, analyze the factors that determine pay, and help you understand whether a fellowship makes financial sense for you.
The Biggest Gap Is Not Resident vs Fellow It’s Fellow vs Attending. While fellows typically earn more than residents, the difference is relatively modest. The more significant financial gap occurs between fellowship and attending-level income, where earnings may increase by several hundred thousand dollars annually. Understanding this distinction is essential when evaluating whether additional training is financially worthwhile.
The National Snapshot - How Much Do Residents and Fellows Earn?
National Salary Overview
Let's start with the broad averages. According to Medscape's 2025 Resident Salary and Debt Report, the average resident earns around $75,000 annually . Primary care medical fellows average slightly higher at $75,943 .
But these averages mask enormous variation. A PGY-4 fellow at Stanford earns $113,276 , while a PGY-4 resident at MUSC makes $69,299 - a difference of nearly $44,000 for the same year of training.
| Training Level | Average Annual Salary | Typical Range |
|---|---|---|
| Resident (All Years) | $75,000 | $62,000 – $91,000 |
| Fellow (All Years) | $75,943 – $80,173 | $66,000 – $124,000+ |
Key Insight: At the national level, the difference between resident and fellow pay is relatively modest - often just $1,000–5,000. But at specific programs, especially in high-cost areas or unionized settings, the gap can be substantial.
Real Program Data - What Actual Fellows Earn
Let's look at real 2025-2026 salary data from programs across the country.
Stanford Medicine (Infectious Diseases)
| Level | 2025-2026 Salary |
|---|---|
| PGY-4 Fellow | $113,276.80 |
| PGY-5 Fellow | $119,558.40 |
| PGY-6 Fellow | $124,280.00 |
Stanford's fellows earn salaries that are notably higher than typical fellowship salaries - and they come with a comprehensive benefits package:
- Moving allowance: $3,500 (new hires moving >50 miles)
- Cell phone allowance: $1,000/year
- Housing stipend: $12,000/year (included in base rate)
- Meal allowance: $2,000/year
- Educational allowance: $2,000/year
- Laptop computer provided
- All licensing fees covered
Mount Sinai (Child Psychiatry)
| Level | 2025-2026 Salary |
|---|---|
| PGY-4 Fellow | $102,224 |
| PGY-5 Fellow | $106,312 |
| PGY-6 Fellow | $110,565 |
Source:
Mount Sinai's fellows also receive:
- $750 annual educational allowance
- $1,200 meal stipend
- 4 weeks vacation
- On-site daycare center
National Fellow Salary Data (Salary.com)
| Percentile | Annual Salary |
|---|---|
| 90th Percentile | $91,112 |
| 75th Percentile | $85,899 |
| Average | $80,173 |
| 25th Percentile | $72,591 |
| 10th Percentile | $65,688 |
Source:
Fellow Salary by Experience Level
Interestingly, fellow salaries continue to grow within fellowship:
| Experience Level | Average Salary |
|---|---|
| Entry-Level (<1 year) | $79,172 |
| Early Career (1-2 years) | $79,480 |
| Mid-Level (2-4 years) | $80,506 |
| Senior-Level (5-8 years) | $81,737 |
| Expert (8+ years) | $83,249 |
Source:
Salary Growth During Fellowship: Over the course of a 3-year fellowship, salaries typically increase by about $4,000–5,000 - modest but consistent.
Real Program Data - What Actual Residents Earn
For comparison, here are resident salaries from the same institutions and others.
University of Arizona College of Medicine – Phoenix
| Level | AY 2025-2026 Salary |
|---|---|
| PGY-1 | $66,500 |
| PGY-2 | $69,000 |
| PGY-3 | $72,000 |
| PGY-4 | $76,000 |
| PGY-5 | $79,750 |
| PGY-6 | $83,750 |
| PGY-7 | $89,750 |
| PGY-8 | $91,500 |
Source: phoenixmed.arizona.edu
UC San Diego (OB/GYN)
| Level | AY 2025-2026 Salary |
|---|---|
| PGY-1 | $91,211 |
| PGY-2 | $93,829 |
| PGY-3 | $97,035 |
| PGY-4 | $100,382 |
Source: obgyn.ucsd.edu
Note: UCSD's salaries are notably high - a PGY-1 there earns more than many fellows nationwide. This highlights the impact of location and institutional factors on compensation.
Direct Comparison: Resident vs Fellow Pay
Same Institution, Different Pay
When you compare residents and fellows at the same institution, the pattern becomes clear:
| Institution | PGY-4 Resident | PGY-4 Fellow | Difference |
|---|---|---|---|
| Arizona | $76,000 | $83,750 (PGY-6) | +$7,750 |
| UCSD | $100,382 | — | — |
| Stanford | — | $113,276 | — |
Sources: phoenixmed.arizona.edu, med.stanford.edu, obgyn.ucsd.edu
National Average Difference
| Level | Average Salary | Range |
|---|---|---|
| Resident (PGY-3) | ~$72,000 | $66,000 – $97,000 |
| Fellow (PGY-4) | ~$80,000 | $72,000 – $113,000 |
| Typical Gap | ~$8,000 | $0 – $20,000+ |
High-End Compensation Example: Stanford - Why Some Fellows Earn So Much
Stanford's fellow salaries - $113,276 for PGY-4 - stand out as exceptional. Contributing Factors:
Factors That Boost Fellow Pay
| Factor | Impact |
|---|---|
| Unionization | Stanford's fellows are covered by CIR/SEIU contracts, which negotiate aggressive raises |
| Cost of living | Bay Area housing costs force higher base salaries |
| Institutional funding | Some departments have more resources |
| Specialty demand | Infectious diseases fellows are highly trained specialists |
| Housing stipends | Stanford includes $12,000/year in base pay, effectively raising the salary |
The Housing Stipend Effect
Stanford's $12,000 housing stipend is included in the base salary figures above, meaning those numbers reflect total compensation including the stipend. Without it, base pay would be lower - but the total package remains exceptionally strong .
Beyond Base Salary - The Benefits Breakdown
Fellows often receive benefits packages that rival or exceed residents', adding thousands to total compensation.
Stanford Medicine Fellows Benefits
| Benefit | Value |
|---|---|
| Moving allowance | $3,500 (one-time) |
| Cell phone allowance | $1,000/year |
| Housing stipend | $12,000/year |
| Meal allowance | $2,000/year |
| Educational allowance | $2,000/year |
| Laptop | Provided |
| Licensing fees | Covered |
| Insurance | Medical, dental, vision, LTD |
Source: med.stanford.edu
Mount Sinai Fellows Benefits
| Benefit | Value |
|---|---|
| Educational allowance | $750/year |
| Meal stipend | $1,200/year |
| Vacation | 4 weeks |
| Day care | On-site, fee-based |
| Malpractice | Covered |
| Wellness | Quarterly wellness days, free psychotherapy |
| Perks | Discounted Broadway tickets, sports events |
Source: icahn.mssm.edu
Total Compensation: Salary + Benefits
When benefits are factored in, the gap between residents and fellows may increase:
| Institution | Base Salary | Benefits Value | Total Package |
|---|---|---|---|
| Stanford Fellow (PGY-4) | $113,276 | $10,000+ | $123,000+ |
| Typical Resident (PGY-4) | $76,000 – $100,000 | $5,000–10,000 | $81,000 – $110,000 |
Opportunity Cost of Fellowship
While fellows earn more than residents, they earn far less than attending physicians. This creates a significant opportunity cost.
The Attending Differential
| Specialty | Attending Starting Salary | Fellow Salary | Annual Gap |
|---|---|---|---|
| Family Medicine | $273,000 | $75,943 | $197,057 |
| Cardiology | $500,000+ | $80,000 | $420,000+ |
| Gastroenterology | $450,000+ | $80,000 | $370,000+ |
Source: sofi.com
Example Financial Comparison
| Scenario | Year 1 | Year 2 | Year 3 | Total "Loss" |
|---|---|---|---|---|
| Fellow (Primary Care) | $76,000 | $78,000 | $80,000 | $234,000 |
| Attending (Primary Care) | $273,000 | $280,000 | $287,000 | $840,000 |
| Difference | -$197,000 | -$202,000 | -$207,000 | -$606,000 |
A primary care fellow may forgo approximately $600,000 in earnings in earnings over three years compared to entering practice immediately. For specialists, the number is dramatically higher.
Break-Even Timeline
| Scenario | Break-Even Point |
|---|---|
| Primary Care | 2-3 years post-fellowship |
| Specialty (Cards, GI) | 3-5 years post-fellowship |
| Surgical Subspecialty | 5-7 years post-fellowship |
The higher your specialty's earning potential, the longer it takes to recoup fellowship losses, but also the higher your long-term ceiling.
👉Compensation Models
The Financial Reality - Why It Matters
The Debt Burden
The average medical school graduate carries $264,519 in student debt (including undergraduate loans) . 73% of medical school graduates have some form of education debt .
For fellows, this debt continues to accrue interest during training. A fellow earning $75,943 with $264,519 in loans at 6% interest faces:
- Monthly loan payment (standard 10-year): $2,937
- Monthly take-home pay (after taxes): ~$4,500
- Remaining for living expenses: ~$1,500
this creates financial constraints for many trainees without income-driven repayment plans, loan forgiveness programs, or outside support.
Survey Insights on Resident and Fellow Compensation
According to Medscape's 2025 survey:
| Statistic | Percentage |
|---|---|
| Feel compensation doesn't meet cost of living | 58% |
| Believe they need at least 26% raise | 70% |
| Believe they need 51%+ raise | 35% |
| Say salary doesn't cover expenses + loan payments | ~60% |
"The cost of living in the United States has really skyrocketed over the past five years." - David Shumway, DO, internal medicine resident
"We already ask residents to make huge sacrifices in terms of giving some of the most productive years of their lives to the study of medicine, making it difficult to maintain a life or start a family. Having enough money to meet basic needs, student loan payments and build a savings fund to cover unexpected expenses is a powerful protective factor for resident well-being, successful program completion and continual regeneration of the future of medicine." - David Shumway, DO
Financial Planning During Fellowship
For those pursuing fellowship, financial survival requires strategy.
Practical Financial Strategies
| Tip | Strategy |
|---|---|
| 1. Make a budget | Track fixed and variable expenses; ensure expenses ≤ income |
| 2. Live within your means | Avoid credit card debt—it's the most expensive kind |
| 3. Choose housing carefully | Consider roommates, proximity to work |
| 4. Delay car purchases | Use public transit or buy used |
| 5. Save on food | Take free meals at work, cook in batches, buy generic |
| 6. Use rewards points | Travel credit cards for vacation discounts |
| 7. Use income-driven repayment | Pause or reduce federal loan payments |
| 8. Try to save | Emergency fund first, then retirement (compound returns!) |
| 9. Consider passive income | Rent a room, rent your car |
| 10. Refinance carefully | Lower payments but lose federal protections |
Loan Strategies for Fellows
| Option | Best For | Trade-off |
|---|---|---|
| Income-Driven Repayment | Federal loan borrowers | Payments based on income, forgiveness after 20-25 years |
| Deferment/Forbearance | Those who can't pay | Interest may accrue |
| PSLF | Non-profit hospital employees | Forgiveness after 10 years |
| Refinancing | High-interest private loans | Lose federal protections |
Source: sofi.com
Is Fellowship Financially Worth It?
When Fellowship May Be Worthwhile
| Scenario | Verdict |
|---|---|
| You need subspecialty for career goals | Worth it |
| Your desired job requires fellowship | Non-negotiable |
| You're passionate about a niche field | Worth it |
| You want academic medicine | Usually required |
| You're burned out and want more training | Consider carefully |
When Fellowship May Require Careful Consideration
| Scenario | Verdict |
|---|---|
| You're doing it just for money | Math rarely works |
| You're already in debt and struggling | Weigh carefully |
| You could enter practice now in a field you'd enjoy | Consider skipping |
Key Takeaways
Fellows generally earn more than residents - about $5,000–10,000 more on average, with top fellows at elite programs earning $113,000+.
But the real cost of fellowship isn't the salary difference between resident and fellow - it's the difference between fellow and attending. This gap can exceed $200,000 annually depending on specialty, adding up to $600,000 or more in foregone earnings over a typical fellowship .
Whether that trade-off is worth it depends entirely on you.
| Factor | Consideration |
|---|---|
| Your specialty | High-earning fields make the math harder |
| Your debt | Higher debt makes extra years harder |
| Your career goals | Some doors only open with fellowship |
| Your passion | If you love it, the math matters less |
These insights can support informed decisions about training and long-term career planning.
About This Analysis
This article is based on data from Medscape Resident Salary Reports, Salary.com, institutional salary disclosures, and healthcare workforce studies. The objective is to provide a structured comparison of resident and fellow compensation by combining salary benchmarks, benefits, and long-term financial considerations. All figures are estimates and may vary by program, specialty, and location.
Written by: MedSalaryData Editorial Team
Healthcare Salary & Career Analysis
Additional Resources
| Resource | Purpose |
|---|---|
| ACGME | Accreditation requirements |
| AAMC FIRST | Financial planning tools |
| White Coat Investor | Physician finance education |
| StudentAid.gov | Loan repayment options |
Disclaimer: Salary data are for the 2025-2026 academic year based on official program publications. Individual offers vary significantly by program, geography, and specialty. This information is for career planning purposes only and does not constitute financial advice.
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