Medical Resident Paid Salary
One question med students have is the average salary for a resident physician After a physician graduates from medical school, they move on to an internship or residency within their specialty. Then earn. But for most of them, it’s simply not even remotely enough for the work that they’re doing. So, it’s common for residents to work 70- or 80-hour weeks.
The average Medical Resident Paid Salary in the United States is around $63,000. Maybe you’re a resident right now, thinking, I don’t even make close to that, or maybe I make more. This rate is average across all specialties. Some specialties will make a little bit more than others, and you can check the Bureau of Labor Statistics for detailed salary data by specialty.
Leverage in Salary Negotiation
Some could be as high as the 60s. Whereas in family medicine, you could be about 50s. Can residents negotiate their salary during training? No, they have no leverage. Anytime you’re negotiating a contract, you base it upon leverage. You can learn more about physician compensation models to understand the varying salary structures that can be in place.
Even those residents coming out of training and moving on to their first employed job don’t have much leverage. Their only influence in those situations is if they’re in a needed medical specialty. Or two if they want to go to an underserved geographic area and need physicians. The American Medical Association (AMA) often publishes information on needed medical specialties and underserved areas.
So, around 63,000 is the medical residency salary. If you think of it this way, if they work 70 to 80 hours a week, they make about $15 hourly and provide care as a doctor for $15 an hour. Now, once they move out of training, their salary increases substantially. And for some specialties could be an eight-fold increase, at least just coming out.
But that’s what it is. That’s one consideration when reviewing and negotiating the resident’s or fellow’s first contract. Most of them don’t have much money coming out of training.
Importance of Relocation Assistance
So, the new employer is offering a signing bonus or relocation assistance. In that case, we want to ensure they get a chunk of that before moving and starting the new job. Wherever, if they are moving from where they’re currently training. Most residents, especially if they have family, maybe the only breadwinner. At that point, they don’t have $10,000 to $15,000 if they’re making a cross-country move. So, we need to ensure that the employers pay their moving costs directly to the moving company. Or they’ll front the money before the physician needs to spend it on the move.
That way, they don’t have to outlay a ton of cash. Because it certainly is expensive moving from one place to an entirely different one. Medical residents certainly are underpaid. Unfortunately, it’s part of the process they must go through to be fairly compensated for their services. But it’s just tough when you’re making that little. And I think the average physician has about. I think 47% of physicians have student loans over $200,000, according to a study by the Association of American Medical Colleges. It could be a significant burden.
When Should a Resident Receive a Signing Bonus?
When should medical residents receive a signing bonus?
The timing of it is essential. When medical residents finish training, they have likely already signed an employment contract. More importantly, when negotiating the contract, usually in their early PGY-3 year, some PGY-2. When receiving the signing bonus is crucial for a couple of factors.
One, physicians in residency don’t make much money. Say they’re training in New York and get a job in California. Moving across the country could be a substantial amount of money, depending on their family size.
Almost every employer someone signs with as a resident will offer relocation assistance—usually between $5,000 to $15,000. You won’t see above $15,000 as far as relocation assistance goes. Somewhere along there, they should pay for the entire amount, to be honest. And some people moving a short distance can also use the relocation assistance money for traveling back to the city. To look for an apartment or a home.
So, airline lodging, all that kind of stuff. Some people could use that money for a security deposit or maybe the first couple of months’ rent. Most employers are flexible in how the physician uses that money. But they want it to be housing-related or relocation-related in some manner.
Negotiate to Get the Amount of the Signing Bonus You Need
Now, the timing of when you earn is important. Usually, the physician will receive different offer bonuses. As I said, one would be relocation assistance between 5,000 and 15,000. And also, a signing bonus is usually paid out during their first resident pay period. Whenever they get paid first after they start with the employer, that’s when they would receive the bonus.
There’s a different way of doing it. Employers often say unless it’s a big hospital network that has established relationships with moving companies. Let’s say you’re running a private medical practice. They’ll say, pay your moving expenses, submit us the receipts, and then we’ll reimburse you. Well, for some people, outlying $10,000 to $15,000 to move is difficult. As I said, you’re not a wealthy doctor when you’re still in training.
So, we assess the situation for the physician and determine if it is helpful if you get this before moving. How soon before you complete training do you need the money? We can say to the employer, “Hey, look. It will help us defray the cost of the move if we receive this before moving.” Or, more importantly, maybe the employer would be willing to pay the amount directly to the moving company. That way, the physician has no cash outlay, which is the entire point.
The signing bonus also. The timing of when the employer pays it can be essential as well. Depending upon the size of the signing bonus, we would like half upon execution of the agreement.
Discuss Resident Physician Repayment Obligations
So, when you sign the actual agreement, and both parties sign it, that’s called the execution of the contract. Many times, we could say we’ll get half upon signing. And then the other half when they start. Both bonuses will have a repayment obligation tied to them. At least, it usually would. This means that let’s say, the physician has an initial two-year term.
The employer states that you’ll owe us a prorated portion of the bonuses if you leave before the initial two-year term. It could be quarterly forgiveness, monthly forgiveness, or yearly forgiveness. Let’s say someone has a $30,000 signing bonus. They say half of it is forgiven after the first year. And the other half is dismissed after the second year.
So, if the physician left between the first and second year, they owe back $15,000. So, the employer is insulated from the physician simply taking the bonuses early. And they were then splitting out on the job by signing the agreement in advance. There’ll be language about the repayment obligations if the employer expresses concerns. Or maybe they don’t utilize that. That would be a good way of saying, look, if you’re concerned about me, take the money, and leave.
Then let’s put in these repayment obligations; therefore, you’re protected if I leave. And I benefit by getting the money in advance.
So, that’s a discussion of when the physician in residency should receive the signing bonus or relocation assistance. It’s just dependent upon the situation for some people. It’s fine receiving it after the fact. But for others, having it upfront is essential—just some things to decide.
Contract Negotiation Tips for Resident Physicians
Today I will talk about contract negotiation tips for resident physicians. An actual employment contract, not a resident agreement, is something that no resident has much knowledge of in my experience. A large percentage of my contract reviews are with residents or fellows just coming out of training. They have this 20-page contract.
They have no idea what should or shouldn’t be in it. Or what the terms are. That’s a large majority of people that contact me. We just kind of work through, okay, what is in here? What also comes up is, well, what is the strategy behind negotiating a resident’s first employment agreement?
What to Expect for Residency Salary
I wish I could give a one-size-fits-all analysis, but I can’t, so we will work our way through it.
First, any negotiation is based on leverage. Does a physician have leverage or not? And this goes for any talks. The individual or entity with the most influence can get better contract terms. In some specialties, a physician without training doesn’t have leverage.
Those specialties would be any medical specialty where one must build a patient base. Primary care, peds cardiology, dermatology, anything where you’re not just doing shift work in the hospital, or maybe some surgery.
If you’re not from the area, you have no ties to the area. You have no existing patient base. There’s not much value you provide to the practice as if you were. Let’s say you were an established physician in the area. Then you have an established patient base and a referral network moving to a new practice. You have much more leverage because you’re bringing in a large patient base.
Suppose you’re in a medical specialty and must build it up to practice. Usually, that takes 12 to 18 months. That means you won’t be that profitable in year one. You don’t have as much leverage to get the type of contract you may want.
Now, that doesn’t mean you don’t have any leverage. Some practices have an absolute need for a new physician. And the reason why that would be is one, there are just volumes that are so high, they need help. Or two, they could be in a location that’s hard to staff.
Consider the Location
Rural communities always need help with staff. The weather also affects that.
If you’re moving into a hard-to-recruit community, you have more leverage immediately. One misconception is that the salary doesn’t usually reflect that of physicians moving into high-cost living areas. I’ll use my hometown, Scottsdale, Arizona, as an example. Scottsdale is a very desirable place to live. It’s a great suburb of Phoenix. The weather is excellent, and many people want to live here.
Because of that, the salaries are depressed a little bit, simply because more people want to live here. The same goes for California, San Diego, and LA, like Miami and Florida’s warmer climate locations. They have more competition amongst physicians for those jobs, giving you less leverage.
Reply Appropriately to Contracts With Facts
Here are some tips on how to get beyond that.
One, you need to talk to your classmates, those in your residency, maybe those in fellowship. What do your job offers look like, and what are they offering you? What’s your base salary, signing bonus, and benefits? Lastly, what’s the productivity compensation down the line? Get in there and compare offers from the other people in your residency program. This data gives you a better idea of employers’ average base salary.
Two, if it is a difficult site to recruit, you must let them know you understand. And say, I’m not trying to be a jerk, but I don’t necessarily have to live here. I have no family here, no community ties. It’s remote. Because of those things, I would expect to make more.
You can attempt to Google some of the industry-standard compensation surveys. The MGMA and some of that data are not available to the public. But you’ll usually find a couple of years old, giving you a better indication that this is normal. Now, the comp in there, the comp averages, and those surveys are averages. So, it’s not just residents. People are coming on training too. It can be people that have been out for 20 years. You need to take that into account as well.
Other Ways to Get More Leverage
A great interview, coming off as an average person, and being easy to work with, are things that make someone desirable too. If I’m hiring somebody in my law firm, it’s someone I think is easy to work with. If the culture can adapt, I’m much more likely to offer them more than I would. Or if someone is kind of super Hi-Q, maybe super-strong academically with writing skills. But a little more socially awkward. Most places don’t want that. They want someone who will be easy to work with and culturally fit. Those are some tips on how to negotiate a resident contract.
How Much Are Fellowship Physician Salaries?
What is the average salary for a physician in a fellowship?
At the basic level, after a physician graduates from medical school, they enter an internship and then a residency program in their medical specialty. And some specialties require extra training. That’s what’s called a fellowship. Depending on the specialty, most fellowships last between one and three years. After that, they can move on and have an employment relationship where they can practice in their medical specialty.
Average Physician Resident and Fellowship Salary
Is there a huge difference between residents’ and fellowship salaries? The answer is no. There isn’t.
The average resident salary they can earn is around 63,000 a year. Now, that’s the average. So, there will be some lower than that and some higher. It’s specialty-dependent.
The average for family medicine, the physician training in the residency, makes around 51,000, and some surgical specialties can be in the high 60s. But you logically would think, alright, if I’m going to get through residency and move on to my fellowship, I’ll make more money. And the answer is not really.
The average fellowship salary is about the same as the average resident salary. Now, the fellowships, anyone who must move into a fellowship is on the higher end of a specialty. So, if the range is between 50 to 70, they’ll be higher towards the 70 range. But there will not be a significant jump between the money people make as residents and the money they earn as fellows.
Moving Expenses and Bonuses
Here’s one word of advice if you are coming out of a residency or fellowship. When you have a new job offer after you finish your PGY-3 or your fellowship, people in training are not flush with cash. And so, almost any employer will offer the physician a signing bonus, relocation assistance, or both.
But most of them will have language in the contract that states they will either reimburse the physician once they start or offer the signing bonus with their first paycheck after they’ve begun providing care. That can burden some physicians who don’t have $10,000 to $15,000 to move.
A Physician’s Contract Must Have This Written in Their Agreement
Suppose a physician has a family and they’re living in New York. If they get a job in California, it can easily be $15,000, and sometimes paying that out of pocket at the beginning can be an enormous financial burden.
So it would be best if you made sure that any of these languages are in your contract:
- Your contract will state that the employer will pay the moving expenses directly to the moving company before the move.
- You will get that money before moving so that you can use that for the moving expenses.
- You can use a portion of the signing bonus to do that.
- And then most contracts will have language that states that if the physician leaves within the initial term, they’ll have to pay back a prorated amount of those bonuses, which I think is fair.
If they outlay, they’ll get the cash upfront. They certainly don’t want a physician to leave after a few months and take all the bonuses with them. A physician in fellowship is around mid $60,000. 47% of physicians have over $200,000 in student loan debt. And then, if you think they’re working 70 to 80 hours a week, which some of them are, it works out to be like $15 an hour, which is tough to support a family at that point.
How Should a Resident Physician Look for a Job?
How should resident physicians look for a job? What steps should they take to find the position they desire?
The timing certainly is important. Most physicians generally start looking for positions early in their PGY-3 year. Some specialties will even sign contracts in their PGY-2 year if they’re not going into fellowship.
If a physician is moving from residency into fellowship, they usually won’t start looking until the end of their last year of residency, or maybe it’s a multiple-year fellowship. Maybe at the beginning of the last year of their fellowship as well. There are several ways medical doctors can find jobs.
How Physicians in Residency Can Look for a Job
The easiest way I’ve found is through colleagues. If you’ve trained with somebody, they’ll usually have information about a place that is recruiting. Or maybe they joined a practice. And they say it’s a great environment that we’re looking to add another physician in a specialty. Perhaps you should look at it. That can vary wildly in location, and location is crucial to some while not necessary to others.
So, it can go all over the place if you get leads from fellow residents or fellows. One way is to talk to colleagues, mentors, or others you’ve met in training. And that’s also a great way of determining the market value at the time. The MGMA data is like an annual physician compensation survey across the nations broken up into geography, specialty, and physician-owned versus hospital-based physicians. In some specialties, the sample size is so tiny.
I don’t think it’s a great tool. Other specialties can usually be a pretty good gauge if there are hundreds and hundreds of responses. I don’t think any physician should base a job search solely on compensation. I think that’s shortsighted. Anyone coming out of training needs to be in an environment where they can learn. Or they’ll have mentors with whom they’ll feel safe and have an opportunity to grow.
I often see it, especially in rural environments, where they need a specialty. They’re willing to throw a bunch of cash at somebody. But they’ll be the only ones in their specialty out there. Like there’ll be no others, no one to learn from, train with, or pick someone’s brain, at least locally. Those scenarios are challenging. Some medical doctors can thrive in that environment, but it’s more complicated for others. So, I think they need to consider that.
Physician Employment Recruiters
Any physician contract is going to have without-cause termination. If a physician is unhappy in their practice, they usually provide 60- or 90-day notice. And they can move on. Even if you’re in a job initially, you’re not stuck there forever. You can find something better. I mean, I see a lot of physicians coming out of residency or fellowship will take the first job. And then they’d say, alright, now I know what I don’t want. So they can look for work more appropriate to the practice they prefer.
Another way is through physician recruiters, which have two types. You have in-house recruiters. Many big hospital networks employ physician recruiters who attend different residency programs. Maybe there’s a job fair, something like that. Or they’ll specifically reach out to people in training, saying, hey, I have this opportunity in this place. Would you be interested? They’re free to physicians. You do not have to pay the recruiter or anything. The employer is the one that pays the recruitment fees.
So, physician recruiters. Both in-house and those that are just private groups where they go out and broker these deals. Typically, they would get a percentage of the first-year salary of the physician or a flat fee—something like that.
But there’s no harm in discussing positions with recruiters. It’s a usual way of doing business nowadays. They usually have their ear to the ground and have information on many different opportunities that could be exciting for physicians.
Physician Job Search
Another way is if you have a specific region in mind. It’s just doing job searches for practices in your specialty in a particular area. Most places will have job posts on regular job sites if they’re looking. Then you can search for those in the city you want, find that, and contact them from their work listing.
That’s another way. So, those are the three biggest ways. Word of mouth through colleagues, doing it through a physician recruiter, or searching in specific cities through job search websites. For those who are maybe J-1 or something like that, that’s an entirely different job search. And I can do a separate video about that. But this is more geared towards those seeking a regular position after training.
Can You Moonlight in Residency?
Can residents moonlight during residency? The short answer is that it depends on the program and the signed residency contract.
The assurance that most residents sign before starting into the residency program is unlike an employment agreement you will sign once you’re finished training and then earn your first job offer. It’s usually much shorter and doesn’t cover the usual terms an employment agreement will cover.
However, some language in that residency contract might state that you can only do outside activities with employer or program approval.
What Are the Requirements Needed for Moonlighting?
If you have language in your contract that states you must get approval to do any outside employment, that’s what you need to do. It would help if you had to get written authorization that says, yes, the medical program is okay with you doing this. And then you also consider several different things.
One, your professional liability insurance is not specific to you. It’s particular to the employer. So, suppose you’re working in a residency program. In that case, any activities you do in that program are covered by that insurance policy.
One policy doesn’t cover you in whatever you do. It would be best if you had a specific procedure for each employer. Now, if you are moonlighting, whoever you’re moonlighting for will cover your professional liability insurance. And then you also need to consider whether, once you leave the moonlighting position, they will pay for your tail insurance if there’s a claims-made policy. I have several blogs about claims-made coverage and tail insurance for medical practitioners.
Avenues for Moonlighting Based on Physician’s Position
I won’t get into it in this blog, but I would also consider it. The specialty is also essential. You’ll usually have a lot if you’re in a shift work type position like ED, hospitalist, or any IM position. You could do urgent care. There are a lot of different avenues for you to moonlight.
Same with surgeons. But most programs are okay if the resident does moonlight. If one, they ask for permission. Two, they ensure professional liability insurance at that new position. Then three, they don’t want any moonlighting to interfere with the resident’s schedule or duties with the program.
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