You have matched into residency, signed a hospital contract, and started planning rent, loan payments, and moving costs. Then a basic question suddenly feels urgent: do you get paid during residency, or is it another period of unpaid medical training?
In the United States, the answer is generally yes. Medical residents are paid employees of the hospital, health system, or university sponsoring their training. They receive a salary, often called a stipend, along with employment benefits. However, the amount, deductions, leave policies, and opportunities to earn additional income vary considerably by institution.
How much do medical residents get paid?
Resident salaries commonly begin in the mid-$60,000s to low-$70,000s per year, although actual compensation may be lower or higher depending on the institution, geographic area, and training year. Programs in expensive cities may offer higher salaries, but the increase does not always make up for higher housing and transportation costs.
Pay usually increases with each postgraduate year. A first-year resident, known as a PGY-1, generally earns less than a PGY-3 or PGY-5 resident. At many institutions, residents at the same postgraduate level receive similar base salaries regardless of specialty. An internal medicine PGY-2 and a surgery PGY-2 at the same hospital may therefore have comparable base pay, even though their schedules and future earning potential differ.
Residents are commonly paid every two weeks or twice a month. The advertised annual stipend is gross income, not the amount deposited into a bank account. Before accepting a position or building a budget, it can help to review practical guidance on understanding how much a position actually pays.
Why is residency pay called a stipend?
The word “stipend” can make residency compensation sound like a scholarship or allowance. In practice, most medical residents are employees who receive wages for providing supervised patient care while completing required education.
Residents typically receive a Form W-2, and their pay is generally subject to federal income tax, Social Security tax, Medicare tax, and any applicable state or local taxes. Health insurance premiums, retirement contributions, parking charges, and other elected benefits may further reduce take-home pay.
Although residency includes substantial education, residents should not assume their earnings qualify for the tax treatment given to scholarships or student grants. Anyone with unusual circumstances, including income from several states or independent clinical work, may benefit from consulting a qualified tax professional.
Are residents paid by the hour or given overtime?
Most residents receive a fixed annual salary rather than an hourly wage. Their paycheck normally remains the same during a demanding intensive care rotation and a rotation with a lighter schedule.
Federal wage rules include a professional exemption that covers employees in qualifying medical internship and residency programs. As a result, residents generally do not receive time-and-a-half simply because they work more than 40 hours in a week.
This can make the effective hourly rate feel surprisingly low. Accreditation rules generally limit clinical and educational work to 80 hours per week, averaged over four weeks, but that limit includes patient care, required education, work completed from home, and moonlighting. It is a safety and training limit, not a promise that overtime will be paid.
What benefits come with residency?
Compensation includes more than the base salary. A typical benefits package may include:
- Medical, dental, and vision insurance
- Disability and life insurance
- Professional liability coverage for assigned clinical duties
- Vacation, sick time, and other paid leave
- Retirement plan access or employer contributions
- Meal allowances or food during clinical assignments
- Educational funds for books, conferences, or equipment
- Licensing, examination, or professional membership support
- Parking, public transit, or commuting assistance
- Mental health and employee assistance services
Not every program offers every benefit, and the value of a benefit can depend on the details. For example, one hospital may pay an entire health insurance premium, while another requires a significant employee contribution. Educational funds may also have restrictions or reimbursement deadlines.
The Accreditation Council for Graduate Medical Education does not set a national resident salary. It does require accredited sponsoring institutions to provide financial support and benefits through the resident’s contract. Its resident employment and compensation guidance also explains applicable leave and work-hour requirements.
Do residents receive paid parental or medical leave?
Residents in ACGME-accredited programs must have access to at least six weeks of approved medical, parental, or caregiver leave on at least one occasion during the program. The first six weeks of that qualifying leave must provide the equivalent of 100 percent of salary, with health and disability benefits continuing during that period. At least one additional week of paid time off must be reserved for use outside those six weeks.
That protection does not mean every absence is automatically paid. Vacation, routine sick leave, additional parental leave, and extended medical leave depend on the institution’s contract and applicable law. Time away may also affect whether the resident completes enough training to qualify for promotion, graduation, or board certification on schedule.
Can residents earn extra money through moonlighting?
Some residents can supplement their income through moonlighting, which means performing clinical work beyond their regular program assignments. Moonlighting may be offered internally by the same institution or externally by another employer.
It is not an automatic right. Eligibility may depend on:
- The program director’s written approval
- The resident’s postgraduate year and academic standing
- A full or limited state medical license
- Hospital credentialing and malpractice coverage
- Visa restrictions for international medical graduates
- Fatigue, patient-safety, and work-hour requirements
All moonlighting hours count toward the 80-hour weekly limit in accredited training. Programs may prohibit moonlighting when it interferes with education, clinical performance, or resident well-being. Extra income may also come from a separate employer and require different tax withholding.
When might residency-related work be unpaid?
The period between medical school graduation and the official employment start date is generally unpaid, even if the graduate is relocating or completing personal paperwork. Whether mandatory orientation is paid depends on when the employment appointment begins and how the contract defines required activities.
Observerships, unpaid research experiences, visiting rotations, and informal clinical shadowing are not necessarily residency appointments. They may provide experience without a salary or employee benefits. International physicians should be particularly careful not to confuse an observership with a paid, accredited residency position.
Payment can also be interrupted if a resident does not meet employment conditions, such as obtaining required credentials, completing onboarding, maintaining work authorization, or renewing a training license. The controlling documents are the appointment agreement and institutional policies.
What should you check before residency begins?
Do not look only at the annual salary. Request the complete appointment agreement and benefits information, then confirm:
- Your gross salary and scheduled pay dates
- The date benefits and paid employment begin
- Health insurance premiums and deductibles
- Vacation, sick, parental, medical, and caregiver leave rules
- Retirement eligibility and employer contributions
- Licensing, examination, parking, meal, and educational expenses
- Moonlighting policies and approval requirements
- Whether leave could extend the training period
If a paycheck is missing or differs from the contract, contact payroll and the graduate medical education office promptly. Keep copies of your agreement, pay stubs, time records, and written communications. Concerns involving broader accreditation requirements can also be raised through the institution’s designated graduate medical education leadership.
The bottom line
Yes, you get paid during medical residency in the United States. Residents generally receive a taxable annual salary and employee benefits, with raises as they advance through postgraduate training. However, they are usually salaried professionals rather than hourly workers, so long shifts do not ordinarily produce overtime pay.
Before ranking programs or signing an appointment agreement, compare take-home income, local living costs, insurance, leave, retirement benefits, and professional expenses. The highest listed salary is not always the offer that leaves a resident in the strongest financial position.
