Key facts
- Residents are paid on a pay scale by PGY level, set by each institution, so compare programs instead of relying on a national figure.
- The AAMC publishes an annual Survey of Resident/Fellow Stipends and Benefits, and the 2025 short version did not ask about benefits.
- ACGME requires institutions to offer at least six weeks of approved medical, parental or caregiver leave at 100 percent of salary once during training.
- Visa, licence and relocation costs often fall on the resident first, so ask your program what it covers.
Resident pay is a salary-like stipend that depends on your program and your training year (PGY level), and benefits vary by institution. For an IMG, the more useful question is not only what you earn but when you are first paid and what you pay before then. This page describes the structure and the costs. It avoids quoting salaries except where an official source reports them.
How resident pay works #
- Pay scale by PGY level. Most institutions publish a table with one rate for each PGY year, often rising each year. Rates are set by the sponsoring institution and differ by region, cost of living and employer type.
- Same pay for the same level, across specialties, in most programs. Pay rises with training year, not with how competitive the specialty is.
- Paid by the institution, not by ECFMG or your visa sponsor. Your offer or contract states the figure for your first year.
- National benchmarks. The AAMC runs the Survey of Resident/Fellow Stipends and Benefits. Its page lists 2025 as the latest survey year and notes that the short version used in odd years does not ask about benefits, which are covered in the longer even-year surveys such as 2024. I did not retrieve national stipend figures from the AAMC files, so this page quotes none. Use your own program's published scale to plan.
Gross pay versus take-home pay #
Your take-home pay is lower than the stated stipend. Typical deductions include:
- Federal income tax withholding, and state and local tax where they apply
- Social Security and Medicare (FICA), which may or may not be withheld depending on your visa and tax residency. See taxes for J-1 and H-1B residents.
- Health, dental and vision premiums
- Retirement plan contributions if you opt in
- Parking, and other voluntary benefits
Ask HR for a sample pay statement or a take-home estimate.
Benefits to compare #
| Benefit | What to ask |
|---|---|
| Health insurance | Start date, premiums, deductibles, whether dependents are covered, and what to do if there is a gap before coverage begins |
| Disability and life insurance | Whether provided, and from what date |
| Paid time off | Vacation days, sick days, conference days, and how leave interacts with board eligibility |
| Parental, medical and caregiver leave | Length, pay, and effect on training dates |
| Meal allowance, on-call rooms, parking | Value and eligibility |
| Education funds | Book or exam funds, Step 3 or licensure fee support |
| Retirement plan | Employer match, if any |
| Malpractice coverage | Normally provided by the institution during training |
| Wellness and mental health services | Access, confidentiality, and cost |
Leave rules #
ACGME's Institutional Requirements set a floor for sponsoring institutions: at least six weeks of approved medical, parental or caregiver leave, available at least once during training, with salary paid at 100 percent for the first six weeks of the first such leave, and a reserved week of paid time off outside those six weeks. Health and disability insurance must continue for residents and eligible dependents during the leave. ACGME says this is a minimum. The ABMS adopted a parallel policy for its member boards that allows at least six weeks of leave without using up other time or extending training, with some exceptions. Boards and specialties can differ in how much additional leave extends training.
Important points for IMGs:
- Your program policy is the practical authority. Read it before accepting an offer.
- Extra leave beyond what your board accepts can extend training, and for a J-1 or H-1B resident this affects visa dates. Talk to the international office before a long leave.
- ACGME also notes that the leave must be available from the day you are required to report.
Hidden and front-loaded costs #
Many of these come due before the first paycheck:
- Visa fees, SEVIS and sponsor fees, and any premium processing. See J-1 visa process and H-1B for residents for who pays what. Ask the program which of these it covers, and whether it is a reimbursement.
- Airfare, shipping and temporary housing
- Housing deposit and first month's rent (housing for residents)
- State training or full licence fees and background check
- Exam fees such as Step 3 and the cost of travel for testing
- Professional attire, equipment and scrubs not provided
- Health insurance premiums before coverage starts or while enrolled
- Loan repayments you owe back home
Compare this with what you saved for the application phase in ERAS and Match costs.
Questions to ask before you accept #
- What is the first-year salary and the PGY scale?
- On what date is the first paycheck, and how often are we paid?
- Does the program pay or reimburse visa, licensing and relocation costs?
- When does health insurance start, and what does it cost for my family?
- What is the parental and medical leave policy, and how does it affect completion dates?
- Is there a housing or meal stipend?
This page is general information, not legal advice. Immigration rules change often and individual circumstances differ. Confirm your situation with your sponsor, the relevant government agency, or a qualified immigration attorney before acting. See our disclaimer.
Frequently asked questions
How much will I earn as a resident?
It depends on the institution, region and PGY level. Programs publish their pay scale on their website, usually by PGY year. Use those figures, not a national average.
When does health insurance start?
It varies. Some programs start coverage on the first day and others after a waiting period. Ask your program and enroll before any deadline.
Do I get paid leave if I have a baby?
ACGME requires at least six weeks of approved medical, parental or caregiver leave at full pay during training. Programs may offer more, and your visa status and board rules also matter.
Is this financial advice?
No. It is general information. Verify figures with your program's GME office.
Sources
- AAMC: Survey of Resident/Fellow Stipends and Benefits
- ACGME: Institutional Requirements
- ACGME: Answers on resident leave policies
- ABMS: ABMS announces progressive leave policy for residents and fellows
- IRS: Foreign student liability for Social Security and Medicare taxes
Found something out of date? Tell us and we will check it against the source.