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Medical Fellowship vs. Residency: Compensation, Stress, Goals & More

Medical Fellowship vs. Residency: Compensation, Stress, Goals & More

Residency is an essential step in becoming a physician, but some doctors-in-training enter a fellowship after residency to get more specialized training before becoming an attending.

We surveyed U.S. residents and fellows at the end of 2023 to understand more about their compensation, debt, stress levels, and more. Let’s take a look at how these factors differ between residents and fellows, based on survey responses. (The full 2024 Residents & Fellows Survey Report is coming soon; sign up to hear about it at the bottom of this page.)

Medical Fellowship vs. Residency

Residencies and fellowships are training programs for physicians after medical school. Residencies are generally more extended, lasting three to seven years, and provide comprehensive training in a specific medical specialty. The primary goal of residencies is to prepare physicians for independent practice within their chosen specialty.

Fellowships, typically lasting one to three years, are specialized training programs within a subspecialty of a physician’s chosen field. These programs focus on advanced training, allowing physicians to develop expertise and skills in a specific area beyond the scope of their residency training. Fellowships aim to refine and deepen a physician’s knowledge in a particular subspecialty.

Compensation

According to survey results, the average annual salary for a resident is $65,395. Fellows reported earning an average of $78,501 every year. When divided by year of training, both resident and fellow answers indicated gradual increases in salary as training progressed.

Average Resident & Fellow Salary By Year

Resident Year 1 $63,020
Resident Year 2 $63,899
Resident Year 3 $64,817
Resident Year 4 $72,401
Resident Year 5-7 $72,789
Fellow Year 1 $77,455
Fellow Year 2 $78,283
Fellow Year 3 $79,633
Fellow Year 4 $72,654
Fellow Year 5-7 $84,562

When asked about their satisfaction with salary on a scale of 1 to 10 (where 1 was very unsatisfied and 10 was very satisfied), both residents and fellows answered similarly: residents answered with an average of 4.7 and fellows answered with an average of 4.6.

Extra Work & Side Gigs

Some residents and fellows work elsewhere in addition to their training program to earn more. Though some programs restrict this based on year of training or for all trainees, we found that 33% of resident respondents said they take on extra work outside of their training program, while 46% of fellows said the same. There aren’t any clear trends as trainees enter subsequent years of their programs.

Percentage of Residents & Fellows Who Take On Extra Work By Year

Resident Year 1 22%
Resident Year 2 33%
Resident Year 3 39%
Resident Year 4 48%
Resident Year 5-7 37%
Fellow Year 1 49%
Fellow Year 2 39%
Fellow Year 3 50%
Fellow Year 4 42%
Fellow Year 5-7 47%

Of residents and fellows who take on extra work, 60% and 77%, respectively, moonlight.

Stress About Finances

When asked about financial stress, both residents and fellows had an average score of 7.4 on a scale from 1 to 10 (where 1 was calm, no stress and 10 was very stressed). Financial stressors differed between the trainee types. Fellows had more stress about lack of retirement savings, and residents were more stressed about low income and non-student loan debt.

Percentage of Residents & Fellows Who Placed Each Stressor In Their Top Three

Stressor Residents Fellows
Growing my family 41% 47%
Inability to stick to a budget 20% 22%
Lack of retirement savings 32% 47%
Low income 50% 38%
Non-student loan debt 45% 33%
Student loan debt 51% 47%
Unexpected financial needs 38% 34%
Other 5% 8%

 

Student Loans & Debt

Student Loan Debt

The majority of residents and fellows surveyed have student loan debt. Eighty percent of residents and 64% of fellows have student loan debt. The average student loan balances for surveyed residents are $303,171 and $271,366 for fellows.

Residents and fellows had similar levels of federal and private student loans. 

Type of Student Loans Residents Fellows
Federal student loans 59% 65%
Mix of federal and private student loans 31% 30%
Private student loans 9% 5%

For those who do carry student loans, a majority of residents and fellows plan to pursue Public Service Loan Forgiveness—63% of residents and 76% of fellows.

Non-Student Loan Debt

Nearly two-thirds (64%) of medical trainees have debt other than student loans, according to our survey. Residents (65%) had other debt more often than fellows (58%). Fellows reported having automobile and credit card debt more often than residents. Residents reported having mortgages and personal loans more often than fellows.

Type of Debt Residents Fellows
Mortgage 27% 23%
Automobile 43% 67%
Credit cards 79% 82%
Personal loans 58% 39%

 

Training & Future Plans

Satisfaction With Training

According to survey responses, residents were more satisfied with the quality of their training program than fellows, rating an average of 8 on a scale from 1 to 10 (where 1 was not satisfied and 10 was very satisfied). Fellows gave an average rating of 7.6 out of 10.

Post-Training Plans

Residents and fellows have the opportunity to pursue different career paths, but according to survey results, residents are more likely to pursue being an employed physician or practice ownership. Fellows are more likely to consider academic medicine.

Career Path Residents Fellows
Practice ownership (including partnership) 18% 14%
Employed physician 53% 43%
Academic medicine 24% 41%
Other 5% 3%

 

Burnout & Workload

Burnout is a prevalent issue for medical trainees. Both residents and fellows have an average score of 6.8 out of 10 when asked how often they experience burnout or high levels of stress (where 1 was rarely and 10 was frequently).

This stress is often attributed to the amount of work required. Fellows rate their workload at a 6.2 out of 10, but residents’ responses averaged higher at a 6.5 (where 1 was manageable and 10 was overwhelming). This correlates with the average number of hours worked per week. Residents report an average of 65.9, and fellows work an average of 59.7 hours per week.

Would Residents & Fellows Choose Medicine Again?

If given the chance to choose a career path again, most residents and fellows said they would choose medicine again (79% and 78%).

Best & Worst Parts Of Training

We asked residents and fellows what the best and most challenging parts of their current training programs were. Residents were more appreciative of program culture and autonomy, while fellows put more value on that quality of clinical training and program reputation.

When asked about the most challenging parts of their training, residents were much more likely to choose workload (46%) than fellows (36%).

Tips For Residents & Fellows

Whether already a resident or fellow or just thinking about your career path, understanding what to expect and how the stages of training differ can help you as you become a physician.

For more residency-focused resources, check out our Resources page or one of our curated articles below:

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