Lowest Paid Medical Specialties in 2026

A neurosurgeon earns almost $830,000 per year. The lowest-paid physician earns under $220,000. Both complete medical school and residency, and the gap between them still runs over $600,000 annually.

Reimbursement structure drives that gap more than effort or years of training. Specialties built around procedures are paid more than those built around long-term cognitive management of chronic disease.

Below are the ten lowest-paid medical specialties in 2026 based on average annual compensation. Income should never be the sole factor in choosing a specialty, but the difference does matter for training length, lifestyle trade-offs, and long-term financial planning.

We excluded pediatric subspecialties from this list. Include them, and most of the lowest-paid specialties on it would be pediatric specialties, largely because of how pediatric care is reimbursed.

#10 | Allergy and Immunology: $335,978

Allergy and immunology physicians diagnose and manage allergic conditions, asthma, and immune system disorders. Care is typically longitudinal and outpatient-focused, with an emphasis on chronic disease management rather than acute intervention.

Training includes a three-year residency in internal medicine or pediatrics, followed by a two-year fellowship in allergy and immunology. Despite the additional subspecialty training, compensation remains modest compared to many other fields.

From a lifestyle perspective, allergy and immunology is often considered one of the more favorable specialties. Emergencies are uncommon, inpatient responsibilities are limited, and work schedules are generally predictable. Many physicians maintain regular clinic hours with minimal calls.

The combination of strong work-life balance and lower reimbursement places allergy and immunology firmly in the middle of this list. Physicians who choose this specialty often prioritize lifestyle stability and patient continuity over higher earning potential.

#9 | Occupational Medicine: $329,380

Occupational medicine physicians focus on workplace health, managing work-related injuries and illnesses, and advising employers on health and safety. Much of the work centers on prevention rather than treatment, including fitness-for-duty evaluations, injury prevention programs, and compliance with workplace safety regulations.

Training falls under the ACGME’s preventive medicine umbrella. It typically involves a brief prerequisite clinical year, such as a transitional internship or the first year of an internal medicine residency, followed by a two-year occupational medicine residency, often paired with a Master of Public Health. That’s one of the shorter paths to board certification in medicine, yet compensation still lands well below many specialties with comparable or shorter total training time.

Lifestyle in occupational medicine is generally favorable. Most physicians work regular business hours in clinic, corporate, or government settings, with minimal call and few true emergencies. Many roles are outpatient-based and involve significant time on administrative or consultative work rather than direct patient treatment.

Occupational medicine reflects the broader pattern seen throughout this list. Work that centers on prevention and population health tends to be reimbursed at a lower rate than procedural or acute care, regardless of the training required to practice it.

#8 | Family Medicine: $325,040

Family medicine physicians provide comprehensive care across the lifespan, treating patients from infancy through older adulthood and managing a broad range of conditions across every organ system. They serve as the backbone of primary care, often acting as the first point of contact for patients navigating the healthcare system.

Training consists of a three-year family medicine residency, making it one of the shortest training pathways in medicine. Family medicine is also consistently among the least competitive specialties to match into, reflecting its broad scope and high demand rather than selectivity.

From a lifestyle standpoint, family medicine is often associated with predictable schedules and minimal calls, particularly in outpatient settings. Many physicians work regular clinic hours, though schedules can vary for those practicing as hospitalists, in urgent care, or in more rural settings where coverage demands may be higher.

Despite its central role in healthcare and its wide scope of practice, family medicine remains one of the lower-paid specialties. Compensation is largely shaped by primary care reimbursement models, which lag behind procedural specialties even as patient volume and responsibility remain high.

Explore and compare every residency specialty on SpecialtyRank.com using the most recent NRMP data to understand competitiveness, match rates, and long-term compensation, all in one place.

#7 | Rheumatology: $321,778

Rheumatology is an internal medicine subspecialty focused on diseases of the joints, connective tissue, and musculoskeletal system. Rheumatologists manage a wide range of conditions, including rheumatoid arthritis, lupus, osteoporosis, and other autoimmune disorders that often require long-term, complex care.

Training includes a three-year internal medicine residency followed by a two-year rheumatology fellowship. Despite this additional specialization, rheumatologists earn less on average than general internists who enter practice directly after residency. This makes rheumatology one of several specialties in which additional training does not translate into higher compensation.

From a lifestyle perspective, rheumatology is generally favorable. Emergencies are rare, inpatient responsibilities are limited, and overnight calls are uncommon. Most rheumatologists practice in outpatient settings with predictable schedules, which makes the specialty attractive to physicians who prioritize work-life balance.

Ultimately, rheumatology is rarely chosen for financial reasons. Physicians who pursue this path tend to value longitudinal patient relationships, intellectual complexity, and lifestyle stability over higher earning potential.

#6 | Medicine/Pediatrics: $319,995

Medicine/Pediatrics, commonly referred to as Med/Peds, is a combined residency that trains physicians in both internal medicine and pediatrics. Graduates are board-certified in both specialties and can care for patients across the full age spectrum, from childhood through older adulthood.

Training consists of a four-year combined residency, which is longer than either internal medicine or pediatrics alone. Despite the broader scope of training and dual certification, compensation for Med/Peds physicians tends to align more closely with primary care salaries rather than reflecting the added training time.

Lifestyle varies depending on practice setting. Physicians working in outpatient primary care roles often have predictable schedules, while those practicing as hospitalists or in mixed inpatient roles may follow shift-based or block schedules. The specialty’s flexibility is one of its main draws.

Med/Peds illustrates a recurring pattern among lower-paid specialties. Additional training and a broader scope do not necessarily lead to higher compensation, particularly when the work remains largely cognitive and non-procedural.

#5 | Endocrinology: $309,782

Endocrinologists manage disorders of the endocrine system, including diabetes, thyroid disease, osteoporosis, and other metabolic and hormonal conditions. Many of these diseases require lifelong management and frequent follow-up, making endocrinology a specialty centered on chronic care rather than acute intervention.

Training includes a three-year internal medicine residency followed by a two- to three-year endocrinology fellowship, resulting in five to six years of post-medical-school training. Despite this extended training, endocrinologists earn less on average than general internists who do not subspecialize.

From a lifestyle perspective, endocrinology is generally favorable. Most practice settings involve outpatient care with predictable schedules and few true emergencies. Inpatient consults and call responsibilities exist but are typically less intense than in many other internal medicine subspecialties.

Endocrinology exemplifies one of the clearest trade-offs in medicine. Physicians accept longer training and lower compensation in exchange for lifestyle stability, intellectual complexity, and the opportunity to manage high-impact chronic diseases that affect large patient populations.

#4 | Geriatrics: $304,411

Geriatricians focus on the medical needs of older adults, often managing multiple chronic conditions, functional decline, cognitive impairment, and fall risk. Care is typically complex and longitudinal, requiring coordination across specialties and close attention to quality of life.

Training requires completion of a three-year internal medicine or family medicine residency followed by a one-year geriatrics fellowship. Despite the added specialization and increased clinical complexity, geriatricians earn less on average than physicians who remain generalists in internal medicine or family medicine.

Lifestyle in geriatrics is generally similar to outpatient primary care. Work schedules are often predictable, inpatient responsibilities are limited, and true emergencies are uncommon. Much of the work takes place in clinics, long-term care facilities, or consultative roles.

As the population continues to age, demand for geriatricians is increasing. However, compensation has not kept pace with this growing need, reflecting broader reimbursement challenges for cognitive, coordination-heavy care rather than a lack of clinical value.

#3 | Medical Genetics: $273,826

Medical geneticists diagnose and manage inherited conditions and provide genetic counseling across the lifespan, from preconception planning to adult-onset disease. Their work often involves complex diagnostic reasoning, coordination with other specialties, and long-term patient guidance rather than procedural care.

Training typically includes prior residency experience followed by specialized genetics training, making the overall pathway relatively short compared to many other subspecialties. Despite this, compensation remains lower than that of nearly every other physician specialty.

From a lifestyle standpoint, medical genetics is generally favorable. Workweeks are often in the 40 to 50-hour range, emergencies are uncommon, and much of the work is outpatient or consult-based. Many geneticists split time between clinical care, research, teaching, and counseling, which adds variety to day-to-day practice.

Medical genetics highlights one of the central realities of physician compensation. Even as genomic medicine continues to expand in clinical importance, reimbursement has not kept pace with the complexity or value of the work. Physicians who choose this specialty typically do so for intellectual fulfillment, lifestyle stability, and the opportunity to work at the intersection of medicine, science, and patient education rather than financial upside.

#2 | Pediatrics: $273,665

Pediatricians provide medical care for patients from birth through young adulthood and complete a three-year pediatric residency. The field is broad, encompassing primary care as well as numerous subspecialties that address everything from complex congenital conditions to chronic childhood disease.

Despite the scope and importance of the work, pediatrics remains one of the lowest-paid specialties. A major driver of this gap is reimbursement. Many pediatric patients are insured through Medicaid, which reimburses at lower rates than commercial insurance. In a fee-for-service healthcare system, this directly limits revenue regardless of time spent, complexity of care, or clinical outcomes.

Additional fellowship training in pediatrics often results in even lower compensation. Many pediatric subspecialists earn less than general pediatricians despite completing several additional years of training. Pediatric infectious disease, for example, averages $217,819, more than $55,000 below general pediatrics, and most other pediatric subspecialties fall somewhere in that range, with pediatric cardiology near the top at $365,395. Pediatric surgery is the exception at $627,126, and it’s telling that the one pediatric subspecialty built around procedures is also the one that pays like a surgical specialty.

Lifestyle varies by practice setting but is generally comparable to primary care. Outpatient pediatricians often have predictable schedules, while hospital-based roles may involve more variable hours and call. Physicians who choose pediatrics typically prioritize patient population, continuity of care, and long-term impact over earning potential.

We broke down how the fee-for-service payment model works and how it compares to value-based care.

#1 | Preventive Medicine: $265,825

Preventive medicine is the lowest-paying specialty in 2026. It focuses on preventing disease before it becomes clinically significant. Physicians in this specialty work on population health initiatives, screenings, risk-reduction strategies, and lifestyle-based interventions to improve long-term health outcomes.

Training pathways vary, but most physicians complete at least 1 year of clinical training, followed by 2 additional years in a preventive medicine residency or fellowship. The specialty is less centered on direct procedural care and more focused on longitudinal health management and systems-level impact.

Lifestyle is one of the strongest draws of preventive medicine. Emergencies are rare, call responsibilities are minimal, and work hours are generally predictable. Many physicians work in public health, occupational health, policy, or academic settings rather than traditional hospital-based roles.

Compensation reflects the specialty’s emphasis on prevention rather than intervention. In a fee-for-service healthcare system, work that reduces downstream utilization is not reimbursed as highly as procedural care, which keeps preventive medicine among the lower-paid specialties despite its long-term value.

How to Think About Specialty Pay

Physician compensation varies widely across specialties, even among doctors with similar training lengths and workloads. As this list shows, lower pay is often tied to cognitive, non-procedural fields that emphasize longitudinal care, prevention, and coordination rather than intervention.

Compensation should never be the sole factor in choosing a specialty, but it has real implications for long-term financial planning, lifestyle flexibility, and career sustainability. The specialties on this list tend to attract physicians who prioritize patient relationships, intellectual challenge, and work-life balance over earning potential.

If you’re an aspiring physician but don’t know which specialty you’d like to pursue, our So You Want to Be series will help you understand the pros and cons of every medical path to help you choose the one that’s best for you.

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