5 Specialties with the Lowest Hourly Rate

When choosing a specialty, many premeds focus on annual salary. But that only tells part of the story.

What often gets overlooked is how many hours physicians are actually working to earn that salary.

To better understand true compensation, we took the average annual salary for each specialty and divided it by the average number of hours worked per week and weeks worked per year. This gives us a clearer picture of hourly earnings, which can significantly reshuffle how specialties rank.

It’s important to note that these are averages. Compensation varies widely based on geography, practice setting, and individual circumstances. Outliers exist, but this data reflects broader trends across the field.

With that in mind, here are the 5 medical specialties with the lowest hourly rates.

#5 | Family Medicine — $136/hour

Starting us off at number five is family medicine at $136 per hour.

Family physicians provide comprehensive care across all ages, from pediatrics to geriatrics, managing everything from preventive care to chronic disease. They are the front line of medicine.

Family medicine physicians earn approximately $319,000 per year while working around 48 hours per week. The lifestyle is relatively predictable, with clinic-based schedules and minimal overnight call.

One of the trade-offs is administrative burden. Like many primary care fields, documentation and charting can take up a significant portion of the day.

Training is a 3-year residency, making it one of the shortest pathways to becoming an attending physician. It is also among the least competitive specialties to match into, with consistently high match rates.

If you want to explore competitiveness data across all specialties, visit SpecialtyRank.com.

#4 | Internal Medicine — $131/hour

At number four is internal medicine at $131 per hour.

Internists manage adult patients with a wide range of conditions, often coordinating care for complex, multi-system diseases.

With an average salary of $326,000 per year and about 51 hours per week, internal medicine offers moderate compensation with moderate workload.

Training consists of a 3-year residency, after which physicians can pursue multiple paths. Some choose outpatient primary care, others become hospitalists, and many go on to subspecialize through fellowship training.

Internal medicine is also the largest specialty in the Match, offering significant flexibility in career direction.

However, it’s worth noting that pursuing additional fellowship training does not always translate to higher hourly earnings.

#3 | Infectious Disease — $123/hour

Number three is infectious disease at $123 per hour.

Infectious disease physicians diagnose and manage complex infections, including HIV, tuberculosis, and emerging pathogens. They also play a key role in public health and antibiotic stewardship.

Despite earning around $321,000 annually, infectious disease physicians work approximately 53 hours per week, which lowers their effective hourly rate.

Training includes a 3-year internal medicine residency followed by a 2-year infectious disease fellowship, totaling five years after medical school.

This highlights a recurring pattern: cognitive specialties, especially those without procedures, tend to earn less per hour despite extensive training.

#2 | Endocrinology — $121/hour

At number two is endocrinology at $121 per hour.

Endocrinologists treat hormonal disorders such as diabetes, thyroid disease, and metabolic conditions. With millions of patients affected by these conditions, demand for endocrinologists remains high.

They earn approximately $291,000 per year while working about 49 hours per week, offering a manageable lifestyle but lower compensation relative to other specialties.

Like infectious disease, endocrinology requires a 3-year internal medicine residency followed by a 2-year fellowship.

The lower hourly rate is largely due to the nature of the work. Endocrinology is heavily cognitive and involves fewer procedures, which are typically reimbursed at higher rates.

#1 | Pediatrics — $115/hour

And at number one, pediatrics has the lowest hourly rate at $115 per hour.

Pediatricians care for infants, children, and adolescents, often building long-term relationships with patients and families.

They earn around $265,000 annually and work approximately 47 hours per week, resulting in the lowest hourly compensation among major specialties.

Training consists of a 3-year residency, and pediatrics is consistently one of the least competitive specialties to match into.

The lower compensation is not a reflection of importance but rather a result of how the healthcare system is structured. Pediatric care is more likely to be reimbursed through Medicaid, which pays less than private insurance. Additionally, pediatric patients typically require fewer procedures, further reducing revenue potential.

Why These Specialties Rank Lower

A clear trend emerges across this list.

These specialties are:

• Primarily cognitive rather than procedural
• Often outpatient-focused
• Less reliant on high-reimbursement interventions

Procedures drive revenue in modern healthcare systems. Specialties that perform more procedures tend to earn more per hour, even if they work longer hours overall.

Final Thoughts

While these specialties rank lowest in hourly earnings, that doesn’t make them “bad” choices.

Many of them offer:

• Strong work-life balance
• Meaningful long-term patient relationships
• High levels of job satisfaction
• Shorter training pathways

Compensation is just one factor. Choosing a specialty based solely on pay is a mistake.

The better question is:

What kind of work do you want to do every day for the next 30 years?

If you want help navigating that decision, explore our guides on how to choose a medical specialty and review detailed competitiveness data at SpecialtyRank.com.

At Med School Insiders, we help students maximize their potential and match into top programs. Learn more about our Residency Admissions Consulting Services to take the next step in your journey.