Osteopathic doctors (DOs) earn a median salary equal to or greater than $239,200 per year, according to the Bureau of Labor Statistics’ May 2024 data. That figure covers all physicians and surgeons, and the BLS does not separate DO and MD earnings because the two degrees lead to the same licensed practice of medicine. What actually determines your pay as a DO is your specialty, practice setting, and years of experience.
Salary by Specialty
Specialty choice is the single biggest factor in how much an osteopathic doctor earns. The gap between the highest and lowest-paid fields is enormous. Orthopedic surgeons average $654,815 per year, and cardiologists average $565,485. On the primary care side, internal medicine physicians average $312,526 and family medicine physicians average $300,813. Pediatric and other primary care specialties consistently sit at the bottom of compensation rankings, while surgical and procedural specialties dominate the top.
DOs are disproportionately represented in primary care. Roughly half of all practicing osteopathic physicians work in family medicine, internal medicine, or pediatrics. That means the “typical” DO salary skews closer to the $275,000 to $315,000 range, even though DOs who pursue surgical or interventional specialties earn well into the $500,000+ range.
Private Practice vs. Hospital Employment
Where you work matters nearly as much as what you practice. Surgeons in private practice earn about 11% more than their hospital-employed counterparts, averaging $354,000 compared to $338,000 across all settings. The gap is even wider for nonsurgical physicians: those in private practice earn roughly 35% more, averaging $282,000 versus $252,000 overall. Physician-owned offices remain the dominant employment setting and consistently offer higher compensation than hospital systems.
Hospital employment does come with trade-offs that soften the pay gap. Employed physicians typically receive benefits like malpractice coverage, retirement contributions, and paid time off that private practice owners fund themselves. Still, on raw earnings, private practice has a clear advantage.
How Pay Grows With Experience
Early-career physicians earn noticeably less than their senior colleagues. In family medicine, full-time starting physicians average $236,079 in salary plus bonus, while those with 20 or more years in practice average $292,373. That’s roughly a $56,000 increase over the course of a career, or about a 24% bump. The steepest salary growth typically happens in the first five to ten years after residency, when physicians build patient panels, develop referral networks, or take on leadership roles.
Subspecialists and surgeons see a similar trajectory but with higher starting points. A new orthopedic surgeon, for example, might start in the mid-$400,000s and climb toward $700,000+ at peak career earnings.
What DOs Earn During Residency
Before earning a full physician salary, every DO completes three to seven years of residency training at a fraction of attending-level pay. Residency stipends are standardized by training year, not specialty, so a surgery resident and a family medicine resident at the same institution earn the same amount. At UCLA, a representative example, first-year residents (PGY-1) earn $89,261 annually as of July 2024, rising to $94,809 by the third year. Updated rates taking effect in October 2025 bump PGY-1 pay to $93,777 and PGY-3 to $99,605.
These figures vary by institution and region, but the range is narrow. Most residency programs across the country pay somewhere between $60,000 and $95,000 for first-year residents, with incremental raises of $2,000 to $4,000 per year. When you factor in the 60 to 80 hours per week that residents routinely work, the effective hourly rate often falls below $20.
Sign-On Bonuses and Extra Compensation
The salary number on a contract rarely tells the full story. The average physician signing bonus is $38,315, and the average relocation allowance is $12,019. When you combine signing bonuses, relocation packages, and continuing medical education (CME) benefits, the average total incentive package comes to $58,854. Signing bonuses have been climbing quickly, up 23% from the prior year, reflecting how aggressively hospitals and health systems are competing for physicians.
These bonuses typically come with strings attached. Most require you to stay with the employer for two to four years or repay a prorated portion. CME allowances, which cover conference attendance and ongoing training, usually range from $2,000 to $5,000 per year, though some employers offer more. Other common benefits include student loan repayment assistance, partnership tracks in private practice, and productivity bonuses tied to patient volume or quality metrics.
DO vs. MD: Is There a Pay Difference?
In practical terms, no. DOs and MDs hold the same licenses, complete the same residency programs through the unified ACGME accreditation system, and are hired into the same positions. Compensation surveys from the BLS and major recruiting firms do not differentiate between the two degrees. Any observed salary difference between DOs and MDs as groups is almost entirely explained by specialty distribution: because more DOs enter primary care and fewer enter the highest-paid surgical subspecialties, the average DO salary across all practitioners is somewhat lower than the average MD salary. Within any given specialty and practice setting, the pay is functionally identical.