Medical fellowship salaries typically range from about $77,000 to $94,000 per year, depending on how many years of training you’ve completed. These stipends are modest relative to attending physician pay, but they do increase incrementally with each year of postgraduate training. The exact amount depends primarily on your program year and the institution where you train, not your chosen subspecialty.
Average Fellowship Stipends by Year
Fellowship training usually begins after residency, which means most fellows start at postgraduate year 4 (PGY-4) or later. The AAMC’s 2025 survey of stipends, based on data from July 2025, reports these nationwide unweighted averages:
- Program year 4: $77,593
- Program year 5: $81,807
- Program year 6: $84,744
- Program year 7: $89,187
- Program year 8: $94,215
These are national averages. Individual institutions can pay above or below these figures. Mayo Clinic, for example, lists its 2026 stipends at $85,398 for graduate level 4, $89,036 for level 5, and $92,376 for level 6, all of which run above the national average.
Why Specialty Doesn’t Change the Number
One of the most common misconceptions is that a cardiology fellow earns more than, say, a pulmonology fellow. In practice, fellowship stipends are set by the training institution and your postgraduate year level. A PGY-5 in gastroenterology and a PGY-5 in infectious disease at the same hospital will typically earn the same stipend.
The real financial divergence by specialty happens after fellowship. Subspecialists in fields like interventional cardiology or orthopedic surgery can earn two or more times what generalists make as attending physicians. But during training, the pay structure is essentially flat across specialties.
Geography matters more than specialty during fellowship. Programs in cities with a high cost of living, such as New York, San Francisco, or Boston, tend to offer higher stipends to offset expenses. The gap between a fellowship in a midwestern city and one in Manhattan can be $10,000 or more per year.
How Fellowship Pay Has Changed Over Time
Fellowship stipends have been rising, but not fast enough to keep pace with inflation. Year-over-year increases for first-year trainees were just 2.2% in 2025, a sharp drop from the 4.6% and 4.7% bumps seen in 2024 and 2023. Before that, growth was even more sluggish: 2.8% in 2022 and a barely noticeable 0.6% in 2021. In practical terms, fellows have been losing purchasing power in recent years even as their nominal salaries tick upward.
Moonlighting as Extra Income
Many fellows supplement their stipend by moonlighting, which means picking up clinical shifts outside their fellowship duties. A typical moonlighting rate for a cardiology fellow, for instance, is around $100 per hour. At 12 hours per week, that adds roughly $60,000 per year before taxes, nearly doubling the base stipend.
Not every program allows it, though. Institutions are required to track total work hours, including both fellowship duties and moonlighting shifts. Programs can and do restrict moonlighting if it affects a fellow’s performance or pushes total hours to unsafe levels. Some fellowships prohibit external moonlighting entirely, so it’s worth asking about the policy before counting on the extra income.
Benefits Beyond the Stipend
Fellowship compensation includes more than the base salary. Most programs provide health insurance, malpractice coverage, and paid time off. Many also offer an annual allowance for continuing medical education, which covers conference travel, textbooks, and board review courses.
If you’re relocating for fellowship, some institutions cover moving expenses. The broader physician recruiting market puts the average relocation allowance around $11,000, though this varies widely. Anything up to $10,000 is considered standard, and some programs offer temporary housing during your first weeks as well.
The Jump to Attending Pay
The financial payoff of fellowship becomes clear when training ends. Attending physician salaries in most subspecialties start well above $200,000 and frequently exceed $300,000 or $400,000 depending on the field and practice setting. That means the transition from fellow to attending often represents a pay increase of three to five times your fellowship stipend, sometimes more in procedure-heavy specialties. For many physicians, this single jump is the largest salary increase they’ll ever experience.
The tradeoff is time. Every fellowship year is another year earning a trainee wage instead of an attending salary. A one-year fellowship delays that income jump by 12 months; a three-year fellowship delays it by 36. Whether the subspecialty training leads to higher lifetime earnings depends on the field, the length of fellowship, and how much additional income the subspecialty generates compared to practicing as a generalist.