How to Become a Physicians, All Other

Where Physicians, All Others have the most money left over after rent

Median pay minus estimated federal + state + FICA taxes, minus 12 months of rent at HUD's 2-bedroom Fair Market Rent. Darker green means more money left over each year. Hover any state for the breakdown.

Education and training

This category captures a broad group: hospitalists, general internists, internal medicine subspecialists who aren't cardiologists or gastroenterologists (pulmonology, rheumatology, endocrinology, nephrology, hematology/oncology, infectious disease, geriatrics), and general practitioners without subspecialty focus. The training paths vary but share a common trunk.

Internal medicine is the most common feeder residency: three years after four years of medical school. The USMLE requirements are standard; IM is moderately competitive without being in the ultra-competitive tier. Match rates for US seniors are around 85-90% into IM, though competitive academic programs and specific programs with great reputations are harder to get into.

Hospitalist medicine doesn't require fellowship. You complete IM residency and can go directly into hospital-based practice. This is one of the more direct pipelines in medicine and produces a specialist who manages complex inpatient medical patients, handles codes, coordinates discharges, and interacts with every other specialty in the hospital.

Subspecialty fellowship after IM residency: pulmonary and critical care is three years, rheumatology is two years, endocrinology is two years, nephrology is two years, hematology/oncology is three years, infectious disease is two years, geriatrics is one year. These fellowships are generally less competitive than cardiology or gastroenterology but still require a strong IM residency record and research if you're targeting academic programs.

General practice or family medicine is a separate path with its own three-year residency (family medicine residency) that covers outpatient adult medicine, pediatrics, OB, and procedural skills. Family medicine graduates often work in direct primary care settings, rural communities, or community health centers.

Licensing and certification

State medical licensing after USMLE Steps 1, 2, and 3. Hospitalists who work locums across states need multi-state licensing. The IMLC simplifies this for participating states.

ABIM board certification (American Board of Internal Medicine) in general internal medicine requires passing the IM boards after residency. Pass rates are around 80-85% on first attempt. Subspecialty certification in each IM subspecialty requires additional fellowship and a separate subspecialty board exam.

MOC requirements for ABIM have been contested and modified over the years. The current model requires periodic knowledge assessments and CME, with less frequent high-stakes recertification exams than previously required. The physician community's pushback against MOC requirements resulted in significant changes to ABIM's program.

Hospitalists need credentialing at every hospital where they work. Subspecialists doing procedures (pulmonologists doing bronchoscopy, nephrologists placing dialysis catheters, hematologists doing bone marrow biopsies) need procedural privileges at each institution.

DEA registration is required for internists prescribing opioids for pain management, stimulants for ADHD, benzodiazepines, and other scheduled substances. State controlled substance registrations may be additional requirements.

What the day-to-day looks like

Hospitalist medicine is the fastest-growing physician practice model in the US, and for good reason. Hospitals found that having physicians dedicated exclusively to inpatient care improved efficiency, throughput, and coordination. A hospitalist carries 15-20 patients on a daily census, rounds every morning, manages acute clinical issues, coordinates consults, and works on discharge planning. Shifts are typically seven days on, seven days off (7-on-7-off), which creates predictable long stretches of time off and predictable long stretches of intense work.

The 7-on-7-off model sounds appealing and has real advantages for planned activities during the off weeks. The reality of seven consecutive twelve-hour days with a complex inpatient census is genuinely exhausting. By day six you're tired in a way that one night of sleep doesn't fix. The off week feels short when you're also trying to recover from the previous work stretch.

IM subspecialists in outpatient practice have more varied days: clinic visits, hospital consults, procedures (pulmonologists in the bronchoscopy suite, rheumatologists doing joint injections), and call coverage for their admitted patients. The call burden varies by subspecialty. Endocrinology call is lighter than pulmonary/critical care call, which can involve overnight management of mechanically ventilated ICU patients.

General internists in outpatient primary care practices see 20-25 patients per day, manage chronic disease, acute visits, preventive care, and coordination of specialist referrals. The administrative burden of primary care (prior authorizations, patient portal messages, medication refills, specialist coordination) is substantial and represents a major driver of physician burnout in this space.

Career progression

Hospitalist medicine starting salaries are in the $280,000-$380,000 range for employed positions, with significant variation by geography and practice setting. Academic hospitalists earn on the lower end of this range with protected teaching and research time. Community hospitalist programs at busy community hospitals may offer higher compensation to recruit and retain physicians for the night and weekend coverage they need.

IM subspecialist salaries vary enormously by subspecialty. Pulmonology/critical care: $350,000-$500,000, with ICU intensivist positions at the higher end. Rheumatology: $250,000-$375,000, one of the lower-earning IM subspecialties despite significant training. Endocrinology: $220,000-$320,000, historically underpaid relative to training duration. Nephrology: $280,000-$400,000. Hematology/oncology: $350,000-$600,000, with significant variation based on whether the practice includes infusion center revenue. Infectious disease: $200,000-$320,000, the lowest-paying IM subspecialty and one facing a workforce shortage partly driven by this pay disparity.

General internists in outpatient primary care: $220,000-$320,000 employed. Direct primary care (DPC) practices that operate on a subscription model and don't bill insurance can be financially successful but require business development skills and a patient panel large enough to cover overhead.

Subspecialty practices with significant ancillary revenue (oncology infusion, pulmonary function testing, rheumatology infusion centers) can generate income significantly above professional fee schedules.

Salary progression

Highest paying states

Where the jobs are

Salary negotiation

IM subspecialist contract negotiation depends heavily on which subspecialty you're in and the supply-demand dynamics. Infectious disease physicians are in shortage and have genuine use. Endocrinologists are in shortage with less financial use because the specialty's reimbursement is structurally lower. Know your market.

Hospitalist contract negotiations should focus on: shift structure and guaranteed shifts per month, night shift distribution, CME allowance, loan forgiveness eligibility if employed by a non-profit system, and career development opportunities. Base salary for hospitalists is relatively standardized, but the details of how shifts are distributed significantly affect quality of life.

For subspecialists entering outpatient practice with the potential to build an infusion center or procedural practice: negotiate ownership or revenue sharing on ancillary services from the start. Establishing that you'll participate in technical fee revenue for procedures you perform or supervise is much easier to include in an initial contract than to renegotiate after you've been building the program.

Loan forgiveness is particularly relevant for primary care and IM subspecialists working in community health centers or rural hospitals. PSLF can retire $200,000-$300,000 in debt for physicians in qualifying positions after 10 years. For subspecialists going into infectious disease or endocrinology, where salaries are lower than the debt burden, PSLF changes the financial calculus significantly.

Malpractice tail coverage needs are lower for non-procedural internists than for surgeons but still present. Clarify whether your employer uses occurrence or claims-made malpractice policies.

What the data doesn't tell you

Internal medicine is where most of American medicine's complexity actually lives. The 80-year-old with heart failure, diabetes, CKD, atrial fibrillation, and a new pulmonary infiltrate is not the patient that gets featured in a specialty's promotional materials, but that's who internists manage every day. The cognitive demands of complex multimorbidity management are genuinely high.

The financial outcomes in IM subspecialties vary so dramatically that choosing your fellowship based primarily on intellectual interest rather than projected income has real consequences. An infectious disease fellow who genuinely loves the epidemiology and pathophysiology of infection is choosing a lifestyle that includes lower income and (historically) excellent lifestyle compared to a cardiologist. That can be the right choice; just make it with open eyes about what the income ceiling actually is.

Hospitalist medicine created a genuine career track where none existed before, and the 7-on-7-off model has been broadly good for physician wellness relative to the traditional inpatient internal medicine attending model. The tradeoff is that hospitalists often lack continuity with patients, which some physicians find unsatisfying. You treat someone through a complex admission and then never see them again.

Primary care is having a genuine crisis in the US. Salaries haven't kept pace with other specialties, administrative burden has increased, and the insurance model creates productivity pressure that undermines the relationship-based care that makes primary care effective. Direct primary care is a partial solution that works for some practices. It doesn't solve the access problem for patients who can't afford it. The people who stay in primary care long-term are typically those who are genuinely committed to the continuity relationship and find ways to manage the system pressures.

Frequently asked questions