English 
Português 
Español 
For the Brazilian physician considering a professional move to the United States, salary is the most visible metric — but it rarely tells the whole story. Compensation varies by orders of magnitude across specialties, and the path to that first paycheck requires passing the USMLE, entering the U.S. medical residency system, and securing immigration status that authorizes clinical practice.
This overview presents figures updated for 2024–2025 from the Medscape Physician Compensation Report, the Bureau of Labor Statistics (BLS OES), and the Association of American Medical Colleges (AAMC), alongside a realistic look at the cost of living in markets such as New York City and the visa options available to foreign-trained physicians.
Compensation Ranges by Specialty
The Medscape Physician Compensation Report 2024 and BLS Occupational Employment and Wage Statistics data show annual averages that differ significantly by specialty. The figures below reflect mean total compensation (including bonuses and profit-sharing), in gross U.S. dollars.
- Orthopedics: $558,000/year
- Cardiology: $525,000/year
- Plastic Surgery: $536,000/year
- Urology: $515,000/year
- Gastroenterology: $512,000/year
- Otolaryngology (ENT): $489,000/year
- Radiology: $498,000/year
- Anesthesiology: $472,000/year
- Oncology: $463,000/year
- Emergency Medicine: $379,000/year
- Psychiatry: $323,000/year
- Internal Medicine: $282,000/year
- Family Medicine: $272,000/year
- Pediatrics: $260,000/year
The gap between the highest- and lowest-paying specialties exceeds $290,000 per year. For Brazilian physicians still choosing a residency track, this is a strategic data point: a decision made in one’s thirties sets the compensation ceiling for the following three decades.
Variables Beyond Specialty
Beyond the field of practice, three factors can move compensation up or down by 30% or more.
Practice Model
Physicians in self-employed practices or partnership arrangements report to Medscape mean compensation 22% higher than those employed by hospitals or health systems. The trade-off is operational risk: office leases, malpractice insurance, administrative staff, billing costs, and direct negotiations with insurers.
Geography
States with lower physician-to-population ratios pay more due to supply dynamics. Nebraska, Kentucky, Alabama, Wisconsin, and Indiana frequently top average compensation rankings. Coastal states with high concentrations of physicians — Massachusetts, California, New York, and the D.C. area — pay less in nominal terms, though they offer access to academic medical centers and research institutions.
Experience and Productivity
Medscape reports that physicians with more than 10 years of practice earn, on average, 35% more than those fresh out of residency. RVU-based payment models reward both volume and case complexity.
Cost of Living in New York City: The Real Adjustment
A gross salary of $350,000 in Manhattan has very different purchasing power than the same figure in Cleveland or Phoenix. The primary drains are housing and taxes.
The median rent for a one-bedroom apartment in Manhattan ranged between $4,300 and $4,800 throughout 2025, according to StreetEasy and Douglas Elliman data. The unlimited monthly subway pass (30-Day OMNY) costs $132. Federal income tax at the $350,000 level falls in the 35% marginal bracket; added to this are Social Security (6.2% up to the wage base), Medicare (1.45% with no cap, plus 0.9% above $200,000), New York State income tax (up to 6.85%), and NYC city tax (up to 3.876%).
The practical result: the monthly take-home pay of a specialist in Manhattan — after taxes, FICA, employer health plan premiums, and maximum 401(k) contributions — typically lands around $18,000 to $21,000. Comfortable by global standards, but financial discipline is essential for wealth building and student loan repayment.
The Regulatory Path: USMLE and Residency
To practice clinical medicine in the United States, a foreign-trained physician must complete three milestones: ECFMG (Educational Commission for Foreign Medical Graduates) certification, passing USMLE Steps 1, 2 CK, and 3, and matching into an ACGME-accredited residency program.
The ECFMG verifies credentials and identity. USMLE Step 1 covers basic sciences; Step 2 CK covers clinical knowledge; Step 3 is typically taken during residency. Since 2024, several states — Tennessee, Florida, Illinois, Virginia, Washington, Idaho, and Iowa — have created alternative pathways that allow provisional licensure for physicians with international training and experience without completing a full U.S. residency, but these require a specific hospital job offer and supervision during a transitional period. This is the exception, not the rule.
Visa Options for Physicians
The EB-2 NIW (National Interest Waiver) is the most sought-after option for physicians with academic or public health profiles. It allows self-petitioning (no employer sponsor required), leads to a green card, and is based on the Matter of Dhanasar (2016) framework: substantial merit and national importance, being well-positioned to advance the endeavor, and net benefit to the United States. Physicians practicing in Health Professional Shortage Areas (HPSA) or Medically Underserved Areas (MUA) typically build strong NIW narratives.
The H-1B requires employer sponsorship (hospital, health system, or university) and is subject to the annual cap of 65,000 plus 20,000 for U.S. master’s degree holders. Hospitals designated as cap-exempt (universities, affiliated institutions, qualifying nonprofit research organizations) may sponsor outside the cap.
The J-1 is the standard visa for residency programs through ECFMG sponsorship. It carries a two-year home residency requirement, which can be waived through the Conrad 30 program (a three-year service commitment in an HPSA/MUA) or an Interested Government Agency (IGA) waiver.
The O-1 serves physicians who can demonstrate extraordinary ability through publications, awards, original contributions to the field, and distinguished roles. It commonly serves as a bridge between the J-1 and an EB-1A or EB-2 NIW green card.
Return on Investment, in Perspective
Building a medical career in the United States takes between six and ten years — encompassing the USMLE, residency, a possible fellowship, and professional stabilization. Direct costs total $50,000 to $80,000 in exams, application fees, travel, and preparation platforms. The return, however, is structurally high: no regulated profession in the United States pays a higher median than specialized medicine. For the Brazilian physician willing to navigate the regulatory and immigration systems, the destination remains among the most competitive in the world in terms of compensation, clinical infrastructure, and research opportunities.
Victoria Harper
Editor-in-Chief
Leading journalism and editorial content at Visto n’ Visa, Victoria helps make immigration topics clear, trustworthy, and easy to understand. Her focus is on delivering useful, human, and relevant content for people exploring new paths abroad.
