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# Is a cardiology or gastroenterology fellowship worth the attending years I give up?
- URL: https://www.financialfellowship.com/cardiology-gi-fellowship-worth-it-hospitalist/
- Published: 2026-10-15T22:17:52.000Z
- Updated: 2026-10-16T04:43:28.000Z
- Author: Ryan Inman
- Tags: #topic-im-res

For cardiology and gastroenterology, yes on the pay data alone. For several other internal medicine fellowships, no, and the same data says so. Cardiology averages $575,000 and gastroenterology $530,000 in the Medscape Physician Compensation Report 2026, against $307,000 for internal medicine overall, gaps of $268,000 and $223,000 a year that repay three fellowship years quickly even after the loan balance grows through training. Endocrinology at $290,606, infectious disease at $320,730, and rheumatology at $324,954 in the Doximity 2025 data all average at or below the Doximity internal medicine average of $326,116, which means those fellowships cost the same three attending years and pay no premium for them. Choose cardiology or gastroenterology and the finances support you. Choose the others for the work and the life, with open eyes, and never as a raise.

Part of the [internal medicine hub](https://www.financialfellowship.com/specialties/internal-medicine/).

## Price the three years honestly

A fellowship after a three year internal medicine residency costs three years of the gap between resident pay and attending pay, plus three more years of interest on the loan balance, plus three years of attending level retirement contributions and compounding that never happen. The cost side is the same for every subspecialty, which is why the far side has to do all the work in this comparison. Cardiology's gap over general internal medicine, $575,000 minus $307,000, is $268,000 a year. Gastroenterology's is $530,000 minus $307,000, or $223,000 a year. At gaps that size, the fellowship years are repaid early in the attending career and the higher income then compounds for decades, in larger retirement contributions, a faster loan exit on any track, and a savings rate the generalist path reaches only with unusual discipline.

The loan side softens the cost more than residents expect. Training years at academic and nonprofit employers usually count toward Public Service Loan Forgiveness on an income driven plan, so a fellow heading for a qualifying attending job banks six years of the 120 payment count by the end of fellowship, and the balance forgiven at the end can be larger because it kept growing at resident payments. The fellowship decision and the loan decision are the same decision, and the [internal medicine student loans page](https://www.financialfellowship.com/specialties/internal-medicine/new-attending/student-loans/) works both sides of it together.

## The fellowships the pay data does not support

Run the same arithmetic on the lower shelf and it inverts. Endocrinology's Doximity average of $290,606 sits below the internal medicine average of $326,116 in the same survey. Infectious disease at $320,730 and rheumatology at $324,954 sit essentially at it. A resident who takes three fellowship years to reach those incomes has paid the full cost of fellowship for a salary the generalist path already offered, while the hospitalist path, at a self reported average of $314,000 for internal medicine trained physicians, was available three years earlier with nights and shift premiums priced on top.

None of that makes those fellowships mistakes. It makes them purchases. Physicians choose endocrinology for the patients, the clinic rhythm, and the absence of nights, and those are real goods worth real money. The failure mode is only the story: telling yourself the fellowship is also the financial move, and then being surprised at 40 that the hospitalist classmate is a decade of compounding ahead. If you want those fields, price the three years, forgive yourself the premium, and go for the life. If you are choosing on money, the survey table at the [internal medicine hub](https://www.financialfellowship.com/specialties/internal-medicine/) is the whole argument, and it points at two fellowships, not eleven.

## Follow up questions

Do my fellowship years count toward PSLF, or does the clock start over?

They count. Training years at academic and nonprofit employers usually qualify on an income driven plan, so a fellow heading for a qualifying attending job banks six years of the 120 payment count by the end of fellowship.

What if the fellowship I want is one of the lower paid ones?

Then it is a purchase, not a raise. Endocrinology, infectious disease, and rheumatology average at or below the internal medicine average, so choose them for the work and the life, with the three years priced and open eyes.