Endocrinology:
physiology, technology, and the long game

At a glance

Every specialty profile on this site involves a trade, but endocrinology's is unusually easy to state: you give up income and procedures; you get intellectual depth, longitudinal relationships, and one of the most controllable lifestyles in internal medicine. If that sounds obviously bad, this page will save you two years. If it sounds obviously good, read on — the field is more interesting, and more in demand, than its paycheck suggests.

What it involves

Endocrinology is the medicine of the body's hormone-producing glands and of metabolic regulation. The bread and butter of adult practice is diabetes mellitus — types 1 and 2, plus gestational and monogenic forms — and thyroid disease: hypo- and hyperthyroidism, nodules, autoimmune thyroiditis, and thyroid cancer. Beyond those two pillars, the field spans adrenal disorders (Cushing's, Addison's, incidentalomas, pheochromocytoma), pituitary and neuroendocrine disease (acromegaly, prolactinomas, hypopituitarism), metabolic bone disease (osteoporosis, hyperparathyroidism, calcium and vitamin D disorders), lipid disorders, reproductive endocrinology (PCOS, hypogonadism, gender-affirming hormone therapy), and — increasingly — obesity medicine. The patient relationship is fundamentally longitudinal: endocrine conditions are chronic, and the work is titration, education, and follow-up over months to years, not episodic rescue. That rhythm is exactly what draws some internists in and drives others away — be honest with yourself about which camp you are in.

A representative week

Because diabetes puzzles and rare zebras get the attention, it is worth stating what the volume actually is. A general adult endocrinologist's week is overwhelmingly outpatient, and the case mix is dominated by two conditions. As a rough sense of a typical general practice (proportions vary widely by setting and referral base):

The honest translation: if you love the idea of endocrinology but would only enjoy the pituitary zebras, know that most of the work is diabetes and thyroid, plus the inbox that chronic outpatient care generates. The people happiest in this field are the ones who find that core genuinely rewarding.

The procedures, and how they vary

Endocrinology has no endoscopy-style procedural engine, but it is not procedure-free. The field's main hands-on skills are thyroid/neck ultrasound and ultrasound-guided FNA, both ACGME fellowship competencies⁵; some endocrinologists deepen them with focused post-graduate courses and a neck-ultrasound certification, and in-office ultrasound and FNA add procedural RVUs — though FNA reimbursement was cut in the 2019 fee schedule⁶. DXA interpretation for bone density is a cognitive competency rather than a procedure, and osteoporosis practice involves overseeing injectable and infusion therapies (zoledronate, denosumab, romosozumab, teriparatide). How much of this you actually do varies sharply by practice: academic centers and larger groups often run dedicated thyroid-ultrasound suites, while smaller practices may refer ultrasound and biopsy out — a concrete thing to ask about when you evaluate a job, because it shapes both your daily work and your RVUs.

What is reshaping the field (as of mid-2026)

Two forces are actively changing the day-to-day, and it is worth separating what is settled from what is still moving. Established: GLP-1 receptor agonists and dual agonists (semaglutide, tirzepatide) have transformed diabetes and obesity care and driven surging demand; automated insulin delivery (“artificial pancreas”) systems are now standard in type 1 care; and the FDA cleared the first over-the-counter CGM in March 2024⁷. As of August 2025, 28.1% of adults with diagnosed diabetes on oral glucose-lowering medications were also using GLP-1 injectables⁸. Still in motion: oral GLP-1s and next-generation agents, expanding type-2 technology use, and the supply, coverage, and cash-pay economics around obesity medicine — all of which shift quickly. Both trends raise demand for endocrinologists and both add data-review and prior-authorization workload. This is among the fastest-moving areas in medicine; treat any specific drug, device, or coverage detail as a snapshot and verify the current state before relying on it.

The training pathway

After a three-year IM residency and ABIM internal medicine certification, fellowship is 24 months (ACGME), of which ABIM requires at least 12 clinical months for board eligibility; academic and research tracks run three years, and ABIM allows a 7-year board-eligibility window after fellowship⁹. The ACGME curriculum tells you what the specialty actually is: required competence in CGM, insulin-pump management, stimulation and suppression testing, DXA interpretation, thyroid ultrasound, and thyroid biopsy, plus inpatient and outpatient consult work and a continuity clinic running the entire fellowship, with at least two ambulatory half-days per week averaged across training — schedules built so inpatient and outpatient duties do not constantly collide, part of why fellowship itself is gentler than cardiology or GI⁵. (Pediatric endocrinology is a separate 3-year fellowship after pediatrics residency, certified by the American Board of Pediatrics, and faces an even more acute and deepening recruiting crisis — about 64% of positions filled in the 2024 cycle, 59.6% in the 2025 appointment year, and just 48.1% in the 2026 appointment-year Match¹⁰.)

Sub-tracks and niches

Unlike cardiology, most endocrine niches are built within or after the standard two years — through case mix, focused clinics, and add-on certifications rather than more ACGME training.

Competitiveness

Endocrinology is less competitive to enter than cardiology, gastroenterology, PCCM, or heme/onc — striking, for a field this deep in demand. Read that correctly, though: it is not an unwanted or underfilled specialty. It fills nearly every seat, every year, with a distinct applicant pool drawn to longitudinal physiology, cognitive medicine, diabetes technology, thyroid disease, and metabolic care. In the 2026 appointment-year Match, endocrinology offered 398 certified positions across 165 programs and filled 389 — a 97.7% fill rate; of 457 applicants who preferred endocrinology, 83.2% matched into it, 1.8% into a different specialty, and 15.1% went unmatched¹. The prior cycle looked the same: 380 of 386 positions filled (98.4%) in the 2025 appointment year¹³. The applicants-per-position ratio sits near 1.1–1.3 — close to parity. A solid IM resident who genuinely wants this field can very likely have it, though not automatically at the most sought-after academic programs, many of which favor their own residents.

The contrast with the procedural fellowships, drawn from the same 2026 appointment-year report, makes the point.

Why so accessible? The field's monetary rewards are lower, and it lacks the high-adrenaline procedures that pull residents toward cardiology and GI. Low US-MD interest is the flip side: in the 2026 appointment year only 27.0% of matched positions went to US MD graduates, 16.7% to DOs, and the majority to international medical graduates (more below)¹. None of this makes endocrinology a lesser field — it makes it a welcoming one for people who actually want it.

What a successful application looks like: solid but not stratospheric board scores; demonstrated interest — an endocrine elective, a case report or small project in diabetes, thyroid, bone, or obesity; and strong letters, ideally including an endocrinologist's alongside your program director's. Endocrinology has followed the NRMP “All In” policy since 2018, interviews are virtual, applicants in the 2025–2026 cycle received 5 program signals, and APDEM has announced formal ERAS program signaling from the 2027 season — check the current cycle's rules before applying¹⁴.

Skills & personality

Endocrinology is a reasoning specialty built on physiology: diagnosis hinges on interpreting dynamic hormone testing, feedback loops, and subtle lab patterns — an ACTH stimulation, a dexamethasone suppression, a glucose tolerance curve — more than imaging or procedures. If you were the resident who lit up working through an unexplained hypercalcemia or a strange electrolyte pattern, that is the daily texture of this job.

The field rewards people who value longitudinal relationships and can coach behavior change over years; who are strong communicators, because insulin teaching, device training, and lifestyle counseling are core clinical acts; who tolerate ambiguity and incremental progress, since wins look like an A1c drifting down over six months rather than a reperfused artery; and who are detail-oriented, because modern diabetes care generates large streams of CGM and pump data to review and act on. An academic inclination helps — many endocrinologists stay involved in research or quality improvement given the field's ties to diabetes and obesity as public-health problems.

Who tends to be unhappy? Physicians who crave procedures, high-acuity intervention, immediate feedback, or maximal income relative to training length. And one more, candidly: people drawn mainly by the schedule. Residents who want a lighter week but do not actually enjoy endocrine content tend to burn out on the inbox, the prior authorizations for insulin, GLP-1s, and devices, and the grind of chronic-disease follow-up. The lifestyle is a reward for loving the work, not a substitute for it.

Lifestyle & balance

Endocrinology consistently ranks among the most controllable-lifestyle specialties in internal medicine. The work is outpatient-dominant, daytime, and clinic-based; reported workweeks cluster around 48 hours. Call is typically phone-based and shared across a group; true endocrine emergencies — adrenal crisis, severe DKA, myxedema — exist but are uncommon, and much after-hours work can be handled by phone or deferred to morning. Nobody is running to a cath lab at 3 a.m. Fellowship follows the same pattern, and the specialty's exam-light, data-heavy nature makes it unusually telemedicine-compatible — a real flexibility advantage over hospital-bound fields, and many endocrinologists arrange part-time work.

Now the honest counterweight: a good schedule has not protected endocrinologists from burnout. In Medscape's 2024 burnout report (9,226 physicians surveyed July–October 2023), over 40% of endocrinologists reported burnout and around 20% depression — over 50% among women versus over 30% among men. The drivers were not hours: they were bureaucratic and EHR burden, prior-authorization friction, and pay, cited as a burnout factor by 45% of the cohort, the second-most-common answer¹⁵. Both things are true at once: the schedule gives you your evenings back, while the administrative load and the paycheck grind on you during the day.

Compensation & the opportunity cost

Here is the defining fact, stated without varnish: endocrinology sits at or near the bottom of physician compensation rankings — below general internal medicine in some surveys — despite two extra years of training. A hospitalist classmate may out-earn you the year you finish fellowship. If income is your top priority, this is the wrong field.

These are self-reported survey averages, not audited payroll²³; there is no endocrinology-specific federal wage code, so the only public floor is the BLS physicians-and-surgeons figure¹⁶. As a directional cross-check, one crowdsourced platform put the average near $326,000 and reported endocrinologist wRVUs (~6,297) running well below cardiology (~9,432) and gastroenterology (~9,616) — read as directional only, since it is self-reported and not a representative survey¹⁷.

Why the low pay despite the shortage? Because reimbursement rewards procedures and volume, not cognitive complexity. Endocrine visits are long and intellectually demanding but are coded as office visits, and the specialty performs few high-RVU procedures. The gap is structural: scarcity raises demand for endocrinologists, but it does not raise the fee schedule. What moves the needle within the field: panel size and volume above all (most employed endocrinologists are on wRVU models); in-office thyroid ultrasound and FNA; DXA and lab ancillaries in some practices; and obesity-medicine or cash-pay lines, a growing supplement. Geography matters in the direction you might not expect: the Northeast and desirable coastal metros tend to pay less, while rural, Midwest, South, and underserved markets pay more, often with signing bonuses and loan repayment.

Intellectual scope

If you are drawn to mechanism — to understanding why the body does what it does — endocrinology may be the purest expression of physiologic reasoning left in internal medicine. It is built on feedback loops, dynamic testing, and puzzles like unexplained hypercalcemia, discordant thyroid tests, or wild glycemic swings that only make sense once you piece the clues together. Because hormones act everywhere, the differential crosses every organ system; and because so much of the work is prevention — of diabetic complications, fractures, cardiovascular disease — you get the long-game satisfaction of changing trajectories rather than treating events.

The science is moving fast: the GLP-1 revolution is arguably the biggest pharmacologic story in medicine right now, and it lives in this specialty; closed-loop insulin delivery has turned type 1 care into a technology discipline; osteoporosis therapeutics keep advancing. Academic endocrinology carries strong NIH-funded research traditions across diabetes, metabolism, bone, and reproductive science, and industry roles in the GLP-1, insulin, and device pipelines are a natural fit. If you like teaching, few fields teach better.

Pathways & career arc

Employed health-system and community practice is the majority destination: clinic-centered work built on diabetes, thyroid, and increasingly obesity, and generally paying more than academia. Academic practice trades income for teaching, research, and complex referral disease — advanced thyroid cancer, Cushing's, acromegaly, pituitary tumors. Independent private practice is less common than in procedural fields but offers ownership upside and ancillary revenue. Beyond the clinic, endocrinology opens unusually good non-clinical doors: pharma and biotech medical affairs and clinical development (the GLP-1 and insulin pipelines run on endocrinologists), diabetes-technology and digital-health companies, informatics, administration, and telehealth-first or cash-pay obesity and diabetes practices. Hybrid careers — part clinic, part virtual, part industry or academic — are more achievable here than in hospital-bound specialties.

The job market is strong and broad. The adult-endocrinologist shortage is well documented: the Endocrine Society's Lewin Group analysis found a shortage of roughly 1,500 adult and 100 pediatric FTE endocrinologists and projected the adult gap would widen to about 2,700 without growth in fellowship output — growth that has remained modest⁴. Wait times for new endocrine appointments have historically run weeks to months, and crowdsourced job boards list hundreds of openings nationwide, with the strongest pay in rural and mid-sized markets¹⁷. Some newer national modeling suggests aggregate supply could look adequate on paper by the late 2030s, but essentially every analysis agrees geographic maldistribution will keep many communities underserved: rural and mid-sized markets struggle most to recruit and pay the most, while coastal academic hubs are more saturated and pay less. Ground your expectations in one sentence: this is a demand story, not a pay story. Job security is excellent and you can work nearly anywhere in the country — within a compensation band that reimbursement structure, not scarcity, sets.

The career arc, honestly. Endocrinology is one of the more durable and sustainable lives in medicine precisely because it is cognitive and outpatient: there is no physical procedural clock running out on you, and the work scales gracefully into part-time, telemedicine, and hybrid arrangements as life changes. Many endocrinologists deepen a niche over time (diabetes technology, thyroid, obesity, bone, or gender-affirming care), move into medical direction of a diabetes program, or add an industry, academic, or informatics dimension. It is a field you can practice at full intensity at 40 and at a chosen tempo at 65 — and one where a second, non-clinical domain (pharma, devices, digital health) is unusually accessible.

Choosing a fellowship & first job

Endocrinology asks you to choose twice: first a fellowship, then a first attending job. The through-line is the same: decide what matters for your direction, evaluate the program or group against it, and negotiate the terms.

Choosing the fellowship. Weigh case mix and diabetes-technology exposure, whether you will graduate confident in thyroid ultrasound and FNA, depth in any niche you care about (obesity, bone, pituitary, reproductive), academic-versus-community orientation, research support if you want it, geography, and — for IMGs — documented visa sponsorship (below). Because many top academic programs favor their own residents, apply realistically and let your signals follow genuine fit.

Choosing the first job. The headline salary matters less than the model. Normalize competing offers to the same terms and get the details in writing:

• The clinical model: panel size and expected volume, the wRVU target and conversion factor, new-versus-follow-up mix, inbox and prior-authorization support (a genuine quality-of-life variable here), and inpatient consult expectations.
• The revenue levers: whether you can perform and bill in-office thyroid ultrasound and FNA, DXA, and lab ancillaries; whether an obesity-medicine or cash-pay line is supported; and how productivity above base is paid.
• The contract: base versus productivity, non-compete scope, without-cause termination, malpractice and tail, and who employs you — plus loan-repayment and sign-on incentives, which are often strongest in the underserved markets that also pay the most.

IMG considerations

If you are an international medical graduate, pay close attention: endocrinology is one of the most IMG-friendly fellowships in all of internal medicine — not as a consolation prize, but as a field where IMGs are central to the workforce. In the 2026 appointment-year Match, non-US-citizen IMGs filled 36.8% of matched positions and US-citizen IMGs another 19.5%, against 27.0% US MDs — combined, IMGs fill roughly half or more of endocrine fellowship positions¹. That is the direct arithmetic of low US-MD interest meeting a near-parity match ratio, and it means programs are genuinely accustomed to evaluating, training, and hiring IMGs. (Two companion analyses take up the wider questions: whether international graduates take US graduates' spots, and the H-1B for physicians in training; practical planning lives on the IMG guide.)

Verify sponsorship program by program — “IMG-friendly” is a field-level average, not a promise about any one program. J-1 (ECFMG-sponsored) visas are widely accepted across endocrine fellowships¹⁸, and many programs also sponsor H-1B, but that varies by institution and some sponsor neither for clinical fellowship. Confirm each program's documented sponsorship policy and recent IMG-match history before you apply, and confirm each prospective employer's waiver eligibility before you rely on a job — do not assume from the field's reputation. One nuance for research-heavy programs: NIH training-grant (NRSA) funding generally requires US citizenship or permanent residency, so visa-holding fellows may be steered toward clinical rather than grant-funded research tracks, though some programs bridge this with internal funding.

The workforce shortage also works in your favor after fellowship. Because the deepest need is in underserved and non-coastal markets, IMGs on J-1 visas frequently find strong job offers tied to Conrad 30 / J-1 waiver positions — often the same rural and mid-sized markets that pay above the specialty's average²². And ABIM's Special Consideration “Pathway E” — a five-year pilot — now offers a narrow, competency-based route to board eligibility for exceptionally qualified IMGs accepted into an ACGME fellowship without a U.S. residency; verify current eligibility with ABIM if your training history is non-standard²³. For an IM-bound IMG who loves physiology and wants a subspecialty that is realistically attainable, visa-navigable, and in durable demand, endocrinology deserves a place near the top of the list.

Bottom line

Consider endocrinology if you love physiology and diagnostic reasoning; you enjoyed the thyroid-nodule workups and the DKA physiology more than the procedures around them; you want longitudinal relationships and long-term impact on chronic disease; you value a controllable, outpatient, family-compatible life with light call; you are energized by the GLP-1 and diabetes-technology shift; or you are an IMG seeking an accessible, visa-navigable subspecialty with excellent job security. It also suits physicians whose values run toward prevention and lifestyle medicine.

It may not fit if you want procedures or procedural income; if compensation is a primary driver — two extra years for pay near the bottom of the specialty spectrum, sometimes below hospital medicine, is a bad trade on money alone; if prior authorizations and inbox medicine are what you most want to escape; if you need immediate, dramatic wins rather than gradual progress; or if you insist on practicing only in saturated coastal metros at top-of-market pay, because the field's best financial opportunities sit in underserved and non-coastal markets.

A last mentor's note: endocrinologists, as a group, chose their field with open eyes and tend to say the trade was worth it — a fulfilling intellectual career and a life outside the hospital. Find one at your program and ask to shadow a clinic; a week there will tell you more than any survey table, including this one.

References

1. National Resident Matching Program. (2025). Results and data: Specialties Matching Service — Match Results Statistics, Medicine and Pediatric Specialties, 2026 appointment year. https://www.nrmp.org/match-data/ Positions, fill rates, applicant match/non-match outcomes, and applicant-type (US MD/DO/IMG) shares (matches conducted 2025). ↩₁ ↩₂ ↩₃ ↩₄
2. Medscape. (2024, 2026). Physician compensation reports (2023 and 2025 earnings). Self-reported survey; subscription access required, not reproduced here. Endocrinology averaged about $256,000 in the 2024 report (2023 earnings), the lowest of 29+ specialties surveyed; it remained in the lower tier in the 2026 report while overall physician pay averaged about $386,000, and endocrinologists are among the least likely to feel fairly paid. ↩₁ ↩₂
3. Doximity. (2025). Physician compensation report 2025 (2024 data). https://www.doximity.com/reports/physician-compensation-report/2025 Self-reported/modeled survey. Adult endocrinology average about $290,606; pediatric endocrinology was the single lowest-paid specialty at about $230,426. ↩₁ ↩₂
4. Vigersky, R. A., et al. (2014). The clinical endocrinology workforce: Current status and future projections of supply and demand. Journal of Clinical Endocrinology & Metabolism (Endocrine Society / Lewin Group). https://pubmed.ncbi.nlm.nih.gov/24940655/ Estimated a shortage of roughly 1,500 adult and 100 pediatric FTE endocrinologists, projected to widen to about 2,700 adult FTE without growth in fellowship output. ↩₁ ↩₂
5. Accreditation Council for Graduate Medical Education. (2026). Program requirements for graduate medical education in endocrinology, diabetes, and metabolism. https://www.acgme.org/globalassets/pfassets/programrequirements/2026-prs/143_endocrinologydiabetesmetabolism_2026.pdf Required competencies include continuous glucose monitoring, insulin-pump management, stimulation and suppression testing, DXA interpretation, thyroid ultrasound and biopsy; continuity clinic runs the full fellowship with at least two ambulatory half-days per week averaged across training. ↩₁ ↩₂
6. American Association of Clinical Endocrinology & American Thyroid Association. (n.d.). Advocacy on fine-needle-aspiration reimbursement. https://pro.aace.com/recent-news-and-updates/aace-support-ata-advocating-better-reimbursement-fine-needle-aspiration Thyroid FNA reimbursement was reduced in the 2019 Medicare fee schedule; the endocrine and thyroid societies have advocated to reverse it. ↩
7. U.S. Food and Drug Administration. (2024, March 5). FDA clears first over-the-counter continuous glucose monitor. https://www.fda.gov/news-events/press-announcements/fda-clears-first-over-counter-continuous-glucose-monitor ↩
8. National Center for Health Statistics. (2025, August). GLP-1 use among adults with diagnosed diabetes (NCHS Data Brief No. 537). https://www.cdc.gov/nchs/data/databriefs/db537.pdf 28.1% of adults with diagnosed diabetes who take oral glucose-lowering medications also used GLP-1 injectables. ↩
9. American Board of Internal Medicine. (n.d.). Endocrinology, diabetes & metabolism certification policies. https://www.abim.org/certification/policies/internal-medicine-subspecialty-policies/endocrinology-diabetes-metabolism/ Two-year fellowship; ABIM requires at least 12 clinical months for board eligibility; a 7-year board-eligibility window applies after fellowship. ↩
10. Decline of the pediatric endocrinology workforce. (2025). Endocrine Practice. https://pubmed.ncbi.nlm.nih.gov/40769309/ Pediatric endocrinology fellowship fill has fallen: about 64% in the 2024 cycle, 59.6% (62 of 104) in the 2025 appointment year, and 48.1% (51 of 106) in the 2026 appointment-year Match. ↩
11. American Board of Obesity Medicine. (n.d.). Certification pathway requirements. https://www.abom.org/ CME route requires 60 AMA PRA Category 1 credits in obesity (at least 30 designated "Group One") in the 36 months before the application deadline. ABOM is a free-standing certifying body, not an ABMS member board, and requires existing certification from an ABMS board. ↩
12. American Board of Clinical Lipidology. (n.d.). Certification pathway requirements. Certification via examination; no separate fellowship required. ↩
13. National Resident Matching Program. (2025). Results and data: Specialties Matching Service, 2025 appointment year. https://www.nrmp.org/match-data/ Prior-cycle fill and applicant-type statistics (published February 2025). ↩
14. Association of Program Directors in Endocrinology, Diabetes & Metabolism. (2025). Match policy and program-signaling announcements. https://www.endocrine.org/apdem Endocrinology has followed the NRMP "All In" policy since the 2018 Match; applicants in the 2025–2026 cycle received 5 program signals, with formal ERAS program signaling announced beginning with the 2027 season. Verify the current cycle’s rules before applying. ↩
15. Medscape. (2024). Endocrinologist burnout & depression report. Self-reported survey of 9,226 physicians (July–October 2023); subscription access required. Over 40% of endocrinologists reported burnout and about 20% depression; drivers were bureaucratic/EHR burden, prior-authorization friction, and pay (cited by 45%), not hours. ↩
16. U.S. Bureau of Labor Statistics. (2025). Occupational Outlook Handbook: Physicians and surgeons. https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm Federal floor only: no endocrinology-specific SOC code; endocrinologists fall within the physicians-and-surgeons group. Excludes many self-employed physicians. ↩
17. Marit Health. (2026). Endocrinologist salary and jobs (community-sourced). https://www.marithealth.com/o/-/endocrinologist/salary Crowdsourced, self-reported salary, wRVU, and job-posting data; directional only, not a representative survey. Pulled July 2026. Averages clustered near $326,000; reported endocrinologist wRVUs (~6,297) ran well below cardiology (~9,432) and gastroenterology (~9,616). ↩₁ ↩₂
18. Educational Commission for Foreign Medical Graduates. (n.d.). Exchange Visitor Sponsorship Program (J-1): General information. https://www.ecfmg.org/evsp/applying-general.html ↩
19. Restriction on Entry of Certain Nonimmigrant Workers, Proclamation No. 10973. (2025, September 24). Federal Register. https://www.federalregister.gov/documents/2025/09/24/2025-18601/restriction-on-entry-of-certain-nonimmigrant-workers Signed September 19, 2025; effective September 21, 2025. Imposes a $100,000 payment requirement on certain new H-1B petitions for beneficiaries outside the United States, with national-interest exemptions and a twelve-month sunset absent extension. ↩
20. U.S. Citizenship and Immigration Services. (2025). H-1B: Frequently asked questions on the September 2025 proclamation. https://www.uscis.gov/newsroom/alerts/h-1b-faq USCIS guidance that the payment requirement applies to new petitions for beneficiaries outside the United States without a valid H-1B visa, and does not reach previously issued visas, earlier-filed petitions, renewals, or change-of-status, amendment, and extension petitions for people already in the country. ↩
21. State of California v. Mullin, No. 1:25-cv-13829-LTS (D. Mass. June 8, 2026) (Sorokin, J.), appeal docketed, No. 26-01699 (1st Cir. 2026). https://www.fragomen.com/insights/united-states-district-court-temporarily-stays-order-vacating-dollar100000-h-1b-fee.html The district court vacated the payment requirement on June 8, 2026 as an unlawful tax and Administrative Procedure Act violation, then temporarily stayed its own order on June 12, 2026 pending appeal; the government appealed to the First Circuit. The requirement therefore remains operational for affected petitions at this writing. A fast-moving matter — verify current status before relying. ↩
22. U.S. Citizenship and Immigration Services. (n.d.). Conrad 30 Waiver Program. https://www.uscis.gov/working-in-the-united-states/students-and-exchange-visitors/conrad-30-waiver-program ↩
23. American Board of Internal Medicine. (n.d.). Candidates for special consideration — Pilot model pathway (Pathway E). https://www.abim.org/certification/policies/candidates-for-special-consideration/proposed-pilot-model-pathway/ A five-year pilot competency-based route to board eligibility for exceptionally qualified IMGs who completed at least three years of internal medicine training abroad and were accepted into an ACGME-accredited ABIM-subspecialty fellowship, without completing a U.S. residency. Requires ECFMG certification, an unrestricted U.S. license, and program-director attestation of competence. Narrowly defined; verify current eligibility with ABIM. ↩

Figures here are survey-, model-, and projection-based and shift year to year; compensation figures are self-reported survey and crowdsourced estimates read only directionally; Match statistics, signaling rules, drug and device developments, and the immigration landscape all move. Verify against the primary source before relying on any single figure for a career, contract, or immigration decision. This page is educational and is not career, financial, immigration, or legal advice.