Treat pain, breathlessness and fear in people with serious illness, and help them decide what happens next.
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What you earn and what it costs to get there.
Median
$236,000
Bottom tenth
$66,260
Where the survey stops
$239,200
There is no separate federal wage figure for palliative care. These doctors are counted inside a residual group called Physicians, All Other, where the median was about $236,000 a year and the bottom tenth $66,260. The survey stops publishing the top end above $239,200, so the real high end is unknown rather than low. A later update of the same group put the median nearer $265,930.
About $65,000 to $90,000 a year
Three years of residency plus a fellowship year, all paid
Residents and fellows are salaried hospital employees. The fellowship year in hospice and palliative medicine pays at roughly the level of a fourth-year resident.
Below the specialist average
Palliative medicine is one of the lower paid physician fields
The work is conversation and symptom control rather than procedures, and American medicine pays for procedures. People choose it knowing that. Hospital and academic employers make up some of the gap with regular hours and no night call in many jobs.
Tuition, fees, exams and kit. Not rent, food or travel
The low end is a community college start into a public university in your own state for the bachelor's degree, then a medical school in your own state at the cheaper end of 30,000 dollars a year. The high end is four full years of undergraduate study plus a private medical school at 65,000 dollars a year or more, with 3,000 to 8,000 dollars for the admission test, applications and interviews. Residency and the palliative care fellowship are paid jobs rather than tuition. Debt of 200,000 dollars or more is normal, but this is one field where federal loan forgiveness genuinely applies, because hospices, academic hospitals and Veterans Affairs are usually nonprofit or government employers.
Debt of $200,000 or more is normal. File the FAFSA (Free Application for Federal Student Aid) every year. This is one field where Public Service Loan Forgiveness genuinely applies, because hospices, academic hospitals and Veterans Affairs are usually nonprofit or government employers.
Hospital palliative care teams
The largest employer. You are consulted by other doctors for patients already admitted.
Hospice agencies
Medical director roles overseeing care delivered at home or in a hospice house.
Cancer centers
Working alongside oncologists from the point of diagnosis, not just at the end.
Veterans Affairs
Federal salary, a pension, and a patient population with heavy palliative need.
The exact path from high school to qualified.
You become a doctor first, in almost any specialty, then add a fellowship.
High school
Grades 11 and 12
Biology, chemistry, physics, math and as much English as you can take. Half of this job is language.
Bachelor's degree
4 years
Any major with the science prerequisites finished, a high GPA, and the medical college admission test.
Medical school
4 years
Four years to an MD (doctor of medicine) or a DO (doctor of osteopathic medicine), passing the first national licensing exams along the way.
Residency in a base specialty
3 to 5 years
Usually internal medicine or family medicine, but emergency medicine, anesthesiology, pediatrics, psychiatry, neurology and surgery all lead here too.
Hospice and palliative medicine fellowship
1 year
A one-year fellowship accredited by the Accreditation Council for Graduate Medical Education, then the subspecialty board exam.
Biology and chemistry
Required for every pre-medical track.
English and writing
You will run the hardest conversations in the hospital. Precise plain language is the skill.
Psychology
Grief, anxiety and family dynamics are daily work, not side issues.
A second language
Interpreters help, but families talk more freely to a doctor who speaks with them directly.
You need a license from the medical board of every state you work in. The national exam sequence, the United States Medical Licensing Examination, is taken in three steps during medical school and residency, and osteopathic students may sit an equivalent instead. Passing it is not a license by itself. Hospice and palliative medicine sits on top as a subspecialty certification, offered through the board of whichever specialty you trained in.
Almost no other subspecialty accepts fellows from so many base specialties. Internists, family doctors, emergency physicians, anesthesiologists, pediatricians, psychiatrists, neurologists, surgeons, obstetricians and radiation oncologists can all enter the same one-year fellowship. That means you do not have to pick this at 22. Plenty of people come to it after a decade doing something else.
Things you don't need, but that help.
Pediatric palliative care
Children with life-limiting conditions and their families. Small, specialized and emotionally the hardest version of the work.
Hospice medical director
Clinical leadership of an agency, including eligibility decisions and staff supervision.
Academic and research work
Teaching communication skills, running trials on symptom control, building a hospital program.
Ethics consultation
Many palliative doctors end up on hospital ethics committees, because they already do this reasoning daily.
Volunteering at a hospice
The single best way to find out whether you can do this work. Start in high school or college.
Communication training
Structured courses in breaking bad news and running family meetings exist, and they measurably help.
Comfort with silence
Not a course. The willingness to sit quietly with someone is the core of the job.
Your own support system
A therapist, a team debrief habit, something outside medicine. Burnout in this field is real and known.
Day to day, pros and cons, where you'd work.
Morning rounds with a team: a nurse, a social worker, a chaplain and you. Review overnight consults, then walk the hospital seeing patients other doctors have asked you about. Adjust pain and breathlessness medication. Sit down with a family for 45 minutes and work out what the person in the bed would actually want. Write the notes, call the hospice agency, arrange the discharge. You will have two or three conversations a day that most people never have once.
The good
The hard parts
Things people don't tell you.
Hospice is care for people expected to live months, usually at home, with treatment aimed at comfort. Palliative care can start on the day of diagnosis and run alongside chemotherapy, surgery or dialysis. Every hospice patient gets palliative care, but most palliative patients are not on hospice.
Hospice and palliative medicine was only recognized as a formal medical subspecialty in the United States in the 2000s. Many of the doctors who built it are still working, which is unusual in medicine.
There is no job code for palliative medicine in the national wage survey. These doctors disappear into a leftover category called Physicians, All Other, which is why every pay figure you find for the field is an estimate.
Most subspecialties add three years or more on top of residency. Hospice and palliative medicine adds one. It is one of the shortest routes from general practice to a recognized subspecialty in American medicine.
Last checked September 2026. Pay figures are typical full-time annual amounts in United States dollars, based on Bureau of Labor Statistics wage data and published pay scales. They vary by state, employer and experience. Tuition is for in-state students at public schools unless the card says otherwise.