2026 Medical Toxicologist Salary Guide: Poison Control & Clinical Toxicology Compensation

Medical toxicologists are physicians with fellowship training and subspecialty board certification in Medical Toxicology — a field covering the diagnosis and management of poisoning, drug overdose, envenomation, environmental exposures, and occupational toxic exposure. The field draws from emergency medicine (the dominant training pathway), internal medicine, pediatrics, and preventive medicine. ABEM (American Board of Emergency Medicine), ABIM (American Board of Internal Medicine), ABP (American Board of Pediatrics), and ABPM (American Board of Preventive Medicine) all offer Medical Toxicology subspecialty certification to their board-eligible physicians who complete a 2-year ACGME-accredited toxicology fellowship. Compensation in 2026 ranges from $220,000 to $380,000 — a modest range that reflects the specialty's largely academic and public health orientation, offset by the unique income opportunities in poison control center directorship, forensic consulting, and occupational toxicology.

Salary overview by practice setting

• Academic medical center toxicology division (clinical + academic): $220,000–$320,000; clinical toxicology consultation service for hospital; poison control center affiliation; research (ACMT research grants, NIDA/NIAAA funding for opioid toxicology); fellowship training; PSLF-eligible at academic nonprofit
• Poison control center medical director: $240,000–$360,000; medical directorship of AAPCC-certified regional poison control center; clinical oversight of specialist-in-poison-information (SPI) staff; protocol development; public education; 55 AAPCC-certified poison control centers nationally, each requiring a medical director with Medical Toxicology board certification; administrative stipend adds $40,000–$80,000 to clinical base
• Emergency medicine with medical toxicology subspecialty (community): $280,000–$380,000; EM attending who practices medical toxicology as a subspecialty alongside EM clinical shifts; toxicology consultation service; higher income ceiling than pure toxicology-only roles due to EM clinical component
• Occupational and environmental toxicology (industry or government): $260,000–$400,000; pharmaceutical company clinical pharmacology/toxicology (regulatory medical officer); chemical/petroleum industry toxicologist; EPA, OSHA, ATSDR public health toxicologist; occupational medicine programs with chemical exposure focus; consulting to legal cases (toxic tort litigation expert witness) at $300–$600/hour
• Forensic toxicology expert witness: Supplemental income of $50,000–$150,000 annually for medical toxicologists serving as expert witnesses in criminal cases (DUI-drug, opioid overdose deaths, poisoning allegations), civil litigation (toxic tort, product liability), and workplace drug testing disputes; medical toxicologists are highly sought expert witnesses because they can address both the toxicological science and the clinical medicine

Clinical toxicology billing and procedures

• Inpatient toxicology consultation: CPT 99254 (moderate complexity inpatient consult) or 99255 (high complexity); professional fee $200–$500; complex poisoning management (acetaminophen overdose with NAC, organophosphate toxidrome, serotonin syndrome, anticholinergic poisoning, heavy metal toxicity); toxicology consultations are highly complex and generate 99255-level documentation in most cases; subsequent daily rounding adds CPT 99232/99233
• ED evaluation of overdose/toxidrome (emergency medicine crossover): CPT 99285 (ED E&M, high complexity); professional fee $250–$500; medical toxicologists who maintain ED clinical shifts bill at emergency medicine rates; the combination of EM clinical income + toxicology consultation income creates the highest total compensation in medical toxicology
• Poison control center telephone consultation: Not separately billed to patients (poison control centers operate under federal/state grant funding with free public access via 1-800-222-1222); physician oversight billing occurs through medical directorship compensation rather than per-call professional fees
• Drug testing interpretation (MRO): Medical Review Officer certification (AAMRO/MROCC) allows medical toxicologists to interpret federal workplace drug tests; $15–$30 per MRO review; supplemental income stream for toxicologists with MRO certification
• Chelation therapy management: CPT 99213–99215 (E&M for lead poisoning, heavy metal follow-up); chelation infusion supervision (CPT 96365 if practice administers IV DMSA or CaEDTA); lead poisoning in children and occupational heavy metal exposure management
• Hyperbaric oxygen therapy (CO poisoning): CPT 99183 (physician attendance during HBO); carbon monoxide poisoning is a UHMS-approved HBO indication; medical toxicologists at programs with HBO access participate in CO poisoning treatment protocols; attending fee for HBO sessions generates ancillary income

Expert witness and consulting income

Medical toxicology is unusual in that expert witness consulting represents a significant and legitimate income supplement for many practitioners. Toxic tort litigation (benzene, PFAS, PCB, pesticide, industrial chemical exposures), criminal toxicology (drug-facilitated sexual assault, pediatric poisoning, healthcare worker poisoning), and DUI-drug cases all require medical toxicologists who can explain dose-response relationships, toxicokinetics, and clinical effects in a legally admissible framework. Top medical toxicologist expert witnesses charge $400–$600/hour for consulting and $600–$1,000/hour for deposition/trial testimony. Active expert witnesses generate $50,000–$200,000+ in annual consulting income on top of their clinical salary.

Geographic variation

• Major academic medical centers with toxicology divisions: $225,000–$325,000; fellowship training program; NIH/NIDA research infrastructure; PSLF-eligible
• Regional poison control centers: $240,000–$360,000 for medical directors; typically embedded within academic medical centers or children's hospitals; 55 centers nationally; turnover is low, making medical director vacancies infrequent but highly sought when they open
• Industry and regulatory roles (pharmaceutical, chemical, government): $280,000–$420,000; non-clinical or hybrid roles with medical toxicology expertise in pharmaceutical regulatory affairs, occupational toxicology, or environmental health; strong demand from pharmaceutical companies for medical toxicologists who understand clinical trial safety data and regulatory submission requirements

What we see at Ava Health

Medical toxicology is a small subspecialty (fewer than 500 ABEM/ABIM/ABP medical toxicology diplomates in active clinical practice) with a limited but stable recruiting market. Most positions are at academic medical centers and poison control centers, which have low turnover. The most active recruiting we do in medical toxicology is for emergency medicine physicians with medical toxicology subspecialty certification who are willing to staff community hospital toxicology consultation services as a supplement to their EM clinical income. The expert witness market for medical toxicologists is highly active and is increasingly managed through litigation consulting firms that connect trial lawyers with qualified medical toxicology expert witnesses.

Related: Emergency Medicine Physician Salary Guide, Preventive Medicine Physician Salary Guide, Addiction Medicine Physician Salary Guide, Occupational Medicine Physician Salary Guide.