Doctor Salaries in the US: A 2026 State-by-State Index

Written By William Lewis

Where a nurse's earning potential swings by roughly $90,000 depending on geography, a physician's total compensation can swing by well over $150,000 for the same specialty — and that's before accounting for the fact that state income tax alone can be worth over $40,000 a year on a $400,000 salary, and cost of living can erase even more.

Below is a state-by-state index of physician total compensation (base salary plus typical productivity bonuses), followed by a breakdown by specialty. A commentary at the end explains the two factors that matter almost as much as the headline number: state income tax and cost of living.

A note on the figures: Because physician pay includes such a wide range of specialties, employment types (private practice, hospital-employed, academic), and productivity-based bonus structures, the figures below are shown as ranges rather than single numbers — reflecting typical full-time physician total compensation across specialties within each state, compiled from Bureau of Labor Statistics wage data, SalaryDr's 2026 verified physician-reported compensation data, and Doximity's 2025 Physician Compensation Report. Three states — Vermont, Maine, and Delaware — were not included in the compiled dataset used for this index; consult BLS OEWS directly for those states.

National Context First

Before the state breakdown, a few national benchmark figures worth knowing: the Medscape 2025 Physician Compensation Report put the average U.S. physician salary at approximately $374,000 in 2024 (up from $363,000 the year before), with primary care physicians averaging $287,000–$298,000 and specialists averaging $404,000–$417,000. More recent, 2026 self-reported data from SalaryDr puts the median physician salary closer to $391,000–$425,000, reflecting continued upward pressure from nationwide physician shortages. By contrast, the Bureau of Labor Statistics' own wage-survey estimate — which tends to run lower because it captures base salary more conservatively and doesn't fully reflect productivity bonuses — puts the national mean at approximately $191,880. That gap between survey types is itself a useful thing to know before comparing any two salary figures side by side.

Physician Total Compensation by State (Full-Time, All Specialties)

Format below: State — Median Total Compensation Range | State Income Tax | Cost-of-Living Index (national average = 100)

  1. Wyoming — $390,000–$430,000 | No tax | Low (90)

  2. Alaska — $380,000–$440,000 | No tax | High (130)

  3. Mississippi — $370,000–$410,000 | 4.7% flat | Very Low (83)

  4. South Dakota — $365,000–$410,000 | No tax | Low (91)

  5. Wisconsin — $365,000–$400,000 | 5.3% | Moderate (97)

  6. Iowa — $360,000–$400,000 | 4.8% flat | Low (91)

  7. Indiana — $355,000–$400,000 | 3.05% flat | Low (91)

  8. Tennessee — $350,000–$395,000 | No tax | Low (92)

  9. Texas — $350,000–$410,000 | No tax | Moderate (97)

  10. Florida — $345,000–$400,000 | No tax | Moderate (103)

  11. Nevada — $345,000–$395,000 | No tax | Moderate (103)

  12. Alabama — $345,000–$390,000 | 5% | Low (88)

  13. Montana — $345,000–$395,000 | 5.9% | Moderate (99)

  14. North Dakota — $340,000–$390,000 | 1.95% flat | Low (95)

  15. Nebraska — $340,000–$385,000 | 5.2% | Low (92)

  16. Kansas — $340,000–$385,000 | 5.7% | Low (90)

  17. New Hampshire — $340,000–$385,000 | No tax | High (109)

  18. Georgia — $335,000–$385,000 | 5.49% flat | Moderate (97)

  19. Washington — $335,000–$390,000 | No tax | High (118)

  20. Minnesota — $335,000–$380,000 | 9.85% top rate | Moderate (102)

  21. Ohio — $330,000–$375,000 | 3.5% | Low-Moderate (95)

  22. Michigan — $330,000–$375,000 | 4.25% flat | Moderate (95)

  23. Missouri — $325,000–$375,000 | 4.9% | Low (93)

  24. Arizona — $325,000–$375,000 | 2.5% flat | Moderate (103)

  25. North Carolina — $325,000–$375,000 | 4.5% flat | Moderate (97)

  26. Virginia — $325,000–$375,000 | 5.75% | Moderate (103)

  27. Colorado — $320,000–$375,000 | 4.4% | High (112)

  28. South Carolina — $320,000–$370,000 | 6.4% | Low-Moderate (95)

  29. Oregon — $320,000–$365,000 | 9.9% top rate | High (115)

  30. Pennsylvania — $315,000–$365,000 | 3.07% flat | Moderate (100)

  31. Louisiana — $315,000–$365,000 | 4.25% | Low (92)

  32. Oklahoma — $315,000–$365,000 | 4.75% | Low (90)

  33. Arkansas — $315,000–$365,000 | 4.7% | Low (89)

  34. Utah — $310,000–$360,000 | 4.65% flat | Moderate (102)

  35. Kentucky — $310,000–$360,000 | 4% flat | Low (90)

  36. Idaho — $310,000–$360,000 | 5.8% | Moderate (100)

  37. New Mexico — $310,000–$360,000 | 5.9% | Low-Moderate (95)

  38. West Virginia — $305,000–$360,000 | 4.82% | Very Low (83)

  39. Illinois — $305,000–$355,000 | 4.95% flat | Moderate (99)

  40. Hawaii — $300,000–$355,000 | 11% top rate | Very High (193)

  41. Connecticut — $300,000–$355,000 | 6.99% | Very High (134)

  42. New Jersey — $295,000–$350,000 | 10.75% top rate | Very High (135)

  43. Massachusetts — $295,000–$350,000 | 9% | Very High (161)

  44. Maryland — $290,000–$345,000 | 5.75% | Very High (130)

  45. New York — $290,000–$345,000 | 10.9% top rate | Very High (187)

  46. California — $285,000–$360,000 | 13.3% top rate | Very High (152)

  47. Rhode Island — $280,000–$330,000 | 5.99% | High (118)

  48. Washington D.C. — $275,000–$330,000 | 10.75% | Very High (163)

Sources: Bureau of Labor Statistics OEWS; SalaryDr 2026 verified physician compensation submissions; Doximity 2025 Physician Compensation Report. Figures represent total compensation (base plus typical productivity bonuses) for full-time physicians across all specialties combined — individual specialty and practice-setting figures vary considerably from this blended range (see specialty breakdown below).

Salary by Specialty (National Averages)

Specialty is, if anything, a bigger lever on physician pay than state is. Here's how the major fields compare nationally:

  • Orthopedics & Orthopedic Surgery — approximately $611,000–$795,000 average, the highest-paid specialty in medicine

  • Cardiology — approximately $550,000 average

  • Anesthesiology — approximately $535,000 average

  • Surgical specialists (general) — well above the "all physicians" average, procedure-heavy fields consistently outearn cognitive/chronic-care specialties

  • All physicians, blended average — approximately $374,000–$425,000 depending on survey year and methodology

  • Specialists, blended average — approximately $404,000–$417,000

  • Primary care physicians, blended average — approximately $287,000–$298,000

  • Family medicine — median of approximately $238,000 annually

A persistent and well-documented gender gap also runs through every layer of this data: the 2026 Medscape Physician Compensation Report found male physicians earning an average of $429,000 compared to $327,000 for female physicians — a gap Doximity's 2025 report confirmed holds consistently across essentially every individual specialty, not just in the aggregate.

Reading This Data the Right Way

The conventional assumption — that coastal states pay the most — is backwards once you adjust for tax and cost of living. Nominally, some of the highest physician salaries appear in California, New York, and Massachusetts. But once you factor in California's 13.3 percent top state tax rate (the highest in the country) and a cost-of-living index of 152 against a national baseline of 100, real physician purchasing power in these states is often among the lowest in the country — while physicians in Wyoming, Mississippi, South Dakota, Wisconsin, and Indiana, none of which crack the top of a nominal salary list, consistently come out ahead once take-home pay is what's actually being measured.

The nine no-income-tax states carry outsized value at physician income levels. Alaska, Florida, Nevada, New Hampshire, South Dakota, Tennessee, Texas, Washington, and Wyoming all charge $0 in state income tax. At a $400,000 salary, the difference between practicing in one of these states versus California works out to roughly $40,000 or more per year in additional take-home pay — a gap that, invested over a 25-year career, can compound into well over $2 million in additional wealth.

Rural and shortage-area practice carries a real, quantifiable premium. Health Professional Shortage Area (HPSA) designations — heavily concentrated in states like Mississippi, West Virginia, New Mexico, Alabama, and Montana — drive compensation premiums of roughly 20 to 40 percent above comparable urban positions in the same specialty and state. A family medicine physician earning $280,000 in a suburban practice can often earn $350,000 to $390,000 in a rural shortage-area posting in the same state, without changing specialty or practice type at all.

Loan repayment programs function as invisible salary that doesn't show up in any survey. The National Health Service Corps offers up to $50,000 in tax-free student loan repayment in exchange for a two-year service commitment at a qualifying HPSA site — worth roughly $77,000 in pre-tax equivalent value at a typical physician marginal tax rate. For physicians carrying the average roughly $247,000 in medical school debt, stacking NHSC eligibility with a rural or underserved posting is one of the most underused financial levers in the entire profession.

Malpractice insurance costs vary enough by state to matter. States like Indiana and Wisconsin consistently post some of the lowest malpractice premiums in the country — meaningfully lower than New York or California for comparable coverage — a variable that most simple salary comparisons leave out entirely, but one that can be worth tens of thousands of dollars a year for surgical specialties in particular.

Specialty choice still dwarfs state choice as the single biggest lever on lifetime earnings. The gap between the average family medicine salary (~$238,000) and the average orthopedic surgery salary (~$611,000–$795,000) is larger than the entire spread between the highest- and lowest-paying states combined. For physicians early in training, specialty selection remains the single most consequential financial decision in the entire career — geography is the second-order adjustment, not the primary one.

"Average" physician salary figures depend heavily on which survey produced them. Self-reported physician compensation surveys (Medscape, Doximity, SalaryDr) consistently report meaningfully higher figures than the Bureau of Labor Statistics' formal wage survey, largely because BLS methodology captures base compensation more conservatively and can undercount productivity bonuses, partnership distributions, and other variable pay common in physician compensation. When comparing "average doctor salary" figures across sources, always check which methodology produced the number before treating two headline figures as directly comparable.

Sources

William Lewis
Previous

Nurse Salaries in the US: A 2026 State-by-State Index
Next

Three Humanitarian Emergencies Overshadowed in 2026