Doctors in the United States earn some of the highest salaries in the global medical industry. However, physician income varies dramatically depending on where they practice.
Based on 2024–2025 data, Wyoming is the highest-paying state for doctors, while San Jose, California, offers the highest metro-level salary, although this is not adjusted for the cost of living.
When factoring in housing prices, taxes, and overall affordability, cities like St. Louis, Louisville, and Indianapolis become more financially rewarding for physicians.
State-Level Overview: Where Doctors Earn the Most
State-level physician compensation often reflects supply and demand dynamics, availability of specialists, and rural/urban incentives. Here are the top 10 states in 2025 by average physician salary:
Highest-Paying U.S. States for Doctors (2025)
| Rank | State | Avg Doctors Salary | Key Factors |
| 1 | Wyoming | $417,000+ | No state income tax, rural physician incentives |
| 2 | Alaska | $415,000+ | Remote care premiums, low competition |
| 3 | North Dakota | $411,000+ | Underserved area bonuses, strong rural demand |
| 4 | Arkansas | $400,000+ | Highest pay for contract-based physicians |
| 5 | South Dakota | $398,000+ | Favorable tax policy, low cost of living |
| 6 | Indiana | $391,000+ | Solid pay structure, consistent across specialties |
| 7 | Kentucky | $387,000+ | Boosted urban compensation in cities like Louisville |
| 8 | Mississippi | $384,000+ | High rural demand, Medicaid expansion region |
| 9 | Montana | $380,000+ | Shortage of specialists, higher fee-for-service rates |
| 10 | Delaware | $378,000+ | Strong locum tenens contracts, small but high-demand market |
1. Wyoming – Avg. Salary: $417,000+
- Income tax: 0% (no state income tax)
- Cost of living index: 94.5 (national average = 100)
- Physicians per 100,000 residents: ~210 (U.S. avg ≈ 277)
Why it pays well: Wyoming’s rural nature means physicians often cover large geographic areas and serve multiple specialties, leading to higher compensation. With a low population and few specialists, doctors here command premium rates.
Family medicine, internal medicine, and emergency care are particularly lucrative due to demand. The absence of a state income tax increases take-home pay by an average of 6–10% compared to nearby states with similar gross earnings.
2. Alaska – Avg. Salary: $415,000+
- Cost of living index: 125.2 (high)
- Physician shortage areas: Over 70% of state-designated HPSAs (Health Professional Shortage Areas)
- Incentives: Up to $50,000 in state recruitment bonuses
Why it pays well: Alaska combines high salaries with an intense need for generalists and specialists alike. Because many areas are remote, telemedicine and travel-based practice models are common.
Emergency and trauma care, OB/GYN, and primary care physicians often receive both high base salaries and relocation benefits. However, housing, transport, and food are costly, resulting in higher nominal salaries but moderate real purchasing power.
3. North Dakota – Avg. Salary: $411,000+
- State income tax: Top bracket at 2.5% only
- Population: 779,261 (2024 estimate)
- Number of hospitals: 50+, with many regional trauma centers
Why it pays well: North Dakota’s medical workforce remains thin, particularly in specialties like psychiatry, geriatrics, and internal medicine.
This leads to signing bonuses exceeding $100,000 in some contracts and government incentives for rural placements. Smaller cities like Bismarck and Fargo offer competitive housing markets and stable hospital employment.
4. Arkansas – Avg. Salary: $400,000+
- Locum tenens pay rate: 132% of the national average
- Uninsured population: ~8.5%
- Healthcare employment growth: +16% (2020–2024)
Why it pays well: Arkansas is the best-paying state for locum tenens physicians. Rural towns often have no full-time doctors and contract with traveling MDs who rotate shifts in 7–14 day cycles.
Arkansas Medicaid reimbursements are increasing, and loan forgiveness programs for rural service can erase up to $160,000 in student debt.
5. South Dakota – Avg. Salary: $398,000+
- Income tax: 0%
- Malpractice premiums: Among the lowest in the U.S.
- Rural hospital network: 65+ small acute care facilities
Why it pays well: Doctors in South Dakota enjoy both high pay and low practice costs. The malpractice insurance premiums are 40% lower than in coastal states, and many practices are physician-owned.
With 40% of the population living in rural counties, specialists regularly travel between facilities, increasing earning opportunities.
City-Level Breakdown: Highest-Paying U.S. Metros
Metropolitan areas show different trends due to urban healthcare demand, population size, and the presence of academic medical centers or private hospitals.
Highest-Paying U.S. Cities for Doctors (2025)
| Rank | Metro Area / City | Avg. Salary | Cost-of-Living Adjusted | Key Notes |
| 1 | San Jose, CA | $475,000 | Low Adjusted | Highest nominal pay, tech-rich population, but expensive housing |
| 2 | Los Angeles, CA | $448,000 | Low Adjusted | Many private practice opportunities, but very high living costs |
| 3 | St. Louis, MO | $443,000 | High Adjusted | Best cost-adjusted salary; major hospitals & low housing costs |
| 4 | Louisville, KY | $437,000 | High Adjusted | Competitive pay + low taxes and affordable real estate |
| 5 | Indianapolis, IN | $430,000 | High Adjusted | Strong medical market, low COL, expanding hospital systems |
| 6 | Sacramento, CA | $425,000 | Moderate Adjusted | Good pay for OB/GYN and internal medicine |
| 7 | Phoenix, AZ | $422,000 | Moderate Adjusted | Growing population, strong private sector |
| 8 | Minneapolis, MN | $418,000 | High Adjusted | Research hospitals, competitive general practice pay |
| 9 | Las Vegas, NV | $416,000 | High Adjusted | No state income tax; popular for contract-based work |
| 10 | Jacksonville, FL | $412,000 | High Adjusted | Strong retirement demand, no state income tax |
1. San Jose, California – Avg. Salary: $475,000
- Cost of Living Index: 179.4
- Median home price: $1.38 million
- State income tax: Top bracket at 13.3%
Raw salary leader: San Jose tops the list in nominal physician income. However, when adjusted for taxes and cost of living, it falls to the bottom third.
Many physicians report net savings under $150,000 per year after housing, taxes, and loan repayments. Still, the region boasts exceptional private practice earnings in tech-adjacent concierge medicine.
2. St. Louis, Missouri – Avg. Salary: $443,000 (Adjusted #1)
- Cost of Living Index: 88.7
- Median home price: $234,000
- Tax burden: Moderate
Best cost-adjusted income: When factoring affordability, St. Louis offers the best real salary for doctors in America. Housing costs are 65% lower than in San Francisco, and private hospitals like Barnes-Jewish and Mercy Health pay competitive specialist rates.
Many physicians here earn above $425,000 in net income.
3. Louisville, Kentucky – Avg. Salary: $437,000 (adjusted)
- Cost of Living Index: 91.3
- Median home price: $267,000
- Medical hub status: Norton Healthcare, Baptist Health
Underrated gem: Louisville is a regional healthcare hub with one of the lowest ratios of doctors per capita in urban areas. The state offers tax credits for rural hospital rotations.
Specialists in endocrinology, urology, and pain management are particularly in demand.
4. Indianapolis, Indiana – Avg. Salary: $430,000 (adjusted)
- Cost of Living Index: 89.4
- Major employers: IU Health, Ascension St. Vincent
- Population growth: +8.1% (since 2020)
Stable income + low cost: Indianapolis consistently ranks as one of the best places for hospital-employed physicians. Family medicine, pediatrics, and OB/GYN enjoy high patient loads and stable working hours, with competitive pay enhanced by low overhead and malpractice premiums.
5. Las Vegas, Nevada – Avg. Salary: $416,000 (adjusted)
- No state income tax
- Cost of Living Index: 104.5
- Population over 65: 17.6% (high demand for geriatrics)
Rapidly growing market: Las Vegas has transformed into a top-tier city for primary care and urgent care providers. With no state income tax and an exploding population, contract physicians often earn more than their salaried peers elsewhere.
Weekend-only urgent care shifts can bring in $8,000–$12,000/month.
Mental-Health Parallel: Counselor Demand in These Same States
Physician shortages rarely stand alone mental health counselor gaps mirror the same underserved regions. If you’re weighing a parallel or complementary career path, accredited distance programs are filling that gap quickly:
“With 1,200-plus U.S. counseling degrees—many fully CACREP-accredited—students can finish licensure-track master’s coursework online while staying in rural practice.”
Explore an online counseling degree to serve communities where psychiatrists and primary-care doctors are already in short supply. Graduates in Wyoming, Arkansas, and the Dakotas see job-placement rates above 95 % and entry salaries of $65–$ 80k in 2025, with HRSA loan forgiveness up to $ 50k for five years of rural service.
Specialty-Based Pay: Which Doctors Earn the Most?
While location matters, your medical specialty has the largest influence on income. Here are 2025 estimates:
| Specialty | National Avg. Salary |
| Neurosurgery | $705,000 |
| Orthopedic Surgery | $557,000 |
| Plastic Surgery | $576,000 |
| Cardiology | $490,000 |
| Radiology | $460,000 |
| Emergency Medicine | $390,000 |
| Psychiatry | $310,000 |
| Primary Care (Family) | $260,000 |
For a related look at how nursing salaries compare across the U.S., see our average income for medical nurses report.
Contract Work: Locum Tenens Highest-Paying States
Locum tenens contracts (temporary positions) allow physicians to work flexible schedules at higher per-hour rates. These are the best-paying states for locum tenens in 2025:
| Rank | State | Pay Rate vs National Avg | Key Advantage |
| 1 | Arkansas | 132% | Top for temp assignments |
| 2 | Mississippi | 128% | High demand for general medicine |
| 3 | Delaware | 127% | Small market, high urgency needs |
| 4 | Colorado | 123% | High ER and specialist demand |
| 5 | Iowa | 121% | Large rural hospital network |
Tax Burden and Cost of Living: Adjusting True Take-Home Pay
It’s not just about salary—taxes and cost of living dramatically impact real income.
- No state income tax: Alaska, Wyoming, South Dakota, Florida, Texas, Nevada, Washington
- Low housing costs: Missouri, Kentucky, Indiana, Arkansas
- High COL cities: San Francisco, New York, Boston, San Jose
Best value combo: States like Wyoming, South Dakota, and Indiana combine high income, no/low taxes, and affordable living, maximizing effective take-home pay.
