The Highest-Paying Medical Specialties in 2026, Ranked by Pay and Pay per Hour

The Quick-View 2026 Specialty Salary Rankings

These are the 20 highest-paying specialties by average annual compensation in Doximity's 2026 report, which covers 2025. Ranks are out of the 51 specialties Doximity lists; it notes that some specialties may be left out because of sample size.

The profiles below follow Doximity's order. Four of them (urology, gastroenterology, dermatology and ophthalmology) sit outside Doximity's top 10, but their SalaryDr medians and per-hour pay put them in the same conversation. Doximity's top 10 also includes interventional radiology, covered in the radiology profile, plus pediatric surgery, radiation oncology and vascular surgery, which we don't profile separately.

The ranking that changes when you sort by income per hour:

The per-hour ranking reveals what the nominal salary ranking obscures: dermatology and ophthalmology top this table on weeks 19 to 23 hours shorter than neurosurgery's. Dermatologists report 40-hour weeks and a $625,000 median, about $300 per hour of clinical time; ophthalmologists report 44-hour weeks and a $670,000 median, about $293. Neurosurgery, which dominates the nominal ranking, drops to fourth: neurosurgeons report 63-hour weeks and a $900,000 median, about $275 per hour. The lifestyle-income tradeoff embedded in these specialties is the most important information in the table.

Neurosurgery — The Highest Average Pay in Medicine

• Doximity 2026 Average: $829,161 (#1 of 51)
• SalaryDr Median: $900,000 (98 reports)
• SalaryDr 10th–90th Percentile: $738,000 to $1,322,000
• Income per Hour: ~$275 (63 hours/week)
• Training: 7-year residency, often +1–2 year fellowship
• Would Choose Again: 91% (SalaryDr)

Neurosurgery is the highest-paying medical specialty in the United States. Doximity's 2026 report puts the average at $829,161, first of its 51 specialties, and the 10.7% raise it recorded for 2025 was the second-largest of any specialty. SalaryDr's median is $900,000, the highest SalaryDr figure on this page. Neurosurgeons top physician salary rankings due to training length, procedure complexity, high liability, and limited supply. In SalaryDr's reports, private-practice neurosurgeons average $1,285,054 (34 reports), against $1,065,228 for hospital-employed neurosurgeons (45 reports).

The income is real, substantial, and sustained across a career. The training commitment is equally real: 4 years of medical school plus 7 years of neurosurgery residency — the longest standard residency in American medicine — plus in many cases a 1 to 2 year fellowship in spine surgery, cerebrovascular neurosurgery, or pediatric neurosurgery. A physician pursuing spine fellowship does not see their first attending paycheck until age 35 to 37 in many cases.

The income mechanics: Neurosurgery income is driven by procedure complexity and volume. A craniotomy for glioblastoma resection, a complex multilevel spinal fusion, or a cerebral aneurysm clipping generate among the highest wRVU values in all of medicine. The malpractice premium reflects the clinical stakes — neurosurgery carries some of the highest malpractice costs in medicine, a cost that either the employer absorbs or the physician must account for in evaluating total compensation.

The honest caveat: Neurosurgery has the highest average income in Doximity's data and one of the heaviest workloads in SalaryDr's: neurosurgeons report 63-hour weeks, the longest in our per-hour table, on top of sustained call and the emotional weight of outcomes that are sometimes catastrophic regardless of surgical skill. Most say it's worth it — 91 percent of neurosurgeons in SalaryDr's reports would choose the specialty again. But the neurosurgeon who sustains peak productivity for 30 years earns extraordinary lifetime income. The neurosurgeon who burns out at 54 and leaves medicine does not.

For the complete neurosurgery salary analysis including subspecialty income breakdowns and wRVU benchmarks, see our Neurosurgery Salary guide.

Thoracic Surgery — The Highest-Stakes Surgical Specialty

• Doximity 2026 Average: $749,707 (#2 of 51)
• 2025 Pay Growth (Doximity): 8.7%, fifth-largest of any specialty
• Training: 5-year general surgery + 2–3 year CT surgery fellowship

Cardiothoracic surgery involves open heart surgery, coronary artery bypass grafting, valve repair and replacement, lung resections for malignancy, and increasingly transcatheter structural heart procedures that overlap with interventional cardiology. The procedures are among the most technically demanding in all of surgery — the hours are long, the stakes are existential, and the training pipeline is one of the most selective and longest in American medicine. Doximity reports the field as a single "Thoracic Surgery" row, with no separate cardiothoracic listing; its $749,707 average is second only to neurosurgery.

Total post-medical-school training: 7 to 8 years — general surgery residency plus a cardiothoracic surgery fellowship. The CT surgery match is highly competitive, drawing candidates from top general surgery programs with strong research records and cardiac surgery experience.

The structural heart transition: The growth of TAVR, MitraClip, tricuspid interventions, and left atrial appendage closure has created a new income stream for CT surgeons working alongside interventional cardiologists in hybrid operating rooms. Structural heart programs generate high-volume, high-wRVU procedural work that has partially offset the decline in open coronary artery bypass volume as medical management of coronary disease has improved.

The caveat: The extreme training demands, unpredictable call burden, and the emotional weight of caring for critically ill patients who do not always survive their operations are part of the job. The financial reward is extraordinary. The personal cost is equally significant.

Orthopedic Surgery — Top-Three Pay With a Shorter Week Than Neurosurgery

• Doximity 2026 Average: $696,852 (#3 of 51)
• SalaryDr Median: $770,000 (122 reports)
• SalaryDr 10th–90th Percentile: $547,000 to $1,000,000
• Income per Hour: ~$279 (53 hours/week)
• Training: 5-year residency + 1-year fellowship (typical)
• Would Choose Again: 89% (SalaryDr)

Orthopedic surgery is the specialty that most consistently delivers high nominal income with a more manageable call and lifestyle profile than neurosurgery. Medscape's 2026 report ranks it first at $611,000, Doximity puts it third at $696,852, and SalaryDr's median is $770,000. Orthopedic surgeons in SalaryDr's reports average 53 hours a week, ten fewer than neurosurgeons.

The financial mechanism in orthopedic surgery is the ambulatory surgery center — the same ASC ownership model that drives income in gastroenterology and ophthalmology, but applied to surgical cases generating higher professional fees per procedure. An orthopedic surgeon who performs total knee replacements, total hip replacements, ACL reconstructions, and rotator cuff repairs in a physician-owned surgical center captures both the professional fee and the facility fee on every case. SalaryDr's reports show the payoff: private-practice orthopedic surgeons average $995,038 (65 reports), against $772,919 for hospital-employed surgeons (31 reports). With a 5-year residency and a 1-year fellowship, an orthopedic surgeon typically starts attending pay around age 32; at Doximity's $696,852 average for 27 years, that is about $18.8 million before tax.

The sports medicine and joint replacement income story: Joint replacement volume is growing with the aging U.S. population — total knee and total hip replacement are two of the highest-volume elective surgical procedures in medicine, with demand rising as baby boomers age into the procedure-eligible demographic. Sports medicine orthopedics captures a younger, cash-pay-adjacent patient population with premium pricing power for elective procedures like meniscus repair and ligament reconstruction.

The would-choose-again data: 89 percent of orthopedic surgeons in SalaryDr's reports say they would choose the specialty again — genuine specialty satisfaction despite the physical demands of surgical work and the moderate call burden.

For the complete orthopedic surgery salary analysis, see our Orthopedic Surgery Salary guide.

Plastic Surgery — The Cash-Pay Surgical Specialty

• Doximity 2026 Average: $625,757 (#6 of 51)
• SalaryDr Median: $740,000 (74 reports)
• SalaryDr 10th–90th Percentile: $610,000 to $900,000
• Income per Hour: ~$269 (53 hours/week)
• Training: 4–6 years post-MD
• Would Choose Again: 90% (SalaryDr)

Plastic surgery's pay story is the cash-pay model: cosmetic plastic surgeons set their own prices for elective procedures that carry no insurance fee schedule ceiling. Doximity's 2026 average of $625,757 ranks it sixth, and SalaryDr's median is $740,000. At 53 hours a week, that median works out to about $269 an hour, fifth in our per-hour table, just behind neurosurgery.

Pay climbs with experience and ownership in SalaryDr's reports. Plastic surgeons 3 to 5 years out average $795,000 (13 reports); those with 16 or more years average $1,450,000, though only 7 reports sit in that group. Private-practice plastic surgeons average $1,003,171 (41 reports), against $740,000 for hospital-employed plastic surgeons (21 reports).

The cosmetic-reconstructive income split: An academic reconstructive surgeon and a cosmetic private-practice surgeon can end up with very different incomes. Both completed the same 6-year training. The business model determines the financial outcome.

The lifestyle position: Plastic surgeons in SalaryDr's reports average 53 hours a week, the same as orthopedic surgeons, urologists, and cardiologists. Cosmetic elective cases are scheduled procedures with predictable timing, and the call burden is lighter than in most surgical fields.

For the complete plastic surgery salary analysis including the cash-pay model mechanics and subspecialty income comparison, see our Plastic Surgery Salary guide.

Radiology — The Most Technology-Disrupted High-Income Specialty

• Doximity 2026 Average: $609,684 (#8 of 51)
• Interventional Radiology (Doximity): $634,658 (#4 of 51)
• SalaryDr Median: $555,000 (113 reports)
• SalaryDr 10th–90th Percentile: $465,200 to $648,000
• Income per Hour: ~$232 (46 hours/week)
• Training: 5 years post-MD
• Would Choose Again: 89% (SalaryDr)

Radiology presents the most complex income story on this list — a specialty with very high median compensation that is simultaneously facing more structural disruption than any other high-income specialty and more opportunity for income amplification through subspecialization and practice model than most articles acknowledge.

Practice model matters: in SalaryDr's reports, private-practice radiologists average $702,102 (49 reports), against $630,098 for hospital-employed radiologists (41 reports). Interventional radiology — the procedural subspecialty that performs image-guided minimally invasive procedures — generates high wRVU production from complex procedures including thrombectomy, tumor ablation, embolization, and biliary interventions.

The AI question addressed honestly: The fear of AI displacement has been significantly overstated relative to actual market data. AI reading assistance is increasing radiologist throughput rather than replacing radiologists — the same technology that assists in screening mammography interpretation allows one radiologist to read more cases per day, not zero cases. Radiology demand continues to grow with cancer screening expansion, aging population imaging volume, and the increasing diagnostic complexity of modern medicine. The fear narrative has affected residency match competitiveness more than it has affected actual radiologist employment or compensation. Doximity's 2026 report backs this up: radiology is the only specialty in its top 10 for pay growth in both 2024 and 2025, with a 6.6% raise in 2025.

The lifestyle position: Radiology offers scheduled work, minimal physical demands, and a hospital-based or teleradiology model that is compatible with flexible work arrangements unavailable in any procedural specialty. Radiologists in SalaryDr's reports average 46 hours a week. The no-patient-contact model is either a feature or a limitation depending on what drew you to medicine.

Interventional radiology note: Interventional radiology — now a separate diagnostic radiology pathway (DR/IR) through an ACGME-accredited independent residency program — produces the highest compensation in radiology and some of the most competitive match data in all of medicine. Doximity lists IR separately at $634,658, fourth of its 51 specialties, and IR's 10.8% raise in 2025 was the largest of any specialty.

Cardiology — Procedures Drive the Pay

• Doximity 2026 Average: $604,635 (#9 of 51)
• SalaryDr Median: $620,000 (177 reports)
• SalaryDr 10th–90th Percentile: $409,100 to $993,000
• Income per Hour: ~$225 (53 hours/week)
• Training: 6–7 years post-MD
• Would Choose Again: 89% (SalaryDr)

Cardiology is ninth in Doximity's 2026 averages at $604,635 and second in Medscape's at $575,000, and it has one of the widest pay spreads of any specialty: SalaryDr's 10th-to-90th percentile range runs from $409,100 to $993,000. Much of that spread is subspecialty. Invasive, interventional, and electrophysiology work pays more than general non-invasive cardiology, but none of the three sources we use breaks cardiology out by subspecialty, so we don't quote subspecialty figures here.

The income mechanism in cardiology is procedural volume — PCI, atrial fibrillation ablation, and TAVR structural heart procedures all carry heavy wRVU values. Unlike most procedural fields, though, cardiology doesn't reward private practice in SalaryDr's reports: hospital-employed cardiologists average $754,279 (77 reports), ahead of private-practice cardiologists at $726,263 (59 reports). It is the only specialty profiled here where that happens.

The satisfaction data: 89 percent of cardiologists in SalaryDr's reports say they would choose the specialty again.

For the complete cardiology salary analysis including wRVU breakdown by subspecialty and cath lab ownership mechanics, see our Cardiology Salary guide.

Urology — Robotics, Cash-Pay Clinics, and a Shortage Market

• Doximity 2026 Average: $566,740 (#11 of 51)
• SalaryDr Median: $590,000 (88 reports)
• SalaryDr 10th–90th Percentile: $500,000 to $717,600
• Income per Hour: ~$214 (53 hours/week)
• Training: 5–6 years post-MD
• Would Choose Again: 93% (SalaryDr)

Urology earns its position on this list through the same mechanisms as gastroenterology and ophthalmology — ASC ownership, cash-pay components, and the robotic surgery revolution that has transformed urological practice. The private practice edge is smaller than you might expect, though: in SalaryDr's reports, private-practice urologists average $686,172 (29 reports), against $641,609 for hospital-employed urologists (38 reports).

The robotic surgery premium: Da Vinci robotic prostatectomy is now the dominant treatment for localized prostate cancer in the United States, and urology's early adoption of robotic technology has created a procedural volume and complexity premium that continues to grow. Urologists credentialed in robotic surgery generate referral volume and reputational differentiation that non-robotic peers cannot match.

The cash-pay dimension: Benign prostatic hyperplasia procedures — UroLift, Rezum, and the traditional TURP — are partially or fully insurance-covered but the newer minimally invasive options carry co-payment structures that generate cash-pay revenue above the procedure's insurance reimbursement in some practice models. Men's health subspecialization — testosterone replacement therapy, erectile dysfunction, male fertility — generates cash-pay clinic income that supplements the procedure-based insurance revenue.

The shortage market premium: Urology has an acute supply shortage — fewer urology residency positions exist relative to demand than in almost any medical specialty, combined with retiring urologists in rural and small community markets who are not being replaced. A urologist willing to practice in a shortage market can command a premium base salary and a sizable signing bonus.

Gastroenterology — The Endoscopy Center Model That Rivals Surgery

• Doximity 2026 Average: $531,345 (#14 of 51)
• SalaryDr Median: $550,000 (94 reports)
• SalaryDr 10th–90th Percentile: $454,000 to $703,000
• Income per Hour: ~$216 (49 hours/week)
• Training: 6 years post-MD (3 IM + 3 GI fellowship)
• Would Choose Again: 94% (SalaryDr)

Gastroenterology pairs strong pay with some of the most satisfied physicians in medicine: 94 percent of gastroenterologists in SalaryDr's reports say they would choose the specialty again. The ASC ownership model in GI is the income mechanism: a physician-owned endoscopy center performing 6,000 colonoscopies annually at $1,000 in facility fees per procedure generates $6,000,000 in annual facility revenue, with physician equity holders capturing distributions on top of their clinical professional fee income. In SalaryDr's reports, private-practice gastroenterologists average $744,887 (31 reports), against $583,316 for hospital-employed gastroenterologists (40 reports).

The screening colonoscopy demand driver is structural and growing: the United States Preventive Services Task Force lowered the recommended starting age from 50 to 45, adding approximately 20 million Americans to the screening-eligible population overnight. Baby boomer surveillance colonoscopy demand ensures procedure volume growth for the next 10 to 15 years regardless of competition or reimbursement changes.

The private equity dimension in GI: GI practices have been among the most actively acquired physician practice targets of the PE consolidation wave. A GI group with a physician-owned endoscopy center at $2,000,000 in EBITDA transacts at 9 to 12 times EBITDA — producing $18,000,000 to $24,000,000 in enterprise value. For a 5-physician group, that is $3,600,000 to $4,800,000 per physician at close, alongside continued employment income and rollover equity in the PE platform.

Advanced endoscopy (ERCP/EUS) premium: Physicians with advanced endoscopy fellowship training in ERCP and endoscopic ultrasound command the highest premiums in the specialty, particularly in shortage markets.

For the complete gastroenterology salary analysis including the endoscopy center ownership mechanics, advanced endoscopy premium, and PE transaction analysis, see our Gastroenterology Salary guide.

Dermatology — The Best Lifestyle-to-Income Ratio in Medicine

• Doximity 2026 Average: $497,509 (#17 of 51)
• SalaryDr Median: $625,000 (86 reports)
• SalaryDr 10th–90th Percentile: $445,000 to $984,500
• Income per Hour: ~$300 (40 hours/week)
• Training: 4 years post-MD
• Would Choose Again: 94% (SalaryDr)

Dermatology achieves what every medical student is looking for: very high income combined with the best work-life balance of any physician specialty. Doximity's 2026 average of $497,509 ranks it 17th, but SalaryDr's $625,000 median, earned over a 40-hour average week, works out to about $300 an hour, the top figure in our per-hour table. No overnight call, office-based practice, and the cash-pay cosmetic model that allows motivated practitioners to build income well above the insurance-based ceiling make dermatology arguably the most financially efficient specialty in medicine when training investment is weighed against career outcome.

The cosmetic vs. medical split is the same story as plastic surgery: A purely medical dermatologist in an employed practice lives on insurance-based revenue. A cosmetic-forward dermatologist with a Botox and filler practice, laser suite, and premium pricing in an affluent market can earn far more. SalaryDr's reports show the gap by setting: private-practice dermatologists average $730,340 (49 reports), against $585,000 for hospital-employed dermatologists (18 reports). Practice owners can add private equity transaction proceeds on top of clinical income — the PE transaction model covered in our Private Equity guide.

The match is ferociously competitive: Dermatology residency acceptance rates are the lowest in medicine — board scores at or above the 95th percentile, research publications, and a strong dermatology sub-internship performance are expected. The 4-year total training (3-year dermatology residency after internship) is as short as physician training gets for a specialty in this pay range.

Mohs surgery fellowship premium: A 1-year Mohs micrographic surgery fellowship adds a procedural income stream on top of general dermatology.

For the complete dermatology salary analysis including the cosmetic revenue model, suburban location premium, and PE transaction economics, see our Dermatology Salary guide.

Ophthalmology — Near the Top of the Per-Hour Ranking

• Doximity 2026 Average: $487,438 (#19 of 51)
• SalaryDr Median: $670,000 (100 reports)
• SalaryDr 10th–90th Percentile: $413,200 to $950,000
• Income per Hour: ~$293 (44 hours/week)
• Training: 4–6 years post-MD
• Would Choose Again: 96% (SalaryDr)

Ophthalmology is where Doximity and SalaryDr disagree most of any specialty on this page. Doximity's $487,438 average ranks it 19th; SalaryDr's $670,000 median, earned over a 44-hour week, works out to about $293 an hour, second in our per-hour table behind only dermatology. The mechanism is cataract surgery efficiency: a short elective outpatient procedure done in high volume, with premium lens (IOL) upgrades that patients pay for out of pocket on top of the insurance-covered surgery.

Practice setting makes a large difference. In SalaryDr's reports, private-practice ophthalmologists average $803,245 (61 reports), against $615,967 for hospital-employed ophthalmologists (30 reports).

The lifestyle case is definitive: Ophthalmology offers minimal call, few overnight emergencies (retinal detachments are the usual exception), and a predictable clinic-to-OR schedule. Ophthalmologists in SalaryDr's reports average 44 hours a week, and 96 percent say they would choose the specialty again.

Why it ranks 19th by Doximity's average but second per hour: SalaryDr's ophthalmologists report 44-hour weeks and a $670,000 median; its neurosurgeons report 63-hour weeks and a $900,000 median. The neurosurgeon earns $230,000 more annually in exchange for about 988 more hours of work per year (19 extra hours a week × 52). At ophthalmology's rate of about $293 per hour, those 988 hours are worth roughly $289,000, so at equal hours the ophthalmologist would come out ahead. The comparison depends on the source, though: in Doximity's averages, neurosurgery leads ophthalmology by $341,723.

The training ROI: 4-year training (internship plus 3-year residency) with optional 1 to 2-year fellowship for subspecialties. Along with dermatology, it is the shortest post-MD training path among the specialties profiled here — which makes the training ROI calculation one of the most favorable in the high-income tier.

For the complete ophthalmology salary analysis, see our Ophthalmology Salary guide.

The Lifetime Earnings Model: What the Rankings Look Like Over a Career

The single-year salary ranking matters — but the career-level comparison changes the picture meaningfully. Here is the lifetime earnings model for the specialties at each end of the training spectrum on this list. It uses Doximity's 2026 averages held flat, before tax, with no raises or investment returns.

The Orthopedic Surgeon vs. The Family Medicine Physician:

The orthopedic surgeon earns about $9.1 million more over a career despite starting 3 years later. At $696,852 per year for 27 years versus $325,040 per year for 30 years: $18,815,004 versus $9,751,200. The 3-year head start in family medicine produces $975,120 in additional income versus the $10,038,924 in additional orthopedic income from the higher salary. The ROI on orthopedic surgery training compared to primary care is among the most decisive in medicine.

The Dermatologist vs. The Ophthalmologist (comparable training length, comparable income):

Both specialties involve 4 to 5 years of post-MD training. Doximity's 2026 averages put them about $10,000 apart ($497,509 and $487,438), and SalaryDr's medians are $625,000 and $670,000. The 30-year career income comparison is essentially equivalent — the decision between them should be based on clinical interest, not financial differentiation.

The key insight from the lifetime earnings model: The training ROI is most favorable for specialties that combine shorter training with high income — dermatology and ophthalmology. It is most challenging for specialties that combine very long training with very high income — neurosurgery and cardiothoracic surgery — where the delayed income start significantly reduces the lifetime advantage versus specialties with shorter training at moderately lower nominal income.

For the complete physician wealth-building trajectory at different income levels, see our Physician Net Worth by Age guide — the most-read article on this site, with detailed net worth benchmarks at every career stage.

Honorable Mentions: Three More Specialties Worth Comparing

Anesthesiology: $557,131 average (Doximity 2026, 12th). SalaryDr's median is $520,000 from 162 reports, about $213 an hour at a 47-hour week. Anesthesiology generates some of the highest per-procedure income in non-surgical medicine. The lifestyle is variable — some anesthesiologists work scheduled cases with predictable hours, while those covering trauma and obstetric cases face unpredictable and intense call schedules. CRNA supervision models affect income at employed practices. See our Anesthesiology Salary guide.

ENT/Otolaryngology: $549,810 average (Doximity 2026, 13th). ENT combines surgical, office procedural, and in-office cash-pay procedures — balloon sinuplasty, hearing aid dispensing, allergy testing — in a way that generates income above pure insurance-based reimbursement. Medscape's 2026 report put ENT among the eight specialties averaging more than $500,000 ($508,000), and 98 percent of otolaryngologists in SalaryDr's reports say they would choose the specialty again, the highest share of any specialty in our per-hour table.

Emergency Medicine: $423,723 average (Doximity 2026, 22nd). Emergency medicine is a shift-based specialty that does not typically offer the same private practice ASC ownership economics as the specialties ranking above it. Per hour it holds up well: SalaryDr's $398,990 median over a 39-hour week works out to about $197 an hour. But total annual income is capped by the shift model in a way that procedural specialties are not.

The Variables That Matter More Than the Ranking

The ranking above describes averages. The variables below determine whether a specific physician earns at the 25th percentile or the 90th percentile of their specialty.

Practice setting (the biggest income variable): Doximity's 2026 report found single-specialty groups ($480,961) and multi-specialty groups ($477,033) paid more on average than any other practice setting, ahead of hospitals ($454,440) and well ahead of academic medicine ($389,591). Inside procedural specialties the spread can be much wider. The employed neurosurgeon at a health system and the private practice neurosurgeon with spine center ownership are both "neurosurgeons" in every salary database — yet in SalaryDr's reports, private-practice neurosurgeons average $1,285,054 against $1,065,228 for hospital-employed ones.

Geographic market: Physicians in shortage markets and rural communities often command compensation premiums over equivalent urban peers, because scarcity, not patient wealth, drives physician compensation in shortage markets. Among the 60 metro areas in Doximity's 2026 report, the highest average compensation was in Oklahoma City.

The gender pay gap is persistent and documented: Doximity's 2026 report puts the gap at 26% for 2025, unchanged from 2024, using estimates that adjust for specialty, location, and years of experience. Men averaged $474,443 and women $352,167, a $122,276 annual gap that compounds over a career into millions of dollars of foregone wealth.

Negotiation skill: Every subsequent raise, bonus threshold, and partnership calculation is based on your starting number, so a weak first contract can cost you for years after you sign it. See our Physician Contract Negotiation guide and Physician Contract Red Flags guide before signing anything.

The after-tax reality: State income tax matters enormously at physician income levels. A neurosurgeon earning Doximity's $829,161 average pays California state income tax on that income; the same physician in Texas, Florida, or Nevada pays no state income tax at all. See our Physician Salary After Taxes guide for the complete after-tax comparison by state.