The national salary floor for Neurosurgery is $250,000. The ceiling is $1,000,000. That is not a typo, and the gap between them — $750,000 — is larger than the average physician’s entire career earnings in some specialties. The current market includes 67 active listings spread across 25 states, from Alabama to Washington, with compensation data available for only six of them. What the data shows is this: Neurosurgery pays extraordinarily well almost everywhere, but where you practice and what you negotiate can mean the difference between comfortable and generationally wealthy.
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The Neurosurgery Job Market at a Glance
67 total listings. 6 listings with salary data. Full range: $250,000 to $1,000,000. Average range: $750,833 to $812,500.
The spread is enormous, even by surgical subspecialty standards. The average range suggests most Neurosurgery positions cluster near or above $750,000 annually, but the floor of $250,000 (almost certainly an academic, part-time, or highly specialized role) drags the lower bound down significantly. The upper range, meanwhile, approaches seven figures with the calm inevitability of a well-placed burr hole.
States represented: Ohio, Missouri, North Carolina, Kentucky, Idaho, Michigan, Iowa, Pennsylvania, Indiana, Texas, Florida, California, Alabama, Utah, Wisconsin, Virginia, Connecticut, Illinois, Georgia, Nebraska, West Virginia, South Carolina, Arkansas, Mississippi, and Washington. The market is geographically diffuse, with no single region dominating supply or setting the tone for compensation.
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How States Stack Up
Overperformers: Missouri leads the nation with a single listing at $975,000 (one job, one data point, one very persuasive reason to consider Springfield). Illinois follows with an average range of $890,000 to $950,000 across two salary listings and four total postings, offering both high pay and reasonable volume. Ohio reports $900,000 from one salary listing among three total jobs, landing squarely in the upper tier.
Near-average: No states fall cleanly into the near-average band outside of Ohio and Illinois, which already appear above. The national average range of $750,833 to $812,500 is sparsely populated in the disclosed data, suggesting most employers either pay well above it or decline to disclose.
Underperformers: Pennsylvania reports $600,000 to $700,000 from one salary listing across eight total postings, falling below the national average despite leading the country in job volume. Alabama anchors the bottom with a range of $250,000 to $400,000 across five listings, a figure so far below the national average that it demands explanation (academic appointment, research focus, or part-time scope are the likeliest culprits).
Volume leaders: Pennsylvania (8 listings), Florida (7), Alabama (5), Indiana (5), California (5), Texas (4), and Illinois (4). Pennsylvania’s volume advantage does not translate to pay leadership. Florida, despite ranking second in job count, provided no salary data. Missouri, with one listing, offers the highest disclosed salary in the dataset.
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What This Means If You’re a Physician
If your priority is maximum compensation: The highest-paying listing in the dataset is located in Springfield, Missouri, offering $975,000 annually. Missouri is a single-listing state, so optionality is limited, but the pay is unambiguous. Illinois offers a close second with $890,000 to $950,000 and four times the job volume, making it a safer bet for those who want high pay and multiple options.
If your priority is maximum optionality: Pennsylvania leads with 8 listings, followed by Florida with 7. Both states offer geographic diversity and practice setting variety, but neither disclosed competitive salary data. Pennsylvania’s single data point ($600,000 to $700,000) falls well below the national average, and Florida provided none. Volume here comes at the cost of transparency and, possibly, compensation.
If your priority is balance: Illinois delivers four listings, two with salary data, and an average range of $890,000 to $950,000. It is the only state in the dataset that combines high pay, reasonable job count, and salary transparency. Ohio offers three listings and $900,000 in reported pay, but with only one data point. For physicians seeking both competitive compensation and a meaningful selection of opportunities, Illinois is the most defensible choice.
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What This Means If You’re a Recruiter
The salary transparency rate is 8.96 percent (6 listings with data divided by 67 total listings). This is extraordinarily low, even by physician job market standards, and presents a significant challenge for candidate pipeline development. Neurosurgeons are highly compensated, highly sought, and highly aware of their market value. Without disclosed salary data, recruiters will need to lead with other differentiators: leadership opportunities, research support, subspecialty case volume, call schedules, or partnership track timelines.
Pennsylvania and Florida represent volume-pay misalignments. Pennsylvania leads in job count but disclosed below-average pay. Florida ranks second in volume but provided no salary data at all. Recruiters in these states will face skepticism from candidates who can access higher pay in Missouri, Illinois, or Ohio with minimal effort. In low-transparency markets, speed to offer and clarity on total compensation (including benefits, bonuses, and equity) become the primary competitive levers.
Missouri, by contrast, demonstrates that scarcity and premium pay can coexist. One listing at $975,000 will attract national attention. Recruiters in high-paying, low-volume markets should emphasize exclusivity and urgency.
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What’s Driving the Numbers
Salary transparency is functionally absent. With fewer than 9 percent of listings disclosing compensation, the Neurosurgery job market operates largely on backchannels, recruiter relationships, and direct negotiation. This benefits experienced candidates with strong networks and penalizes early-career physicians or those relocating from outside the U.S. The lack of transparency also suggests that many employers are either unwilling to compete on salary publicly or are targeting passive candidates who do not require posted ranges to engage.
Volume and pay are uncorrelated. Pennsylvania leads in job count but trails in salary. Missouri has one listing and the highest pay. Florida has seven listings and no salary data. This breaks the typical supply-demand model and suggests that Neurosurgery hiring is driven more by institutional need, subspecialty match, and candidate scarcity than by regional market forces. Physicians cannot assume that high-volume states will pay competitively, nor that low-volume states will pay poorly.
The salary floor is an outlier. The $250,000 figure in Alabama sits $500,000 below the national average low and $725,000 below the highest listing. It is almost certainly a part-time, academic, or research-focused role. If it is full-time clinical Neurosurgery, it represents either a severe market inefficiency or a red flag. Either way, it distorts the national range and should be treated as a statistical outlier rather than a realistic comp benchmark.
Geographic dispersion is wide, but data is thin. 25 states have listings, but only 5 states provided salary data. The market is national in scope but regional in transparency. Physicians evaluating opportunities will need to rely on peer networks, professional societies, and recruiter intel to fill the gaps. The states that do disclose — Missouri, Illinois, Ohio, Pennsylvania, Alabama — set the visible tone, but the invisible majority may tell a very different story.
The Bottom Line
The Neurosurgery job market is robust, well-compensated, and maddeningly opaque. Physicians with strong negotiation skills, access to peer salary data, and geographic flexibility will do well. Those relying on posted ranges will find themselves operating with less than 10 percent of the available information. The states that do disclose salaries reveal a market that rewards subspecialty expertise, tolerates dramatic regional variation, and consistently clears $750,000 annually for competitive roles.
There is a lot of money available for drilling holes in skulls, but you will have to ask where most of it is hidden.
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Salary data based on 6 listings with disclosed compensation. Figures may reflect part-time or specialized roles. This report is informational and should not replace professional judgment or financial planning.
