North Carolina is paying Family Medicine physicians an average of $390,000 to $414,375 per year. This is not a typo, nor is it limited to a handful of boutique practices. It represents the compensation reality across 112 active job listings in a state that has apparently decided primary care is worth funding like a specialist service. The national Family Medicine market currently features 2,581 active listings, with salary data available for 742 of them. What the data shows is this: geography determines your earning power more than almost any other variable, and the relationship between cost of living and compensation has become fascinatingly detached from logic.
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The Family Medicine Job Market at a Glance
Total listings: 2,581. Listings with salary data: 742. Full salary range: $160,000 to $800,000. National average range: $260,927 to $292,172.
The spread is wide enough to park a small hospital system inside. At the floor, you have positions that barely clear $160,000 (likely part-time or academic roles with creative benefit accounting). At the ceiling, $800,000 represents either an executive-level outlier or a rural critical access facility willing to pay whatever it takes to keep the doors open. Most positions cluster between $200,000 and $332,000, which is where the actual market lives. The average range of $260,927 to $292,172 reflects the pull of high-volume, mid-tier markets like California and New York, which together account for 546 listings and exert significant downward pressure on the national mean.
States represented: California, New York, South Carolina, Arizona, Illinois, Pennsylvania, Massachusetts, Iowa, Texas, Florida, Connecticut, Minnesota, Missouri, Indiana, Georgia, Ohio, New Jersey, Colorado, South Dakota, Nevada, Vermont, Washington DC, Kansas, Louisiana, Washington, Hawaii, Michigan, New Hampshire, Alabama, Maryland, Alaska, North Carolina, Virginia, North Dakota, Kentucky, Delaware, Arkansas, Guam, Tennessee, Oklahoma, Wisconsin, Montana, Maine, Nebraska, New Mexico, Idaho, Utah, West Virginia, Oregon, Mississippi, Rhode Island, Wyoming.
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How States Stack Up
Overperformers: North Carolina ($390,000 to $414,375) is paying nearly $100,000 above the national average with 112 listings, making it the rare combination of volume and premium compensation. New Mexico ($384,600) offers top-tier pay but with only two salary listings, so consider it a high-reward, low-visibility market. Kentucky ($360,880 to $373,360) and Montana ($355,429 to $358,286) both clear $355,000 on average, rewarding physicians willing to work in lower-density markets. Arkansas ($339,120 to $351,320) pays a meaningful premium over the national average across five salary listings. Mississippi ($335,000 to $380,000) shows strong pay, though the single data point makes it more anecdote than trend. North Dakota ($325,000) and Guam ($315,000 to $330,000) both break $315,000, with Guam offering the added benefit of never having to shovel snow. South Dakota ($315,625 to $321,250) and Iowa ($313,750 to $320,000) round out the overperformers, both offering $50,000+ premiums over the national average despite modest job counts.
Near-average performers: Washington ($272,219 to $320,605) spans a wide range but averages near the top of the national midpoint. Illinois ($269,953 to $293,465) and Georgia ($269,164 to $317,909) both sit comfortably at the national average, with Illinois offering 87 listings and Georgia 104. Arizona ($276,750 to $309,750) performs slightly above average but with only eight salary listings across 63 postings. Missouri ($290,385 to $303,077) edges above the mean, while Nevada ($288,000 to $304,000) does the same with a smaller sample. Texas ($288,750 to $299,667) offers 129 total listings but only 12 with salary data, placing it near average despite its size. Florida ($283,810 to $295,543) sits just above the national average with 181 listings, making it a high-volume, mid-pay market. Delaware ($275,000 to $300,000) and Tennessee ($300,000) both hover near the national benchmark. California ($256,099 to $293,292) is the definition of average, which is remarkable given its 399 listings and status as the most expensive state in the union. Connecticut ($249,812 to $276,353) and New Jersey ($252,200 to $267,200) both sit slightly below average despite being high-cost Northeastern markets.
Underperformers: Kansas ($201,667 to $283,000) posts the lowest average in the country, with a floor that dips nearly $60,000 below the national mean. Colorado ($225,800 to $267,400) pays below average despite its desirability and cost of living. Rhode Island ($230,000 to $250,000) offers the second-lowest average nationally, which is difficult to justify in a New England market. New York ($235,327 to $272,784) pays below the national average across 147 listings, a stunning underperformance for one of the highest cost-of-living states in the country. Massachusetts ($239,400 to $268,300) similarly trails the national midpoint across 98 listings, likely reflecting the influence of academic medical centers and public health systems. Maryland ($239,286 to $254,857) and Virginia ($239,265 to $257,167) both pay below average, despite proximity to Washington DC and its federal salary benchmarks. Pennsylvania ($236,923 to $272,923) underperforms relative to its 66 listings, and Ohio ($244,571 to $267,000) does the same across 21 salary postings. Alabama ($243,500 to $245,500) shows a compressed and below-average range across 10 listings.
Volume leaders: California leads with 399 listings. Florida follows with 181. New York posts 147. Texas has 129. North Carolina has 112. Georgia has 104. Massachusetts has 98. Illinois has 87.
California and New York dominate volume but pay at or below the national average. North Carolina is the outlier: high volume, high pay. Florida and Texas both offer strong job counts with near-average to slightly above-average compensation. Massachusetts posts nearly 100 listings but pays below the national mean, a mismatch worth noting.
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What This Means If You’re a Physician
If your priority is maximum compensation: North Carolina is the market. It offers $390,000 to $414,375 on average with 112 listings, meaning you are not chasing a single outlier position. New Mexico, Kentucky, Montana, and Arkansas all offer $335,000+ averages, though with significantly lower job volume. The highest single listing identified is in North Carolina at $414,375, though the raw data does not specify city or scope.
If your priority is maximum optionality: California offers 399 listings, more than double any other state. Florida and New York follow with 181 and 147 listings, respectively. Texas adds 129. If you want choice, these four states account for 856 of the 2,581 national listings. The trade-off is clear: California and New York pay below the national average, and Florida and Texas pay near it. You are exchanging compensation for selection.
If your priority is balance: Minnesota offers $310,957 to $326,391 across 52 listings, placing it in the top compensation tier with meaningful volume. Washington ($272,219 to $320,605) offers 49 listings and a wide range that skews upward. Illinois ($269,953 to $293,465) provides 87 listings at the national average. These are the markets where pay and opportunity intersect without requiring you to move to a state with one stoplight. The cost-of-living mismatch is most glaring in New York and Massachusetts, both of which pay below the national average despite being among the most expensive places to live in the country. The compensation gap between North Carolina ($390,000+) and Kansas ($201,667) is $188,333 at the low end, which is enough to fund a second career or a very aggressive retirement plan.
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What This Means If You’re a Recruiter
The salary transparency rate is 28.7% (742 listings with data divided by 2,581 total listings). This is low enough to create friction in the candidate pipeline, particularly in competitive markets where physicians are evaluating multiple offers simultaneously. Candidates will assume the worst about unlisted salaries, and they will be correct often enough to make that assumption rational.
The volume-pay misalignment is most pronounced in California, New York, and Massachusetts. California posts 399 listings but pays $256,099 to $293,292 on average. New York posts 147 listings but pays $235,327 to $272,784. Massachusetts posts 98 listings but pays $239,400 to $268,300. These are not markets where compensation will close the deal. Recruiters will need to lead with lifestyle, institutional reputation, academic affiliation, or geography. If you are recruiting in Kansas ($201,667 to $283,000), you will need to explain why a physician should accept $60,000 less than the national average. If you are recruiting in North Carolina, you can lead with the number and let it do the work.
The inverse is also true: low-volume, high-pay markets like Montana, Kentucky, and Arkansas will struggle with candidate awareness, not compensation. The challenge is not what you are offering. It is whether anyone knows you are offering it.
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What’s Driving the Numbers
Geographic scarcity commands a premium, but only in specific markets.
Montana, South Dakota, North Dakota, and Iowa all pay $313,000+ on average, well above the national mean. These are low-density states with aging populations and limited physician supply. The premium reflects scarcity, but it is not universal. Kansas, despite being rural and underserved, pays $201,667 to $283,000, which is the lowest in the country. The difference is likely payer mix, state Medicaid reimbursement rates, and whether the employer is a critical access hospital with federal funding or a struggling independent practice. Scarcity drives pay only when the employer has the revenue model to support it.
High-cost states are not paying for their cost of living.
New York, Massachusetts, and California all pay at or below the national average despite being three of the most expensive states in the country. This is not an oversight. It is a structural feature of markets dominated by academic medical centers, large health systems, and public payers. These employers offer stability, benefits, and prestige in place of cash compensation. Whether that trade-off works depends entirely on the physician’s financial situation and career stage. For a physician with $400,000 in student loans, it does not work.
Volume and pay are inversely correlated in this market.
The states with the most listings (California, Florida, New York, Texas) pay at or below the national average. The states with the highest pay (North Carolina, New Mexico, Kentucky, Montana) have fewer than 112 listings, and most have fewer than 30. The exception is North Carolina, which offers both volume (112 listings) and premium pay ($390,000+). This makes it the most efficient market in the country for Family Medicine physicians. Every other market forces a trade-off.
Part-time and academic roles are distorting the floor.
The $160,000 floor is not a full-time primary care salary. It is either a part-time role, an academic position with significant non-clinical time, or a fellowship with creative accounting. The same is likely true for positions in the $200,000 to $220,000 range in high-cost markets like New York and Massachusetts. These roles should not be excluded from the data, but they should be understood for what they are: structurally different from standard outpatient Family Medicine positions. The $800,000 ceiling is similarly an outlier, likely tied to ownership, executive responsibility, or a rural hospital willing to pay whatever it takes to avoid closure.
The Bottom Line
The Family Medicine job market is geographically vast, compensation is highly variable, and the relationship between cost of living and salary has become untethered from rational expectations. North Carolina is paying like a procedural specialty, Kansas is paying like a residency program, and California is paying like it has 399 other options (because it does). Physicians have leverage in this market, but only if they are willing to move. Recruiters have inventory, but not necessarily the compensation to match it. The market is working, but it is working in favor of those who treat location as negotiable.
If you want to be paid well for keeping people healthy, go where people are scarce and employers are desperate.
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Salary data based on 742 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.
