The single most striking signal in August’s dataset is geographic arbitrage writ large: the highest ceilings are repeatedly found in low‑volume, interior markets rather than coastal prestige centers. Pain Management posts top at $700,000 in Eldorado, IL; Cardiology shows a $725,000 Kentucky listing; Gastroenterology spikes toward $782,080 in Michigan; and neurology locum rates in Coeur dAlene annualize above $572,000. Those numbers are not outliers in isolation — they are the recurring pattern across specialties.
At the market level compensation remains heterogeneous and information‑scarce. A subset of specialties (primary care, dermatology, some procedural subspecialties) disclose enough points to form reliable midbands; many others either publish almost nothing or let hourly/locum contracts define national ceilings. The practical implication: candidates who bring the map (and the willingness to move) will materially out‑earn those who treat a specialty as a single national market.
Primary Care & General
Primary care is no longer a single dial. Read the primary care reports together — Family Medicine, Internal Medicine, Med‑Peds, Primary Care Physician, Geriatrics, and Hospitalist — and the headline is divergence.
National midbands sit in the mid‑$200Ks for core generalist roles (Family Medicine average range $260,927$292,172; Internal Medicine $264,631$303,612; Primary Care physician $262,838$301,741). But pockets pay like specialists: North Carolina Family Medicine averaged $390,000$414,375, VermontInternal Medicine reports $522,480$556,800, and some hospitalist postings top $400,000$500,000 (Buffalo hospitalist $350,000$500,000; highest listed $350,000$500,000 and one Buffalo posting at $350K$500K).
Med‑Peds and Geriatrics are instructive microcases: Med‑Peds shows a $200K$400K full spread with an average near $250K$288K; Geriatrics is thin on disclosure (6 of 50) but the visible ceiling ($250K$325K in Sun City, FL) confirms that leadership and program scope lift pay. Disclosure rates vary: primary care networks publish aggressively (Primary Care report showed ~71.6% disclosure), while Hospitalist and Geriatrics remain opaque; that changes candidate behavior: where numbers are posted, applicants show up faster and with higher baseline expectations.
Medical Specialties
Group the larger medical specialty bucket and two patterns dominate: (1) procedural or device‑adjacent specialties still command the highest ceilings; (2) locum/hourly work and low‑volume markets repeatedly set the top end across otherwise cognitive fields.
Procedural‑leaning specialties show high ceilings: Anesthesiology averages $510K$576K nationally with Texas averaging ~$735K; Dermatology clusters ~$419K$545K with a ceiling at $800K; Gastroenterology midband is $520K$575K but Michigan shows $782K averages on small samples. Interventional cardiology and noninvasive cardiology both sit well above most medical peers (Interventional avg ~$681K$752K; Noninvasive avg ~$619K$641K), with Midwest markets (KY, IA, IL) posting some of the highest disclosed averages.
Cognitive specialties show mixed signals. Psychiatry averages ~$294K$336K but includes $550K ceilings; Neurology midband $334K$368K with locum hourly work annualizing above $500K. Infectious Disease is a transparency problem (6 of 46 disclosures, all NY) but disclosed band is $220,833$247,500. Rheumatology shows a broad $220K$450K range (national avg ~$309K$329K) where scarcity, not RVUs, sets pay.
Two meta‑points: locum/hourly roles are lifting ceilings across cognitive fields (neurology, EM, anesthesiology), and states with single or few listings (Idaho, Kentucky, Iowa, parts of the Plains) repeatedly top national tables. That means top compensation increasingly belongs to physicians willing to be mobile or accept short‑term contracts.
Surgical Specialties
Surgical compensation still sits at the top overall, but the story is qualification and disclosure. General Surgery shows a national average band near $390K$438K with individual listings north of $565K (Smithtown, NY $575K) — yet only 13 of 146 surgery listings disclosed pay. Breast Surgery (5 of 20 disclosed) averages ~$414K$433K with Washington posting $475K$550K.
What surprises is the opacity: surgical fields have some of the largest nominal ceilings but also among the lowest disclosure rates. That combination amplifies the advantage for candidates who secure those published outliers: the market pays, but you usually have to call to find out how much.
Advanced Practice Providers
The nurse practitioner and physician assistant markets are their own economies. Nurse Practitioners (1,776 listings, 764 disclosed) show an average band of ~$144,761$186,129 with a national floor dragged down by part‑time roles ($45K) and a ceiling at $400K. Physician Assistants (1,239 listings, 542 disclosed) average ~$154,122$195,898 with travel/locum PAs annualizing into the high $200Ks and beyond.
Both APP markets look like two economies: salaried staff roles that form a relatively tight midband, and mobile/locum work that produces outsized short‑term pay. Disclosure rates hover around ~43% for NP and ~43.7% for PA; the more that employers publish bands, the faster that APP pipelines move. NPs show larger absolute ceilings in some rural scarcity markets, while PAs display more pronounced locum‑driven upside.
Cross‑Cutting Observations
1) Geography is the dominant multiplier. Across specialties the same pattern repeats: small‑sample interior markets (Plains, parts of the Midwest, specific rural towns) pay the highest ceilings. Examples: Pain Management Eldorado, IL ($700K), Cardiology Kentucky ($725K), Gastroenterology Michigan ($782K). If you want top dollars, be willing to go where others dont.
2) Volume rarely equals premium. High listing counts (CA, NY, FL, TX) often coincide with average or below‑average pay. Exceptions exist (California in some specialties), but the general rule this month: density suppresses wages unless the employer chooses otherwise.
3) Transparency is uneven and strategic. Several specialties disclose in the 3040% range; many disclose under 20%. Low disclosure inflates recruiter leverage and lengthens time‑to‑fill. Where employers publish bands (notably primary care networks and parts of dermatology), candidate pipelines accelerate and negotiating leverage shifts toward job seekers.
4) Locum/hourly work is shaping ceilings across cognitive fields. Annualized hourly rates are producing six‑figure tops in neurology, EM, anesthesia, and PAs. Those ceilings are real money but not the same as salaried guarantees; treat them as tradeable options, not default comparators.
5) Procedural versus cognitive still matters — but less reliably. Procedural fields (cardiology, GI, interventional specialties, surgery) tend to sit higher, yet the highest single numbers often come from non‑coastal cognitive or leadership roles when scarcity bites (e.g., Hem/Onc and Pain listings in undercovered markets). In short: procedure = higher baseline; scarcity = occasional windfall.
Watch next month for any inflection in disclosure and coastal pricing. If high‑volume coastal markets begin publishing competitive bands, the nationwide map will shift rapidly; if they continue to hide numbers, the inland arbitrage will keep widening and candidates who read the full map will continue to win materially.
