Somewhere in Hartford, Connecticut, a hospital is willing to pay a single human being $1,100,000 a year to operate on brains. Somewhere in Alabama, another hospital is advertising the same job title for $250,000. Both listings are live. Both are labeled “Full Time Neurosurgery.” The gap between them is $850,000, which is itself a full neurosurgeon salary in most of the country. Across 67 national listings in 25 states, only 7 employers disclosed what they intend to pay. The thesis: Neurosurgery remains one of medicine’s highest-ceiling specialties, but the floor is closer than anyone wants to admit.
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The Neurosurgery Job Market at a Glance

Total listings: 67
Listings with disclosed salary: 7
Full national range: $250,000 to $1,100,000
Average range: $659,371 to $754,571

Seven disclosed salaries out of sixty-seven is not a data set. It is a rumor with spreadsheets. Still, the spread it reveals is instructive: the top of the market pays roughly four-and-a-half times the bottom for what is, on paper, the same specialty. That kind of variance does not exist in orthopedics or cardiology. It exists here because neurosurgery demand is intensely local, and because “neurosurgeon” covers everything from a solo rural generalist to a fellowship-trained skull base specialist running a tumor program.

States represented: Connecticut, Florida, Idaho, Oregon, Iowa, Pennsylvania, Missouri, Texas, Wisconsin, North Carolina, Indiana, Ohio, Michigan, Illinois, California, Georgia, Utah, West Virginia, Mississippi, Nebraska, New Jersey, Alabama, Kentucky, Tennessee, Colorado.
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How States Stack Up

Overperformers:

• Connecticut ($800,000–$1,100,000): The national ceiling, driven by a single Hartford listing that is doing all the heavy lifting.
• Ohio ($900,000): The rare state that combines a high disclosed number with actual listing volume.
• Illinois ($850,000–$900,000): Chicago-adjacent economics behaving exactly as Chicago-adjacent economics tend to.

Near-average:

• Idaho ($665,600–$832,000 annualized from $320–$400/hour): A locum rate in Pocatello that quietly out-earns most permanent jobs in bigger states.

Underperformers:

• Florida ($650,000): Sun, beaches, and a number that sits below the national average midpoint.
• New Jersey ($500,000): Below what its cost of living should tolerate.
• Alabama ($250,000–$400,000): The national floor, and not by a small margin.

Volume leaders: Indiana (7), Florida and Ohio (5 each), Missouri, Georgia, and Kentucky (4 each). Indiana leads the country in listing count and discloses exactly zero salaries. Missouri and Georgia do the same. Ohio is the only high-volume state also willing to put a number in writing.
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What This Means If You’re a Physician

If your priority is maximum compensation: The Hartford, Connecticut Full Time Neurosurgery role posted by CompHealth, at $800,000 to $1,100,000, is the highest-paying listing in the dataset. No sub-specialty scope was disclosed (which, at seven figures, is a question worth asking on the first call).

If your priority is maximum optionality: Indiana has 7 openings, none with published salaries. You will be negotiating blind, but you will be negotiating often.

If your priority is balance: Ohio is the only state offering both volume (5 listings) and a disclosed high-end salary ($900,000). Idaho’s locum rate annualizes competitively with most permanent roles nationally, without the permanence.

Cost-of-living flag: New Jersey at $500,000 is the listing that deserves scrutiny. Alabama at $250,000 to $400,000 deserves an entire interview’s worth of questions about call, scope, and whether the number is a base or a total.
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What This Means If You’re a Recruiter

Salary transparency rate: 7 of 67, or 10.4%. Nearly nine out of ten neurosurgery listings ask candidates to inquire within. For a specialty where the compensation delta between two identical job titles can exceed $850,000, that opacity is not a negotiation strategy. It is a pipeline problem.

Indiana leads the country in listings and discloses nothing. Missouri, Georgia, and Kentucky follow the same script. These are the markets where recruiters will need to lead with something other than the number, because there is no number to lead with. Case volume, subspecialty support, call structure, non-compete geography, and signing incentives are what will move a candidate off a screen and onto a plane. Ohio, by contrast, has already done the work: a disclosed $900,000 and 5 open roles is a self-marketing listing.
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What’s Driving the Numbers

Scope and setting command the premium. The top three states (Connecticut, Ohio, Illinois) cluster around established, high-acuity health systems. The $1.1 million ceiling is not a rural retention bonus. It is a tertiary-center number attached to a tertiary-center caseload, and it comes with the operating volume to justify it.

Locum work is quietly rewriting the floor. Idaho’s $320 to $400 per hour annualizes to $665,600 to $832,000 at 2,080 hours — a range that lands squarely inside the national average and above several permanent listings. Temporary work is no longer the compromise position. In neurosurgery, it is increasingly the arbitrage.

Underserved markets are not pricing in scarcity. Alabama should, in theory, be paying a premium to attract a neurosurgeon to a market that struggles to retain one. Instead, its listings sit at the national floor. Either the roles are narrower in scope than the title suggests, or the market has decided that scarcity is someone else’s problem.

Volume and pay have decoupled. Indiana leads in openings and discloses nothing. Ohio is the only state where high volume and high pay coexist on the same listings page. Everywhere else, the two variables appear to be running independent experiments.

The Bottom Line

Neurosurgery in 2026 is a specialty where the top of the market pays like private equity and the bottom pays like general practice, and 90% of employers would prefer you not know which one they are. The disclosed data points paint a range from $250,000 to $1,100,000, and the undisclosed 60 listings are somewhere inside that canyon. Ohio is the cleanest signal. Connecticut is the ceiling. Alabama is the cautionary tale. Idaho is the sleeper.

In a specialty where the difference between two job titles can be $850,000, silence from the employer is not discretion — it is a negotiating position.
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Salary data based on 7 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.