Somewhere in Williston, North Dakota — population roughly 29,000 and windchill roughly personal — an Internal Medicine physician can walk into a flat $350,000 offer. Meanwhile, in New York City, a full-time internist is being courted at $155,000. Same specialty. Same board certification. Same stethoscope. The zip code is doing all the heavy lifting. Across the country, 1,523 active Internal Medicine listings are currently live, sprawling from Manhattan to Franconia to Greeley. The thesis is simple: Internal Medicine is one of the deepest, widest, and most geographically contradictory physician markets in the country, and the map is not the territory you think it is.
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The Internal Medicine Job Market at a Glance

Total listings: 1,523
Listings with salary data: 470
Full salary range: $125,000 to $650,000
National average range: $263,624 to $303,888
Practical clustering band: $240,000 to $360,000

The spread here is enormous — a $525,000 gap between floor and ceiling — and it tells you everything about how Internal Medicine is priced. The specialty is the workhorse of American medicine, which means it is both ubiquitous and wildly inconsistent. Urban saturation drags the floor down. Rural scarcity pushes the ceiling up. Part-time and specialized roles muddy the middle.

Listings appeared in 50 markets: MA, NY, CA, FL, CT, IL, NH, LA, ND, GA, SC, CO, VA, TN, TX, MD, IN, ME, VT, AL, IA, MO, PA, WA, NV, WI, NC, NM, AZ, WY, NJ, OK, KY, MN, MI, AR, OR, MS, OH, UT, KS, MT, SD, RI, ID, WV, HI, AK, NE, and DC.

Internal Medicine, in other words, is everywhere. The compensation, however, is not.
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How States Stack Up

Overperformers

• Pennsylvania ($306,250 to $425,000): the highest structural range in the country on 22 listings — small volume, serious money.
• Nevada ($232,500 to $490,000): a two-listing sample producing a canyon of a range, which is either a premium opportunity or a rounding error (probably both).
• Louisiana ($257,143 to $417,857): seven listings, real dollars, no gimmicks.
• Wisconsin ($300,667 to $384,000): quietly one of the best-paying markets in America, and no one talks about it.
• Tennessee ($330,000 to $360,000): five listings, tight range, top-tier average.
• North Dakota ($333,750 flat): eight listings all clustered at the same number, which is what scarcity pricing looks like on a spreadsheet.
• Oregon ($325,000 flat) and Montana ($325,000 flat): rural West competing hard.
• New Jersey ($274,625 to $378,675): a surprisingly strong upper band for the Northeast.

Near-average

• California ($272,887 to $311,961): solid, not spectacular, especially when you divide by rent.
• Florida ($296,211 to $316,895): consistently competitive.
• Texas ($281,176 to $302,941): predictable, deep, and durable.
• Illinois ($285,350 to $310,150): boringly reliable.
• Connecticut ($258,215 to $295,316): stable mid-tier.
• Virginia ($258,286 to $296,286) and North Carolina ($278,750 to $295,000): dependable benchmarks.
• Massachusetts ($236,208 to $269,167) and Maryland ($242,778 to $272,222): mid-Atlantic and New England compression.
• Georgia ($259,233 to $344,333), South Carolina ($286,500 to $305,500), Alabama ($264,000 to $289,000), Missouri ($275,000 to $303,125), Ohio ($264,000 to $291,000), Arizona ($289,000 to $347,000), Colorado ($249,750 to $327,250), Washington ($269,917 to $304,413), Minnesota ($293,500 to $299,750), Indiana ($276,667 to $300,000), New Mexico ($242,000 to $292,000), Maine ($262,500 to $300,000), Kentucky ($280,000 flat), and Nebraska ($260,000 flat): the sturdy middle of the American internist economy.

Underperformers

• Oklahoma ($140,000 to $160,000): a single listing, but the number is startling — roughly half the national average.
• New Hampshire ($175,000 to $200,000): one part-time listing skewing the state’s optics.
• Vermont ($206,500 to $220,000): trailing the national norm meaningfully.
• New York ($230,893 to $271,607): 117 listings, second-highest volume in the country, and one of the softest averages in the Northeast (more on that in a moment).

Volume leaders: California (189), New York (117), Florida (113), Texas (99), Connecticut (97). New York carries the second-largest listing count and one of the weakest per-listing averages, which is not a coincidence.
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What This Means If You’re a Physician

If your priority is maximum compensation: Look at Pennsylvania, Wisconsin, Tennessee, and rural high-ceiling markets like North Dakota, Montana, and Oregon. The single highest-paying listings in the dataset are the $250,000 to $400,000 roles posted by Enterprise Medical Recruiting in Atlanta, GA and Greeley, CO, alongside The Inline Group’s flat $350,000 offer in Williston, ND. Nevada’s $490,000 upper band exists but rests on two listings — verify the scope before you buy the plane ticket.

If your priority is maximum optionality: California (189), New York (117), Florida (113), and Texas (99). You will have options. You may not always love the numbers attached to them — especially in New York, where volume and compensation move in opposite directions.

If your priority is balance: Florida, Illinois, Arizona, and North Carolina offer competitive averages and enough listing depth to give you leverage. Cost-of-living mismatch worth scrutinizing: California and New York, where a $270,000 salary and a $4,500 studio apartment share a ZIP code.
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What This Means If You’re a Recruiter

Salary transparency rate: 470 of 1,523 listings disclose compensation — 30.9%. Roughly seven in ten Internal Medicine postings ask candidates to inquire. That is a pipeline problem dressed up as a negotiating tactic. Candidates increasingly filter by disclosed comp before they ever click.

The volume-pay misalignment is glaring in New York and, to a lesser extent, California. If you are recruiting for a New York system at $230,000 to $271,000, you are not going to win on money. You will need to lead with schedule, patient panel, academic affiliation, loan support, or lifestyle. Florida and Texas recruiters have an easier pitch: competitive comp and deep candidate interest. Rural and low-volume states — North Dakota, Montana, Oregon, Wisconsin — should lead with the number. It is the number.
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What’s Driving the Numbers

Scope and setting command a premium. The listings clearing $400,000 are concentrated in either rural scarcity markets or roles bundling additional responsibility. Pennsylvania’s $425,000 upper band and Louisiana’s $417,857 ceiling are not accidents — they reflect what employers pay when the candidate pool is thin or the job description is thick.

Part-time roles distort the floor. New Hampshire’s $175,000 to $200,000 average is a single part-time listing from Medrina in Franconia. Oklahoma’s $140,000 to $160,000 is one listing. These are not state markets — they are single data points wearing state-market costumes. Treat them accordingly.

Underserved markets price in scarcity. North Dakota’s flat $333,750, Montana’s flat $325,000, and Oregon’s flat $325,000 all tell the same story: when a state cannot generate enough internists organically, it stops negotiating and starts posting the number on the door. Rural America is the highest-paying tier of Internal Medicine in the country (a fact that continues to surprise everyone except rural America).

The volume-pay relationship breaks at the top. California and Florida hold together — high volume, competitive pay. New York does not. 117 listings averaging $230,893 to $271,607 is the clearest example in the dataset of what happens when supply of physicians catches up to demand: the number softens. Volume is not a proxy for compensation. Sometimes it is the opposite.

The Bottom Line

Internal Medicine in 2026 is a market of contradictions: enormous, geographically ubiquitous, and priced on a curve that punishes prestige ZIP codes and rewards zip codes most Americans could not find on a map. The best money is in Pennsylvania, Wisconsin, and the rural high plains. The worst leverage is in New York. The middle is honest, deep, and negotiable. And nearly 70% of employers are still refusing to post a number, which is a strategy that ages poorly in a transparent market.

Internal Medicine will pay you well — as long as you are willing to practice somewhere the recruiter has to describe using the phrase “quality of life.”
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Salary data based on 470 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.