The highest-paying Internal Medicine listing in America right now is not in Manhattan, not in San Francisco, not in Boston. It is in Buffalo, New York — a city more famous for lake-effect snow than for $500,000 paychecks. That single data point tells you almost everything about the current state of the Internal Medicine market: the money has migrated, and it did not consult the coasts on its way out. Across 1,559 active listings nationwide, the spread between the floor and the ceiling runs from $100,000 to $600,000. The thesis is simple: Internal Medicine pay is no longer a function of zip code prestige — it is a function of who is desperate, and where.
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The Internal Medicine Job Market at a Glance

Total listings: 1,559
Listings with disclosed salary: 469
Full salary range: $100,000 to $600,000
National average range: $263,431 to $301,591

The $500,000 spread between floor and ceiling is the story. Internal Medicine is the connective tissue of American healthcare — the specialty everyone needs and no one can quite agree how to price. A $100,000 listing and a $600,000 listing technically describe the same job title. They do not describe the same job.

The average range clusters tightly between roughly $263,000 and $302,000, which means the middle of the market is sane. The tails are where the drama lives.

States represented: CA, NC, FL, AL, NY, IN, SC, GA, IL, CT, MA, PA, WA, TN, LA, ND, WI, ME, VA, NJ, NM, TX, MO, NH, DE, CO, MD, AZ, IA, OK, WY, NV, VT, SD, HI, MN, MT, AR, OH, MI, KS, NE, OR, ID, MS, WV, RI, UT, AK, KY, DC. Fifty-one jurisdictions. Internal Medicine is, fittingly, everywhere.
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How States Stack Up

Overperformers:

• Pennsylvania ($315,000–$420,000) leads the country on average compensation despite offering only 25 listings (a small sample punching well above its weight).
• North Dakota ($320,000 flat) pays the same number on both ends of the range, which is either disciplined or suspicious depending on your reading.
• Oregon ($325,000 flat) does the same trick, with similar deadpan consistency.
• Delaware ($350,000–$400,000) is a single listing, but it is a loud one.
• Wisconsin ($287,500–$412,500) offers one of the widest premium bands in the country.
• Louisiana ($257,143–$417,857) tops out high, with significant variance underneath.
• Tennessee ($312,000–$340,000) quietly outperforms most of its Southeast peers.
• Iowa and Wyoming ($250,000–$400,000 each) show single-listing strength in low-volume states.
• Kentucky ($300,000 flat) clears the national average on one data point.

Near-average:

• California ($280,686–$313,409) — high volume, market-rate pay.
• Florida ($285,231–$306,385) — same story, sunnier.
• Texas ($290,555–$319,444) — the most consistent big market.
• Illinois ($287,765–$311,471) — Midwestern reliability.
• Connecticut ($258,580–$293,787) — slightly soft for its volume.
• Washington, Virginia, Colorado, Arizona, Montana, Nevada, Ohio, South Carolina, North Carolina, New Mexico, Nebraska, New Jersey, Missouri, Georgia, Alabama, Indiana, Maryland, Massachusetts — all clustered within shouting distance of the national mean, with Massachusetts ($234,769–$269,615) sitting on the lower edge.

Underperformers:

• Oklahoma ($170,000–$180,000) — the lowest disclosed compensation in the country.
• New Hampshire ($175,000–$200,000) — second-lowest, with limited volume to explain it.
• Vermont ($206,500–$220,000) — small market, smaller paychecks.
• Maine ($233,333–$266,667) — closer to average but still trailing.
• New York ($229,435–$271,082) — below-average pay on 112 listings, which is the loudest misalignment in the dataset.

Volume leaders: California (198), New York (112), Florida (104), Texas (95), Connecticut (94). New York leads the nation in offering high volume at below-average pay (a recruiter problem we will return to).
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What This Means If You’re a Physician

If your priority is maximum compensation: the highest-paying listing in the country sits in Buffalo, NY, at $350,000 to $500,000. Pennsylvania, North Dakota, Delaware, and Wisconsin offer the strongest state-level averages. Louisiana’s ceiling ($417,857) deserves a second look if you are open to the Gulf South.

If your priority is maximum optionality: California (198 listings), New York (112), Florida (104), Texas (95), and Connecticut (94) give you the deepest benches. Pay is market-rate in most of them and frankly subpar in New York.

If your priority is balance: Texas and Illinois pair real volume with above-or-at-average pay. Pennsylvania offers premium compensation but thinner inventory. Oregon’s $325,000 average looks great until you price a house in Portland (the cost-of-living asterisk is doing real work there).

Scrutinize: New York’s volume-versus-pay gap, and any New Hampshire or Oklahoma listing that asks you to relocate for under $200,000.
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What This Means If You’re a Recruiter

Salary transparency rate: 469 of 1,559 listings = 30.1%. Roughly seven out of ten Internal Medicine postings still decline to disclose compensation, which is a candidate-acquisition problem dressed up as discretion.

The pipeline implication is direct: physicians screen on salary before they screen on anything else. Listings without numbers get skipped. In a market where Pennsylvania and North Dakota are publishing $315,000-plus averages, silence reads as weakness.

The volume-pay misalignments are concentrated in New York (112 listings, $229,435–$271,082), Massachusetts (83 listings, $234,769–$269,615), and Connecticut (94 listings, $258,580–$293,787). In these markets, recruiters will need to lead with something other than the number: academic affiliation, patient mix, schedule flexibility, loan forgiveness, or geography. The paycheck alone will not close the candidate.
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What’s Driving the Numbers

Scope and setting command a premium, not prestige. The top-paying states (Pennsylvania, North Dakota, Oregon, Delaware, Wisconsin) are not the brand-name medical markets. They are systems that need internists and are willing to pay to get them. The Buffalo listing — $500,000 in a secondary metro — proves the point. The premium is going to coverage, not to letterhead.

Part-time and specialized roles are distorting the floor. A $100,000 Internal Medicine listing is not a full-time hospitalist job. It is almost certainly a fractional, locum, or narrowly scoped position. The average range ($263,431–$301,591) is the more honest read of the full-time market; the floor is statistical noise dressed as a job.

Underserved markets are pricing in scarcity, with caveats. North Dakota, Wisconsin, Louisiana, and rural Pennsylvania pay above average because the supply of internists willing to live there is thin. The scarcity premium is real. The single-listing states (Delaware, Iowa, Wyoming, Kentucky) post big numbers because one generous employer can swing the entire state average.

The volume-pay relationship has broken. Conventional logic says big markets pay more. The data says the opposite: California and Florida pay average, New York pays below average, and the highest averages cluster in states with 25 or fewer listings. Demand in dense markets is being met by oversupply. Demand in thin markets is not.

The Bottom Line

Internal Medicine is the largest, most distributed, and most quietly stratified market in physician compensation. The middle is stable. The ceilings are climbing in places no one expected. The floors are being dragged down by part-time roles and high-supply urban markets that no longer need to compete on price. Physicians have leverage — but only if they are willing to read a map. Recruiters have a transparency problem — and only 30% of them seem to know it.

The money in Internal Medicine has stopped following the skyline and started following the shortage.
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Salary data based on 469 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.