Opening
The single most interesting signal this month is how often the highest pay lives off-map: seven-figure and near-seven-figure offers are concentrated in small or non‑obvious markets, not coastal prestige hubs. From a $1,000,000 flat Gastroenterology posting in Virginia and Idaho to a $900,000 Urology base in Iowa, the money is where scarcity collides with willingness to pay—often in places recruiters expect candidates to skip.
Across 37 specialty snapshots, two cross-cutting truths dominate: compensation remains highly bifurcated (wide ceilings driven by ownership/partnership/locum models vs. compressed employed bands), and disclosure is inconsistent enough to be a material market force. Employers that publish numbers are winning candidate attention; those that dont are asking physicians to negotiate blind.
Primary Care & General
Primary care is the market of ubiquity and geographic arbitrage. The family medicine market (Family Medicine) shows a practical cluster around $200k00k with an average band of $257,78128,281, while the broader internal medicine market (Internal Medicine) centers around $260,91529,211. The specialty-trained hybrids—Med‑Peds—cluster tighter ($242,56783,447) and have a narrower market identity: modest mid-six figures are available, but volume leaders (California, New York, Florida) often pay below what the cost of living justifies.
Hospital medicine (Hospitalist) and urgent care (Urgent Care) show the same dynamic at different scales. Hospitalists cluster ~ $321k56k nationally, but outliers—Corning, NY at $600k—prove that small‑market premiums exist. Urgent care averages sit in the high $200ks, with Western outliers (Sunnyvale CA near $395k) lifting the ceiling. Geriatrics (Geriatrics) and primary‑care‑physician postings (Primary Care Physician) remain mid‑range ($230k275k; $265k06k respectively) and suffer from near‑universal non‑disclosure outside a few Sun Belt premiums.
Pressure points: (1) coastal metros are high-volume but often pay at or below the national average; (2) rural and mid‑market employers pay meaningful premiums when they choose to—so mobility still buys dollars.
Medical Specialties
The medical bucket shows the largest structural split between employed/cognitive roles and procedural/ownership upside. Look at extremes: Gastroenterology reports $200k,000k with a practical employed band around $450k50k but seven‑figure partnership/owner models at the top. Dermatology posts a similar bifurcation: median-ish floors north of $400k, ceilings up to $850k once cosmetic/ownership elements appear.
High‑ceiling proceduralists: Anesthesia (practical full‑time cluster $400k60k, locum hourly annualized above $700k), Radiology (avg $545k20k; locum bands exceed staff), and parts of Cardiology (national average $476,96049,387 but Prosser, WA tops at $835k). Cognitive specialty ceilings are lower and narrower: Psychiatry clusters ~$303k47k, Infectious Disease sits tightly at $238k59.5k, and Rheumatology averages ~$291k26.8k.
Big movers and outliers: Interventional cardiology (Interventional) and procedural GI show radical upside when partnership/ownership or rural staffing premiums are in play (IC ceilings near $990k; GI one‑off $1,000k listings). Conversely, specialties like Nephrology are nearly unreadable: only three disclosed salaries across 49 listings, so the market feels opaque rather than extreme on paper.
Procedural vs cognitive: procedural specialties deliver both higher ceilings and more intra‑state variance—ownership/ancillary revenue is the differentiator, not board certification.
Surgical Specialties
Surgery, broadly, still sits at the top of the comp ladder, but it’s uneven. Orthopedics averages $579k51k with state outliers up to $975k. Neurosurgery reports average bands in the $750k+s but only six disclosed listings; its floor ($250k) is almost certainly academic/part‑time noise. Urology throws a striking outlier: Iowa at $900k. Where it surprises is coastal underperformance—General Surgery and OB/GYN include high ceilings, but New York and California often sit at or near the average rather than the top.
Summary: surgical pay remains excellent, but top dollar increasingly shows up in non‑metro markets that must staff operative services—again, scarcity + willingness to pay.
Advanced Practice Providers
NPs (Nurse Practitioner) and PAs (Physician Assistant) are their own labor markets. NPs: 1,808 listings, disclosed range $65k,250k, average $142,36083,626; PAs: 1,211 listings, $78k00k, average $150,69490,553. The ceilings are specialty‑specific (dermatology/cosmetic NP roles and high‑intensity locum PA gigs push the upper tail), but medians are mid‑six figures for PAs/NPs in specialty/advanced‑scope roles and roughly $120k10k for primary‑care/APRN posts. Note: NP disclosure is higher (~43.2%) than many physician specialties, which is helping recruiters convert candidates faster.
Cross‑Cutting Observations
1) Geography trumps prestige. Repeatedly, mid‑America or small‑market employers (Iowa urology $900k; Sterling, IL interventional cardiology $990k; Normal, IL radiology $850k) outpay coastal metros. The implication is simple: willingness to pay for coverage beats brand recognition when staffing risk is acute.
2) Ownership/partnership and locum models create extreme ceilings. When a specialty has ancillary revenue (GI, Derm, Cardiac intervention) or a robust locum market (Anesthesia, Radiology), the tail explodes. Employers offering partnership or equity materially change lifetime earnings; those offers are the difference between a comfortable career and generational wealth.
3) Disclosure is a competitive weapon—and most employers are not using it. Several specialties report single‑digit disclosure rates (Emergency Medicine 5.3%, Radiology 7.5%, Neurosurgery ~9%, Nephrology 6.1%). Where numbers are published, listings cut through inbox noise. Silence functions as a filter that disproportionately screens out candidates with options.
4) Volume ≠ pay. High listing counts (NY/CA in many specialties, or Texas/FL in several markets) do not reliably correlate with better compensation. Often the opposite: volume markets compress pay; low‑volume markets that choose to compete post premium offers.
5) Part‑time/locum postings distort floors—treat the extremes with care. Multiple specialties show sub‑market floors driven by part‑time or fellowship‑adjacent roles (e.g., Gastro $200k part‑time, Pulmonology $175k part‑time). For full‑time comp benchmarking, focus on the middle bands reported per specialty.
Watch next month for two leading indicators: whether high‑volume Sun Belt markets begin publishing salaries (that will shift pipelines immediately), and whether locum and partnership offers keep inflating the procedural ceilings or stabilize as hiring normalizes. If silence on pay persists in high‑listing states, expect continued geographic arbitrage as physicians vote with relocation.
