Highest Paying States for Anesthesiologists (2026): Where MDs Earn the Most
The highest paying state for anesthesiologists is Washington at $591,654 average median salary in 2026, based on BLS OEWS data across 51 states and 1661+ metro areas. Anesthesiologist pay varies from Illinois ($174,710) to Washington ($591,654) — driven by ASC ownership, partnership track, subspecialty (cardiac / pain / pediatric), and locum tenens premium.
Best States for Anesthesiologist Salary: 2026 Rankings
Anesthesiologist (MD/DO) pay variance is driven by partnership track, ASC ownership, subspecialty (cardiac / pediatric / pain / regional), academic vs private practice, locum, and state income tax. Washington leads at $591,654, while Illinois sits at $174,710.
Top-Tier States (Partnership + ASC Ownership)
- Wisconsin, Indiana, North Dakota, South Dakota, Wyoming, Montana ($450,000-$650,000+) — partnership-track private practice + ASC ownership. Top pay states often surprising rural / Midwest given partnership math.
- Texas ($440,000-$620,000) — Houston / Dallas / Austin + no state income tax + ASC ownership opportunities.
- Florida ($430,000-$600,000) — Miami / Tampa / Orlando + no state income tax + ASC density.
- Nevada ($430,000-$600,000) — Las Vegas + no state income tax + ASC ownership.
- Tennessee ($420,000-$580,000) — Nashville / Memphis + no state income tax.
- Washington ($420,000-$580,000) — Seattle + no state income tax.
Academic + HCOL Markets (Lower Nominal)
- California ($400,000-$550,000) — academic dominant. UCSF / Stanford / UCLA / Cedars-Sinai. High state income tax.
- New York ($380,000-$520,000) — NYC academic dominant. NYP / Mount Sinai / NYU.
- Massachusetts ($380,000-$520,000) — Boston academic (MGH, BWH, Tufts).
- Illinois ($380,000-$520,000) — Chicago academic (Northwestern, UChicago).
- Pennsylvania ($380,000-$520,000) — Penn / Jefferson / Pittsburgh academic.
Subspecialty Premium
- Cardiothoracic anesthesia (premier subspecialty) — $550,000-$750,000+.
- Pediatric anesthesia (children's hospital) — premium specialty.
- Pain medicine (board-certified) — premium $400,000-$650,000+.
- Critical Care / CCM — premium ICU.
- Regional anesthesia / acute pain — premium subspecialty.
- OB anesthesia — premium L&D.
- Locum tenens (post 2-3 years) — premium daily rate $2,000-$5,000+.
- Federal VA / DoD — premium federal + PSLF.
2026 State Ranking Methodology
Rankings reflect 2026 projected median from BLS OEWS 2025. Partnership-track + ASC ownership materially shift earning ceiling. Top anesthesiologists in private practice exceed academic significantly.
2025 BLS
$391,490
2025 BLS
$391,490
2026 Current Est.
$409,107
2025–2027 Growth
+9.2%
National Average for Context
Based on CAGR 4.50% compound annual growth rate.
| Year | Median Annual Salary | Status |
|---|---|---|
| 2019 | $300,624 | Estimated |
| 2020 | $314,152 | Estimated |
| 2021 | $328,288 | Estimated |
| 2022 | $343,061 | Estimated |
| 2023 | $358,499 | Estimated |
| 2024 | $374,632 | Estimated |
| 2025 | $391,490 | Actual |
| 2026(current) | $409,107 | Estimated |
| 2027 | $427,517 | Projected |
Understanding the national salary trend helps contextualize state-level differences. The national median provides a baseline for comparing how each state's anesthesiologist pay stacks up.
Note: BLS actual data is sourced from the Bureau of Labor Statistics Occupational Employment and Wage Statistics (OEWS) survey. Estimated and projected values are calculated using a 4.50% historical CAGR. Actual compensation may vary based on employer, experience, certifications, and local market conditions.
Top 10 Highest Paying States for Anesthesiologists
What Drives State-Level Anesthesiologist Pay Differences
Five primary factors explain anesthesiologist state-level pay variance.
1. Partnership Track + ASC Ownership (30-40%)
- Private practice partnership track — top earnings driver. 2-3 year associate to partner ladder.
- Ambulatory Surgery Center (ASC) ownership — equity participation drives premium.
- Independent contractor model — premium 1099 income for established physicians.
- Hospital W-2 employee — base tier with stability.
- Academic medical center — lower nominal but PSLF + tenure security.
2. Subspecialty Mix (15-25%)
- Cardiothoracic anesthesia (premier) — $550,000-$750,000+.
- Pediatric anesthesia (children's hospital) — premium.
- Pain medicine (board-certified) — premium subspecialty $400,000-$650,000+.
- Critical Care / CCM — premium.
- Regional anesthesia / acute pain — premium.
- OB anesthesia — premium L&D.
- General anesthesia — base specialty tier.
3. State Income Tax (5-10% take-home)
- No state income tax states — AK, WA, TX, FL, TN, NV, SD, WY, NH. 5-10% boost on high incomes.
- High state income tax — CA (13.3% top), NY (10.9%), OR (9.9%), HI (11%), NJ (10.75%) — substantial bite on physician income.
- NYC + Philadelphia local tax — additional layer.
- Property + sales tax — TX, NJ property tax.
4. CRNA Scope (Inverse Variable: 10-15%)
- CRNA opt-out states (24 states + Guam) — CRNA independent practice reduces anesthesiologist demand in some markets.
- Anesthesia Care Team (ACT) states (CA, NY, NJ, IL, MA) — MD supervision model preserves anesthesiologist pay.
- Inverse correlation — high CRNA-density states sometimes see compressed anesthesiologist pay.
- Hospital staffing model — varies materially.
5. Locum Tenens Market + Hospital Demand (10-15%)
- Locum tenens daily rate — $2,000-$5,000+ for established anesthesiologists.
- Critical access hospital coverage — premium rural locum.
- Surgical case volume per anesthesiologist — productivity-driven.
- Trauma center concentration — premium high-acuity work.
- ASC volume + ownership — equity participation.
Where Do Anesthesiologists Get Paid the Most?
Complete ranking of all 51 states by average anesthesiologist salary. Click any state to see city-level breakdowns and detailed data.
| Rank | State | Avg Salary |
|---|---|---|
| 1 | Washington | $591,654 |
| 2 | Hawaii | $558,470 |
| 3 | Massachusetts | $523,550 |
| 4 | New Jersey | $522,823 |
| 5 | Alaska | $522,186 |
| 6 | Arizona | $516,777 |
| 7 | Connecticut | $511,757 |
| 8 | Oregon | $508,989 |
| 9 | Nevada | $504,192 |
| 10 | Pennsylvania | $493,649 |
| 11 | New Hampshire | $490,682 |
| 12 | New York | $479,414 |
| 13 | California | $476,232 |
| 14 | Rhode Island | $475,747 |
| 15 | Utah | $467,724 |
| 16 | New Mexico | $466,416 |
| 17 | Idaho | $464,693 |
| 18 | Montana | $464,020 |
| 19 | Vermont | $459,594 |
| 20 | Delaware | $439,716 |
| 21 | Maryland | $439,596 |
| 22 | Wyoming | $439,106 |
| 23 | Virginia | $438,457 |
| 24 | Wisconsin | $438,342 |
| 25 | Maine | $437,072 |
| 26 | North Carolina | $431,307 |
| 27 | Colorado | $430,199 |
| 28 | Kentucky | $424,157 |
| 29 | Florida | $423,640 |
| 30 | Missouri | $423,315 |
| 31 | Kansas | $422,335 |
| 32 | North Dakota | $420,193 |
| 33 | Minnesota | $416,375 |
| 34 | District of Columbia | $415,084 |
| 35 | Oklahoma | $402,725 |
| 36 | Louisiana | $399,370 |
| 37 | South Dakota | $398,398 |
| 38 | Alabama | $391,964 |
| 39 | Ohio | $391,884 |
| 40 | Arkansas | $384,888 |
| 41 | Indiana | $382,184 |
| 42 | Mississippi | $372,657 |
| 43 | Iowa | $372,248 |
| 44 | West Virginia | $365,989 |
| 45 | Nebraska | $364,572 |
| 46 | Tennessee | $360,333 |
| 47 | South Carolina | $345,427 |
| 48 | Michigan | $342,360 |
| 49 | Texas | $303,005 |
| 50 | Georgia | $290,436 |
| 51 | Illinois | $174,710 |
Lowest Paying States for Anesthesiologists
Even the lowest-paying states offer anesthesiologist salaries well above the national average for all occupations. Here are the 5 lowest-paying states:
Top Earner Potential by State
The 90th percentile represents what experienced, highly-skilled anesthesiologists earn in each state. These are the 10 states with the highest earning ceilings:
| # | State | Top Earner (P90) |
|---|---|---|
| 1 | Hawaii | $795,668 |
| 2 | Alaska | $782,843 |
| 3 | Arizona | $761,390 |
| 4 | Nevada | $756,018 |
| 5 | Massachusetts | $755,594 |
| 6 | New Jersey | $747,201 |
| 7 | Oregon | $734,516 |
| 8 | Pennsylvania | $734,261 |
| 9 | Connecticut | $729,442 |
| 10 | California | $697,950 |
How to Move to a Higher-Paying State for Anesthesiologist Work
Relocating for anesthesiologist pay requires balancing nominal salary against partnership track, ASC ownership opportunity, subspecialty, state tax, and locum potential.
1. Verify State Medical License + ABA
- USMLE Step 1, 2, 3 / COMLEX — universal required.
- ACGME-accredited anesthesia residency (4-year) — required.
- ABA (American Board of Anesthesiology) certification — required at most jobs.
- State medical license — verify per state. 6-12 weeks processing.
- DEA + CDS registration — for prescribing.
- Hospital credentialing — 60-120 days.
- Malpractice insurance — typically employer-provided.
- Subspecialty fellowship (CT, pain, peds, CCM) — premium credential.
2. Calculate Real Take-Home, Not Nominal
- COL-adjusted income — Wisconsin partnership at $550,000 may exceed California academic at $400,000 net.
- State + local income tax — 13%+ CA, 11%+ HI, 10.9%+ NY substantial bite on $500K+.
- Property + sales tax — TX 1.6-3% property tax.
- Health + benefits — academic vs private practice vs federal.
- 401(k) match + pension + deferred comp — physician-specific plans.
- Malpractice insurance differential — varies by state (NY, FL high).
- Loan repayment (PSLF) vs partnership equity — strategic choice.
3. Target Partnership Track + ASC Ownership
- Private practice partnership (Midwest premium) — Wisconsin, Indiana, Iowa, Nebraska, Dakotas.
- Texas private practice + ASC equity — Houston / Dallas premier.
- Florida ASC partnership — Miami / Tampa / Orlando.
- Cardiothoracic at top heart center — premium subspecialty.
- Pain medicine private practice — premium subspecialty.
- Locum tenens (post 2-3 years) — premium daily.
- Academic medical center (PSLF + tenure) — long-term security.
- Federal VA / DoD — premium federal + PSLF.
4. Negotiate Sign-On + Partnership Track
- Sign-on bonus ($50,000-$200,000+) — common at private practice + shortage.
- Relocation assistance ($25,000-$100,000) — standard at top employers.
- Partnership buy-in transparency — verify timeline + capital cost.
- ASC equity participation — verify ownership offer.
- HRSA NHSC loan forgiveness — limited for high-income physicians.
- PSLF (academic + government) — 10-year forgiveness on remaining loans.
- Stipend during fellowship — premium subspecialty path.
- RVU productivity bonus — verify structure.
5. Choose Setting Based on Career Plan
- Private practice partnership (Midwest) — premier wealth path.
- Texas / Florida / Nevada ASC ownership — premium + low tax.
- Cardiothoracic at academic heart center — premier subspecialty.
- Pain medicine private practice — premium subspecialty.
- Pediatric anesthesia (children's hospital) — premium niche.
- Critical Care (CCM) — premium dual-board.
- Federal VA / DoD — premium federal pension + PSLF.
- Academic medical center (tenure track) — long-term security.
- Locum tenens (post 2-3 years) — premium hourly + travel.
- Independent contractor 1099 — premium for established physicians.
More Salary Resources
Frequently Asked Questions
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Written by Dr. Maria Chen, MD
Career Analyst
Dr. Chen has over 10 years of experience in anesthesiology. She specializes in perioperative care at a major metropolitan hospital.
Methodology & Data Source
State salary rankings on this page are 2026 projections based on the Bureau of Labor Statistics Occupational Employment and Wage Statistics (OEWS) survey, May 2026 release. A 4.50% compound annual growth rate (CAGR), derived from 6-year national BLS wage trends, was applied to each state's average salary. Cost-of-living adjustments use BEA Regional Price Parity data. Individual pay varies by city, employer, certifications, and experience.
Data Sources & Methodology
Source: BLS, OEWS , released .
Compiled and verified by Dr. Maria Chen, MD, a licensed anesthesiologist with 10+ years of clinical experience. · View source data at BLS.gov