Anesthesiologist Salary by State (2026): Physician Pay Compared Across All 50 States

Anesthesiologist salary by state varies more than for almost any other physician specialty in the United States — primarily because state CRNA opt-out rules, surgical case volume, and private-practice density shape regional anesthesia compensation in ways that don't show up for most other physician specialties. The national median for Anesthesiologists sits at $409,107, but state-by-state pay across the 51 states tracked here ranges widely — from $174,710 in Illinois to $591,654 in Washington. That spread reflects state-level cost of living, state CRNA opt-out status under CMS 42 CFR §482.52, the regional balance between private-practice and employed anesthesia, ASC density, and state physician licensure compact participation.

This page compares the average anesthesiologist salary by state across 1661+ metropolitan and non-metropolitan areas — drawing on the Bureau of Labor Statistics Occupational Employment and Wage Statistics (OEWS) survey for SOC 29-1211. If you're a working anesthesiologist evaluating relocation, a resident or fellow planning your first attending job, or a hospital or anesthesia group recruiter benchmarking pay, the state-level comparison below is the central reference point.

How Anesthesiologist Salary by State Is Measured

The BLS reports state-level anesthesiologist salary through three numbers — with important caveats for physician compensation data:

• Annual median (50th percentile) — used to rank state-level pay in the table below. BLS OEWS reports W2 wages and doesn't fully capture private-practice partner distributions or 1099 locum tenens income, so reported anesthesiologist medians can understate real take-home compensation in private-practice-dense markets.
• Annual mean (average) — typically runs 5–12% above median in most states; states with dense independent private-practice anesthesia (Texas, Florida, Tennessee, Indiana, Ohio, Georgia) show wider mean-median spreads because partner-track and locum income at top of distribution pulls averages up.
• Percentile distribution (P10 / P25 / P75 / P90) — P10 reflects new attending anesthesiologists in academic positions or employed staff at large hospital systems; P90 reflects senior private-practice partners, cardiac and interventional pain specialists, and locum tenens anesthesiologists in opt-out critical-access markets.

The state-comparison table below applies BEA Regional Price Parity (RPP) adjustment so both nominal pay and real purchasing power are visible. Note that for physician compensation, MGMA (Medical Group Management Association) and other professional survey data often report higher anesthesiologist compensation than BLS OEWS because MGMA captures partnership distributions and 1099 income that BLS doesn't.

1. State CRNA Opt-Out Rules — A Major Anesthesiologist Pay Driver

The single largest state-level non-cost-of-living driver of anesthesiologist pay is state CRNA supervision status. Under CMS 42 CFR §482.52, states can "opt out" of physician supervision requirements for CRNA anesthesia care for Medicare billing purposes. The opt-out status materially shapes state-level anesthesiologist compensation:

• Opt-out states — Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, Montana, South Dakota, Wisconsin, California, Colorado, Kentucky, and others. In opt-out states, CRNAs can independently bill Medicare without physician supervision. The opt-out structure has two effects on anesthesiologist pay: (1) employed anesthesiologists at critical-access hospitals in opt-out states often command sign-on bonuses and premium pay because hospitals must compete to attract physician anesthesia coverage; (2) private-practice anesthesia groups in opt-out states often build practices around CRNAs working under medical-direction agreements that change the economics.
• Supervision states — many states retain physician supervision requirements for CRNA Medicare billing. In supervision states, anesthesiologists in ACT (Anesthesia Care Team) model practices supervise CRNAs at 4:1 or 3:1 ratios, which sustains demand for physician anesthesiologists at hospital-affiliated practices.
• State-level anesthesia group structure — Texas, Florida, Tennessee, Georgia, Ohio, Indiana, and other states have dense independent private-practice anesthesia groups (US Anesthesia Partners, NAPA Anesthesia, Sheridan Healthcare, North American Partners in Anesthesia, EmCare anesthesia subsidiaries). Private-practice partner distributions in these states drive upper-percentile anesthesiologist pay above the BLS-reported median.

2. State Cost of Living: Nominal vs Real Pay

Cost of living drives nominal state-level anesthesiologist pay, though less than for lower-income healthcare occupations because anesthesiologist compensation is high enough that COL differences matter less in absolute purchasing-power terms. California, Hawaii, Connecticut, Massachusetts, New York, New Jersey, Washington, Alaska, Oregon consistently lead nominal pay rankings. After BEA RPP adjustment, the real-purchasing-power gap narrows. Texas, Florida, Tennessee, Indiana, Ohio, Georgia — no-state-income-tax states or low-cost states with strong independent private practice — deliver strong real-dollar take-home for partner-track anesthesiologists.

3. State Demand-Supply Dynamics for Anesthesiologists

State-level anesthesiologist pay reflects the demand-supply balance:

• Surgical case volume and ASC density — states with dense ambulatory surgery center concentration (Texas, Florida, Arizona, Tennessee, Indiana) have rapidly expanding outpatient anesthesia demand. ASC-focused anesthesia practices generate substantial private-practice partner income in these states.
• Critical-access hospital concentration — Kansas, Nebraska, Iowa, Minnesota, Texas, Montana, North Dakota, South Dakota have the highest critical-access hospital concentration. Sole-anesthesia-provider positions at CAHs in opt-out states routinely offer $50,000–$150,000 sign-on bonuses plus federal student-loan repayment.
• Academic medical center density — Massachusetts, Maryland, Pennsylvania, Texas, North Carolina, California concentrate Level-1 trauma centers and academic medical centers. Academic anesthesiologists earn 20–35% less than community private-practice peers but with stronger benefits, sabbatical eligibility, and academic appointments.
• State physician licensure compact participation — the Interstate Medical Licensure Compact (IMLC) participation accelerates multi-state licensure for anesthesiologists practicing locum tenens or telemedicine consult. Most states are IMLC members; non-member states (California, New York, Florida, others) have longer separate licensing timelines.
• State pain-management practice density — states with strong interventional pain practice density (Texas, Florida, California, Pennsylvania, Ohio) support upper-percentile pain-medicine-fellowship anesthesiologist pay through procedural revenue capture.

4. ABA Board Certification and Subspecialty Fellowship Distribution by State

Most practicing anesthesiologists hold American Board of Anesthesiology (ABA) board certification. ACGME-accredited 1-year fellowship subspecialty distribution by state shapes upper-percentile anesthesiologist pay:

• Cardiothoracic anesthesiology — concentrated at quaternary cardiac programs (Cleveland Clinic, Mayo, Mass General, Texas Heart Institute, NYU, Penn, UCSF, Cedars-Sinai, Methodist, Duke). States with multiple cardiac centers (Ohio, Texas, Massachusetts, Minnesota, California, New York, Pennsylvania) support upper-percentile cardiac anesthesia pay.
• Pediatric anesthesiology — concentrated at quaternary children's hospitals.
• Pain medicine — concentrated at procedural pain practices; supports upper-percentile pay through interventional procedure revenue.
• Critical care medicine / Obstetric anesthesia / Regional anesthesia / Acute pain medicine — fellowship subspecialties cluster in markets with corresponding demand.

How to Compare Anesthesiologist Salary by State Effectively

When comparing the average anesthesiologist salary by state, work through this checklist:

• Verify state CRNA opt-out status first — opt-out status shapes private-practice anesthesia economics and critical-access hospital sign-on packages.
• Compare nominal and real (cost-adjusted) pay together — a state with the highest nominal median can have lower real purchasing power if its cost of living is higher.
• Check state income tax — anesthesiologists in Texas, Florida, Tennessee, Nevada, Washington, Wyoming, South Dakota, Alaska, and New Hampshire keep substantially more of every dollar. State income tax savings can reach $40,000–$80,000 annually for top-percentile anesthesiologists.
• Compare percentile distribution, not just median — states with dense private-practice anesthesia (Texas, Florida, Tennessee, Indiana, Ohio, Georgia) have wide P75–P90 spreads because partner distributions pull upper percentiles up. BLS OEWS data may understate real partner income in these states.
• Factor in practice model — employed staff anesthesiologist pay clusters around state median; private-practice partner income reaches P90+; locum tenens income can exceed P90 with full utilization.
• Consider critical-access hospital opportunities — sole-anesthesia-provider CAH positions in opt-out states (Iowa, Nebraska, Kansas, Montana, North Dakota, South Dakota, Wisconsin) routinely offer $75,000–$150,000 sign-on plus federal loan repayment.

2026 State-Level Anesthesiologist Salary Outlook

Anesthesiologist pay has grown at a compound annual rate of 4.50% nationally over the past five years. States with sustained ASC and outpatient surgery growth (Texas, Florida, Arizona, Tennessee), opt-out states with critical-access coverage needs (Iowa, Nebraska, Kansas, Montana, North Dakota), and states with rapidly expanding interventional pain practice (Texas, Florida, California, Pennsylvania, Ohio) are seeing the fastest state-level pay growth through 2026. The BLS projects Anesthesiologists employment growth in line with overall surgical demand through 2033, keeping strong upward pressure on state-level wages, especially in opt-out states with limited physician anesthesia supply.

Browse the state-by-state comparison table below to see the $409,107-baseline state ranking, top 10 and bottom 10 states by projected median, regional groupings (Northeast / Midwest / South / West), and direct links to per-state pages for deeper city-level breakdown.