Doctor take-home pay in the US after tax, 2026
Nowhere pays doctors more in headline terms than the United States, yet the gross number conceals two large swings: the state you practise in, and an Additional Medicare Tax that arrives far earlier than most physicians assume. Set out below is what each stage of a medical career keeps once federal deductions are done.
Net pay at each stage of a medical career, 2026
Deductions here cover federal income tax on the standard deduction, Social Security at 6.2% up to the $176,100 wage base, and Medicare at 1.45% with the Additional Medicare Tax layered on above $200,000. State income tax is left out, and the section below explains why that omission matters so much at these salaries.
| Career Stage | Gross Salary | Monthly Net (federal only) | Effective Rate |
|---|---|---|---|
| Resident, PGY-1 | $65,000 | $4,522/mo | 16.5% |
| Resident, PGY-7 (Chief) | $77,000 | $5,226/mo | 18.6% |
| Family Medicine (attending) | $255,000 | $15,521/mo | 27.0% |
| Internal Medicine / Hospitalist | $280,000 | $16,854/mo | 27.8% |
| General Surgeon | $402,000 | $23,224/mo | 30.7% |
| Orthopedic Surgeon | $558,000 | $31,368/mo | 32.5% |
Source: Medscape Physician Compensation Report, AAMC resident stipend survey 2026. Excludes call pay, productivity bonuses (RVU-based comp adds substantially for surgical specialties), and state income tax.
The Additional Medicare Tax nobody warns you about
Beyond the usual 1.45% Medicare charge sits a further 0.9% Additional Medicare Tax on wages past $200,000 for a single filer. Payroll only starts withholding it once your cumulative pay crosses that line, so for most physicians it appears without warning somewhere around the middle of the year.
- Below $200,000: Medicare is a flat 1.45%, no surprises
- Above $200,000: every additional dollar of wages carries 2.35% combined Medicare withholding (1.45% + 0.9%)
- A hospitalist on $280,000 pays an extra $720/year in Additional Medicare Tax alone versus what a simple 1.45% estimate would suggest
- An orthopedic surgeon on $558,000 pays $3,222/year in Additional Medicare Tax - small next to the income tax bill, but a real, permanent line item once you clear attending-level pay
Medicare has no wage-base ceiling in the way Social Security does, so it applies to every dollar earned and the extra 0.9% neither phases out nor caps. Anyone holding two W-2 positions, locums work alongside a hospital job for instance, can also end up under-withheld when neither employer sees the combined income pass $200,000, which is worth checking before filing.
Texas against California, where the real money is decided
Specialty matters less to a physician's net pay than the address on the contract. Nine states, Texas and Florida among them, charge no income tax whatsoever. California climbs to a top marginal rate of 13.3% on income beyond roughly $1M, and is already past 10.3% well before that point.
- An orthopedic surgeon on $558,000 in Texas keeps the full $31,368/month federal-only figure above
- The same surgeon in California loses an additional 10-11% of gross to state tax - roughly $4,700-$5,100/month less, even before accounting for California's higher cost of living
- Family medicine physicians on $255,000 see a smaller absolute gap (~$2,000-$2,200/month) but it's still one of the largest single variables in their take-home
That is exactly why recruiters in Texas, Florida, Tennessee and Washington can honestly advertise net pay matching or beating nominally larger California salaries, and why a great many American doctors weigh state tax as heavily as specialty when choosing where to practise.
Malpractice cover, the cost no salary survey reports
Hospitals generally pay the professional liability premiums for physicians on staff, though not in every case, and the sums swing wildly between specialties and states:
- Family medicine / internal medicine: roughly $8,000-$15,000/year in most states
- General surgery: roughly $30,000-$50,000/year
- Neurosurgery / OB-GYN in high-litigation states (New York, Florida, Illinois): can exceed $100,000-$200,000/year
In private practice, or on a 1099 as an independent contractor, physicians pay this themselves, which makes it a genuine reduction in income that no salary table records. It is one reason surgeons in litigation-heavy states often prefer hospital employment to private practice even on a smaller headline figure.
How US physicians spread across the pay range
| Percentile | Gross Annual | Monthly Net (federal only) |
|---|---|---|
| P25 (residents) | ~$65,000-$77,000 | ~$4,520-$5,230/mo |
| P50 Median (primary care attending) | ~$255,000-$280,000 | ~$15,500-$16,850/mo |
| P75 (surgical specialties) | ~$400,000 | ~$23,200/mo |
| P90 (top surgical subspecialties) | ~$558,000+ | ~$31,400+/mo |
State tax is excluded throughout. Owners of private practices, and anyone earning substantial RVU-based productivity bonuses, will run well past these numbers. Source: Medscape Physician Compensation Report, 2026.
Frequently asked questions
A PGY-1 resident on $65,000 keeps around $4,522 a month on federal taxes alone. A family medicine attending on $255,000 keeps about $15,521, and a general surgeon on $402,000 roughly $23,224. None of this counts state income tax, which runs from nothing in Texas and Florida to over 13% in California and is usually the largest single variable in what actually arrives.
It does, noticeably. An Additional Medicare Tax of 0.9% applies to wages over $200,000 on top of the standard 1.45%, and almost every attending crosses that line. An orthopedic surgeon on $558,000 pays $3,222 a year purely because of the surtax, which never caps and takes its share of every dollar above the threshold.
Enormously. Texas, Florida and seven other states charge no income tax at all while California tops out at 13.3%. A surgeon on $558,000 keeps $4,700 to $5,100 more a month by practising in a no-tax state instead of California, before anyone looks at living costs. Plenty of physicians weigh state tax as heavily as base salary when comparing offers.
At the top end it is hard to argue with, since few careers deliver a surgeon's $23,000 to $31,000 a month. Getting there is long and costly: median medical school debt runs $200,000 to $250,000, residency pays $65,000 to $77,000 for three to seven years, and malpractice cover, board certification and continuing education keep costing money afterward. The case is strongest for anyone who reaches a well-paid specialty and practises in a low-tax state. Primary care physicians in high-tax states end up with a considerably thinner premium over other graduate professions.