Doctor salary in the US after tax — 2026

Take-home pay by career stage — 2026

Figures show federal income tax (standard deduction), Social Security (6.2% up to the $176,100 wage base) and Medicare (1.45%, plus the Additional Medicare Tax above $200,000). State income tax is not included — see below for why that matters enormously at physician income levels.

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 — a surtax most doctors don't see coming

On top of the standard 1.45% Medicare tax, a 0.9% Additional Medicare Tax applies to wages above $200,000 (single filer). It isn't withheld until your employer processes payroll above that line, which means it usually shows up mid-year without warning.

• 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

Unlike Social Security tax, there's no wage-base ceiling on Medicare — it applies to every dollar earned, and the additional 0.9% never phases out or caps. High earners with two W-2 jobs (locums plus a hospital job, for example) can also be under-withheld if neither employer sees the combined income crossing $200,000 — worth checking at tax time.

Texas vs California — the state tax gap that dwarfs almost everything else

The single biggest lever on a US physician's real take-home isn't specialty choice — it's geography. Nine states, including Texas and Florida, levy no state income tax at all. California's top marginal rate reaches 13.3% (on income above roughly $1M, with a substantial bracket already at 10.3%+ well below that).

• 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

This is why physician recruiters in no-tax states (Texas, Florida, Tennessee, Washington) can credibly advertise take-home pay that rivals or beats nominally higher California salaries — and why many US doctors treat state tax as seriously as specialty choice when deciding where to practice.

Malpractice insurance — the cost line that isn't in any salary survey

Malpractice (professional liability) insurance premiums are usually covered by the employer for hospital-employed physicians, but not always — and they vary enormously by specialty and state:

• 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

Physicians in private practice or those who are 1099 independent contractors typically pay this directly, making it a real deduction against gross income that a simple salary table can't capture. It's one reason many surgeons in high-litigation states prefer hospital employment over private practice, even at a lower headline income.

Salary distribution — where US physicians sit

Excludes state tax. Private practice owners and those with significant RVU-based productivity bonuses can substantially exceed these figures. Source: Medscape Physician Compensation Report 2026.