Neurosurgeon Salary 2026: Average US Pay, By State & Career Outlook
Neurosurgeons sit at the very top of the physician pay ladder in the United States. Doximity’s Physician Compensation Report 2026 puts average neurosurgery compensation at $829,161 a year — more than $75,000 above the next-ranked specialty — making brain and spine surgery the highest-paid medical specialty for yet another year. Depending on the survey, the source, and what exactly gets counted, a full-time neurosurgeon in the US earns somewhere between roughly $725,000 and $960,000, with the middle of the market near $830,000 to $900,000.
This guide breaks down what US neurosurgeons actually earn in 2026: the average pay, what changes it by state, how it climbs with experience, the gap between academic and private practice, what the training path looks like, and what the job outlook holds for the next decade.
Neurosurgeon Salary Snapshot (2026)
| Measure | Figure | Source |
|---|---|---|
| Average annual compensation | $829,161 | Doximity Physician Compensation Report 2026 |
| Median total compensation | $962,912 | MGMA (via Panacea Financial) |
| Median (self-reported) | $941,384 | Marit, May 2026 |
| Median base salary | $790,000 | Resolve 2026 contract data (AMA) |
| Typical range | $567,389 – $995,329 | Salary.com, Sept. 2026 |
| Practical planning range | $725,000 – $960,000 | Across major physician surveys |
A few things worth knowing before comparing these numbers. Doximity’s report is based on nearly 23,000 compensation surveys collected during 2025 from full-time US physicians working at least 40 hours a week. MGMA’s figure folds in base salary, productivity bonuses, call pay and incentives. Self-reported databases like Marit tend to skew high because higher earners benchmark themselves more often. And notably, Medscape’s widely cited 2026 report — which puts average physician pay at $386,000 — does not cover neurosurgery at all. Neurosurgeons also average about 63 hours a week, so the effective hourly rate is far lower than the annual number suggests.
Average Neurosurgeon Salary Per Year and Per Month
At Doximity’s $829,161 average, the rough monthly equivalent is about $69,100 before taxes — approximate, since compensation surveys report annual figures and bonuses often land separately. At the MGMA median of $962,912, it works out to roughly $80,240 a month.
For perspective, the average neurosurgeon earns about double the typical US physician (Medscape’s $386,000). The Bureau of Labor Statistics reported an average of $371,280 for all surgeons in 2024 — but that figure lumps surgeons together and excludes pediatric and orthopedic surgeons, so it isn’t a neurosurgery number. The real gap is wider than the government average suggests.
Neurosurgeon Salary by State
State-level numbers deserve a caveat: neurosurgeons make up only about 0.6% of active US physicians, so a state average can swing on a handful of respondents. Treat these as directional rather than gospel. The regional pattern from MGMA data, though, is consistent:
| Region | Median total compensation (MGMA) |
|---|---|
| Midwest | $1,017,089 |
| Western | $979,223 |
| Southern | $950,551 |
| Eastern | $911,250 |
Highest-paying states per MGMA data:
| Rank | State | Median total compensation |
|---|---|---|
| 1 | South Carolina | $1,439,660 |
| 2 | Virginia | $1,178,753 |
| 3 | Minnesota | $1,144,000 |
| 4 | Florida | $1,127,357 |
| 5 | California | $1,117,888 |
What actually drives the differences is less about geography itself and more about market dynamics. Hospitals in rural or underserved states often raise base pay, signing bonuses and loan-repayment offers to compete with big-city lifestyle appeal. Markets that depend on a handful of neurosurgeons for trauma call tend to pay more for that coverage. And a $1.1 million offer in a high-cost metro may buy less than $900,000 somewhere with lower taxes and housing costs — cost-of-living adjustment matters more than headlines.
Neurosurgeon Salary by Experience
Neurosurgeons don’t really have a “low” starting salary once training ends — the paycheck jumps dramatically the moment residency is over. But the growth curve after that is gentler than in most specialties:
| Experience (attending) | Average annual compensation |
|---|---|
| 0–2 years | ~$799,000 |
| 3–5 years | ~$830,000 |
| 6–10 years | ~$890,000 |
| 11+ years | ~$951,500 |
(Figures from Marit’s self-reported data; representative of the trend across sources.)
That’s a rise of roughly 19% over a career — a modest slope compared with most professions. Much of the long-term growth comes from partnership stakes, referral networks and productivity rather than tenure alone. The real “catch” is the delayed start: most neurosurgeons enter independent practice between ages 33 and 36, earning trainee stipends of roughly $69,000 to $91,000 during the 12 to 13 years of post-college training that come first.
Academic vs Private Practice: Where the Pay Diverges
Practice setting often moves pay more than geography does:
| Setting | Compensation |
|---|---|
| Physician-owned private practice | ~$1,092,667 (MGMA) |
| Hospital or integrated-system employed | ~$962,492 (MGMA) |
| Academic | ~$647,000 (one compilation) vs ~$786,000 in hospital settings |
Private practice pays the most but brings business risk, overhead and partnership hurdles. Hospital employment trades some income for stability and less administrative burden. Academic medicine sits lowest on raw pay, though Public Service Loan Forgiveness can offset part of the gap for surgeons carrying federal student debt. Subspecialty matters too: spine and endovascular surgeons tend to earn the most, while pediatric and functional neurosurgeons typically earn less — though a 2020 peer-reviewed study found the gap tracked case volume (work RVUs) more than the subspecialty label itself.
Factors That Affect a Neurosurgeon’s Salary
Beyond location and setting, several levers move the needle:
- Subspecialty and case mix. High-volume spine surgeons, especially in practices that own surgery centers, can exceed $2 million; cerebrovascular comes next, with neuro-oncology, functional and pediatric progressively lower.
- Productivity (work RVUs). Many contracts tie bonuses to RVU output — neurosurgeons generate some of the highest work RVUs across all specialties.
- Call burden. Covering trauma call at a Level I center is one of the most common ways neurosurgeons raise income — and one of the biggest lifestyle costs.
- Ownership income. Stakes in a practice or ambulatory surgery center can add substantially to total compensation.
- Sign-on and relocation bonuses. Signing bonuses now appear in 87% of physician search engagements, with the average starting physician salary reaching $419,000 per AMN Healthcare.
- Malpractice and tail coverage. Negotiate this carefully — it has real dollar value when you change jobs.
How to Become a Neurosurgeon: Education and Training Path
The path to neurosurgery is one of the longest in all of medicine:
- Bachelor’s degree (4 years) — usually with a pre-med focus.
- Medical school (4 years) — MD or DO degree.
- Neurosurgery residency (7 years) — the longest residency of any specialty.
- Fellowship (1–2 years, typical) — optional but common; subspecialties include spine, pediatric, vascular/endovascular, neuro-oncology and functional neurosurgery.
- Board certification — through the American Board of Neurological Surgery.
That’s 12 to 13 years after college before independent practice, plus ongoing CME throughout the career. If you’re weighing healthcare careers with shorter training paths, it’s worth comparing — for example, see our breakdown of Phlebotomist Salary 2026: US Pay, Hourly Rates & Jobs to see how compensation stacks up for an entry-level clinical career.
Career Outlook for Neurosurgeons
The Bureau of Labor Statistics doesn’t publish a neurosurgeon-specific projection — it groups the specialty under “surgeons.” The BLS Occupational Outlook Handbook projects employment of surgeons to grow 4% from 2025 to 2035 (from 54,000 to 56,200 jobs), about as fast as the average for all occupations. Across all physicians and surgeons, about 22,100 openings are projected each year over the decade, mostly from retirements and career changes.
What keeps demand strong is demographics: an aging US population is driving steady growth in degenerative spine disease, aneurysms and neuro-oncologic conditions. Physician-supply projections have consistently pointed to shortages, and compensation has grown nearly 50% over the last decade as demand rebounded after the pandemic. Barring major reimbursement upheaval, neurosurgery should remain among the most secure and best-paid specialties in medicine through 2030 and beyond.
Frequently Asked Questions
How much does a neurosurgeon make in 2026?
Doximity’s 2026 report puts the average at $829,161. Other major sources range from about $725,000 (Salary.com) to a median of $962,912 (MGMA), depending on methodology.
Is neurosurgery the highest-paid specialty?
Yes — Doximity ranks neurosurgery first among all physician specialties in 2026, more than $75,000 ahead of the second-ranked thoracic surgery at $749,707.
Which state pays neurosurgeons the most?
MGMA data lists South Carolina first at $1,439,660, followed by Virginia, Minnesota, Florida and California. Small survey samples mean these rankings can shift year to year.
How long does it take to become a neurosurgeon?
About 12 to 13 years after college: four years of medical school, seven years of residency, and usually one to two years of fellowship. Most enter practice between ages 33 and 36.
Do neurosurgeons earn more in private practice or hospitals?
Private practice. MGMA data shows roughly $1,092,667 in physician-owned practices versus about $962,492 for hospital-employed neurosurgeons and roughly $647,000 in academic settings.
What is the lowest a neurosurgeon can earn?
Entry-level attending neurosurgeons average around $799,000, though self-reported ranges bottom out near $567,000 (Salary.com). During residency, trainees earn only $69,000 to $91,000 a year.
Is the gender pay gap a factor in neurosurgery pay?
Medscape’s 2026 data shows a persistent gap across medicine — among all physicians, 22% of men report a net worth of $5 million or more compared with 14% of women, and women are more likely to fall at the bottom of the scale. Neurosurgery-specific gender pay data isn’t published by the major surveys, so the specialty-level gap isn’t precisely measured.
Conclusion
Neurosurgery pays the most of any US physician specialty in 2026 — a realistic planning range is $725,000 to $960,000 a year, with the market center near $830,000 to $900,000. But the headline number hides the tradeoffs: more than a decade of training, 60-plus-hour weeks, heavy call burdens and high malpractice exposure. Use national averages as a starting point, then price your own offer by setting, call burden, ownership potential and real hours worked. The number that matters is what you keep, per hour worked, over a long career.
Sources: Doximity Physician Compensation Report 2026 (via Becker’s ASC); MGMA data via Panacea Financial; Marit self-reported data, May 2026; Salary.com; SalaryDr; Resolve 2026 physician contract data via AMA; Medscape 2026 Physician Compensation Report; U.S. Bureau of Labor Statistics Occupational Outlook Handbook (physicians and surgeons, 2025–35 projections); Physicians Thrive; a 2020 peer-reviewed study of academic neurosurgeon salaries. Figures are estimates and change over time. This article is general information, not financial or career advice.
