Neurosurgeons are by no means typical physicians. On the pay scale, they are at the very top. But the numbers get a lot more granular when you consider where a surgeon works and what type of compensation structure they are under. The average neurosurgeon salary differs by hundreds of thousands of dollars depending on whether the surgeon works in a private practice or a hospital-employed position.
For physicians at the point of negotiating their first or future contracts, understanding what drives differences in the average neurosurgeon salary can lead to better long-term compensation.
Key Takeaways
- The national average neurosurgeon salary is $788,000.
- Private practice neurosurgeons tend to make more than hospital-employed neurosurgeons, due to ownership profits and productivity-based pay.
- Hospital-employed neurosurgeons have more predictable compensation, with typically higher benefits but a salary cap.
- Neurosurgeon compensation can vary by region: those in the Western U.S. reported a median income of $959,235, while neurosurgeons in the South had an average income of $655,220.
- Bonuses and other incentives are still prevalent among the top earning specialties, with neurosurgeons at the top.
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National Average Neurosurgeon Salary
According to the 2024 Physician Compensation Report by Physicians Thrive, the average neurosurgeon salary ranks highest among all medical specialties, with a median annual income of $788,000.This number is the sum of a base salary, productivity incentives, and bonuses.
Regional variation plays a key factor in compensation. The same report noted that median neurosurgeon pay was nearly $959,000 in the West, about $900,000 in the Midwest, $812,000 in the South, and approximately $731,000 in the East. The cause of these large gaps stems from supply and demand and includes local provider shortages, regional payer mixes, and different reimbursement rates from commercial, Medicaid, and Medicare patients.
Outside of the U.S., neurosurgery is not as financially lucrative. For example, the average neurosurgeon in Canada can expect to make the equivalent of $350,000–$400,000 USD per year. The U.S. will continue to be the top choice for compensation.
Private Practice: Highest Average Neurosurgeon Salary
A physician-owned or independent practice can often bring in the highest average neurosurgeon salary. This is typically true of any specialty. A report by NERVES, a neurosurgery practice management service, found that neurosurgeons in physician-owned practices earned a median of $862,938 in 2023. Neurosurgeons employed by a hospital earned a median of $766,648.
Income drivers in private practice include:
- Productivity-Based Models: As noted, compensation is usually tied to RVUs or net collections. This drives high surgical volume.
- Ownership Equity: In multi-owner practices, partners are entitled to a share of the profits on imaging centers, ASCs, and any other revenue-generating components of the practice.
- Negotiation Flexibility: Independent groups are free to negotiate directly with payers, hospitals, and ancillary providers, customizing contract terms to drive volume.
These advantages do come at a cost, however. Private practitioners are responsible for overhead expenses, staff management, and the highest malpractice insurance premiums in medicine. Shifts in the payer mix or economic downturns can result in income volatility.
Hospital Employment: Stability and Benefits
In contrast, hospital-employed neurosurgeons typically earn a lower average neurosurgeon salary but benefit from predictable paychecks and comprehensive benefits. Hospital contracts provide malpractice insurance and tail coverage, robust retirement and health benefits, and typically include guaranteed salaries and paid time off.
Other advantages include:
- Employer-paid malpractice insurance and tail coverage
- Robust retirement plans, health benefits, and paid leave
- Access to cutting-edge equipment, research opportunities, and teaching appointments
Hospital-based contracts are appealing for their security, but caps in compensation structure can be long-term detriments for income growth. Bonuses based on RVUs, collections, and quality metrics are unlikely to match the upside potential of private practice ownership.
Regional Differences and Demand
As with the general workforce, geography affects the average neurosurgeon salary. Western states including California, Nevada, Oregon, and Washington boast the highest median income, which was nearly $959,000. Southern states were the lowest in average compensation, with an average income of $655,220, which is partly due to payer mix and lower reimbursement.
The state-by-state data from the Medical Group Management Association (MGMA) show that the state-level median salary can often be much higher than the national average, especially in the Southeast. South Carolina’s median neurosurgeon compensation, for example, was over $1.4 million in 2025.
Neurosurgeons and other physicians with in-demand sub-specialties can also demand premium salaries and signing bonuses by working in shortage areas.
Incentives and Bonuses
Incentive pay is still used widely. Across all specialties, 59% of physicians reported receiving an RVU-based bonus in 2023, with neurosurgeons having a high incidence. Signing bonuses for physicians in 2023 averaged $37,473, which was a 20% increase from the previous year, and are typical for physicians relocating for new roles. Relocation expenses are also a common bonus.
Outside of productivity bonuses and incentives, private practices may offer year-end profit sharing. Hospital-employed neurosurgeons and other physicians tend to receive bonuses tied to performance or quality metrics.
Workload and Lifestyle Considerations
No conversation about compensation can be complete without considering workload. Neurosurgery is among the most time-intensive specialties, requiring extended clinical hours, frequent call coverage, and substantial administrative workload beyond direct patient care. This workload contributes to burnout, which remains one of the highest in medicine.
Hospital-employed physicians may have more consistent schedules and administrative support, while private practice may allow for more flexibility at the cost of higher managerial responsibility.
Make the Most of the Average Neurosurgeon Salary
Whether to choose private practice or hospital employment is a decision that can only be made after serious consideration of personal goals and priorities. Physicians looking to maximize their total income and have control over the business side will typically prefer a private practice, while neurosurgeons who want a more predictable salary with teaching and research opportunities will lean towards hospital employment.
Both pathways can lead to the highest salaries in medicine. With the average neurosurgeon salary already at the top and demand projected to increase, proper planning and decision-making now can turn today’s compensation into long-term wealth.
At Physicians Thrive, we empower neurosurgeons and other physicians to maximize their earning potential, whether through contract review, insurance planning, or long-term wealth management. Contact us today.
