Neurosurgery is one of the most challenging and rewarding careers in medicine. In the right markets, it also offers the highest paid neurosurgeon salary for dedicated professionals. Leading compensation benchmarks in 2024 show several states where base salaries topped $1 million for the first time ever.

However, geography remains the most critical determinant of income. As physicians consider relocation options or evaluate new offers, it is important to understand how geography, cost of living, and ownership model impact earnings.

Key Takeaways

The highest paid neurosurgeon salary surpassed $1 million per year in several states for the first time, led by South Carolina.
The median neurosurgeon compensation for all physicians was approximately $962,912, according to the latest MGMA benchmarks.
Physician-owned practices continue to pay higher salaries than hospital-employed neurosurgeons. Median 2023 compensation was $862,938 and $766,648, respectively, according to NERVES data.
States with the highest median neurosurgeon pay are found in the South and Midwest, including South Carolina, Virginia, Minnesota, Florida, and California.
Cost-of-living differences, state income tax policies, and hospital demand can significantly affect take-home pay despite similar salary figures.
Smart financial planning and contract negotiation are key to turning a top-line salary into long-term wealth.

Table of Contents

National Overview: How Much Do the Highest Paid Neurosurgeons Earn?

The most recent compensation report from MGMA shows a national median total annual neurosurgeon compensation of about $962,912. This number includes base salary, plus bonuses, call pay, and productivity incentives.

It is worth noting that other industry sources, including NERVES, track median compensation for both hospital-employed and physician-owned neurosurgeons. These groups earned median salaries of $766,648 and $862,938, respectively.

These numbers reinforce the fact that neurosurgery is the most lucrative major physician specialty, and top-line salaries can reach well into the seven figures.

States Offering the Highest Paid Neurosurgeon Salary

MGMA also compiles state-level data to show where neurosurgeon compensation is at the top of the scale. As of 2025, the following U.S. states offer the highest median compensation:

South Carolina – $1,439,660
Virginia – $1,178,753
Minnesota – $1,144,000
Florida – $1,127,357
California – $1,117,888

These states have strong patient demand, competitive hospital systems, and in some cases lower neurosurgeon density, creating ideal conditions for the highest paid neurosurgeon salary. South Carolina is now the undisputed leader, with the highest reported median salary.

Highest Paying Cities for Neurosurgeon Income

City-level data is less comprehensive than state data, but the trends are similar. Larger metropolitan areas with major academic centers, high-trauma volumes, and population growth are the most desirable for neurosurgeons chasing the highest salary. A few high-paying cities include:

Charleston, South Carolina: The home of leading academic medical centers and high demand for both cranial and spine procedures.
Minneapolis, Minnesota: Offers extensive hospital networks and case volumes.
Miami, Florida: A large patient base, no state income tax, and high salaries result in high real take-home pay.
Los Angeles, California: Top neurosurgical research and facilities combined with patient demand make it attractive despite a higher cost of living.

While neurosurgeons can earn the highest paid neurosurgeon salary in these locations, cost of living must be factored in. California, for example, has high housing and tax rates that may offset its base salaries, while Florida’s lack of state income tax boosts the actual take-home amount.

Factors Driving the Highest Paid Neurosurgeon Salary

Several factors are driving neurosurgeon salaries to all-time highs:

Limited Supply of Specialists: Neurosurgeons are relatively rare, and the aging U.S. population is driving demand for complex spinal and cranial surgery.
Procedure Complexity: High-risk and high-stakes operations such as tumor resections and aneurysm repairs justify premium pay.
Ownership and Profit Sharing: Physician-owned practices and partnerships can share profits, allowing top performers to reach over $1 million in total compensation.
Incentives, Bonuses, and Call Stipends: Signing bonuses, call stipends, and productivity-based RVU bonuses can add hundreds of thousands of dollars in total annual compensation.
Geographic Incentives: Rural and underserved areas often offer higher base pay and loan repayment incentives to attract specialists.

Balancing Salary with Cost of Living

The highest paid neurosurgeon salary does not translate directly into take-home pay. Neurosurgeons earning $1.1 million in San Francisco may have less disposable income than a peer in a lower-cost area such as Birmingham, Alabama. Some key take-home factors include:

State Income Taxes: Florida, Texas, and several other states have no state income tax, providing a bigger net paycheck.
Housing and Insurance Costs: Urban areas with expensive housing and higher insurance rates can reduce real take-home pay.
Malpractice Insurance: While neurosurgeons typically pay the highest malpractice insurance premiums in any state, these can vary widely by region.

Long-Term Career Value of Geographic Decisions

Geographic decisions should not be made in the short term. Practicing in one of the states with the highest paid neurosurgeon salary can dramatically accelerate student-loan repayment, increase retirement contributions, and improve leverage in future contract negotiations.

Additional value comes from federal or state loan repayment assistance that hospitals in underserved areas can provide.

Strategies to Maximize Neurosurgeon Earnings

Physicians often focus on states or cities with the highest paid neurosurgeon salary. However, there are several strategies to increase lifetime earnings:

Negotiating Contracts: Ensure your offer meets or exceeds industry benchmarks using MGMA data as a baseline.
Evaluating Ownership Opportunities: Joining a new or existing physician-owned practice can significantly increase your long-term take-home pay.
Optimizing Taxes: Work with a financial advisor to build a tax-efficient retirement account strategy and understand practice deductions.
Continuing Subspecialty Training: Subspecialties such as complex spine, peripheral nerve, or endovascular surgery can command additional salary premiums.

At Physicians Thrive, we are committed to helping neurosurgeons evaluate the full value of their earnings through contract review, insurance planning, and long-term wealth building. We want to help physicians realize the true value of their career choices, not just their salary alone.

Whether it’s negotiating a new contract in a high-paying city or considering a relocation to one of the states with the highest median neurosurgeon pay, our team of independent experts can provide objective guidance. Contact us to see how we can help.