Fazlur Rahman
Two anesthesiologists can do the same fellowship, work the same hours, and sign contracts in the same week — and one walks away with an offer roughly three times the other. The difference is not the specialty. It is not the residency. It is the state on the offer letter, the scope-of-practice law in that state, and whether a CRNA opt-out has changed the local market. The 2026 numbers tell that story in a way the national mean wage hides.
This guide walks through what 1,326 self-reports on Marit Health, 166+ reports on SalaryDr, and the BLS May 2025 Occupational Employment and Wage Statistics release (published May 2026) actually show when you sort them by state, employer, and subspecialty. The takeaway is not a single national figure — it is a map of where the offers cluster, and what to ask before you sign.
The Geographic Gap That the Mean Wage Hides
BLS reports a national annual mean wage of $336,640 for anesthesiologists (BLS, May 2026) — but that number includes every hospital-employed, academic, and military role in the country. When physicians self-report on Marit Health, the median jumps to roughly $535K-$570K. When you sort the 1,326 Marit reports by state, the top of the list sits near $653K and the bottom near $283K — a $370K gap (Marit Health, June 2026) — and that spread is not random.
Three forces drive most of the spread:
- CRNA opt-out. States where CMS lets CRNAs practice without physician supervision (Iowa, Nebraska, Idaho, Minnesota, Wisconsin, and a growing list) tend to show anesthesiologist salaries $300K-$450K, because CRNAs absorb a large share of the case volume.
- Private practice partnership economics. Single-specialty groups and ASC ownership models pay on a revenue-share basis after overhead. Partners at USAP, NorthStar, and similar groups regularly clear $700K-$1.2M.
- Geography of demand. Rural and Plains-region markets have to outbid coastal metros to attract physicians, so self-reported Plains-region averages land near $595K even when the BLS metropolitan figure looks low.
The national mean is real, but for contract negotiation it is almost useless. The state-level picture is where the offer actually gets made.
Where Marit Health 1,326 Self-Reports Cluster
Sort the 2026 self-reports by total compensation and ten states own the top of the list. The report counts in the table below matter: a state with 200+ reports is statistically anchored, while a state with 11 reports is a thin signal that should be read as a directional.
| State | Average total comp | Reports | Top 10% |
|---|---|---|---|
| Oregon | $653,500 | 27 | $750K |
| Minnesota | $645,500 | 14 | $740K |
| South Carolina | $632,500 | 34 | $725K |
| New Jersey | $632,000 | 33 | $730K |
| Nevada | $617,500 | 12 | $700K |
| Wisconsin | $617,000 | 25 | $710K |
| Connecticut | $614,500 | 17 | $700K |
| Kansas | $610,500 | 11 | $695K |
| California | ~$580,000 | 200+ | $700K+ |
| Pennsylvania | ~$570,000 | 90+ | $680K |
| Michigan | ~$550,000 | 70+ | $650K |
Regionally, regions show: Plains region averages $595,500, West & Pacific Islands $591,000, Rocky Mountain $530,500. Geography moved these averages more than almost any other factor in 2026 (Marit Health, June 2026).
Why BLS and Marit Tell Two Different Stories
BLS OEWS pulls from employer payrolls. Marit pulls from physician self-reports. The methodologies measure different things and the gap between them is not an error — it is the spread between hospital-employee W-2 income and partner-track take-home.
The BLS May 2025 release (published May 2026) is the cleanest source for comparing apples to apples across states:
| State | Annual mean wage | Hourly mean wage | Hourly COL-adjusted |
|---|---|---|---|
| Washington | $508,520 | $244.48 | $214.27 |
| Minnesota | $449,130 | $215.93 | $228.26 |
| New Hampshire | $433,850 | $208.58 | $187.24 |
| Pennsylvania | $425,950 | $204.78 | $210.68 |
| Florida | $422,780 | $203.26 | $198.88 |
| Ohio | $422,500 | $203.13 | $215.41 |
| Connecticut | $416,580 | $200.28 | $177.71 |
| Wisconsin | $411,910 | $198.04 | $202.70 |
| Indiana | $389,030 | $187.04 | $205.54 |
| Virginia | $388,620 | $186.84 | $185.36 |
| Idaho | $385,470 | $185.32 | $185.51 |
| Alabama | $376,440 | $180.98 | $204.27 |
| Kansas | $375,020 | $180.30 | $203.04 |
| Maryland | $371,320 | $178.52 | $154.70 |
| Nebraska | $369,590 | $177.69 | $191.89 |
| Louisiana | $368,640 | $177.23 | $192.02 |
| New York | $349,940 | $168.24 | $134.48 |
| New Mexico | $325,930 | $156.70 | $167.24 |
| Tennessee | $323,070 | $155.32 | $172.00 |
| Kentucky | $310,560 | $149.31 | $161.42 |
| Vermont | $290,320 | $139.58 | $122.87 |
| South Carolina | $283,240 | $136.17 | $143.79 |
| Georgia | $276,840 | $133.10 | $143.89 |
| Texas | $276,470 | $132.92 | $144.32 |
The COL-adjusted column matters more than most physicians expect. Washington state has the highest hourly mean wage at $244.48 — but at Minnesota's cost-of-living index (94.6 vs Washington's 114.1), Minnesota's $215.93 buys more real purchasing power. The opposite end of the list is New York: $168.24 nominal becomes $134.48 after COL. Wages at or above $115/hour ($239,200/year) are suppressed by BLS, so the actual ceiling runs higher than the table shows (BLS OEWS, May 2026).
What Moves the Number the Most
Five variables explain most of the variation between a $310K offer in Kentucky and a $700K offer in Oregon. None of them are negotiable in the moment, but all five are knowable before you pick where to sign.
- CRNA supervision rules. Strict-supervision states (California, New Jersey, New York, Massachusetts) keep anesthesiologist demand and comp high. CRNA-opt-out states (Iowa, Nebraska, Minnesota, Wisconsin, Idaho) push anesthesiologist comp down by $100K-$200K per salary-band overlap.
- Specialty track. Cardiac and pediatric-cardiac anesthesia pay 25-50% premiums. Pain medicine with private-practice ownership can pay $500K-$900K, with $1M-$2M+ achievable when you own the ASC.
- Employer model. Hospital-employed (community) roles cluster $400K-$500K. Academic medical centers sit in the same range with more protected time. Single-specialty private practice partners clear $500K-$700K, with top 10% $850K-$1.2M and top 1% $1.5M-$2M+.
- Call burden and hours. A 1:4 call rotation with 45-50 hours/week is standard. 1:7 calls and ASC-only schedules push effective hourly comp higher for the same annual number.
- Geography and cost-of-living. The Plains-region and Pacific Northwest self-report averages run $590K+ because rural and lifestyle-fit markets have to bid up. Coastal metros rely more on equity, signing bonus, and partnership track.
Specialty Premiums That Lift the Ceiling
The subspecialty premium structure (SalaryDr, April 2026) is the variable most worth negotiating toward. The premium is paid on top of the geographic base, so the same fellowship in Oregon vs Vermont can swing a $400K outcome.
| Specialty | Median total comp | Premium over general |
|---|---|---|
| Cardiac anesthesiology | $600K-$800K | +25-40% |
| Pediatric cardiac anesthesia | $650K-$850K | +30-50% |
| Pain medicine (private practice) | $500K-$900K | +30-60% |
| Pediatric anesthesiology | $400K-$550K | −5 to +5% |
| Critical care medicine | $400K-$500K | 0% |
| Regional anesthesiology | $500K-$650K | +10-20% |
| OB anesthesiology | $500K-$600K | +10-15% |
| Neurosurgical anesthesiology | $550K-$700K | +15-25% |
| Trauma anesthesiology | $500K-$650K | +10-20% |
| Ambulatory/ASC anesthesiology | $400K-$500K | −20 to 0% |
Pain medicine with private practice ownership has the highest ceiling in the dataset — often $1M-$2M+ — because the practice itself pays the physician on top of professional services. The catch is the upfront capital: practice acquisition or ASC build-out typically runs $1M-$3M (SalaryDr, April 2026).
Who Pays the Most, and Why the List Is Not What You'd Expect
The employer map is less about hospital brand and more about the practice model and supervision economics. Top-paying employer types in 2026 (Becker's ASC 2026 + Marit Health):
- Single-specialty group practices: $500K-$700K+. US Anesthesia Partners (USAP), NorthStar Anesthesia, Sheridan Anesthesia, Somnia, Allied, El Camino, Premier Anesthesia. Revenue-share after overhead is the lever.
- Academic private practice hybrids: $450K-$600K. Faculty at major AMCs but with the private practice track layered in.
- Hospital-employed (academic medical centers): $400K-$500K total comp. NYU Langone, UCSF, Mass General Brigham, Stanford, Penn Medicine, Johns Hopkins, Cedars-Sinai, UPMC, Hospital for Special Surgery.
- Hospital-employed (community): $400K-$500K. HCA Healthcare, Tenet, Adventist, CommonSpirit, Ascension.
- ASC-employed (ambulatory): $400K-$500K. USPI, AmSurg, Surgical Care Affiliates, Surgery Partners.
- Government (VA, military): $300K-$400K. Lower base, but the loan forgiveness and benefits stack can change the comparison.
The CRNA Question (and Why It Matters for Your Offer Letter)
Anesthesiologist salary in 2026 is meaningfully shaped by what CRNAs are allowed to do in the same state. CRNA scope-of-practice laws split the country into two compensation tiers, and the difference translates to $100K-$200K on the same offer letter.
Provider comparison 2026:
- Anesthesiologist (MD/DO): $535K-$570K median. 12 years training (4 college + 4 med school + 4 residency) plus optional 1-year fellowship.
- CRNA (Certified Registered Nurse Anesthetist): $200K-$260K median. 7-8 years training (4 BSN + 3 DNP).
- Anesthesiology Assistant (AA): $170K-$220K median. 6 years training (bachelor's + master's).
CRNAs at full CMS opt-out scope (16 states, with Florida, Pennsylvania, and Tennessee under review for 2027) can practice independently. Anesthesiologist salary in those markets is consistently 30-40% lower than in strict-supervision states. If your offer is in an opt-out state, that gap is structural — it is not something you negotiate past.
Two related reads: the CRNA-by-state salary map (CRNA salary 2026 by state) covers the opt-out geography in detail, and the physician-assistant-by-state salary map (physician assistant salary 2026 by state) shows the parallel pattern in a different specialty where the supervision rules are less contested.
How to Read These Numbers in Your Negotiation
Three rules of thumb from the dataset:
- Pin the geography first. Your state and your supervision regime set the band before you say a number. Sign in Oregon or New Jersey and you start closer to $650K. Sign in Kentucky or Vermont and you start closer to $310K — even with the same fellowship.
- Pin the practice model second. Hospital-employed W-2 vs single-specialty partner track is a $200K+ swing for the same clinical work. Read the W-2 vs K-1 structure in the contract before you read the salary.
- Pin the specialty track third. Cardiac, pain, and regional anesthesia premiums stack on top of geography and model. The 25-50% premium on cardiac is real, and pain-medicine ownership is the only path in the dataset to a routine seven-figure take-home.
The job description and the training pipeline (4-year residency + 1-year fellowship, ABA boards, state licensure) have not changed materially in 2026. What has changed is the spread between the top and the bottom of the market, and the speed at which CRNA scope expansion is reshaping it.
Last verified: October 5, 2026 — Marit Health (1,326 verified reports), SalaryDr (166+ reports), BLS OEWS 2025 (released May 2026), Becker's ASC (May 2026).
