For physicians weighing a career move, state income tax is often the deciding variable, and in high-earning specialties, the wrong state can cost more than $50,000 a year.
Here are five things to know:
2. According to a report from Residency Advisor, moving from California — with a top income tax rate of 13.3% — to Texas on a $400,000 salary saves over $53,000 per year in state tax alone. Alaska, Florida, Nevada, South Dakota, Tennessee, Texas, Washington and Wyoming have no state income tax.
2. At a $600,000 salary, the net pay difference between Texas and California is approximately $55,000 per year. If the offers are “$600,000 in Texas” vs. “$650,000 in California,” a large share of the $50,000 raise is clawed back by higher state tax.
3. The average physician salary is now $386,000, according to the 2026 Medscape Physician Compensation Report, with eight specialties averaging above $500,000.
4. According to SalaryDr’s 2026 physician take-home pay comparison, the states where physicians net the most after federal and state income taxes are concentrated among no-income-tax states. Here are the five states where physicians take home the most pay:
- Wyoming
- Alaska
- Florida
- Nevada
- South Dakota
5. According to the Residency Advisor report, two physicians with identical salaries can see after-tax differences of $40,000 to $80,000 per year just by practicing in different states.
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