Surgeon Salaries by U.S City: Where Surgeons Keep the Most Money in 2025

Surgeons rank among the highest-paid professionals in the U.S., often earning well over half a million dollars annually. However, take-home pay can vary dramatically by city once taxes and cost of living are considered. In fact, a surgeon in New York may have far less real spending power than a peer in Dallas, Nashville, or Las Vegas.

Surgeons are among the highest-paid professionals in the U.S., with six-figure incomes that often exceed half a million dollars a year. But earning power is only half the story. After accounting for taxes and cost of living (COL), a surgeon in New York may have far less spending power than one in Dallas, Nashville, or Las Vegas.

This ranking breaks down surgeon salaries in 30 major U.S. cities and adjusts them for after-tax income and real spending power. If you want to know where surgeons make the most money in 2025 — and more importantly, where they keep the most — this data tells the full story.
 

 

Where Surgeons Make the Most Money vs. Where They Keep the Most

Coastal Cities Pay the Highest Salaries, but Take the Biggest Bite : Surgeons in San Francisco ($640k) and New York City ($620k) earn the highest gross incomes in the country. Yet their real spending power falls to just $245k–$255k once high state taxes and extreme housing costs are factored in.

Southern and Midwestern Cities Stretch Incomes Further : In cities like Dallas, Nashville, and Las Vegas, salaries average closer to $500k, but after-tax income and cost-of-living advantages push real spending power to $325k–$340k. That means surgeons in Tennessee or Texas may actually live better than peers in Boston or New York.

Tax-Free States Give Surgeons an Edge : States with no income tax (Texas, Florida, Nevada, Tennessee) offer surgeons the chance to take home significantly more pay. A Miami surgeon making $530k can keep nearly as much real income as a Boston surgeon earning $610k — without the same COL squeeze.

Midwest Winners: Affordable Living, Strong Pay : Cities like Cleveland, Columbus, and Pittsburgh prove you don’t need to live on the coasts to maximize your earnings. Their salaries may be lower, but thanks to modest housing and living costs, real incomes rival those of much higher-paying metros.

If you’re a surgeon looking to maximize your financial freedom, where you practice matters as much as what you earn.

• Best for Gross Salary: San Francisco, New York, Boston
• Best for Real Income: Dallas, Nashville, Las Vegas, Houston
• Best Hidden Value: Cleveland, Pittsburgh, Columbus

Ultimately, surgeons in low-tax, affordable cities get to keep the most money. While the prestige of a coastal salary looks impressive on paper, the South and Midwest deliver the best lifestyles for surgeons in 2025.