Where Anesthesiologists Earn the Most: Gross Pay, Taxes, and Real Spending Power Across U.S. Cities

Anesthesiologist salaries vary widely across U.S. cities. This guide compares gross pay, after-tax income, and real spending power, revealing where doctors keep and stretch their earnings most.

Key Insights

• High-paying but high-cost metros: Cities like San Francisco, San Jose, Los Angeles, and New York show the highest gross salaries, but high taxes and soaring housing costs significantly reduce anesthesiologists’ real purchasing power.
• Tax-free states boost take-home pay: In cities such as Houston, Dallas, Miami, Las Vegas, and Nashville, gross and after-tax income are identical because these states do not levy state income tax.
• Real spending power can exceed after-tax income: In affordable cities with no income tax, such as Houston and Jacksonville, anesthesiologists’ real spending power is greater than their after-tax pay, because the cost of living is below the U.S. average.
• Balanced opportunities: Cities like Charlotte, Columbus, and Denver offer a mix of strong incomes, moderate tax burdens, and manageable living expenses, giving anesthesiologists a more balanced financial outlook.

Anesthesiologists rank among the highest-paid medical specialists in the United States, but where they practice has a major impact on how far those earnings go. While a strong gross income looks impressive, the reality of taxes and cost of living means anesthesiologists in some cities keep far less of their paycheck than others.

This article compares gross income, after-tax income, and cost-of-living–adjusted real spending power for anesthesiologists across 30 major U.S. cities. Gross income is based on a median annual salary of $350,000, adjusted slightly by market. After-tax income reflects federal and state/local tax burdens, while real spending power shows what those earnings are worth once adjusted for each city’s living costs.

Anesthesiologist Earnings and Real Spending Power in 30 Major U.S. Cities

The table below compares anesthesiologist gross income, after-tax income, and cost-of-living–adjusted real spending power across major metropolitan areas:

Note: In some cities, particularly those in states with no state income tax (Texas, Florida, Nevada, Tennessee) and a lower cost of living, anesthesiologists’ real spending power can appear higher than their after-tax income. For example, in Houston (TX), both gross and after-tax income equal $360,000, but adjusted for cost of living, that income stretches to nearly $380,000.

For anesthesiologists deciding where to work or relocate, these comparisons show why it’s important to look beyond just headline salary numbers. Taxes and living costs can dramatically reshape financial well-being. A high salary in a coastal metro may not go as far as a lower salary in a tax-friendly, affordable city.

Ultimately, the best cities for anesthesiologists combine strong earnings with low tax burdens and reasonable living costs — giving physicians the freedom to keep more of what they earn while enjoying a high quality of life.