Real Salary Index

Best states for family medicine physicians

The best states for family medicine physicians start with the national median wage of $290,640. Once federal tax, state income tax and local housing costs are applied, that salary is worth $487,952 in Puerto Rico and only $184,085 in California.

WeakestStrongest
100.0
Excellent
Puerto Rico — top ranked

After-tax income $227,251 · cost index 0.47

National median wage

$290,640

Best state

Puerto Rico

Weakest state

California

Real pay spread

$303,867

Federal effective rate

22.4%

States compared

52

Ranked

Real purchasing power for family medicine physicians, by state

Median wage after federal and state income tax, divided by a local cost-of-living index built from rent and home values.

  1. 1
    Puerto Rico0.0% state tax$487,952
  2. 2
    South Dakota0.0% state tax$256,531
  3. 3
    North Dakota1.9% state tax$249,035
  4. 4
    Arkansas3.9% state tax$248,258
  5. 5
    Louisiana3.0% state tax$247,672
  6. 6
    Tennessee0.0% state tax$247,361
  7. 7
    Iowa3.8% state tax$246,258
  8. 8
    Mississippi4.7% state tax$245,517
  9. 9
    Wyoming0.0% state tax$245,170
  10. 10
    Oklahoma4.8% state tax$242,863
  11. 11
    Alabama4.7% state tax$240,348
  12. 12
    Kentucky4.0% state tax$239,061
  13. 13
    West Virginia4.8% state tax$238,145
  14. 14
    Nebraska5.2% state tax$235,308
  15. 15
    Missouri4.8% state tax$234,749
  16. 16
    Kansas5.6% state tax$234,164
  17. 17
    Texas0.0% state tax$234,142
  18. 18
    Indiana3.0% state tax$233,922
  19. 19
    Ohio3.5% state tax$233,901
  20. 20
    New Mexico4.9% state tax$230,880
  21. 21
    Nevada0.0% state tax$227,298
  22. 22
    North Carolina4.5% state tax$226,947
  23. 23
    Wisconsin5.3% state tax$225,014
  24. 24
    Pennsylvania3.1% state tax$223,690
  25. 25
    Michigan4.3% state tax$223,248
  26. 26
    South Carolina6.4% state tax$222,408
  27. 27
    Alaska0.0% state tax$222,013
  28. 28
    Montana5.9% state tax$221,850
  29. 29
    Idaho5.8% state tax$220,184
  30. 30
    Florida0.0% state tax$219,749
  31. 31
    Georgia5.4% state tax$219,604
  32. 32
    Arizona2.5% state tax$218,449
  33. 33
    New Hampshire0.0% state tax$218,164
  34. 34
    Utah4.5% state tax$216,382
  35. 35
    Illinois5.0% state tax$212,842
  36. 36
    Maine7.2% state tax$212,579
  37. 37
    Washington0.0% state tax$212,358
  38. 38
    Vermont6.6% state tax$212,254
  39. 39
    Delaware5.5% state tax$211,401
  40. 40
    Virginia5.0% state tax$210,284
  41. 41
    Minnesota7.0% state tax$209,490
  42. 42
    Rhode Island4.8% state tax$208,582
  43. 43
    Colorado4.4% state tax$208,015
  44. 44
    Connecticut5.5% state tax$203,785
  45. 45
    Maryland5.3% state tax$201,863
  46. 46
    Massachusetts5.0% state tax$201,032
  47. 47
    Oregon8.8% state tax$195,066
  48. 48
    New York6.0% state tax$194,287
  49. 49
    New Jersey5.5% state tax$193,974
  50. 50
    District of Columbia7.0% state tax$188,122
  51. 51
    Hawaii7.9% state tax$185,639
  52. 52
    California8.0% state tax$184,085

Wages are national medians: this shows where the same salary goes furthest, not where employers pay more.

How the Real Salary Index works

We start from the BLS national median wage, subtract an effective federal income tax estimate and the state's income tax rate, then divide the result by a cost-of-living index built from state median gross rent and median home value against the national average.

The output is the salary's real purchasing power, and the 0–100 RSI score simply ranks every state between the weakest and strongest result for that occupation.

Source: U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics (national median annual wages, May 2024); U.S. Census Bureau, American Community Survey 5-year estimates (state cost-of-living proxy); State income tax parameters, 2026 tax year.

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