The best cost-of-living-adjusted metro areas in the Doximity 2025 report are Rochester, St. Louis, Oklahoma City, Omaha, and Kansas City. This matters because local costs can offset nominal salary differences, which changes what an offer is actually worth when you negotiate.
Spoiler alert: That “prestigious” Boston job might be making you poorer than your friend in Kansas City.
Clinical Summary: Geographic Compensation (2025)
- Rochester, MN is #1 at $495,532 and also #1 after cost-of-living adjustment.
- Rochester grew 8.7% YoY vs 3.7% nationally.
- Five of the top 10 nominal metros are in California.
- Boston and Washington, DC are the two lowest after cost-of-living adjustment.
- Kansas City is #16 nominal at $437,624 and #5 after adjustment.
- Pay increased in 54 of 60 metros.
Bottom line: “Where you practice” can matter almost as much as “What you practice,” Highlighting the importance of location in salary and lifestyle considerations.
Physician’s Take (Dr. Kathryn Sarnoski, MD):
Base salary tells only part of the story. Evaluating total compensation alongside call burden, staffing support, and flexibility-related contract terms gives a more accurate picture of what the job will actually require and what the financial impact may be.
Dr. Kathryn Sarnoski, MD, is a board-certified OB/GYN and Director of Physician Education at Contract Diagnostics.
The data (what Doximity measured)
Doximity’s 2025 Physician Compensation Report is based mainly on self-reported compensation surveys from full-time U.S. physicians (40+ hours/week). The 2025 report uses 37,000+ surveys completed in 2024, alongside a dataset of 230,000+ surveys across six years. Doximity also includes additional surveys and Newsfeed polls fielded in 2024 and 2025.
For the cost-of-living adjustment, Doximity uses 2023 Regional Price Parities from the U.S. Bureau of Economic Analysis (BEA).
The metro pay leaderboard (nominal)
These are metro-wide averages across all specialties. Use them as a market signal, not a personal target.
Highest Average Physician Compensation (2024)
| Rank | Metro Area | Average Compensation |
|---|---|---|
| 1 | Rochester, MN | $495,532 |
| 2 | St. Louis, MO | $484,883 |
| 3 | Los Angeles, CA | $470,198 |
| 4 | San Jose, CA | $469,878 |
| 5 | Sacramento, CA | $460,671 |
| 6 | Phoenix, AZ | $459,082 |
| 7 | Riverside, CA | $455,986 |
| 8 | Minneapolis, MN | $452,598 |
| 9 | San Francisco, CA | $449,830 |
| 10 | Charlotte, NC | $448,400 |
Doximity notes that half of the top 10 are in California, and 8 of the bottom 10 are on the East Coast.
Lowest Average Physician Compensation (2024)
| Rank | Metro Area | Average Compensation |
|---|---|---|
| 1 | Durham–Chapel Hill, NC | $358,782 |
| 2 | Rochester, NY | $364,160 |
| 3 | Ann Arbor, MI | $373,154 |
| 4 | Charleston, SC | $384,419 |
| 5 | Washington, DC | $386,731 |
| 6 | Providence, RI | $386,788 |
| 7 | San Antonio, TX | $389,495 |
| 8 | Boston, MA | $390,799 |
| 9 | Baltimore, MD | $392,507 |
| 10 | Worcester, MA | $397,188 |
The great flip (cost-of-living adjusted)
This is the part most physicians feel but rarely quantify.
Doximity’s message is straightforward: cost of living shapes real income, and the “best-paying” markets can look very different after adjustment.
Highest Compensation After Cost-of-Living Adjustment
| Rank | Metro Area |
|---|---|
| 1 | Rochester, MN |
| 2 | St. Louis, MO |
| 3 | Oklahoma City, OK |
| 4 | Omaha, NE |
| 5 | Kansas City, MO |
| 6 | Charlotte, NC |
| 7 | Buffalo, NY |
| 8 | Louisville, KY |
| 9 | New Orleans, LA |
| 10 | Salt Lake City, UT |
Lowest Compensation After Cost-of-Living Adjustment
| Rank | Metro Area |
|---|---|
| 1 | Boston, MA |
| 2 | Washington, DC |
| 3 | Seattle, WA |
| 4 | Denver, CO |
| 5 | San Francisco, CA |
| 6 | Baltimore, MD |
| 7 | Providence, RI |
| 8 | Philadelphia, PA |
| 9 | New York, NY |
| 10 | Portland, OR |
The takeaway: the “coastal premium” often does not withstand the pressure of living costs. Doximity calls out that higher expenses in metros like Boston, DC, Seattle, San Francisco, and Denver can erode earning power even when nominal pay rises.
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Frequently Asked Questions (FAQ)
Why do East Coast cities rank so poorly for physician salary after cost-of-living adjustment?
Eight of the bottom 10 metros for physician compensation are on the East Coast. Despite offering competitive nominal salaries, cities like Boston, Washington DC, New York, Philadelphia, and Providence carry living costs that significantly erode purchasing power. A physician earning $390,000 in Boston may have less financial flexibility than one earning $437,000 in Kansas City once housing, taxes, and daily expenses are factored in.
Why does California dominate the top 10 for nominal physician pay?
Five of the top 10 highest-paying metros by nominal compensation are in California, including Los Angeles, San Jose, Sacramento, Riverside, and San Francisco. This reflects a combination of high demand for physicians, strong unionization in some markets, and state-level healthcare regulations that drive up compensation. However, California’s high cost of living means several of these metros drop significantly after cost-of-living adjustment.
How much did physician compensation grow in 2024?
Physician compensation grew 3.7% nationally in 2024 according to the Doximity report. Rochester, MN significantly outpaced that average at 8.7% year-over-year growth. Pay increased in 54 of the 60 metros tracked, suggesting broad-based compensation growth rather than isolated market spikes.
Should I use metro-level salary averages to set my compensation expectations?
Metro averages cover all specialties combined and should be used as a market signal, not a personal target. A family medicine physician in Rochester and a neurosurgeon in the same city will have dramatically different compensation figures that both get averaged into the same number. Your specialty, practice setting, call burden, and contract structure all determine what a competitive offer actually looks like for your situation.
Does the Doximity compensation report include all types of physician income?
The Doximity report is based on self-reported compensation surveys from full-time physicians working 40 or more hours per week, using over 37,000 surveys completed in 2024 alongside a six-year dataset of 230,000+ surveys. It captures total compensation as reported by physicians themselves, which may include base salary, productivity bonuses, and other income – but self-reported data can vary in how respondents define and calculate their total earnings.
About the Author
Jon Appino is the Founder and CEO of Contract Diagnostics. Over the past 14 years, his firm has reviewed more than 18,000 physician contracts and helped physicians secure millions in improved compensation. He passionately advocates for physicians and believes they deserve to be compensated fairly — and to understand and control the business side of their career.
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