How do you know if an anesthesia attending salary offer is competitive?

You triangulate three numbers: the regional median from published data, what the group's physicians actually earned last year, and at least one competing offer. Never trust one spreadsheet. A $560,000 base in Des Moines with no noncompete is a completely different deal than the same number in a state that enforces a 2 year radius noncompete.

Method 1: Start with the regional medians

Published compensation data gives you the floor of the conversation. Medscape's physician compensation report (2025 data) puts anesthesiology at $543,000, 5th of 29 specialties, nationally. Marit Health publishes self reported, specialty specific data, with a $560,000 median and a $500,000 to $630,000 middle band, that lets you filter closer to your actual market instead of a national average that blends Manhattan with Mississippi.

Use these numbers for one thing: the range. If the median for your region is $480,000 and you are offered $560,000, you are above market. If you are offered $430,000, you are below it and the group should be explaining why. Never treat a single data source as gospel. Medscape skews toward employed physicians. Marit skews toward whoever bothered to self report. Both beat guessing.

Method 2: Ask what the group's physicians actually made last year

The median tells you the market. The group's W2s tell you the job. Ask for the actual total compensation of physicians at your seniority level for the last full year: base, bonus, call stipends, and retirement contributions, all in. A "$500,000 base" with $40,000 in call pay and a $30,000 retirement contribution is a $570,000 job. A "$550,000 base" with no call pay and a 3 percent match is a $566,500 job. The bigger base number loses.

Ask specifically about the range, not just the average. If the group's attendings made between $520,000 and $610,000 last year, that spread tells you how much of the pay is hustle dependent: extra call, extra rooms, extra weekends. A tight range means the pay is the pay. A wide range means the number they quoted you is the floor and the ceiling costs your Saturdays.

Also ask what changed. If last year's average was $590,000 and this year's offer is $540,000, something moved: a payer contract, a hospital subsidy, a staffing model. Find out what before you sign.

Method 3: Get a competing offer, even one you will not take

Nothing calibrates a number like a second number. You do not need five offers. You need one real alternative in a comparable market, far enough along that the compensation is in writing. A competing offer does two things a spreadsheet cannot: it tells you what your specific profile commands right now, and it gives you something to point at in negotiation that is not a website.

This does not mean manufacturing a bidding war. It means doing the obvious thing: interview at two places, get two numbers, compare them. Residents skip this because it feels disloyal to the group they like. The group will survive. You sign one contract that governs the next 2 to 5 years of your life. Get the second number.

Adjust for cost of living and the noncompete

Raw salary comparisons lie. Here is the math, labeled illustrative because your tax situation and spending will differ: a $560,000 salary in Des Moines, where a 4 bedroom house costs around $450,000, leaves dramatically more after housing than the same $560,000 in San Diego, where that house costs $1,400,000. Fully financed at 7 percent over 30 years, the San Diego house costs roughly $75,800 more per year in mortgage payments alone. That is after tax money, so it works like a pay cut of about 20 percent hiding inside the zip code.

Then price the noncompete. In a state that enforces them, a 2 year, 15 mile radius noncompete can mean, leaving the metro if the job does not work out. That restriction has a dollar value: the cost of relocating your family, selling a house, and rebuilding a referral network. Conservatively, $100,000 to $200,000 in friction costs, plus a year of disrupted income. A no noncompete offer at $540,000 can easily beat a $580,000 offer with a punishing radius once you price the option value of being able to leave. State rules vary a lot. California bans them, and Texas now caps physician noncompetes at 1 year and 5 miles.

Same number. Different universe.

The questions that reveal the real number

When the group quotes compensation, ask:

1. What did physicians at my level actually take home last year, all in?
2. What is the range, and what drives the top of it?
3. How much of total comp is base versus call, bonus, and stipends?
4. What changed in the last two years, up or down?
5. What is the noncompete, exactly, in miles and years?

If the answers are crisp, the number is real. If the answers are vague, the number is marketing.

For the contract language behind the number, see the contracts guide. For the full new attending picture, the Anesthesiology New Attending hub.