Surgeon Salary in Virginia (2026)
The average Surgeon in Virginia earns around $510,000/year. After taxes, your estimated take-home is $318,177/year ($26,515/month).
Take-Home Pay Breakdown
| Category | Amount |
|---|---|
Annual Take-Home Pay | $318,177 |
Monthly Take-Home Pay | $26,515 |
Biweekly Take-Home Pay | $12,238 |
Hourly Take-Home Pay based on 2,080 hrs/year | $153/hr |
Federal Tax | $141,634 |
State Tax | $28,564 |
FICA Taxes | $21,624 |
Effective Tax Rate total taxes ÷ gross salary | 37.61% |
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Surgeon Salary Ranges in Virginia
Not all Surgeons earn the same — not even close
VA surgeon comp clusters around three regional ecosystems plus federal medical employers and Charlottesville UVA + Roanoke Carilion secondary markets. NoVA: Inova Health System + cross-DC academic (Georgetown / GWU / Children's National) + federal medical (Walter Reed Bethesda + NIH + DOD). Richmond: VCU Health (Massey NCI-designated + Children's Hospital of Richmond) + HCA Virginia (~14 hospitals) + Bon Secours Mercy. Hampton Roads: Sentara Healthcare (12 hospitals + Sentara Heart Hospital) + EVMS + Naval Medical Center Portsmouth + Children's Hospital of The King's Daughters.
Inova Heart & Vascular Institute Cardiothoracic Surgery
$565,000–$835,000 + RVU + call
Inova Fairfax anchor · transplant + complex CT · NoVA federal-medical adjacency
UVA Health Neurosurgery + Surgical Oncology
$565,000–$815,000 + RVU + research
UVA Comprehensive Cancer Center · academic faculty + 403(b) + 457(b) + research time + PSLF
VCU Massey Cancer Center Surgical Oncology (Richmond)
$485,000–$725,000 + RVU + research
NCI-designated · academic faculty + research time + PSLF-qualifying
Sentara Heart Hospital Cardiothoracic + Transplant
$525,000–$785,000 + RVU + call
Sentara Norfolk General Trauma I · Hampton Roads anchor + transplant
Walter Reed / Naval Portsmouth Active-Duty Surgeon (O-5/O-6)
$240,000–$340,000 + military pension
O-5/O-6 + medical specialty pay + variable special pay · PSLF + FERS/military retirement + SB 528
Children's National Pediatric Surgery (cross-DC NoVA)
$485,000–$725,000 + RVU + research
Top-10 US peds · academic faculty + research time · NoVA-resident NoVA-employed common
McLean / Tysons / Richmond Cosmetic Plastic Surgical Owner
$525,000–$1.3M+ owner draw
Cash-pay aesthetic · S-corp + Solo 401(k) + cash-balance · NoVA + Richmond + Virginia Beach clusters
Anesthesiology + Pain Management (VA private group)
$385,000–$555,000 + group share
CRNA-supervision · ASC partnership at outpatient surgical centers
HCA Virginia / Bon Secours Cardiothoracic + Orthopedic
$465,000–$685,000 + RVU + call
Henrico Doctors / Chippenham + St. Mary's + Memorial Regional · Richmond community + academic mix
Worth knowing: VA-specific layers: federal medical infrastructure unique to VA — Walter Reed Bethesda (cross-MD line), Naval Medical Center Portsmouth (largest US Navy hospital), DOD, NIH cross-MD, Pentagon medical employ surgeons at GS-15 / O-6 ranks with FERS / military pension. SB 528 military retirement exemption phases to $40K by 2026. No local income tax (one of only six states without overlay). Property tax 0.82% — among lowest in country. VA conforms to federal Section 1202 — $10M exclusion preserved. $2M cap on med-mal damages constitutional 2018 — caps premium pressure (mid-low tier US). PTET election available.
Surgical comp levers, federal medical career path, and VA's clean tax structure
$40K
SB 528 military retirement exemption max by 2026 — meaningful for retiring military surgeons
0%
VA local income tax — one of only six states with no city or county overlay
0.82%
VA property tax — among lowest in country; half OH 1.55%, third of NJ 2.21%
VA surgeon RVU compensation parallels NC / PA / OH — $55-$75 per work-RVU above threshold. High-volume orthopedic + cardiothoracic surgeons at Inova / UVA / VCU / Sentara clear 12,000-15,000 work-RVU/year ($650K-$950K combined comp before ASC). Call coverage at Inova Fairfax / VCU / Sentara Norfolk General / Carilion Roanoke Trauma I adds $1,500-$5,000/24-hour shift. Combined federal + VA + Medicare marginal at $700K is ~42-44% — meaningfully lower than NJ's 46-49% or NY+NYC's 50-53%. The no-local-tax overlay is the structural early-career win.
eligibility broad: Inova, UVA, VCU, Sentara, Bon Secours, Carilion, Riverside, EVMS, HCA Virginia (some entities) all qualify. Federal medical employers (Walter Reed, Naval Portsmouth, DOD, NIH cross-MD) are PSLF-qualifying as government employers. The federal medical career path combines PSLF + FERS pension + for distinctive long-term retirement structure. UVA Comprehensive Cancer Center + VCU Massey + Inova Schar + Children's National (cross-DC) anchor the marquee VA surgical career arcs.
The federal medical career path is structurally distinctive. Active-duty military surgeons at Walter Reed Bethesda + Naval Medical Center Portsmouth + DOD facilities earn O-3 to O-6 + medical specialty pay + variable special pay ($240K-$380K total at O-5 / O-6 surgical subspecialty tier). Civilian federal surgeons at GS-13 to GS-15 earn $135K-$220K base + locality. SB 528 exempts up to $40K military retirement from VA state tax by 2026 (phased from $20K in 2024). Naval Portsmouth + DOD → Sentara civilian transition at retirement is a common Hampton Roads career arc — captures SB 528 + civilian comp continuity.
VA progressive 2-5.75% with top above just $17K means most attending surgeons effectively pay 5.75% on most income. No local income tax saves $7-15K/year for attending-tier comp vs OH (RITA / CCA 1.5-2.5%) or PA (EIT 1-3.92%). Property tax 0.82% on a $1M McLean / Vienna home = $8.2K/year vs $22K+ NJ equivalent. VA $2M cap on med-mal damages (held constitutional 2018) caps malpractice premium pressure — high-risk subspecialty $40K-$95K/year (mid-low tier US). ASC partnership: NoVA + Richmond + Hampton Roads ASC density; buy-in $200K-$1.5M generates $80K-$400K/year facility-fee distribution. VA conforms to federal Section 1202 . VA PTET election saves $4K-$9K/year on $400-800K net SE income.
Virginia surgeon economics — NoVA + Richmond + Hampton Roads
NoVA surgeon market: Inova Health System (~110K employees system-wide, Inova Fairfax + Inova Heart & Vascular Institute + Inova Children's + Inova Schar Cancer Institute + Inova Loudoun + Inova Alexandria), cross-DC academic (Georgetown, GWU, Children's National, Walter Reed Bethesda just over MD line), federal medical (DOD, Pentagon medical, NIH cross-MD). Housing Fairfax (McLean / Vienna / Oakton / Falls Church) / Loudoun (Ashburn / Herndon / Leesburg) at $750K-$1.4M, or Fredericksburg / Stafford / Spotsylvania exurban at $400-575K.
Richmond surgeon market: VCU Health (academic, VCU Massey Cancer Center NCI-designated, Children's Hospital of Richmond at VCU), HCA Virginia (Henrico Doctors' + Chippenham, ~14 hospitals), Bon Secours Mercy (St. Mary's + Memorial Regional + Richmond Community). Housing Henrico (Glen Allen / Short Pump) / Hanover (Mechanicsville / Ashland) / Chesterfield at $400-650K — Richmond is the cost-of-living arbitrage VA surgeon market.
Hampton Roads surgeon market: Sentara Healthcare (12 hospitals, Sentara Norfolk General Trauma I + Sentara Heart Hospital + Sentara Princess Anne), EVMS (Sentara academic affiliate), Naval Medical Center Portsmouth (largest US Navy hospital), Riverside Health, Children's Hospital of The King's Daughters. Housing Virginia Beach / Chesapeake / Suffolk at $360-600K. Charlottesville (UVA, ~13K employees) and Roanoke (Carilion Clinic, ~13K employees) anchor secondary academic markets at smaller scale.
VA late-career retirement: Age Deduction caps at $12K with phase-out (~$50K single / $75K ) — less generous than PA's full retirement exemption. For senior VA surgeons retiring with $300K-$500K of cash-balance + + SS, AGI typically exceeds the phase-out and most retirement income is state-taxable at 5.75%. Combined with 0% local + 0.82% property tax, total VA retirement burden runs $13-22K/year. SB 528 ($40K military retirement exemption by 2026) materially reduces state tax for retired military surgeons. Many stay in-state because cheap property + no local tax + Outer Banks / Shenandoah second-home access outweigh marginal FL / TN / NC relocation savings.
How VA progressive 2-5.75% + 0% local + 0.82% property + SB 528 reshape surgeon comp
VA progressive 2-5.75% with top above just $17K means most attending surgeons effectively pay 5.75%. For a $700K-TC surgeon, VA state tax = ~$39K/year vs NJ ~$54K, NY+NYC ~$103K. No local income tax (one of only six states) is cleaner than OH or PA. Combined federal + VA + Medicare marginal at $700K ~42-44% — 4-5 points lower than NJ. Property tax 0.82% on a $1M McLean / Vienna home = $8.2K/year vs $22K+ NJ equivalent.
eligibility broad: Inova, UVA, VCU, Sentara, Bon Secours, Carilion, Riverside, EVMS, HCA Virginia (some entities) all qualify, plus federal medical employers (Walter Reed, Naval Portsmouth, DOD, NIH cross-MD) as government employers. $0 tax-free $300K-$500K student loan forgiveness over 10 years. The federal medical path combines PSLF + FERS pension + for distinctive long-term retirement structure. Active-duty military surgeons at Walter Reed / Naval Portsmouth earn $240K-$380K total at O-5 / O-6 surgical subspecialty.
SB 528 military retirement exemption phases to $40K by 2026 (from $20K in 2024) — transformative for retiring military surgeons (Walter Reed, Naval Portsmouth, Pentagon medical, DOD civilian medical-corps officers). Age Deduction caps at $12K with phase-out (~$50K single / $75K ) — less generous than PA's full exemption. Social Security is fully VA-exempt. For senior surgeons retiring with $300K+ of + SS, AGI typically exceeds the phase-out and most retirement income is taxable at 5.75% — distribution timing matters at the $50K / $75K AGI breakpoint.
VA conforms to federal Section 1202 — federal $10M exclusion preserved (relevant for surgeon-investors in VA medtech / device startups). VA $2M cap on med-mal damages (constitutional 2018) caps malpractice premium pressure — high-risk subspecialty $40K-$95K/year (mid-low tier US). Cash-balance + Solo stack: $270K-$370K/year pre-tax shelter at age 50+. VA PTET election saves $4K-$9K/year on $400-800K net SE income. Tangible personal property tax ("car tax") adds $400-1,200/year per personal vehicle.
- →Federal medical career path — Walter Reed / Naval Portsmouth / DOD active-duty O-5/O-6 + medical specialty pay + military pension + SB 528 + combines uniquely in VA
- →SB 528 military retirement exemption — file for up to $40K/year by 2026; meaningful for late-career military medical-corps officers transitioning to civilian practice
- →Cash-balance + Solo stack at 1099 / = $270K-$370K/year pre-tax shelter at age 50+
- → at Inova / UVA / VCU / Sentara / Bon Secours / Carilion / EVMS / federal medical = $0 tax-free $300K-$500K student loan forgiveness
- →VA PTET election for / partnership = federal -cap workaround saving $4K-$9K/year on $400-800K net SE income
- →Plan retirement distribution timing to keep below Age Deduction phase-out (~$50K single / $75K ) — every $1 over reduces $12K deduction by $1
Three Virginia surgeon markets — what each one looks like
VA surgeon comp varies by region + federal medical employer density + cross-DC academic option + Sentara military medical adjacency. Three regional markets, plus secondary Charlottesville UVA + Roanoke Carilion academic anchors.
NoVA (Inova / cross-DC academic / Walter Reed + DOD federal medical)
Inova academic $565K-$835K · cross-DC + federal medical $385K-$725K · cosmetic owner $525K-$1.3M+Inova Health System (~110K employees system-wide — Inova Fairfax + Inova Heart & Vascular Institute + Inova Children's + Inova Schar Cancer Institute + Inova Loudoun + Inova Alexandria), cross-DC academic (Georgetown, GWU, Children's National, Walter Reed Bethesda just over MD line), federal medical (DOD, Pentagon medical, NIH cross-MD). Housing Fairfax (McLean / Vienna / Oakton) / Loudoun (Ashburn / Herndon / Leesburg) at $750K-$1.4M, or Fredericksburg / Spotsylvania exurban at $400-575K.
NoVA is the federal-medical hub of the country. Inova Fairfax + Inova Heart & Vascular Institute anchor suburban academic medicine; cross-DC + federal medical creates a career mix unavailable elsewhere. Many NoVA career surgeons settle exurban Fredericksburg / Spotsylvania for housing math.
Richmond (VCU Health / HCA Virginia / Bon Secours Mercy)
VCU academic $485K-$725K · HCA / Bon Secours $465K-$685K · cosmetic owner $475K-$1.0M+VCU Health System (academic, VCU Massey Cancer Center NCI-designated, Children's Hospital of Richmond at VCU), HCA Virginia (Henrico Doctors' + Chippenham, ~14 hospitals), Bon Secours Mercy (St. Mary's + Memorial Regional + Richmond Community). Housing Henrico (Glen Allen / Short Pump) / Hanover / Chesterfield at $400-650K — meaningfully cheaper than NoVA.
Richmond is the cost-of-living arbitrage VA surgeon market — top-tier academic + community medicine + dramatically cheaper housing than NoVA. Many career VA surgeons choose Richmond at the manager-promotion mark for family stability + housing math.
Hampton Roads (Sentara / EVMS / Naval Medical Center Portsmouth)
Sentara $525K-$785K · Naval Portsmouth military O-5/O-6 $240K-$340K + pension · cosmetic owner $475K-$1.0M+Sentara Healthcare (12 hospitals, Sentara Norfolk General Trauma I + Sentara Heart Hospital + Sentara Princess Anne), EVMS (academic affiliate), Naval Medical Center Portsmouth (largest US Navy hospital, ~6,000 personnel), Riverside Health, Children's Hospital of The King's Daughters. Housing Virginia Beach / Chesapeake / Suffolk at $360-600K.
Hampton Roads is the military medical hub for VA. Naval Portsmouth + DOD + Sentara civilian medical create a distinctive career mix. Many career military surgeons transition from Naval Portsmouth to Sentara civilian at retirement — captures SB 528 + civilian comp continuity.
The Virginia surgeon career arc — residency to retirement
Years 1-9 (med school + residency + fellowship). 4 years med school + 5-9 years residency + 1-3 years fellowship. PGY1 ACGME stipend at VA programs $65K-$85K. UVA, VCU, Inova, Sentara, EVMS, Carilion residencies all -qualifying. Walter Reed + Naval Portsmouth run military surgical residencies. Most VA surgical residents finish with $300K-$500K federal debt; PSLF at non-profit / government hospital = $0 tax-free forgiveness over 10 years.
Years 1-3 attending ($365K-$465K). Hospital-employed at Inova / UVA / VCU / Sentara / Bon Secours / Carilion, or $345K-$425K + revenue-sharing at private group, or $240K-$340K active-duty O-3/O-4 at Walter Reed / Naval Portsmouth / DOD with FERS / military pension. Most new attendings buy $500-900K starter home in Richmond / Hampton Roads / Fredericksburg exurban; NoVA-employed surgeons typically rent or live exurban given $1M+ Fairfax / Loudoun pricing.
Years 4-10 attending ($485K-$725K TC). Subspecialty premium: ortho $585K, cardiothoracic $695K, neurosurgery $755K. Inova / UVA / VCU / Sentara / private-group partnership buy-in ($200K-$1.5M) year 3-5; ASC equity ($150K-$500K) year 5-7. Federal medical military officers reach O-5 / O-6 with 10-15 years of pension accumulation. Cash-balance + Solo max age 45-55 = $270K-$370K/year shelter. By year 10, VA surgeon net worth typically $2.5M-$8M.
Years 10+ (senior partner / department chair / late career). $665K-$1.2M+ TC. Inova / UVA / VCU / Sentara Department Chair $750K-$1.2M; McLean / Richmond Short Pump / Virginia Beach cosmetic plastic owner clears $1M-$1.3M draw. Retired military surgeons at O-6 / Captain with 20+ years capture SB 528 ($40K exemption) + military pension + transition to Sentara civilian or NoVA private practice. VA tax math (5.75% top + 0% local + 0.82% property + SB 528) makes in-state retirement attractive for military retirees; civilian retirees see modest FL / TN / NC compounding but smaller gap than higher-tax states.
Where Virginia surgeons actually live
VA surgeon housing weights schools + commute + practice location + cost-of-living arbitrage. Most under-45 surgeons buy single-family in suburban metro near practice; senior partners upgrade to premium primary residence near hospital or top private school. NoVA cost-of-living is real — most career surgeons eventually relocate to Fredericksburg / Spotsylvania exurban for housing math. Richmond is the structural arbitrage market; Hampton Roads offers coastal lifestyle + military medical adjacency.
McLean / Vienna / Oakton (Fairfax)
Top-tier suburban schools · Inova Fairfax 15 min · cross-DC + federal medical access · $850K-$1.4M
Ashburn / Leesburg (Loudoun)
Inova Loudoun access · suburban schools · $700K-$1.1M
Fredericksburg / Stafford / Spotsylvania
NoVA jobs at half the housing cost · I-95 commute · $400-575K · exurban arbitrage
Glen Allen / Short Pump (Henrico)
Top suburban schools · VCU + HCA + Bon Secours access · $400-650K · Richmond arbitrage
Virginia Beach / Chesapeake (Hampton Roads)
Coastal lifestyle · Sentara + Naval Portsmouth access · $400-650K · hurricane risk
Charlottesville (Albemarle)
UVA Health 10-15 min · top schools · $500-900K · academic small-town
VA cost-of-living arbitrage + 5.75% top + 0% local + 0.82% property tax + SB 528 (military retirees) make in-state retirement attractive for most senior VA surgeons. Civilian senior VA surgeons with $1M+ portfolios still see FL / TN / NC compounding but gap is smaller than higher-tax states. Many stay through retirement because cheap property + no local tax + Outer Banks / Shenandoah second-home access outweigh marginal relocation savings. Hurricane risk along Hampton Roads coast is real but manageable.
Is this the right move?
Virginia for surgeons — federal medical + clean tax + cost-of-living arbitrage
Working in your favor
- +Federal medical infrastructure unique to VA — Walter Reed Bethesda + Naval Medical Center Portsmouth + DOD + NIH cross-MD
- +Inova Fairfax + UVA Health + VCU Health + Sentara all top-tier academic + community medicine
- +Zero local income tax — one of only six states without city or county overlay
- +0.82% property tax is among lowest in country — half OH 1.55%, third of NJ 2.21%
- +SB 528 military retirement exemption phasing to $40K by 2026 — meaningful for retiring military surgeons
- +Cost-of-living arbitrage at Richmond + Hampton Roads + Fredericksburg exurban — top-tier medicine + cheap housing
Worth knowing before you sign
- −Top 5.75% state rate kicks in above just $17K — most attendings effectively pay top rate
- −NoVA housing ($750K-$1.4M for top-tier school districts) erodes net wealth-building meaningfully
- −Age Deduction caps at $12K with AGI phase-out — less generous than PA's full retirement exemption
- −Healthcare IS SSTB — Section 199A QBI eliminated above $553K MFJ
- −Tangible personal property tax ("car tax") on vehicles adds $400-1,200/year per personal vehicle
- −Charlottesville and Roanoke markets are materially smaller — career mobility limited outside major metros
Job Market in Virginia
Virginia has active demand for Surgeons.
Growth outlook: 3% growth projected 2022-2032 (slower than average) overall — but specific subspecialties (cardiothoracic, neurosurgery, plastic, transplant, pediatric subspecialty) face severe shortage with 8-15 year supply lag from training pipeline. Aging Boomer demographic = sustained surgical volume through 2035+. AI/robotics augment but do not replace operative judgment in the 10-year window.
Related job titles:
Cost of Living in Virginia
Virginia has a varied cost of living by region.
💰 Monthly take-home: $26,515
🏠 Typical rent: $1,600/mo
📊 After rent: $24,915/mo
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