Highest-Paying Jobs in the U.S.

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The highest-paying job in the U.S. is pediatric surgeon, with an annual mean wage of $502,050 in the Bureau of Labor Statistics (BLS) Occupational Employment and Wage Statistics (OEWS) survey. Cardiologists follow at $454,940. Every one of the top 10 salaries belongs to a physician, surgeon or dental surgeon. The first occupation outside clinical medicine is airline pilots, co-pilots and flight engineers at $288,650, in 12th place. Among the 25 best-paid occupations, 23 are in healthcare. The two exceptions are pilots and chief executives.

Choosing between these careers depends on more than rank, though. The figures measure one specific thing, the gaps between neighboring entries are often small, and the cost of qualifying differs widely.

What the ranking is based on

The order follows the annual mean wage for each occupation as published in the BLS OEWS tables, sorted from highest to lowest. Three features of that data shape what the numbers mean.

It is a mean, not a median. A mean is the average across all workers in the occupation, so a group of very high earners can pull it up. For most occupations the median (the midpoint earner) would be a better guide to typical pay. For top physician specialties, however, BLS reports percentile wages, including the median, only up to a capped upper value. Many of these occupations hit that cap, which leaves the mean as the only figure that can rank them against one another.

It covers employees, not owners. OEWS surveys wage and salary workers at business establishments. Self-employed workers are excluded. That matters most where private practice is common, such as dentistry, orthodontics, oral surgery, dermatology and some physician specialties. A practice owner’s income is not in these figures. Only the pay of employed practitioners is.

It counts wages, not total compensation. OEWS wages include base pay, cost-of-living allowances, guaranteed pay, hazardous-duty pay, tips, and incentive pay such as commissions and production bonuses. They exclude overtime premiums, shift differentials, nonproduction bonuses, severance and the employer’s cost of benefits. Stock awards are not wages either. This is why chief executives rank 17th at $269,630, even though some CEOs of large public companies receive most of their pay in equity.

Converting to monthly or hourly pay

BLS calculates annual wages for most salaried occupations as hourly wage × 2,080 hours (40 hours a week for 52 weeks). You can reverse that to compare the list on a monthly or hourly basis:

• Monthly: annual mean ÷ 12. For pediatric surgeons, $502,050 ÷ 12 ≈ $41,838 a month before taxes.
• Hourly: annual mean ÷ 2,080. For pediatric surgeons, ≈ $241.37 an hour.

Both conversions assume full-time, year-round work. Neither reflects actual hours, which for surgeons, emergency physicians and obstetricians often include nights, weekends and on-call time. On a per-hour-worked basis, the gaps between specialties with long hours and those with predictable schedules would shrink.

Why medicine fills the top of the list

The common thread is a long and expensive path to qualify. A surgeon typically needs a bachelor’s degree, a medical degree, and then three to nine years of internship and residency. Subspecialists add a fellowship of one to three more years. Pediatric surgeons, the top earners, complete a general surgery residency and then a pediatric surgery fellowship. Most top-10 entries therefore start earning attending-level pay in their thirties.

The clinical work itself adds to the pay. Many of the top roles involve high-stakes procedures, emergency response or both. Pediatric surgeons operate on infants, children and adolescents. Orthopedic surgeons combine scheduled hip, knee and spine procedures with trauma cases. Anesthesiologists manage pain relief and patient safety before, during and after surgery, and are often on call.

How to read the gaps between entries

The distance between ranks varies a lot, and that affects how much a ranking position should weigh in a decision.

• The top two stand apart. Pediatric surgeons lead cardiologists by about $47,000, and cardiologists lead third-place radiologists ($381,530) by about $73,000.
• Ranks 3 to 7 are tightly bunched. Radiologists, “surgeons, all other” ($373,930), orthopedic surgeons ($373,570), general surgeons ($364,360) and anesthesiologists ($360,570) fall within about $21,000 of one another. Orthopedic surgeons and the “all other” surgeon category are separated by $360.
• Ranks 15 to 25 form a plateau. General physicians ($277,260) down to “dentists, all other specialists” ($247,930) span under $30,000 across 11 occupations.

Within those clusters, pay can vary by state, employer type, experience and subspecialty by more than the gap between neighboring ranks. An occupation’s rank is a useful signal for its broad earning range. It does not mean one specialty will pay you more than the one ranked just below it.

Residual categories need care. “Surgeons, all other,” “physicians, all other” and the general “physicians” line group doctors who do not fit a more narrowly defined BLS occupation. Their averages mix very different specialties, so they describe no single career path.

Comparing the leading occupations

Once pay differences are small, work patterns tend to separate the top-10 occupations more than salary does.

• Surgical, with emergency exposure: pediatric, orthopedic and general surgeons. General surgeons handle a wide range, from appendectomies to cancer resections.
• Procedural and diagnostic: cardiologists treat heart conditions and may subspecialize in electrophysiology or procedures such as stent placement. Radiologists diagnose with MRI and CT imaging, and interventional radiologists also perform minimally invasive procedures.
• Perioperative: anesthesiologists, who must react quickly to emergencies during surgery.
• Dental surgical: oral and maxillofacial surgeons ($346,490) operate on the mouth, jaw and face, for impacted teeth, facial trauma or cosmetic reasons. Many run private practices, so the employed-only figure covers only part of this field.
• More predictable hours: dermatologists ($323,520) diagnose and treat thousands of skin, hair and nail conditions and may perform cosmetic or surgical procedures. The relatively regular schedule makes the specialty highly competitive.
• Irregular hours: emergency medicine physicians ($317,480) work in emergency departments and commonly cover nights, weekends and holidays.

Ophthalmologists ($304,650) narrowly miss the top 10. Their practice mixes surgery, such as cataract removal and LASIK, with routine eye care in outpatient clinics.

High earners outside the physician track

Several entries in the top 25 offer a shorter or different route than medical school.

Airline pilots, co-pilots and flight engineers ($288,650) are the highest-paid occupation that requires no medical training. Becoming an airline pilot requires Federal Aviation Administration certification, which includes 1,500 flight hours. Schedules are irregular and often cross time zones.

Chief executives ($269,630) lead organizations and make strategic decisions. They generally report to a board of directors, which elects them. Because equity is excluded, the figure sits closer to the pay of executives at smaller firms than to that of CEOs of large public companies.

Nurse anesthetists ($248,320) are advanced practice registered nurses who administer anesthesia and monitor patients around surgery. The role typically requires a master’s or doctoral degree in nurse anesthesia plus state licensure. It is the highest-paid nursing occupation on the list.

Dental specialists appear several times. Prosthodontists ($268,630) design and fit replacements such as crowns and veneers and repair tooth structure. Orthodontists ($259,400) realign teeth and jaws with braces or aligners over long treatment periods. “Dentists, all other specialists” ($247,930) includes endodontists, who perform root canals, and periodontists, who perform gum surgery.

Among the remaining physician entries, psychiatrists ($269,940) differ from psychologists in that they can prescribe medication. Pathologists ($285,420) work mainly in labs analyzing tissue and fluids, with little direct patient contact. Neurologists, internists and family medicine physicians cluster between about $255,000 and $268,000.

What the salary figure leaves out

Time and debt before earning. A surgeon who trains for a decade or more after college gives up years of income that a pilot or nurse anesthetist might already be earning. Many also repay education loans out of the later salary, so total earnings over a working life can differ from what peak annual pay suggests.

Taxes and location. These are pre-tax national averages. Take-home pay on the same salary differs by state, and states with no income tax keep more of a high wage than high-tax states. Local living costs then decide what that income buys.

Purchasing power over time. Comparing these figures with older salary lists without adjusting for prices overstates real growth. The U.S. inflation rate by year shows how much of a nominal raise inflation absorbs.

Outside income. OEWS reflects one job’s wages. It leaves out investment returns, business ownership and equity, which is how the largest fortunes are usually built.

Highest pay is not the same as fastest growth

A high wage says nothing about how many openings an occupation will add. BLS projects some of the strongest employment growth through 2034 in different occupations: wind turbine service technicians, solar photovoltaic installers, nurse practitioners and data scientists. Of these, only nurse practitioners sit in the same broad field as most of the top earners. A reader choosing a career can weigh a top-25 salary against an occupation’s projected demand, which comes from a separate BLS list.

The Bottom Line

Ranked by annual mean wage, medicine holds every top-10 spot. Pediatric surgeons and cardiologists lead by a wide margin, and the next five occupations sit close together. Because the figures cover employed workers’ wages only, they leave out practice owners’ income and executives’ equity. Within a cluster, training length, hours, location and taxes separate careers more than rank does. Pilots, nurse anesthetists and dental specialists offer top-25 pay without the physician training path.