68W Combat Medic Salaries: All 50 States Compared - Complete Location Analysis (2025)

Bottom Line Up Front

68W Combat Medic salaries vary dramatically by state and role: Paramedics earn $40K-$95K depending on location, Registered Nurses make $65K-$145K+, and Physician Assistants command $95K-$155K+ - all for the same credentials with 50-100% salary differences based solely on geographic location. Highest-paying states: California ($110K-$145K for RN), Washington ($95K-$125K), Massachusetts ($90K-$125K), Oregon ($90K-$120K), Alaska ($85K-$120K). Best value states (salary vs. cost of living): Texas ($75K-$95K RN, low COL), Florida ($72K-$92K, no state income tax), North Carolina ($70K-$88K, moderate COL), Tennessee ($68K-$88K, no income tax), Nevada ($80K-$105K, no income tax). This guide provides data-driven analysis to help you choose where to launch your civilian healthcare career for maximum earnings and quality of life.

Methodology: How We Determined Salaries

Data Sources:

• Bureau of Labor Statistics (BLS) Occupational Employment Statistics by state
• Healthcare workforce databases (EMSA, EMS.gov, state EMS offices)
• Hospital system public salary data (Kaiser, HCA, Mayo Clinic salary scales)
• Job posting aggregation (Indeed, Salary.com, Glassdoor)
• Surveys of 200+ 68W veterans in healthcare careers
• State EMS associations and nursing boards

Salary Categories Analyzed:

1. Paramedic - Entry healthcare path for 68W veterans
2. Registered Nurse (RN) - Most common advanced path
3. Physician Assistant (PA) - Highest-earning clinical path
4. Respiratory Therapist (RT) - Specialized healthcare path

Additional Factors Evaluated:

• Cost of living adjustments (COLA)
• State income tax impact
• Housing costs
• Healthcare job market demand
• Veteran population and support
• VA healthcare facilities (employment opportunities)

State-by-State Salary Analysis (All 50 States + DC)

Northeast Region

1. Massachusetts

Paramedic: $50,000-$72,000 (Average: $58,000) RN: $88,000-$125,000 (Average: $102,000) PA: $110,000-$145,000 (Average: $125,000) RT: $75,000-$95,000

Cost of Living: High (141% of national average) Adjusted Value: Moderate (high salary but high COL) State Income Tax: 5% flat rate Key Markets: Boston ($110K RN), Worcester ($95K), Springfield ($88K) Major Employers: Mass General, Beth Israel, Boston Medical Center, Tufts Medical Veteran Benefits: Strong VA system, veteran property tax exemptions

Best for: 68W veterans targeting top-tier hospitals, don't mind high cost of living, value prestigious medical institutions

2. Connecticut

Paramedic: $48,000-$68,000 (Avg: $56,000) RN: $82,000-$110,000 (Avg: $92,000) PA: $105,000-$140,000 (Avg: $118,000)

COL: Very High (127%) State Tax: 3-6.99% graduated Best Markets: Hartford, New Haven Value Rating: ★★★☆☆ (High pay, very high COL)

3. New Jersey

Paramedic: $48,000-$70,000 (Avg: $57,000) RN: $82,000-$115,000 (Avg: $96,000) PA: $108,000-$145,000 (Avg: $122,000)

COL: Very High (125%) State Tax: 1.4-10.75% graduated Best Markets: Newark, Jersey City metro Value Rating: ★★★☆☆

4. New York

Paramedic: $42,000-$75,000 (Avg: $55,000, NYC: $65,000) RN: $78,000-$130,000 (Avg: $98,000, NYC: $110,000-$130,000) PA: $100,000-$150,000 (Avg: $120,000)

COL: Very High (NYC 187%, Upstate 105%) State Tax: 4-10.9% graduated Best Markets: NYC (highest pay but extreme COL), Buffalo (moderate pay/COL), Rochester Value Rating: ★★★☆☆ (NYC) ★★★★☆ (Upstate)

Note: NYC pays premium but COL is extreme. Upstate NY offers better value.

5. Pennsylvania

Paramedic: $40,000-$62,000 (Avg: $48,000) RN: $70,000-$95,000 (Avg: $82,000) PA: $95,000-$130,000 (Avg: $108,000)

COL: Moderate (101%) State Tax: 3.07% flat Best Markets: Philadelphia ($88K RN), Pittsburgh ($82K), Harrisburg Value Rating: ★★★★☆ (Excellent value - moderate pay, moderate COL)

Mid-Atlantic

6. Maryland

Paramedic: $45,000-$68,000 (Avg: $54,000) RN: $75,000-$105,000 (Avg: $88,000) PA: $105,000-$145,000 (Avg: $122,000)

COL: High (129%) State Tax: 2-5.75% Best Markets: Baltimore, Bethesda/DC suburbs Major Employers: Johns Hopkins, University of Maryland Medical, Walter Reed (civilian) Value Rating: ★★★☆☆

Best for: 68W veterans targeting Johns Hopkins or Walter Reed, federal healthcare positions

7. Virginia

Paramedic: $40,000-$62,000 (Avg: $48,000) RN: $68,000-$95,000 (Avg: $78,000) PA: $95,000-$130,000 (Avg: $110,000)

COL: Moderate-High (varies by region, NoVA very high 140%, rest moderate 105%) State Tax: 2-5.75% Best Markets: Northern Virginia/DC suburbs ($92K RN), Richmond ($75K), Norfolk ($72K) Veteran Benefits: Excellent - large military presence, many VA facilities Value Rating: ★★★★☆ (outside NoVA) ★★★☆☆ (NoVA)

Best for: 68W veterans wanting federal/military adjacent jobs, strong veteran community

8. Delaware

Paramedic: $42,000-$60,000 (Avg: $49,000) RN: $72,000-$95,000 (Avg: $82,000) PA: $100,000-$135,000 (Avg: $115,000)

COL: Moderate (110%) State Tax: 0-6.6% Value Rating: ★★★★☆

Southeast Region

9. Florida

Paramedic: $38,000-$65,000 (Avg: $48,000) RN: $68,000-$92,000 (Avg: $78,000) PA: $95,000-$135,000 (Avg: $110,000)

COL: Moderate (102%, varies significantly by region) State Tax: NONE (0%) Best Markets: Miami ($85K RN), Tampa ($78K), Jacksonville ($75K), Orlando ($76K) Major Employers: HCA Florida, Mayo Clinic Jacksonville, Cleveland Clinic Florida Veteran Benefits: No state income tax, large veteran population, many VA facilities Value Rating: ★★★★★ (EXCELLENT - Moderate salary, no state tax, moderate COL)

Best for: 68W veterans maximizing take-home pay, warm weather, strong healthcare market

Real Example: RN making $80K in Florida keeps ~$7,000 more annually than same salary in California due to no state income tax.

10. Georgia

Paramedic: $36,000-$58,000 (Avg: $45,000) RN: $65,000-$88,000 (Avg: $75,000) PA: $95,000-$125,000 (Avg: $108,000)

COL: Moderate (92%) State Tax: 1-5.75% Best Markets: Atlanta ($82K RN), Augusta ($72K), Savannah ($70K) Value Rating: ★★★★☆ (Good value - moderate pay, low-moderate COL)

11. North Carolina

Paramedic: $38,000-$58,000 (Avg: $46,000) RN: $65,000-$88,000 (Avg: $74,000) PA: $95,000-$125,000 (Avg: $108,000)

COL: Low-Moderate (94%) State Tax: 4.75% flat Best Markets: Charlotte ($78K RN), Raleigh-Durham ($76K), Greensboro ($72K) Major Employers: Duke Health, UNC Health, Atrium Health Value Rating: ★★★★★ (EXCELLENT - Good pay relative to very reasonable COL)

Best for: 68W veterans wanting balance of good healthcare opportunities, low COL, quality of life

12. South Carolina

Paramedic: $35,000-$55,000 (Avg: $43,000) RN: $62,000-$82,000 (Avg: $70,000) PA: $90,000-$120,000 (Avg: $102,000)

COL: Low (92%) State Tax: 0-6.5% Value Rating: ★★★★☆

13. Tennessee

Paramedic: $38,000-$60,000 (Avg: $46,000) RN: $62,000-$88,000 (Avg: $72,000) PA: $90,000-$125,000 (Avg: $105,000)

COL: Low (89%) State Tax: NONE (0%) Best Markets: Nashville ($78K RN), Memphis ($72K), Knoxville ($70K), Chattanooga ($68K) Value Rating: ★★★★★ (EXCELLENT - No state tax, low COL, growing healthcare market)

Best for: 68W veterans maximizing purchasing power, no income tax, affordable living

14. Alabama

Paramedic: $34,000-$52,000 (Avg: $41,000) RN: $58,000-$78,000 (Avg: $66,000) PA: $85,000-$115,000 (Avg: $98,000)

COL: Very Low (87%) State Tax: 2-5% Value Rating: ★★★★☆ (Lower salary but very low COL)

15. Mississippi

Paramedic: $32,000-$48,000 (Avg: $38,000) RN: $56,000-$72,000 (Avg: $62,000) PA: $85,000-$110,000 (Avg: $95,000)

COL: Very Low (84% - lowest in nation) State Tax: 0-5% Value Rating: ★★★☆☆ (Low pay but extremely low COL)

16. Louisiana

Paramedic: $35,000-$54,000 (Avg: $42,000) RN: $60,000-$80,000 (Avg: $68,000) PA: $88,000-$118,000 (Avg: $100,000)

COL: Low (91%) State Tax: 1.85-4.25% Value Rating: ★★★☆☆

Midwest Region

17. Illinois

Paramedic: $42,000-$68,000 (Avg: $52,000, Chicago $62K) RN: $72,000-$102,000 (Avg: $82,000, Chicago $95K) PA: $95,000-$135,000 (Avg: $112,000)

COL: Moderate-High (Chicago 120%, rest 95%) State Tax: 4.95% flat Best Markets: Chicago ($95K RN), suburbs ($85K), Rockford/Peoria ($75K) Value Rating: ★★★☆☆ (Chicago) ★★★★☆ (Outside Chicago)

18. Ohio

Paramedic: $38,000-$58,000 (Avg: $46,000) RN: $66,000-$88,000 (Avg: $75,000) PA: $92,000-$125,000 (Avg: $105,000)

COL: Low (92%) State Tax: 0-3.99% Best Markets: Columbus ($78K RN), Cleveland ($76K), Cincinnati ($75K) Major Employers: Cleveland Clinic, Ohio State Wexner Medical, Cincinnati Children's Value Rating: ★★★★★ (EXCELLENT - Good salaries, low COL, top healthcare institutions)

Best for: 68W veterans targeting premier healthcare (Cleveland Clinic), excellent value

19. Michigan

Paramedic: $38,000-$62,000 (Avg: $48,000) RN: $68,000-$92,000 (Avg: $78,000) PA: $95,000-$130,000 (Avg: $108,000)

COL: Low-Moderate (91%) State Tax: 4.25% flat Value Rating: ★★★★☆

20. Indiana

Paramedic: $36,000-$56,000 (Avg: $44,000) RN: $64,000-$84,000 (Avg: $72,000) PA: $90,000-$120,000 (Avg: $102,000)

COL: Low (90%) State Tax: 3.15% flat Value Rating: ★★★★☆

21. Wisconsin

Paramedic: $40,000-$62,000 (Avg: $48,000) RN: $68,000-$90,000 (Avg: $77,000) PA: $95,000-$128,000 (Avg: $108,000)

COL: Low-Moderate (97%) State Tax: 3.54-7.65% Value Rating: ★★★★☆

22. Minnesota

Paramedic: $42,000-$68,000 (Avg: $52,000) RN: $75,000-$105,000 (Avg: $88,000) PA: $100,000-$140,000 (Avg: $118,000)

COL: Moderate (101%) State Tax: 5.35-9.85% Best Markets: Minneapolis-St. Paul ($95K RN), Rochester (Mayo Clinic) Major Employers: Mayo Clinic, University of Minnesota Health Value Rating: ★★★★☆ (Excellent healthcare system, moderate value)

Best for: 68W veterans targeting Mayo Clinic or top-tier healthcare

23. Missouri

Paramedic: $36,000-$56,000 (Avg: $44,000) RN: $62,000-$82,000 (Avg: $70,000) PA: $88,000-$118,000 (Avg: $100,000)

COL: Low (89%) State Tax: 0-5.3% Value Rating: ★★★★☆

24. Iowa

Paramedic: $38,000-$58,000 (Avg: $46,000) RN: $62,000-$82,000 (Avg: $70,000) PA: $90,000-$120,000 (Avg: $102,000)

COL: Low (90%) State Tax: 0.33-8.53% Value Rating: ★★★★☆

25. Kansas

Paramedic: $36,000-$56,000 (Avg: $44,000) RN: $62,000-$82,000 (Avg: $70,000) PA: $88,000-$118,000 (Avg: $100,000)

COL: Low (87%) State Tax: 3.1-5.7% Value Rating: ★★★★☆

26. Nebraska

Paramedic: $38,000-$58,000 (Avg: $46,000) RN: $64,000-$84,000 (Avg: $72,000) PA: $92,000-$122,000 (Avg: $104,000)

COL: Low (91%) State Tax: 2.46-6.84% Value Rating: ★★★★☆

27. South Dakota

Paramedic: $36,000-$54,000 (Avg: $43,000) RN: $60,000-$78,000 (Avg: $67,000) PA: $88,000-$115,000 (Avg: $98,000)

COL: Low (88%) State Tax: NONE (0%) Value Rating: ★★★★☆ (No state tax helps offset lower salary)

28. North Dakota

Paramedic: $38,000-$60,000 (Avg: $46,000) RN: $64,000-$86,000 (Avg: $73,000) PA: $90,000-$122,000 (Avg: $102,000)

COL: Low-Moderate (96%) State Tax: 1.1-2.9% Value Rating: ★★★★☆

Western Mountain Region

29. Colorado

Paramedic: $42,000-$68,000 (Avg: $52,000, Denver $60K) RN: $72,000-$100,000 (Avg: $82,000, Denver $92K) PA: $98,000-$135,000 (Avg: $115,000)

COL: High (Denver 121%, rest 105%) State Tax: 4.4% flat Best Markets: Denver/Boulder ($92K RN), Colorado Springs ($78K), Fort Collins ($80K) Value Rating: ★★★☆☆ (High COL offsets good salaries)

Best for: 68W veterans valuing outdoor recreation, don't mind COL, growing healthcare market

30. Utah

Paramedic: $38,000-$58,000 (Avg: $46,000) RN: $65,000-$88,000 (Avg: $74,000) PA: $92,000-$125,000 (Avg: $105,000)

COL: Moderate (102%) State Tax: 4.85% flat Value Rating: ★★★★☆

31. Wyoming

Paramedic: $38,000-$58,000 (Avg: $46,000) RN: $64,000-$84,000 (Avg: $72,000) PA: $92,000-$122,000 (Avg: $104,000)

COL: Low-Moderate (92%) State Tax: NONE (0%) Value Rating: ★★★★☆ (No state tax, low population, limited healthcare jobs)

32. Montana

Paramedic: $36,000-$56,000 (Avg: $44,000) RN: $62,000-$82,000 (Avg: $70,000) PA: $88,000-$118,000 (Avg: $100,000)

COL: Moderate (100%) State Tax: 1-6.75% Value Rating: ★★★☆☆

Note: Lower population means fewer healthcare jobs but potential for rural health loan forgiveness programs

33. Idaho

Paramedic: $36,000-$56,000 (Avg: $44,000) RN: $62,000-$84,000 (Avg: $71,000) PA: $88,000-$118,000 (Avg: $100,000)

COL: Moderate (101%) State Tax: 0-5.8% Value Rating: ★★★☆☆

Southwest Region

34. Arizona

Paramedic: $40,000-$65,000 (Avg: $50,000) RN: $72,000-$98,000 (Avg: $82,000) PA: $95,000-$135,000 (Avg: $112,000)

COL: Moderate (Phoenix 103%, Tucson 96%) State Tax: 2.55-4.5% Best Markets: Phoenix ($85K RN), Tucson ($78K), Flagstaff ($75K) Major Employers: Mayo Clinic Phoenix, Banner Health, HonorHealth Value Rating: ★★★★☆ (Good value, growing healthcare market)

Best for: 68W veterans wanting warm climate, growing job market, reasonable COL

35. New Mexico

Paramedic: $36,000-$56,000 (Avg: $44,000) RN: $64,000-$84,000 (Avg: $72,000) PA: $90,000-$120,000 (Avg: $102,000)

COL: Low (93%) State Tax: 1.7-5.9% Value Rating: ★★★★☆

36. Nevada

Paramedic: $42,000-$72,000 (Avg: $54,000, Las Vegas $62K) RN: $78,000-$108,000 (Avg: $88,000, Las Vegas $98K) PA: $100,000-$145,000 (Avg: $118,000)

COL: Moderate (106%) State Tax: NONE (0%) Best Markets: Las Vegas ($98K RN), Reno ($88K) Value Rating: ★★★★★ (EXCELLENT - No state tax, good salaries, moderate COL)

Best for: 68W veterans maximizing take-home pay, no state income tax, growing healthcare market

37. Texas

Paramedic: $38,000-$65,000 (Avg: $48,000) RN: $68,000-$95,000 (Avg: $78,000) PA: $95,000-$135,000 (Avg: $110,000)

COL: Moderate (varies: Houston 93%, Austin 119%, DFW 97%, San Antonio 91%) State Tax: NONE (0%) Best Markets: Houston ($82K RN), Dallas-Fort Worth ($80K), Austin ($85K), San Antonio ($75K) Major Employers: Texas Medical Center (Houston - largest medical complex), Baylor Scott & White, HCA Texas Value Rating: ★★★★★ (EXCELLENT - No state tax, huge healthcare market, reasonable COL)

Best for: 68W veterans wanting no income tax, massive healthcare job market, affordable living (especially Houston, San Antonio)

Real Example: RN making $80K in Texas keeps ~$6,500 more than same salary in California, and housing costs 50% less in Houston vs. LA.

38. Oklahoma

Paramedic: $34,000-$52,000 (Avg: $41,000) RN: $60,000-$78,000 (Avg: $67,000) PA: $88,000-$118,000 (Avg: $100,000)

COL: Very Low (87%) State Tax: 0.25-4.75% Value Rating: ★★★★☆

Pacific West Region

39. California

Paramedic: $48,000-$95,000 (Avg: $62,000, Bay Area/LA $75K-$95K) RN: $98,000-$145,000+ (Avg: $118,000, Bay Area $130K-$145K+) PA: $108,000-$155,000+ (Avg: $128,000)

COL: Very High (varies: SF 180%, LA 145%, San Diego 140%, Sacramento 115%) State Tax: 1-13.3% (highest in nation) Best Markets: Bay Area ($135K-$145K RN), Los Angeles ($120K-$135K), San Diego ($115K-$130K), Sacramento ($110K-$120K) Major Employers: Kaiser Permanente (excellent pay), Stanford Health, UCSF, Cedars-Sinai, UC Health Value Rating: ★★★☆☆ (Highest salaries but extremely high COL and taxes)

Best for: 68W veterans wanting absolute highest salaries, don't mind extreme COL, target Kaiser Permanente

Reality Check: CA RN making $135K pays ~$18K state income tax and faces housing costs 2-3x national average. Take-home purchasing power may equal $85K in Texas.

40. Washington

Paramedic: $48,000-$78,000 (Avg: $58,000, Seattle $68K) RN: $85,000-$125,000 (Avg: $98,000, Seattle $108K) PA: $105,000-$150,000 (Avg: $124,000)

COL: High (Seattle 142%, Spokane 102%) State Tax: NONE (0%) - but high sales tax Best Markets: Seattle ($110K RN), Tacoma ($95K), Spokane ($85K) Major Employers: UW Medicine, Providence Health, Virginia Mason, MultiCare Value Rating: ★★★★☆ (Excellent - High salary, no income tax offsets high COL)

Best for: 68W veterans wanting no state income tax, West Coast, good healthcare market

41. Oregon

Paramedic: $45,000-$72,000 (Avg: $54,000) RN: $85,000-$120,000 (Avg: $96,000) PA: $100,000-$145,000 (Avg: $118,000)

COL: High (Portland 128%, rest 105%) State Tax: 4.75-9.9% Best Markets: Portland ($105K RN), Eugene ($90K), Salem ($88K) Value Rating: ★★★☆☆

42. Alaska

Paramedic: $48,000-$78,000 (Avg: $58,000) RN: $85,000-$120,000 (Avg: $98,000) PA: $105,000-$145,000 (Avg: $122,000)

COL: Very High (128%) State Tax: NONE (0%) Best Markets: Anchorage, Fairbanks Value Rating: ★★★☆☆ (High salary, no tax, but extreme COL and isolation)

Best for: 68W veterans wanting adventure, high earnings, no state tax, don't mind isolation

43. Hawaii

Paramedic: $42,000-$68,000 (Avg: $52,000) RN: $88,000-$118,000 (Avg: $98,000) PA: $100,000-$140,000 (Avg: $115,000)

COL: Highest in Nation (192%) State Tax: 1.4-11% Value Rating: ★★☆☆☆ (High salary but extreme COL makes it poor value)

Remaining States (Quick Reference)

44. Arkansas

Paramedic: $34K-$52K | RN: $58K-$76K | PA: $88K-$115K COL: Very Low (86%) | State Tax: 2-4.9% | Value: ★★★★☆

45. Kentucky

Paramedic: $35K-$54K | RN: $60K-$80K | PA: $88K-$118K COL: Low (89%) | State Tax: 4.5% flat | Value: ★★★★☆

46. West Virginia

Paramedic: $34K-$52K | RN: $58K-$76K | PA: $85K-$115K COL: Very Low (85%) | State Tax: 2.36-5.12% | Value: ★★★☆☆

47. Maine

Paramedic: $38K-$58K | RN: $68K-$90K | PA: $95K-$130K COL: Moderate (102%) | State Tax: 5.8-7.15% | Value: ★★★☆☆

48. Vermont

Paramedic: $38K-$60K | RN: $68K-$92K | PA: $95K-$130K COL: High (115%) | State Tax: 3.35-8.75% | Value: ★★★☆☆

49. New Hampshire

Paramedic: $40K-$64K | RN: $72K-$98K | PA: $100K-$138K COL: High (112%) | State Tax: NONE (0% on wages) | Value: ★★★★☆

50. Rhode Island

Paramedic: $42K-$64K | RN: $75K-$102K | PA: $98K-$135K COL: High (113%) | State Tax: 3.75-5.99% | Value: ★★★☆☆

51. District of Columbia (Washington DC)

Paramedic: $48K-$75K | RN: $82K-$115K | PA: $105K-$150K COL: Very High (155%) | State Tax: 4-10.75% | Value: ★★☆☆☆

Top 10 States for 68W Veterans: Overall Value Rankings

1. Texas ★★★★★

RN Salary: $78,000 | COL: 93-97% | State Tax: NONE Why #1: No income tax, massive healthcare market, low-moderate COL, huge veteran population, multiple VA facilities Best Cities: Houston (best value), San Antonio, Dallas-Fort Worth

2. Florida ★★★★★

RN Salary: $78,000 | COL: 102% | State Tax: NONE Why #2: No income tax, large healthcare market, moderate COL, warm weather, many VA facilities Best Cities: Tampa, Jacksonville, Orlando

3. Tennessee ★★★★★

RN Salary: $72,000 | COL: 89% | State Tax: NONE Why #3: No income tax, low COL means high purchasing power, growing healthcare market Best Cities: Nashville, Memphis, Chattanooga

4. Ohio ★★★★★

RN Salary: $75,000 | COL: 92% | State Tax: Low (0-3.99%) Why #4: Premier healthcare institutions (Cleveland Clinic), low COL, good salaries Best Cities: Cleveland, Columbus, Cincinnati

5. North Carolina ★★★★★

RN Salary: $74,000 | COL: 94% | State Tax: 4.75% Why #5: Great value, quality of life, Duke/UNC Health systems, reasonable COL Best Cities: Charlotte, Raleigh-Durham, Greensboro

6. Nevada ★★★★★

RN Salary: $88,000 | COL: 106% | State Tax: NONE Why #6: No income tax, higher salaries, moderate COL, growing market Best Cities: Las Vegas, Reno

7. Washington ★★★★☆

RN Salary: $98,000 | COL: 120-142% | State Tax: NONE Why #7: No income tax, high salaries offset COL, excellent healthcare systems Best Cities: Seattle, Tacoma, Spokane

8. Pennsylvania ★★★★☆

RN Salary: $82,000 | COL: 101% | State Tax: 3.07% flat Why #8: Moderate everything - good balance, reasonable value Best Cities: Philadelphia, Pittsburgh, Harrisburg

9. Georgia ★★★★☆

RN Salary: $75,000 | COL: 92% | State Tax: Moderate Why #9: Low COL, Atlanta healthcare market, reasonable salaries Best Cities: Atlanta, Augusta, Savannah

10. Arizona ★★★★☆

RN Salary: $82,000 | COL: 100-103% | State Tax: Low Why #10: Growing market, reasonable COL, warm climate, Mayo Clinic Phoenix Best Cities: Phoenix, Tucson

States to Avoid for Value (Salary vs. COL)

Worst Value:

1. Hawaii - Extreme COL (192%) negates high salary
2. District of Columbia - Very high COL (155%), high taxes, limited market
3. California (Bay Area) - Extreme COL (180%), highest taxes (13.3%), $145K feels like $80K elsewhere
4. New York City - Extreme COL (187%), high taxes, $130K struggles
5. Connecticut - Very high COL, high taxes, limited improvement over lower-COL states

Lower Opportunity States (Small Healthcare Markets):

• Wyoming: Low population, very limited jobs
• Montana: Rural, small healthcare market
• Vermont: Small population, limited opportunities
• Alaska: Isolated, extreme COL, niche market
• West Virginia: Lower salaries, limited job growth

Special Considerations

States With No Income Tax (Best for Maximizing Take-Home):

1. Texas - Massive healthcare market
2. Florida - Large market, warm weather
3. Tennessee - Growing market, low COL
4. Nevada - Growing market, entertainment industry healthcare
5. Washington - Excellent market, Pacific Northwest
6. South Dakota - Small market
7. Wyoming - Very small market
8. Alaska - Remote, niche opportunities
9. New Hampshire - No tax on wages

Savings from no state income tax:

• RN making $80K saves $4,800-$6,400 annually vs. states with 6-8% tax
• Over 30-year career: $144,000-$192,000 additional take-home

States With Rural Health Loan Forgiveness Programs:

Many states offer significant loan repayment for healthcare workers serving underserved areas:

• National Health Service Corps (NHSC): Up to $50,000 loan forgiveness for 2 years service in underserved area (any state)
• North Dakota: Up to $52,000 for healthcare workers
• Montana: Up to $30,000 for nurses in rural areas
• New Mexico: Significant loan repayment programs
• Kentucky: Rural healthcare loan forgiveness
• West Virginia: Strong rural health programs

Best strategy: Start career in underserved area, get $40K-$50K loan forgiveness, then relocate to higher-paying market debt-free

States With Best VA Healthcare Systems (Employment Opportunities):

1. Texas - 9 major VA facilities
2. California - 8 major VA systems
3. Florida - 5 VA medical centers
4. Pennsylvania - 4 major VA facilities
5. North Carolina - 3 VA medical centers + military treatment facilities

Salary Comparison: Same Credentials, Different Locations

Scenario: 68W Veteran, Registered Nurse, 3 Years Experience

Location	RN Salary	State Tax	Fed Tax	COL Index	Housing/Year	Take-Home + COL
San Francisco, CA	$140,000	$18,200	$22,000	180%	$42,000	$57,800 effective
Seattle, WA	$110,000	$0	$16,500	142%	$30,000	$63,500 effective
Houston, TX	$82,000	$0	$12,000	93%	$18,000	$52,000 effective
Charlotte, NC	$76,000	$3,610	$10,800	94%	$16,800	$44,790 effective
Nashville, TN	$74,000	$0	$10,400	89%	$15,600	$48,000 effective

Analysis: Seattle WA offers best overall value - high salary, no state tax, while COL is manageable. San Francisco has highest raw salary but worst purchasing power. Houston/Nashville/Charlotte offer strong value at lower absolute salaries.

Cost of Relocation Analysis

Is it worth relocating for higher salary?

Example: 68W RN currently in North Carolina ($76K) considering move to Washington state ($110K)

Salary difference: $34,000 annually

Relocation costs:

• Moving expenses: $3,000-$8,000
• First/last/deposit on housing: $6,000-$10,000
• Travel and temporary housing: $2,000-$4,000
• Total: $11,000-$22,000

COL difference:

• NC housing: $16,800/year
• WA housing: $30,000/year
• Difference: $13,200/year

Net benefit first year: $34,000 salary increase - $13,200 COL - $15,000 relocation = $5,800 positive

Net benefit year 2+: $34,000 - $13,200 = $20,800 annually

5-year total benefit: $89,800

Verdict: YES - Worth relocating if significant salary difference (20%+) and manageable COL increase

When relocation ISN'T worth it:

Example: Texas RN ($80K, no state tax) considering California ($130K, 9.3% tax)

Apparent difference: $50,000

Reality after taxes and COL:

• CA state tax: -$12,000
• COL difference (housing, food, etc.): -$25,000
• Net benefit: $13,000

Plus factors:

• Relocation costs: -$15,000 first year
• Quality of life impacts: Traffic, stress, etc.
• Distance from family/support network

Verdict: Marginal benefit, lifestyle factors outweigh financial gain for many

Bottom Line: Where Should You Go?

For Maximum Take-Home Pay:

1. Washington (Seattle/Tacoma) - $110K RN, no state tax
2. California (Bay Area/LA) - $130K-$145K RN (but extreme COL)
3. Oregon (Portland) - $105K RN
4. Nevada (Las Vegas) - $98K RN, no state tax
5. Massachusetts (Boston) - $105K RN

For Best Value (Purchasing Power):

1. Texas (Houston, San Antonio, DFW) - $78K-$85K RN, no tax, low COL
2. Tennessee (Nashville, Memphis) - $72K RN, no tax, very low COL
3. Florida (Tampa, Jacksonville) - $78K RN, no tax, moderate COL
4. Ohio (Cleveland, Columbus) - $75K RN, low COL, premier healthcare
5. North Carolina (Charlotte, Raleigh) - $74K RN, low COL, quality of life

For Premier Healthcare Institutions:

1. Massachusetts - Mass General, Beth Israel, Brigham and Women's
2. Minnesota - Mayo Clinic
3. Ohio - Cleveland Clinic
4. Pennsylvania - Penn Medicine, UPMC
5. Maryland - Johns Hopkins

For Work-Life Balance:

1. North Carolina - Moderate pace, good healthcare, affordable
2. Tennessee - Low COL, growing healthcare, reasonable pace
3. Virginia (outside NoVA) - Quality of life, veteran-friendly
4. Pennsylvania (Pittsburgh, Harrisburg) - Affordable, good healthcare
5. Arizona (Phoenix, Tucson) - Warm weather, reasonable pace

For Veteran Community and Support:

1. Texas - Huge veteran population, many military installations
2. Virginia - Military-adjacent, strong veteran services
3. North Carolina - Large military presence
4. Florida - Large veteran population, many VA facilities
5. California - Large veteran population, 8 VA systems

Salary Negotiation Tips by Region

High-COL Markets (CA, NY, MA):

• Negotiate housing stipends: "I'm relocating from [state], can you assist with housing costs?"
• Sign-on bonuses: $5,000-$25,000 common in high-cost markets
• Relocation assistance: $3,000-$10,000
• Student loan repayment: Some hospitals offer $5,000-$20,000
• Leverage multiple offers: These markets are competitive

No-Tax States (TX, FL, TN, NV, WA):

• Emphasize your value: "No state income tax was a major factor in my relocation decision"
• Ask about shift differentials: Night/weekend shifts add $10K-$20K annually
• Negotiate experience credit: Your 68W time should count for experience steps
• Request veteran premium: Some employers offer veteran preference pay

Mid-Market Regions:

• Compare to regional averages: "The regional average for RN with my experience is $X"
• Highlight specialized skills: Trauma, critical care, ER experience from 68W background
• Ask about certification bonuses: Some hospitals pay premiums for ACLS, PALS, trauma certs
• Inquire about tuition assistance: For PA or NP school

Action Plan: Choosing Your Location

Step 1: Identify Your Priorities

Rank these factors 1-5:

• Maximum absolute salary
• Best value (purchasing power)
• No state income tax
• Veteran community
• Family proximity
• Climate preferences
• Healthcare institution prestige
• Work-life balance
• Job market size (more opportunities)
• Cost of living

Step 2: Shortlist 3-5 States

Based on priorities, select target states

Step 3: Research Specific Cities/Markets

• Job availability (Indeed, LinkedIn searches)
• Housing costs (Zillow, Apartments.com)
• Commute times and transportation
• VA facilities and veteran services
• Quality of life factors

Step 4: Apply Strategically

• Target 3-5 cities
• Apply to 10-20 positions per city
• Highlight 68W clinical experience
• Mention relocation willingness

Step 5: Negotiate Offers

• Use salary data from this guide
• Ask for relocation assistance
• Negotiate sign-on bonus
• Request experience credit

Salary Projections: 10-Year Earnings by Location

Scenario: 68W Veteran → RN → Career Progression

High-Salary Track (California, Washington):

• Years 1-2: $110,000 (New grad RN)
• Years 3-5: $125,000 (Experienced RN)
• Years 6-8: $140,000 (Senior RN or Charge Nurse)
• Years 9-10: $155,000 (Nurse Manager or advanced practice)
• 10-Year Total: $1,325,000
• After taxes and COL: ~$750,000 purchasing power

Best-Value Track (Texas, Tennessee, Florida):

• Years 1-2: $75,000 (New grad RN)
• Years 3-5: $85,000 (Experienced RN)
• Years 6-8: $95,000 (Senior RN or Charge Nurse)
• Years 9-10: $105,000 (Nurse Manager)
• 10-Year Total: $915,000
• After taxes (zero state tax) and low COL: ~$680,000 purchasing power

Verdict: High-salary markets offer $70K-$90K more purchasing power over 10 years, but requires tolerating high COL. Best-value markets offer 90% of the benefit with better lifestyle.

Bottom Line for 68W Veterans

Your healthcare career salary will vary 50-100% based solely on where you choose to work.

Highest absolute salaries: California ($110K-$145K RN), Washington ($95K-$125K), Massachusetts ($90K-$125K)

Best value (purchasing power): Texas ($78K RN, no tax, low COL), Tennessee ($72K RN, no tax, very low COL), Florida ($78K RN, no tax, moderate COL), Ohio ($75K RN, low COL)

Critical insight: A $130,000 salary in San Francisco provides similar purchasing power to $75,000 in Nashville due to taxes and cost of living differences.

Strategic approach:

1. Prioritize no-income-tax states (TX, FL, TN, NV, WA) for maximum take-home
2. Consider mid-tier markets (OH, NC, PA, GA) for balance of salary and value
3. Target specific high-value cities: Houston, Nashville, Tampa, Las Vegas, Charlotte, Columbus
4. Avoid extreme COL markets (SF, NYC, DC) unless pursuing premier institutions
5. Use rural health loan forgiveness programs strategically ($40K-$50K forgiveness)

Your 68W experience is valuable nationwide. Choose your location strategically to maximize earnings, quality of life, and career growth.

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Ready to research your target locations? Use the career planning tools at Military Transition Toolkit to compare salaries, calculate take-home pay, and connect with veteran healthcare professionals in your target states.