The 10 states with the highest tax burden in 2026

Two physicians can earn the same salary and keep very different amounts of it, and where they practice plays a big part in why. State and local taxes vary widely from one state to the next, and the gap is wide enough to matter at a physician's income.

A 2026 WalletHub report, "Tax Burden by State," ranks all 50 states by that measure, using data from the Tax Policy Center. The number it uses is tax burden, not tax rate: the share of total personal income that residents pay in property, income and sales and excise taxes combined.

Because it is figured on average income across a state, a physician's own share runs higher wherever the tax is tied to earnings, and the income tax line is the one that moves with a bigger paycheck.

For a high earner the income tax piece usually hits hardest, but property and sales taxes pull their weight too, and some of the heaviest-taxed states lean almost entirely on one. These are the 10 states where WalletHub found the combined burden to be heaviest.