I would agree that with interventional fellowship training (pain sports and spine sports) , or medical directorship, or both... It would be hard to get more as new grad over 250K salary...
However based on my experience this last year with jobs in areas at or below 500k population ... It is not unreasonable to make 300K with right benefits package sign on loan repayment ect.
500k base Salary with or without incentives seems odd or possibly "shady", but I guess could be done if you have a large percent of market share referral base no competition own percentage of ancillary imaging dme profits and maybe are instant buy in partner
Just never seen a job like that.
I've looked in western NE too and no 500k jobs there