Healthcare Recruiting
Physician Assistant (PA) Salary Guide 2026: Specialty Breakdown, State Pay, and Negotiation
Physician assistant (PA) compensation has accelerated significantly since 2022, driven by expanded practice authority in multiple states, post-pandemic staffing shortages, and healthcare system reliance on APPs to extend physician capacity. The 2026 national median for full-time PAs is approximately $128,000 — but that number conceals a $60K+ spread between the lowest-paying outpatient primary care positions and the highest-paying surgical and procedural specialties.
This guide covers what PAs are actually earning in 2026 across specialties, settings, and states, plus how to evaluate offers and negotiate effectively.
National Compensation Snapshot — 2026
| Metric | Value (2026) |
|---|---|
| National median total compensation | $128,000 |
| 25th percentile | $105,000 |
| 75th percentile | $155,000 |
| 90th percentile (procedural/surgical specialties) | $185,000+ |
| Median sign-on bonus (employed) | $10,000–$25,000 |
| Median locum tenens rate | $70–$110/hr (specialty-dependent) |
| Typical loan repayment offering (rural) | $20,000–$40,000 over 2–3 years |
PA Compensation by Specialty (2026)
| Specialty | Median Base Salary | Typical Total Comp | Notes |
|---|---|---|---|
| Dermatology | $145,000 | $155,000–$195,000 | High-volume cosmetic + medical; often production-tied |
| Cardiology / Cardiothoracic Surgery | $138,000 | $145,000–$175,000 | Cath lab, device follow-up, structural heart programs |
| Orthopedic Surgery | $135,000 | $140,000–$172,000 | First-assist surgical role commands premium |
| Emergency Medicine | $132,000 | $140,000–$165,000 | Shift-based; night/weekend differentials often add $10–$20K |
| Neurosurgery | $130,000 | $138,000–$165,000 | Spine programs pay the most; neuro ICU also strong |
| General Surgery / Surgical Oncology | $128,000 | $135,000–$160,000 | First-assist + first-call model |
| Urgent Care | $120,000 | $125,000–$145,000 | Shift-based, predictable hours; chain groups pay lower |
| Hospital Medicine (Hospitalist) | $118,000 | $125,000–$148,000 | 7-on-7-off gaining share; night shifts add $8–$15K |
| Critical Care / ICU | $122,000 | $130,000–$155,000 | Intensivist-supervised or independent in some states |
| Oncology | $115,000 | $120,000–$140,000 | Outpatient infusion or inpatient heme-onc |
| Primary Care / Family Medicine | $108,000 | $112,000–$130,000 | Lowest floor; highest supply relative to demand |
| Psychiatry / Behavioral Health | $112,000 | $118,000–$138,000 | Rising rapidly; telehealth panels increasing supply |
PA Compensation by State (Top 10 + Bottom 5)
| State | Median Total Comp | Driver |
|---|---|---|
| Alaska | $162,000 | Rural premium, severe shortage, cost-of-living adj |
| Connecticut | $148,000 | High cost-of-living; dense specialist practices |
| Washington | $145,000 | Tech-adjacent healthcare, Pacific NW demand |
| New Jersey | $143,000 | NYC metro spillover; dense hospital market |
| Nevada | $140,000 | Las Vegas shortage; no nearby training program pipeline |
| California | $138,000 | Largest absolute market but high supply; UCSF/Kaiser scale |
| New York | $135,000 | NYC premium; upstate runs 15% lower |
| Oregon | $133,000 | OHSU + Providence + rural premium outside Portland |
| Massachusetts | $132,000 | Academic medical center density; MGH/Brigham pipeline |
| Colorado | $130,000 | UCHealth + SCL growth; mountain town shortages |
| — Bottom of national range — | ||
| Mississippi | $98,000 | Low absolute comp; rural solo or FQHCs dominant |
| Arkansas | $100,000 | Same; narrow healthcare market |
| West Virginia | $102,000 | WVU Medicine dominant; academic scale compresses salaries |
| Alabama | $104,000 | UAB system caps upward pressure |
| South Carolina | $106,000 | MUSC + Prisma; growing but wages lagging |
W-2 Employed vs 1099 Independent
Most PAs work W-2 employed — either hospital-employed, health system, or large medical group. A growing minority (estimated 12–15% of full-time PAs) work 1099 or mixed structures, particularly in urgent care, dermatology, and locum tenens.
| Structure | Gross Pay Range | Key Trade-off |
|---|---|---|
| W-2 employed (base only) | $100K–$155K | Benefits, PTO, malpractice included; less flexibility |
| W-2 base + wRVU bonus | $115K–$175K | Production upside if volume is there |
| 1099 independent contractor | $130K–$200K gross | SE tax (~15%), no benefits, self-pay malpractice |
| Locum tenens (via agency) | $70–$110/hr all-in | No long-term commitment; housing often covered |
1099 math: a PA billing $90/hr, 40hr/week, 48 weeks/year grosses $172,800. After SE tax ($24,400), malpractice ($5,000–$8,000), health insurance ($8,000–$15,000), and retirement contributions ($6,000+), net take-home often lands at $120K–$135K — comparable to a well-compensated W-2 position. The 1099 value is in flexibility, not raw take-home.
RVU-Based Compensation
RVU (relative value unit) productivity bonuses are increasingly common in outpatient specialty PA roles. Structure typically looks like:
- Base salary: $100K–$120K (lower than flat-salary peers because the production upside exists)
- wRVU target: 3,500–5,500 wRVUs/year (specialty-dependent)
- Conversion factor: $28–$38 per wRVU over target
- Typical production bonus earned: $10K–$40K/year
PAs in dermatology and outpatient surgical specialties are the most likely to hit high production bonuses — particularly in cosmetic-heavy practices where patient volume per session is high and wRVU per visit is significant.
Factors That Move PA Salaries the Most
- Surgical first-assist — PAs with first-assist experience and RNFA/CSFA credentials can command $15K–$35K above base vs clinical-only PAs in the same specialty.
- Night/weekend call — In EM and hospitalist roles, after-hours differentials add $10K–$25K/year. Call pay structures vary widely — per-shift, per-hour, per-call period.
- Rural or underserved setting — Loan repayment ($20K–$40K), housing stipends, and higher base pay are common in rural critical access hospitals and FQHCs to attract and retain PAs.
- Supervising physician autonomy — In states with OTP (Optimal Team Practice) authority or reduced-supervision requirements, PAs running more independent panels can justify higher comp with employers.
- Years of experience — Early-career PAs (1–3 years) start 10–15% below median. PAs with 10+ years and a stable specialty niche are 15–25% above median.
What to Negotiate Beyond Base Salary
Base salary is the most visible but not always the most impactful lever. High-value items to negotiate:
- Sign-on bonus ($10K–$25K typical; up to $40K in shortage specialties) — ask for the full amount with a 2-year clawback rather than graduated payback
- Loan repayment — separate from sign-on; can be structured as a non-taxable benefit in some configurations
- Malpractice tail coverage — if moving from a claims-made policy, ensure the employer covers the tail (can be $15K–$40K if you pay out-of-pocket)
- CME allowance — $2,500–$5,000/year plus 5 days of protected CME leave is market-standard; below-market is $1,000 or fewer days
- Production bonus structure — if offered, negotiate the wRVU target lower and the conversion factor higher; the employer cares more about the floor
- Promotion and title trajectory — "Lead PA," "Senior PA," or "PA Director" designations often come with pay bands 10–15% above staff PA
What We See at Ava Health
PA roles are among the fastest-moving searches in our healthcare recruitment pipeline. Demand is highest in surgical specialties, hospital medicine, and urgent care — particularly in Florida, Texas, North Carolina, and the Mountain West. Employer willingness to pay sign-on bonuses has increased significantly since 2023, and loan repayment sweeteners are now more common than they were pre-pandemic in rural and mid-market positions.
For PAs evaluating offers: the total-comp number matters more than base. A $115K base with a $20K sign-on, $5K CME, fully covered malpractice with tail, and a $3K annual production bonus easily beats a flat $128K offer with no extras.
Related: Anesthesiologist Compensation 2026, Nurse Practitioner Salary Guide, Travel Nurse Salary Guide, Hospitalist Contract Guide 2026.
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