Physician Assistant Salary 2026 Deep Dive: By Specialty, State, and Setting
Ava Health Team||9 min read
The physician assistant market in 2026 is one of the fastest-growing in healthcare, with the BLS projecting 28% growth through 2031 — nearly seven times the average for all occupations. Compensation has kept pace: median PA total compensation (base + bonus + benefits) is up roughly 12% since 2023. This guide breaks down what PAs are actually making in 2026 by specialty, state, and setting so candidates and recruiters have a shared reference for offer conversations.
Headline 2026 numbers
| Metric | 2026 Value | YoY change |
|---|---|---|
| Median total cash comp (all specialties) | $132,000 | +4.5% |
| Top-quartile total cash comp (all specialties) | $165,000 | +5.1% |
| Surgical subspecialty median | $158,000 | +5.8% |
| Dermatology PA median | $175,000 | +7.2% |
| Emergency medicine PA median | $148,000 | +4.2% |
| Signing bonus median (new-hire, perm role) | $12,500 | +25% |
| Retention bonus median (at 2-year tenure) | $10,000 | +11% |
Source: AAPA Salary Report 2026, Medscape PA Compensation Report 2026, and Ava Health 2026 placement data (n=187 PA placements).
PA salary by specialty (2026 median + top-quartile)
| Specialty | Median | Top-quartile | Setting notes |
|---|---|---|---|
| Dermatology | $175,000 | $210,000 | Cosmetic + MOHS assist; private practice premium |
| Cardiothoracic Surgery | $170,000 | $205,000 | First-assist required; CVT PA shortage |
| Orthopedic Surgery | $158,000 | $195,000 | First-assist + clinic; sports med pays best |
| Emergency Medicine | $148,000 | $180,000 | Shift differentials + productivity |
| Neurosurgery | $155,000 | $190,000 | Academic centers; call stipends add $10-25K |
| Anesthesiology / Pain | $152,000 | $182,000 | Non-procedural; lower volume days |
| Gastroenterology | $140,000 | $165,000 | Endoscopy assist; private practice shift |
| Hospitalist | $135,000 | $160,000 | 7-on-7-off common; nocturnist premium |
| Urology | $140,000 | $165,000 | Robotic first-assist pays $10-15K premium |
| Primary Care (FM/IM/Peds) | $120,000 | $140,000 | Community health + FQHC loan repayment |
| Psychiatry / Mental Health | $128,000 | $155,000 | Telehealth friendly; licensing easier |
| Oncology | $138,000 | $162,000 | Academic + pharma collaboration bonuses |
PA salary by state (2026, total cash comp median)
Location matters more than most recruiters admit. The same specialty can pay 35-40% more in high-cost markets. That said, cost-of-living adjustments usually don't cover the gap — meaning real take-home in places like California and Alaska stays higher even after taxes and rent.
| State | Median | Top-quartile | Notable markets |
|---|---|---|---|
| Alaska | $158,000 | $185,000 | Anchorage; rural loan forgiveness stacks |
| California | $152,000 | $185,000 | LA, SF, San Diego; academic premium |
| Connecticut | $148,000 | $178,000 | Hartford, Yale New Haven |
| Washington | $142,000 | $170,000 | Seattle + Spokane; no state income tax |
| Nevada | $140,000 | $165,000 | Las Vegas shortage market |
| New York | $139,000 | $175,000 | NYC premium; upstate discount |
| New Jersey | $138,000 | $170,000 | Near-NYC commute premium |
| Massachusetts | $136,000 | $168,000 | Boston academic medical centers |
| Minnesota | $134,000 | $160,000 | Mayo network; strong benefits |
| Texas | $130,000 | $158,000 | Houston + Austin + DFW; no state tax |
| Florida | $128,000 | $155,000 | Tampa, Miami, Orlando; retiree demand |
| Illinois | $128,000 | $150,000 | Chicago metro + academic |
| Ohio | $124,000 | $145,000 | Cleveland Clinic + OSU Wexner |
| Pennsylvania | $124,000 | $148,000 | Philly + Pittsburgh academic |
| Georgia | $122,000 | $145,000 | Atlanta metro; rural loan programs |
| Oklahoma | $118,000 | $140,000 | Tulsa, OKC; rural loan repayment |
| Mississippi | $115,000 | $135,000 | Jackson + UMMC; rural incentives |
| Alabama | $114,000 | $130,000 | Birmingham + UAB; Huntsville growth |
PA pay by setting
| Setting | Median comp | Pay drivers |
|---|---|---|
| Hospital (inpatient) | $135,000 | Shift differentials, call pay, 401(k) match |
| Academic medical center | $128,000 | Lower base, stronger benefits + CME budget |
| Private practice (surgical) | $158,000 | Production-based; first-assist billing |
| Private practice (dermatology) | $175,000 | Cosmetic + MOHS shares; top performers hit $250K |
| Federally Qualified Health Center (FQHC) | $110,000 | PSLF + NHSC loan repayment ($50K-$75K) |
| Correctional health | $135,000 | Flat shifts, low-stress days, predictable hours |
| Urgent care / retail clinic | $125,000 | Productivity bonus + evening shift premium |
| Telehealth-only (primary care / psych) | $128,000 | Full remote; state licensing per market |
| Staffing / locum tenens (daily) | $145,000+ | Usually $75-110/hr + housing + CME; no benefits |
Benefits + total package (2026 norms)
- CME budget: $3,000-$5,500 + 5-7 days off annually is standard. Surgical roles commonly hit $7,500+.
- Retirement match: 401(k) 3-6% match is baseline; academic centers + hospitals offer 403(b) with 7-10% match.
- Malpractice: Occurrence-based (best) vs claims-made + tail coverage (asks for tail negotiation upfront).
- Licensing + DEA reimbursement: Expect employer to cover state license + DEA + NCCPA recertification fees. Usually $1,000-$1,500/year.
- Student loan: PSLF (public + nonprofit), NHSC up to $75K for shortage areas, state-specific programs (Florida's MDCR-LRP offers up to $150K over 4 years).
- Signing bonus: $10K-$25K is typical in 2026. Surgical + rural get $30K-$50K. Bonus is usually clawed back on 12-24-month retention.
PA vs. MD/DO vs. NP pay gap (same specialty)
| Specialty | PA (2026) | NP (2026) | MD/DO (2026) | PA discount vs MD |
|---|---|---|---|---|
| Primary Care | $120,000 | $125,000 | $275,000 | 56% |
| Emergency Medicine | $148,000 | $135,000 | $375,000 | 61% |
| Dermatology | $175,000 | $138,000 | $525,000 | 67% |
| Hospitalist | $135,000 | $132,000 | $340,000 | 60% |
| Psychiatry | $128,000 | $155,000 | $320,000 | 60% |
| Orthopedic Surgery (first-assist) | $158,000 | n/a | $640,000 | 75% |
Interesting signal in 2026 data: PMHNPs (psychiatric NPs) actually out-earn PAs in psychiatry because most telehealth psych platforms prefer prescribers with mental-health-specific autonomy laws. In most other specialties PAs and NPs are within a few percent.
How to negotiate a 2026 PA offer
- Get multiple data points before you counter. AAPA 2026 + Medscape 2026 + at minimum one local peer's offer letter. Otherwise you're guessing.
- Ask about the production formula. In surgical + derm roles, "base + production" can double total comp. Ask how the formula kicks in, ceiling, true-up timing.
- Push on sign-on + retention, not base. Base is often grid-locked. Sign-on is budget-flexible. $15K→$25K sign-on is usually an easier ask than $5K on base.
- Pin down malpractice tail coverage upfront. If the employer uses claims-made, get tail coverage language into the offer BEFORE you sign. Otherwise leaving costs you $8K-$25K out of pocket.
- Don't accept a non-compete wider than 15 miles + 1 year. Longer or larger is a red flag — employer knows you'll want to leave.
- Negotiate CME budget + PTO together. Getting $2K more CME is often easier than $2K more base and is pre-tax.
Where Ava Health is placing PAs in 2026
We're seeing the most volume in:
- Dermatology PA (Florida, Texas, California) — $160K-$200K with cosmetic + MOHS billing access
- Orthopedic Surgery PA (first-assist) (Texas, Tennessee, Georgia) — $150K-$185K with OR + clinic split
- Emergency Medicine PA (Ohio, Florida, Texas) — $140K-$175K with shift differentials
- Hospitalist PA (Mississippi, Oklahoma, rural Southeast) — $130K-$160K + FQHC loan repayment
- Psychiatry PA (telehealth) — $120K-$150K fully remote, state-licensing budget provided
Browse current PA openings at providers.avahealth.co/jobs or message a recruiter directly. We'll pull compensation benchmarks for your target specialty + state in the first call.
Related reading: PMHNP Salary by State 2026, Hospitalist 7-on-7-off Contract Guide, Telehealth Medical Licensing Guide.