Physician Assistant Salary by Specialty 2026: Complete Pay Breakdown

# Physician Assistant Salary by Specialty 2026: Complete Pay Breakdown Physician assistant compensation varies dramatically by specialty — a cardiovascular surgery PA can earn nearly double what a primary care PA earns. This guide delivers concrete salary data by specialty, setting, and geography, plus the mechanisms that drive those differences and how to use them in your next contract negotiation. ## National Salary Benchmarks: PA Overview Before drilling into specialties, the baseline: | Metric | Value (2026) | |--------|-------------| | National median (all specialties) | $121,000 | | Entry-level PA (0–2 yrs) | $95,000–$108,000 | | Mid-career PA (5–10 yrs) | $115,000–$135,000 | | Senior PA / Lead (10+ yrs) | $130,000–$160,000+ | | Top 10th percentile | $160,000+ | These are **total cash compensation** figures (base + any production bonuses + call pay). Signing bonuses ($5,000–$20,000) and benefits are separate and highly variable. ## PA Salary by Specialty ### Surgical Specialties (Highest Paying) **Cardiovascular / Cardiothoracic Surgery** - Range: $130,000–$180,000 - Why: OR first assist, complex post-op management in cardiac ICU or step-down. High acuity, high call burden. Median: ~$155,000. - Typical hours: 50–60/week including call. OR availability expected on short notice. **Orthopedic Surgery** - Range: $120,000–$165,000 - Why: High procedural volume (joint replacements, fracture repair), strong OR first-assist demand. Many ortho PAs own their schedule once established. - Median: ~$140,000. - Setting split: hospital-employed vs. private orthopedic practice (private sometimes pays more with lower benefits). **Neurosurgery** - Range: $125,000–$172,000 - Why: Complex patient management, spine and cranial first assist, high-stakes post-op monitoring. Smaller supply of neurosurg-trained PAs inflates pay. - Median: ~$145,000. **Plastic / Reconstructive Surgery** - Range: $110,000–$150,000 - Why: Mix of elective and reconstructive work. Hours more predictable than trauma surgery. Florida plastic surgery market (heavy retirement corridor) pays on the higher end. **General Surgery** - Range: $108,000–$145,000 - Why: OR first assist + floor/ICU management. Call burden is significant at community hospitals. ### Hospital-Based / Procedural Specialties **Cardiovascular / Interventional Cardiology** - Range: $125,000–$165,000 - Why: Cath lab assist, hemodynamic monitoring, post-procedure management. High-acuity, high-value procedures. Call typically involves being on-site for STEMI activations. **Emergency Medicine** - Range: $118,000–$155,000 - Median: ~$132,000. - Why: Autonomous, shift-based (no productivity pressure). Premium for nights, overnight, and weekends (differential pay common: 10–20% above base). No call beyond scheduled shifts. - Florida EM market: high demand, especially in high-growth regions (Naples, Sarasota, Jacksonville). **Critical Care / Intensivist** - Range: $120,000–$162,000 - Why: Complex ventilator management, vasopressors, procedures (central lines, arterial lines). Growing presence in overnight ICU coverage models. Nocturnist premium (overnight-only) can reach $160,000+. **Dermatology** - Range: $115,000–$155,000 - Why: High-productivity outpatient model; many dermatology PAs own busy patient panels. Some earn base + % of revenue (production model). - Florida note: Florida's sun exposure and skin cancer burden make dermatology one of the most in-demand PA specialties in the state. Wait times are 3–6 months at many practices, creating strong demand for PAs who can absorb overflow. ### Outpatient / Primary Care Specialties **Primary Care / Family Medicine** - Range: $95,000–$125,000 - Median: ~$108,000 - Why: High volume, lower per-visit complexity, no call in most outpatient settings. Base salary + panel-size bonuses common. - Production models: some FM PAs earn significant bonuses by exceeding RVU targets. **Internal Medicine (Inpatient Hospitalist)** - Range: $108,000–$140,000 - Why: Shift-based, no OR burden, but 12-hour shifts and variable patient volume. 7-on/7-off schedules are common. Production not typically a factor. **Pediatrics** - Range: $90,000–$118,000 - Why: Generally lower acuity than adult medicine. Peds PAs earn among the lowest nationally, offset by more predictable hours and lower call. **Oncology (Medical)** - Range: $108,000–$145,000 - Why: Complex chemotherapy management, supportive care, clinical trial work. Intellectual complexity is high; workload is less shift-intensive than surgical roles. **Psychiatry** - Range: $100,000–$135,000 - Growth specialty: behavioral health shortage is severe nationally, but particularly acute in rural Florida. Telepsychiatry PAs can earn $130,000+ fully remotely. **Gastroenterology** - Range: $110,000–$148,000 - Why: Endoscopy assist, complex IBD/hepatology management. Procedural PAs in high-volume GI practices can command strong production bonuses. **Urgent Care** - Range: $95,000–$120,000 - Shift-based, no call, high-volume. Corporate urgent care (CityMD, GoHealth, Carbon Health) typically pays lower; independent urgent care chains pay better. Good entry point for new grads. ### Florida-Specific Market Observations Florida's unique demographics (large retiree population, seasonal influx, significant uninsured/Medicaid burden in rural areas) create demand concentrations: - **Orthopedics + joint replacement**: highest demand in Southwest FL, Space Coast, Treasure Coast (active retiree population) - **Dermatology**: statewide shortage, particularly Fort Myers to Naples corridor - **Emergency medicine**: growing trauma designation in newer facilities; EM PA demand is consistent - **Psychiatry / behavioral health**: acute shortage in rural Collier, Hendry, Glades counties - **Oncology**: new cancer center openings (NCH, Lee, AdventHealth expansions) creating sustained demand ## What Drives PA Salary Differences? Understanding the mechanisms helps you negotiate: **1. Procedural volume**: PAs who assist in the OR or perform bedside procedures (intubation, central lines, endoscopy) command higher pay because they generate direct physician productivity leverage. Each surgical case a PA first-assists may generate $2,000–$8,000 in billed revenue — your salary is a small fraction of that. **2. Call burden**: Every specialty that includes on-call pay effectively boosts total compensation. A PA earning $120,000 base + $25,000 in call pay is outperforming a $140,000 base with no call — but also working more. **3. Geographic demand**: Rural and underserved areas consistently pay 10–20% above metro comparators for equivalent specialties. Cost of living doesn't fully offset this. **4. Employment model**: - Hospital employment: lower ceiling, better benefits, predictable hours - Physician group employment: variable (depends on specialty group success) - Direct patient care (some states, limited): higher ceiling, more complexity **5. Production bonuses**: Outpatient specialties increasingly use RVU-based production models. A PA who generates 5,000 RVUs/year at a $48/RVU rate earns $240,000 — but most primary care PAs generate 3,500–4,000 RVUs under typical panel constraints. Know your RVU value before signing a production contract. ## Total Compensation Beyond Base **Signing bonus**: $5,000–$20,000 typical; high-demand specialties (CV surgery, neurosurgery, dermatology) may offer $20,000–$40,000. Note the repayment clause (usually 1–2 year clawback). **CME allowance**: $2,000–$5,000/year typical; negotiable. **Malpractice**: Hospital-employed PAs almost always have employer-provided malpractice (tail coverage included). Private groups may offer occurrence vs. claims-made — always ask about tail coverage. **Benefits**: Health insurance, dental, vision, 401k (3–6% match is standard; 50% match with vesting schedule is typical). Some hospital systems offer pension for long-tenured employees. **Loan forgiveness**: PHS/NHSC programs apply to PAs working in Health Professional Shortage Areas (HPSAs). Florida HPSAs include rural Hendry, Hardee, and DeSoto counties. Loan forgiveness can offset lower rural salaries. ## Negotiation: What to Know **1. Counter with data**: AAPA Salary Report, MGMA data, and Merritt Hawkins surveys are the most credible benchmarks. Cite them directly in negotiation. **2. Counter the whole package, not just base**: If base is firm, push on signing bonus, CME allowance, loan repayment, or earlier review date. **3. RVU rate matters more than base in production models**: A $48/RVU rate vs. $45/RVU rate on 4,000 RVUs is a $12,000 difference. Don't get anchored on base salary. **4. Ask about the production bonus floor**: Most production models include a base salary "draw" against future production. If you don't hit the draw target, do you owe it back? That's a critical distinction. **5. Non-compete clauses**: Florida courts have enforced non-competes for PAs in the past, though the FTC's 2024 non-compete rule created uncertainty. Consult a healthcare attorney if the non-compete radius/duration seems aggressive. ## PA vs. NP: Salary Comparison 2026 A frequent comparison: | | PA | NP | |--|----|----| | National median | $121,000 | $118,000 | | Surgical specialty ceiling | $180,000+ | $140,000 (limited OR role) | | Primary care median | $108,000 | $110,000 | | Remote/telehealth | $105,000–$130,000 | $105,000–$135,000 | Overall, PAs and NPs earn comparably at the national median, but PAs retain a surgical premium that few NP specialty paths match. NPs have a slight edge in independent practice states (Florida is a restricted-practice state for both, but NPs have broader prescriptive autonomy in some outpatient contexts). The more meaningful comparison is specialty match: if your clinical interests are in surgery, PAs have more established pathways. If your interest is in autonomous outpatient practice in a full-practice-authority state, NP may offer more flexibility.