Physician Assistant (PA) Salary Guide 2026: PA-C Pay by Specialty, Setting & State

Physician assistants (PAs) practice across virtually every medical and surgical specialty, and the PA workforce has grown faster than almost any other healthcare profession over the past two decades. In 2026, PA compensation ranges from the high $90s in entry-level primary care roles to over $185,000 for experienced surgical PAs in high-volume procedural settings. This guide covers current PA salary benchmarks by specialty and setting, with data on NCCPA specialty certifications, locum rates, and geographic differentials.

PA salary by specialty and setting

Specialty is the strongest predictor of PA compensation — procedural and high-acuity settings consistently outpay cognitive outpatient roles:

• Surgical PA (first assist): $130,000–$185,000; cardiovascular surgery, orthopedic surgery, neurosurgery, and general surgery first-assist roles; compensation often includes call pay and OR case volume bonuses; highest-paying PA segment
• Emergency medicine PA: $120,000–$165,000; shift-based scheduling; night/weekend differentials add $8–$15/hour; fast-track and main ED roles; high demand in rural and community EDs
• Critical care / ICU PA: $120,000–$170,000; intensivist-embedded models; post-operative ICU and medical ICU; procedures (central lines, intubation, bronchoscopy support) drive comp toward the top of the range
• Orthopedics PA: $120,000–$175,000; clinic + surgical assist hybrid; joint replacement and sports medicine subspecialties at top of range; high case volume and call responsibility drives comp
• Dermatology PA: $110,000–$160,000; outpatient cognitive + procedural mix; cosmetic procedures (botox, fillers, lasers) in non-academic private practices can add substantial revenue-sharing to base
• Hospital medicine / hospitalist PA: $115,000–$155,000; shift-based, often 7-on/7-off scheduling; nocturnist role adds premium; 3-shift weekend differentials common
• Cardiology PA: $115,000–$155,000; outpatient cardiology, heart failure clinic, interventional assist; echo and stress test interpretation adds scope
• Oncology PA: $115,000–$160,000; hematology-oncology and radiation oncology; complex symptom management; academic cancer centers toward top of range
• Psychiatry / behavioral health PA: $105,000–$145,000; growing demand driven by mental health access gaps; telepsychiatry PAs at the higher end through productivity models
• Primary care (FM / IM) PA: $105,000–$140,000; broadest employment segment; academic and FQHC settings often below private practice; NHSC loan repayment available for PAs in shortage areas
• Urgent care PA: $105,000–$138,000; often hourly or per diem; $55–$75/hour for urgent care locum shifts; strong per diem demand in weekend and evening slots
• Neurology PA: $110,000–$145,000; stroke program, epilepsy, movement disorders; academic neurology at lower end due to research time allocation

Locum PA rates

Locum tenens PA demand has grown significantly as independent group practices and hospital systems use locum PAs to cover vacancies and surge capacity:

• Emergency medicine locum PA: $75–$110/hour; housing and travel typically included; multi-week contracts
• Surgical locum PA: $70–$100/hour; first-assist coverage for orthopedics, CV surgery, general surgery
• Hospitalist locum PA: $65–$90/hour; 7-on/7-off block contracts common; rural premium in critical access hospitals
• Primary care locum PA: $60–$85/hour; clinic-based; FQHC and VA locum PA contracts at the lower end but with stable volume

NCCPA certification and specialty CAQs

The PA-C credential from NCCPA (National Commission on Certification of Physician Assistants) is required for PA licensure in all states. Beyond PA-C, NCCPA offers Certificate of Added Qualifications (CAQ) in recognized specialties — these confer a $5,000–$15,000 salary premium in specialties where employer demand is high:

• CAQ-EM (Emergency Medicine): Most commonly sought; significant employer preference in competitive ED hiring markets
• CAQ-HM (Hospital Medicine): Growing recognition as hospitalist medicine formalizes as a PA specialty
• CAQ-ORS (Orthopedic Surgery): Recognized by orthopedic practices and ASC groups; relevant for first-assist roles
• CAQ-PSY (Psychiatry): Growing demand as behavioral health integration expands
• CAQ-NE (Nephrology): Specialized; relevant in dialysis and nephrology group practice

PA salary by state and geography

Geographic location creates meaningful compensation variation, with high-cost states leading on nominal pay but moderate COL markets offering strong purchasing power:

• California / New York: $130,000–$185,000; highest nominal PA salaries; high COL partially offsets; surgical and critical care PAs at the top of the national range
• Washington / Massachusetts: $125,000–$165,000; strong academic medical center and health system market
• Texas / Florida: $115,000–$150,000; no state income tax; strong purchasing power; high travel PA demand in rural and community settings
• Midwest (IL, OH, MN): $108,000–$145,000; moderate COL; academic medical centers and large health system PA programs well-established
• Southeast rural (AL, MS, GA rural): $100,000–$135,000; rural and shortage-area premiums can add $10,000–$25,000; NHSC loan repayment available for primary care PAs in HPSA-designated areas
• Alaska / Wyoming / rural Mountain West: $115,000–$160,000; geographic isolation premium; rural health clinics and critical access hospitals aggressively competing for PA supply

What we see at Ava Health

PAs are increasingly central to how health systems staff both primary care and specialty departments — we see client demand for PAs across emergency medicine, hospital medicine, orthopedics, and behavioral health as the most consistent segments. The shift toward team-based care models (physician + PA + APP team) in procedural specialties like orthopedics and cardiology has expanded the PA placement market significantly. For PAs in our network who are exploring specialty transitions — particularly from primary care to EM, hospitalist, or surgical assist roles — we focus on matching to openings that include specialty-specific mentorship or CAQ support, since those offers tend to have the best long-term retention outcomes.

Related: Family Medicine Physician Salary Guide, Nurse Practitioner Salary Guide, CRNA Salary Guide, Internal Medicine Physician Salary Guide.