Highest Paid Physician Assistants Salaries by Specialty

Last updated: May 2026.

Physician Assistant Salaries in 2026: What PAs Earn by Specialty

Physician Assistants (PAs), also increasingly referred to as Physician Associates, are medical providers who diagnose illnesses, develop and carry out treatment plans, prescribe medications, perform procedures, and assist in surgeries. Their job responsibilities closely parallel those of physicians or general internists. In its 2026 rankings, U.S. News & World Report named the PA profession the #2 Best Health Care Job for the ninth consecutive year, as well as the #4 Best STEM Job and #5 among the 100 Best Jobs across all occupations.

One traditional distinction between an M.D. and a PA has been that physician assistants must practice under the supervision of a licensed physician. However, that requirement is evolving. As of 2026, seven states (Iowa, Montana, New Hampshire, North Dakota, South Dakota, Wyoming, and Utah) have what the AAPA categorizes as “optimal” scope-of-practice laws, and North Carolina became the largest state to remove supervision requirements for experienced PAs in 2025. PAs earn master’s degrees from accredited programs that typically take approximately 27 months to complete, including both classroom coursework and supervised clinical rotations. For a closer look at how PA roles compare with physician roles, see our breakdown of physician assistant vs. doctor scope and training.

How Much Do Physician Assistants Make in 2026?

PA compensation has risen considerably in recent years, and the latest data confirms that trend. According to the U.S. Bureau of Labor Statistics (May 2024 data, the most current BLS release), the median annual wage for physician assistants is $133,260. The lowest-paid 25% earned $113,770, while the best-paid 25% earned $160,160. The top 10% of PAs earned $182,200 or more per year.

The AAPA’s 2026 Digital Salary Report, released in May 2026 and reflecting 2025 compensation data, shows that median total PA compensation has risen to $140,000, up from $134,000 the previous year, a 4.5% increase. More than 58% of PAs reported receiving a bonus from their primary employer, with a median bonus of $6,000. Approximately 83% of PAs are salaried employees, while 14% are compensated hourly and 3% are paid primarily on productivity.

For new graduates and entry-level PAs (those with 0 to 1 years of experience), the AAPA’s 2025 data shows a median starting salary of approximately $118,000 per year, though starting pay can range from $95,000 to $115,000 depending on geography, specialty, and practice setting. Hospital-based PAs, regardless of specialty type, reported a median compensation of $140,000 according to the AAPA 2025 report.

The job outlook for PAs remains exceptionally strong. The BLS projects employment growth of 20% from 2024 to 2034, much faster than the average for all occupations, with about 12,000 openings for physician assistants projected each year over the decade. This sustained demand is driven by the nationwide shortage of physicians, the cost-effectiveness of PA services, and the profession’s shorter training period compared to medical school and residency. Understanding the factors that affect PA salaries can help you plan your career strategically from the outset.

What Are the Highest Paid Physician Assistant Specialties in 2026?

Like physicians, PAs have the option to specialize in various fields, and some specialties command significantly higher compensation than others. The AAPA’s 2025 Salary Report (covering 2024 compensation data from 8,811 respondents) provides the most comprehensive specialty salary data available. Family medicine remains the most common PA specialty at 16.4% of the workforce, followed by orthopedic surgery at 11.5% and emergency medicine at 7.8%. But the highest-paying specialties tend to be procedural or surgical. Here is how compensation breaks down across the top-paying specialties.

Cardiovascular and Cardiothoracic Surgery

Physician assistants in this specialty work alongside cardiothoracic surgeons to manage patients undergoing heart, lung, or esophageal procedures. They assist throughout the surgical process, from preoperative evaluation through postoperative recovery. According to the AAPA 2025 Salary Report, cardiovascular and cardiothoracic surgery PAs earn a median base salary of $162,914 and a median total compensation of $171,000, making this the highest-paid PA specialty. Approximately 1.9% of PAs work in this field, and they have a median of 11 years of experience. The vast majority (89%) are salaried, and 55% received a bonus. These PAs typically work a median of 45 hours per week. Most PAs in cardiothoracic surgery work in hospital settings.

Dermatology

Dermatology PAs diagnose and treat conditions related to the skin, hair, and nails, performing both medical and minor surgical procedures such as biopsies and excisions. According to the AAPA 2025 data, dermatology PAs earn a median base salary of $140,000 and a median total compensation of $166,000 per year. What sets dermatology apart is its significant bonus potential: the median bonus for dermatology PAs was $21,000, and 60% of those surveyed received a bonus. At the 90th percentile, base salaries in dermatology can reach as high as $290,000, the most extraordinary earning upside of any PA specialty. Roughly 3.8% of PAs specialize in dermatology, with a median of 9 years of experience, and the majority work in office-based private practices. They also tend to work a slightly lighter schedule, with a median of 38 hours per week. If you’re interested in comparing PA earnings with those of the highest-paid doctors in the United States, the gap is noteworthy but so is the difference in training time.

Emergency Medicine

PAs in emergency medicine treat patients in emergency departments, urgent care centers, or critical care units. They manage both acute presentations and chronic conditions that worsen acutely. The AAPA 2025 Salary Report shows that emergency medicine PAs earn a median base salary of $146,000 and a median total compensation of $155,070 per year. Approximately 7.8% of PAs work in emergency medicine, making it one of the larger PA specialties by volume. Emergency medicine PAs have a median of 9 years of experience. However, it is worth noting that burnout rates in emergency medicine have risen sharply since 2020, a trend documented in the NCCPA’s 2024 specialty report.

Urgent Care

Urgent care PAs treat patients with non-life-threatening conditions that still require prompt attention, such as sprains, lacerations, infections, and minor fractures. The AAPA 2025 data reports a median base salary of $138,710 and a median total compensation of $147,000 for urgent care PAs. About 4.5% of PAs work in urgent care, with a median of 9 years of experience. Half are salaried, and 64% received a bonus, with a median bonus of $8,000. Urgent care PAs work a median of 40 hours per week, and the specialty appeals to PAs who prefer a more predictable schedule than hospital-based emergency departments typically allow.

Critical Care

PAs in critical care settings manage patients in intensive care units, handling ventilator management, hemodynamic monitoring, and complex medication adjustments in collaboration with intensivists. The AAPA 2025 report shows critical care PAs earn a median base salary of $141,000 and a median total compensation of $146,000. About 1.7% of PAs work in critical care, and they have a median of 7 years of experience, which is notably lower than several other high-paying specialties. The majority (83%) are salaried, and 46% received a bonus, with a median bonus of $7,000. They work a median of 40 hours per week.

Neurosurgery

Neurosurgery PAs assist neurosurgeons with patient histories, physical exams, intraoperative tasks, and postoperative management of patients with brain, spinal, and peripheral nerve conditions. They often split their time between operating rooms and ICUs. The NCCPA confirms neurosurgery as one of the highest-compensated PA specialties. Previous AAPA data placed the median total compensation for neurosurgery PAs at approximately $129,000, with a median base salary of $124,000, though experienced PAs in this field can earn considerably more. (Neurosurgery was not individually broken out in the AAPA 2025 Top 10, likely due to sample size thresholds.) Most neurosurgery PAs work in hospitals or academic medical centers.

Pathology

In pathology, PAs play a critical role in analyzing laboratory specimens, assisting with autopsies, gross examination of surgical specimens, and preparing pathology reports. Their work is essential to disease diagnosis, even though they work behind the scenes rather than at a patient’s bedside. Median salaries for pathology PAs are approximately $122,000 per year, a figure that has remained relatively stable in recent survey cycles.

Pain Medicine

PAs specializing in pain medicine help diagnose, manage, and treat patients with both chronic and acute pain conditions. They conduct physical exams, interpret diagnostic imaging, administer injections, and coordinate long-term treatment plans. Median salaries for pain medicine PAs are approximately $120,000 or higher per year, with private clinics sometimes offering incentive-based compensation on top of base salary.

Psychiatry

Psychiatric PAs diagnose and treat mental health conditions, including anxiety disorders, depression, bipolar disorder, and substance use disorders. They work primarily in office-based private practices, behavioral health facilities, or hospital psychiatric units. Previous AAPA survey data placed psychiatry PA total compensation at approximately $130,000 per year, though current specialty-specific data from the 2025 report was not individually broken out for this field. Demand for psychiatric PAs has remained strong, reflecting the broader national shortage of mental health providers.

Surgical Subspecialties

This category includes specialties such as gynecologic surgery, ophthalmology, orthopedics, pediatric surgery, plastic surgery, urology, and vascular surgery. PAs in these fields assist with diagnostic exams, intraoperative support, patient care, and pre- and post-surgical management. Orthopedic surgery, the second most common PA specialty overall at 11.5% of the workforce, carries a median base salary of approximately $135,000. Across surgical subspecialties more broadly, median salaries range from $125,000 to $130,000, depending on the specific field and practice setting. Surgical subspecialties are now the most common specialty area for PAs as a group.

PA Salary Comparison Table (2026 Data)

Gender Pay Gap and Burnout Trends Among PAs

While the PA profession offers strong compensation and high career satisfaction (87.1% of PAs report satisfaction, according to the NCCPA’s 2024 statistical profile), the data also reveals disparities worth understanding. On average, male PAs earn $20,892 more annually than female PAs across all specialties. The largest pay gaps by specialty appear in obstetrics and gynecology ($34,069 difference), dermatology ($29,359), and cardiovascular and thoracic surgery ($24,769). These figures come from the NCCPA and underscore a profession-wide issue that prospective PAs should be aware of as they weigh specialty choices and negotiate compensation.

Burnout is another trend worth watching. All PA specialties reported higher burnout rates compared to 2020, with the sharpest increases seen in gastroenterology and emergency medicine. This is consistent with broader healthcare workforce trends, and it is a factor that can affect both career longevity and quality of life. Understanding the realistic day-to-day demands of a specialty, not just its salary, is important when making career decisions.

How PA Practice Authority Is Changing in 2026

The scope of practice for PAs is evolving quickly across the United States. The traditional model required physician assistants to practice under a formal supervisory agreement with a licensed physician. While this remains the standard in many states, a growing number of states have moved to reduce or eliminate these requirements.

In 2025, North Carolina became the largest state to remove supervision requirements for experienced PAs practicing in team-based settings. Seven states now have what the AAPA categorizes as “optimal” PA scope-of-practice laws: Iowa, Montana, New Hampshire, North Dakota, South Dakota, Wyoming, and Utah. Additionally, as of January 1, 2026, a new California law increased the maximum number of PAs a physician may supervise from four to eight in any practice setting.

These legislative shifts reflect growing recognition of the PA role in addressing provider shortages, particularly in rural and underserved communities. For pre-PA students, this means the profession’s autonomy and career flexibility are expanding in meaningful ways. For a broader comparison of how PA and physician roles differ in modern healthcare settings, see our article on physician associate vs. physician: who does what in a modern care team.

Telemedicine and the Evolving PA Workplace

Another notable development in the PA profession is the growing role of telemedicine. According to the AAPA’s 2025 data, about 49% of all PAs used telemedicine in their clinical work within the past year. This is relevant to both salary expectations and career planning, since telemedicine roles may offer different compensation structures, scheduling flexibility, and geographic independence compared to traditional clinical settings. Pre-PA students should factor this trend into their long-term career planning, as comfort with telehealth technology is becoming a practical skill expectation in many PA positions.

What Factors Shape PA Salary Differences?

Specialty is the most visible factor in PA compensation, but it is not the only one. Several other variables consistently affect what a PA earns.

Geographic location plays a significant role. PAs in metropolitan areas and states with higher costs of living tend to earn more, but so do PAs in rural areas with acute provider shortages, where signing bonuses and loan repayment incentives are sometimes offered to attract candidates. Practice setting matters as well: hospital-based PAs reported a median compensation of $140,000, while those in outpatient or private practice settings may see different figures depending on the specialty.

Years of experience consistently correlate with higher compensation. Many of the top-paid specialties in the AAPA data show median experience levels of 7 to 11 years. Bonus and productivity pay can substantially increase total compensation, as the dermatology figures make clear. And hours worked vary meaningfully by specialty: cardiothoracic surgery PAs work a median of 45 hours per week, while dermatology PAs average 38 hours. Salary figures alone do not tell you what a specialty will actually feel like on a weekly basis.

For a more detailed look at the variables that influence PA pay, our guide on factors affecting physician assistant salaries covers geography, experience, negotiation, and more.

How PA Salaries Compare with Other Healthcare Professions

It is useful to put PA compensation in context. The BLS reports that physician salaries are substantially higher on average, but physicians also complete significantly more training: four years of medical school plus three to seven years of residency, compared to the 27-month PA master’s program. Nurse practitioners, another common comparison point, earn a median salary that is somewhat lower than the PA median, though roles and scope overlap in many settings. You can read more about those distinctions in our comparison of nurse practitioner vs. physician assistant. Nursing specialties that command top pay are covered separately in our article on highest-paid nursing specialties.

The PA profession’s combination of strong starting salaries, a relatively short educational path, high career satisfaction, and rapid job growth makes it one of the most appealing healthcare careers available. But the numbers should be weighed alongside personal interests, lifestyle preferences, tolerance for specific work environments, and long-term career goals.

Building a Competitive PA School Application

Getting into PA school is competitive, and strong applications require more than a good GPA. Admissions committees look for meaningful clinical exposure, patient care hours, strong recommendation letters, and evidence that you understand what the PA role involves day to day. Clinical internships, structured shadowing, and mentored healthcare experiences can significantly strengthen your application by demonstrating genuine commitment and practical readiness.

IMA offers pre-PA internship programs that provide structured clinical observation, mentorship, and professional reflection in international healthcare settings. These experiences are designed to give pre-PA students honest exposure to clinical environments, not to replace formal training. Participants observe, support within approved limits, and learn within professionally supervised settings while building the kind of perspective that helps both in applications and in practice.

If you are in the earlier stages of planning and want to understand what a PA internship involves and how to find one, that guide covers what to expect, how to prepare, and what admissions committees actually value.

PA compensation is strong and growing. The profession’s scope is expanding, demand is rising, and specialties offer real earning variation. But the most important first step is gaining the clinical exposure, mentorship, and self-knowledge that help you get into a strong PA program and start your career with clear eyes about what lies ahead.

Frequently Asked Questions

Which physician assistant specialty pays the most in 2026?

Surgical specialties lead PA pay. According to the AAPA, cardiothoracic surgery physician assistants report the highest compensation, with a median base salary of $162,914. Dermatology and emergency medicine also rank among the higher-paying PA fields.

What is the median physician assistant salary in 2026?

The U.S. Bureau of Labor Statistics reports a median PA salary of $133,260 (May 2024 data, the most current release). The AAPA’s latest Salary Report puts median total compensation at $140,000 once bonuses and incentives are included.

Do physician assistant salaries differ by state?

Yes. PA pay varies widely by location, and higher-cost states generally report higher salaries. Because cost of living differs, the state with the highest sticker salary is not always the one with the strongest real wages.

How much can experienced physician assistants earn?

Compensation rises with experience. PAs with 15 to 19 years of experience report a median around $146,000, and those with 20 or more years report about $150,000, more than $32,000 above a new graduate.

Do most physician assistants receive bonuses?

Yes. Roughly 58 percent of full-time PAs received a bonus in 2025 according to the AAPA, so total compensation often exceeds base salary alone.