Healthcare Recruiting
Physician Assistant Salary 2026 Deep Dive: By Specialty, State, and Setting
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 freejobpost.co 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.
Hiring in this space?
Ava Health places physicians, nurses, and therapists nationwide
Permanent, locum, and travel placement. No fees to candidates.
Explore staffing services →Free tool
2026 Healthcare Salary Calculator
Estimate comp by specialty, state, experience, and practice setting. Based on MGMA, AMGA, and BLS benchmarks.
Try the salary calculator →Be on the launch list
Salary data, hiring plays, and market trends. We'll email you when issue 1 ships. Free, unsubscribe anytime.
No spam. Unsubscribe anytime. We never share your email.