When I first started looking into the medical world, everyone talked about doctors or nurses. Nobody really gave a straight answer on the "middle ground"—the Physician Assistants (or Physician Associates, as the branding goes now). Honestly, if you’re asking how much do PAs make, you’re probably seeing a lot of conflicting numbers. One site says $110,000 and another screams $180,000.
Both are actually true.
It's weird how much your paycheck changes based on where you stand and what you're holding. A PA in a small family clinic in rural Ohio is living a completely different financial reality than one scrubbing into neurosurgery in downtown San Francisco.
The baseline is impressive, though. According to the Bureau of Labor Statistics (BLS) data for late 2024 and heading into 2026, the median annual wage for physician assistants is sitting right around $133,260. That’s roughly $64 an hour. But "median" is just the middle of the sandwich. The top 10% of earners are clearing $182,200 or more, while the newcomers usually start their journey closer to $95,000.
The Specialty Trap: Why Your Choice of Medicine Matters Most
You might love pediatrics, but your bank account won't. That’s just the cold truth of the American healthcare system. Primary care—which includes family medicine and general pediatrics—is consistently the lowest-paid sector for PAs.
If you want the high numbers, you go where the procedures are.
Cardiothoracic and Vascular Surgery PAs are currently at the top of the food chain. Recent reports from the AAPA (American Academy of Physician Associates) show these pros pulling in a median total compensation of nearly $163,000. Why? Because it’s high-stakes, the hours are brutal, and you're often on call when the rest of the world is sleeping.
Dermatology is the "lifestyle" winner. It's a bit of a unicorn specialty. You get high pay—often around $145,000 to $150,000—without the 3:00 AM emergency trauma calls. Plus, the bonuses in derm are legendary. While a family med PA might get a few thousand bucks as a year-end "thank you," a derm PA can see bonuses of $20,000 or more because they generate so much revenue through procedures and products.
How Much Do PAs Make Across the Country?
Location is the biggest lever you can pull. If you move from a low-paying state to a high-paying one, it’s like getting a $40,000 raise overnight.
California remains the heavyweight champion. PAs there average about $161,980. It sounds like a fortune until you try to rent a two-bedroom apartment in San Jose. That’s the catch. You have to look at the "adjusted" salary.
Interestingly, when you adjust for the cost of living, states like Oklahoma, Michigan, and Missouri actually offer more "real" money. You might earn $130,000 in Oklahoma, but that money buys you a mansion, whereas $160,000 in San Francisco gets you a roommate and a long commute.
- Alaska and Washington also consistently rank in the top five for raw salary.
- The Northeast (Connecticut, New York, New Jersey) is a hotbed for high wages due to the density of major hospital systems.
- The South generally lags behind, but the lower taxes and housing costs can make a $115,000 salary feel much larger.
The Hidden Factors: Bonuses and Ownership
People forget about the "extras." About 57% of full-time PAs received a bonus last year. The median bonus is about $7,500, but in surgical subspecialties, it hits five figures easily.
👉 See also: The Foot Diagram for Organs: What Reflexology Actually Gets Right (and Wrong)
Then there’s the "productivity" model.
Most PAs are on a straight salary. But a growing number—about 5%—are paid based on how many patients they see or how much revenue they bring in (RVUs). These PAs are the ones you hear about making $200,000+. It’s high-reward but high-stress. If you have a slow week, your paycheck reflects it.
Why the 2026 Outlook is Looking Even Better
The demand is just... it's huge. The BLS projects the profession to grow by 27% over the next decade. That is nearly five times faster than the average job.
We have an aging population and a shortage of doctors. PAs are the solution. Hospitals are desperate for clinicians who can hit the ground running, and that desperation is driving up sign-on bonuses. I’ve seen PAs getting $10,000 to $20,000 just to sign a contract, plus student loan repayment assistance.
Negotiating Your Worth
You've got to be your own advocate. Don't just take the first offer.
Employers expect you to counter. If you have a Certificate of Added Qualifications (CAQ) in something like Emergency Medicine or Psychiatry, use it. That piece of paper proves you have advanced skills, and it should be worth at least an extra $5,000 to $10,000 in your base pay.
Also, look at the retirement match. A 3% match vs. a 10% match is a massive difference over a 30-year career.
Actionable Steps for Maximizing Your PA Income:
- Check the AAPA Salary Report yearly. Don't rely on "vibes" or what your coworkers say. Get the hard data for your specific zip code and specialty.
- Get a CAQ. If you've been in your specialty for a few years, take the exam. It’s the easiest way to "level up" your credentials without going back to school.
- Consider Locum Tenens. If you're single or don't mind traveling, "travel PAs" can make $100 to $120 per hour. They often get their housing and travel covered, too.
- Audit your benefits. If your salary is stagnant, negotiate for more CME (Continuing Medical Education) funds or more 401k matching. It’s still money in your pocket.
- Look at Hospital Systems. PAs working in "Government" (like the VA) or "Outpatient Care Centers" often have higher median wages (around $147,000 - $151,000) compared to those in small solo physician offices.
The career is solid. You're helping people, the job security is basically ironclad, and the pay allows for a very comfortable life. Just make sure you aren't leaving money on the table by settling for a "standard" offer in a high-demand market.