Physician Assistant Salary by State (2026): PA-C Pay Compared Across All 50 States

Physician assistant salary by state varies meaningfully across the U.S., though less than for nurse practitioners because PA scope-of-practice is more uniform nationally. The national median for Physician Assistants sits at $140,391, but state-by-state pay across the 51 states tracked here ranges widely — from $108,185 in Alabama to $176,661 in California. That spread reflects state-level cost of living, state Optimal Team Practice (OTP) laws, the local mix of surgical specialty practices versus primary care, the regional density of dermatology / emergency medicine / orthopedic surgery employers, and state-level demand for hospital-employed PAs versus independent practice models.

This page compares the average physician assistant salary by state across 1681+ metropolitan and non-metropolitan areas — drawing on the Bureau of Labor Statistics Occupational Employment and Wage Statistics (OEWS) survey for SOC 29-1071. If you're a working PA-C evaluating relocation, a PA student planning where to start, or a hospital or physician-group recruiter benchmarking pay, the state-level comparison below is the central reference point.

How PA Salary by State Is Measured

The BLS reports state-level PA salary through three numbers:

• Annual median (50th percentile) — used to rank state-level pay in the table below. Most representative measure for PA pay because surgical specialty premiums create a long upper tail in some states.
• Annual mean (average) — typically runs 4–8% above median in most states; states with dense surgical specialty practice (CA, NY, FL, TX) show a wider mean-median spread because senior surgical-first-assist and dermatology PAs pull the average up.
• Percentile distribution (P10 / P25 / P75 / P90) — P10 reflects entry-level PA-Cs in primary care or community-health settings; P90 reflects senior PAs in dermatology, plastics, orthopedic surgery, emergency medicine, and cardiothoracic surgery specialties, plus PA-Cs holding NCCPA Certificates of Added Qualifications (CAQ) in those specialties.

The state-comparison table below applies BEA Regional Price Parity (RPP) adjustment so both nominal pay and real purchasing power are visible.

1. State Cost of Living: Nominal vs Real Pay

The largest driver of nominal PA salary differences across states is cost of living. West Coast and Northeast states — California, Connecticut, Alaska, Nevada, Washington, Massachusetts, New Jersey, Hawaii — consistently lead the state-level pay rankings. After applying BEA RPP adjustment, the real-purchasing-power gap narrows. Texas, Florida, and Tennessee — no-state-income-tax states — deliver strong real-dollar take-home for PAs even though nominal medians sit below California or Connecticut.

2. State Optimal Team Practice (OTP) Laws and PA Scope

Unlike nurse practitioners — where state Full Practice Authority laws create wide pay gaps — PA scope of practice is more uniform nationally because every state requires some form of physician collaboration or supervision. However, state-level scope rules still affect PA hiring and pay in measurable ways:

• Optimal Team Practice (OTP) movement — recognized in some form in many states; OTP frameworks move away from rigid one-to-one supervisory ratios toward team-based practice with eligibility-based supervisory requirements. States that have moved toward OTP-friendly statute (Arizona, Wisconsin, Michigan, Iowa, Mississippi, and others) attract more PA hiring and support stronger state-level PA pay growth.
• State prescriptive authority and controlled-substance scope — every state grants PAs prescriptive authority but the breadth and required physician collaboration around Schedule II controlled substances differs by state. Broader scope correlates with stronger state-level PA market rates.
• State PA chart co-signature requirements — states requiring fewer co-signatures support more efficient PA practice and higher hiring volume.
• State telemedicine and supervision-by-video rules — states permitting remote physician supervision via telemedicine enable PA placement in rural areas, supporting rural-state pay through HPSA-driven demand.

3. State Demand-Supply Dynamics for PAs

State-level PA pay reflects the demand-supply balance in each state:

• Health professional shortage areas (HPSAs) — rural and underserved markets routinely offer $15,000–$50,000 sign-on bonuses plus federal student-loan repayment through the NHSC Loan Repayment Program for primary-care PAs. States with the highest HPSA concentration (Mountain West, rural Deep South, Appalachian) show competitive PA pay despite lower cost of living.
• State PA-school graduate supply — states hosting multiple ARC-PA-accredited PA programs (Pennsylvania, New York, California, Florida, Texas, North Carolina) have larger PA graduate pipelines, which can compress entry-level state pay in oversupplied metros — though dense specialty practice in those same states offsets the supply pressure at senior levels.
• Surgical specialty practice density — states with strong orthopedic surgery, cardiothoracic surgery, neurosurgery, plastic surgery, and dermatology specialty concentration (California, Texas, Florida, New York, North Carolina) support upper-percentile PA pay because surgical first-assist PAs and procedural-specialty PAs command premium pay.
• State emergency medicine demand — states with high Level-1 trauma center density and busy emergency departments support strong EM-PA pay across the state.
• Hospital corporate-employed PA growth — Texas, Florida, Pennsylvania, Tennessee, North Carolina, Ohio, and Georgia have rapidly expanding hospital-system PA employment that drives competitive PA pay statewide.

4. NCCPA CAQ Specialty Credentials and State-Level Pay Distribution

The NCCPA Certificate of Added Qualifications (CAQ) program offers seven specialty credentials. CAQ-holder distribution by state shapes state pay rankings:

• CAQ in Cardiovascular and Thoracic Surgery — cluster in cardiac-surgery-dense markets (Texas, Florida, Ohio, New York, California, Pennsylvania, Minnesota).
• CAQ in Emergency Medicine — cluster in Level-1 trauma center markets (Texas, California, New York, Pennsylvania, Florida, Illinois).
• CAQ in Hospital Medicine — cluster in major hospital-system states.
• CAQ in Orthopaedic Surgery — cluster in states with dense ortho specialty hospital concentration.
• CAQ in Nephrology, Pediatrics, Psychiatry — niche credentials at corresponding specialty markets.

How to Compare PA Salary by State Effectively

When comparing the average physician assistant salary by state, work through this checklist:

• Compare nominal and real (cost-adjusted) pay together — a state with the highest nominal median can have lower real purchasing power if its cost of living is higher.
• Check state income tax — PAs in Texas, Florida, Tennessee, Nevada, Washington, Wyoming, South Dakota, Alaska, and New Hampshire keep more of every dollar.
• Verify state OTP and prescriptive authority breadth — OTP-friendly states with broad prescriptive scope support stronger PA hiring and pay growth.
• Compare percentile distribution, not just median — a state with a high median but compressed range may pay less to senior surgical-PAs than a state with a moderate median and strong P90 senior pay.
• Factor in specialty market density — if you specialize (or plan to) in dermatology, plastics, orthopedics, cardiac surgery, or emergency medicine, target states with strong corresponding specialty practice concentration.
• Consider HPSA loan repayment — federal NHSC loan repayment plus state-level supplemental programs (e.g., Texas state PA-NP loan repayment, California Steven M. Thompson Loan Repayment) can add substantial effective compensation to state-baseline pay for primary-care PAs.

2026 State-Level PA Salary Outlook

PA pay has grown at a compound annual rate of 3.32% nationally over the past five years. States with rapid PA hiring at surgical specialty practices (California, Texas, Florida, New York), states with state-level OTP statute movement (Arizona, Wisconsin, Iowa, Mississippi), and rural shortage states using NHSC loan repayment plus state programs to recruit (Montana, Wyoming, North Dakota, Alaska, West Virginia) are seeing the fastest state-level pay growth through 2026. The BLS projects Physician Assistants employment growth at 27% through 2033 — among the fastest of any U.S. occupation — keeping strong upward pressure on state-level wages, especially in surgical specialty, emergency medicine, and rural primary-care markets.

Browse the state-by-state comparison table below to see the $140,391-baseline state ranking, top 10 and bottom 10 states by projected median, regional groupings (Northeast / Midwest / South / West), and direct links to per-state pages for deeper city-level breakdown.