The 2022 report on physician associate (PA) compensation from the American Academy of PAs (AAPA) reveals that PA compensation varies considerably from state to state. As an example, Alabama pays on the low end with an average, unadjusted median base salary of $95,000 in 2021, while Alaska is on the high end paying $140,000. This is in line with results of past years’ surveys. “We didn’t see a whole lot of surprises,” says Sean Kolhoff, senior research analyst for AAPA. “The states that had the highest amount of raw salary continued to keep that raw median salary.”
However, when a cost-of-living adjustment is applied to the data, it tells a different story. The highest and lowest paying states for PAs change positions — dramatically in some cases. “When you look at how the states compare based on how expensive it is to live there, you see those numbers shift considerably,” Kolhoff says. Alaska’s adjusted median base salary drops to $114,462, while Alabama’s climbs to $109,497.
Highest paying states for PAs
Unadjusted median base salaries were highest for PAs in Alaska, Hawaii, the Pacific Coast states, and New England. The top five highest paying states (unadjusted) for PAs included:
1. Alaska ($140,000)
2. California ($131,000)
3. Hawaii ($130,000)
4. Washington ($126,000)
5. Connecticut ($121,000)
Figure 1. Median PA base salary by state rankings
However, when adjusted for cost of living, the ranking shifts to favor the Midwest and states with large rural populations like Texas and Georgia. The top five highest paying states for PAs adjusted for cost of living are:
1. Oklahoma ($132,457)
2. Michigan ($128,872)
3. Missouri ($128,365)
4. Texas ($127,842)
5. West Virginia ($125,952)
Figure 2. Cost-of-living adjusted PA salary by state rankings
In some cases, differences in cost of living made a drastic difference in the state ranking. For example, Hawaii dropped from second highest among all states for unadjusted median base salary ($130,000) to number 50 on the list with an adjusted base salary of just $92,700. The AAPA defines the cost-of-living adjustment as the equivalent buying power that a PA’s salary would have in any U.S. state.
Some states saw a jump in their ranking when compared to the prior year’s data. In 2021’s report, Kansas was 44th for raw median base salary ($102,000) and 30th with the cost-of-living adjustment ($111,447). But in the 2022 report, Kansas ranked much higher at 21st with a big increase in raw median base salary ($114,000); when adjusted for cost of living, Kansas rose to 7th place ($124,616). So, for PAs practicing in Kansas, base pay is rising faster than the cost to live there.
Lowest paying states for PAs
On the bottom end of the scale, unadjusted median base salaries were lowest in the Southern states:
47. South Carolina ($103,199)
48. Louisiana ($103,000)
49. Mississippi ($100,000)
49. Tennessee ($100,000)
51. Alabama ($95,000)
When adjusted for cost of living, the buying power of PAs practicing in Hawaii and East Coast states was impacted the most:
47. Rhode Island ($95,896)
48. Massachusetts ($93,318)
49. Maryland ($93,149)
50. Hawaii ($92,784)
51. District of Columbia ($78,280)
PA earning potential by community
AAPA researchers are quick to point out that state-level data doesn’t tell the whole story. PAs who are looking to relocate to increase their earning potential should compare PA opportunities at a community level rather than the state level.
“In some rural areas, the cost of living is still very low, while in others — like Durango, Colorado, for example — it’s really high,” says Noel Smith, AAPA’s senior director of PA and industry research and analysis. “So, we recommend that you look at your locality as well, not just at the state. State data is really great guidance to start, but you should dive in a little bit deeper to figure out what’s best for you.”
When looking to maximize your earning potential, Smith says it’s important to compare the differences in terms of both real salary and the cost-of-living adjusted salary, but they aren’t the only factors to consider. “Remember these are starting points, and everything is negotiable unless the employer says it’s not,” she says. “Make sure you know your value and come prepared with the resources to show it.”
Additional compensation resources for PAs
PAs interested in additional resources can access the full digital report on PA compensation, which is available online to all AAPA members. The online report includes tools for comparing earnings with the national medians as well as detailed information on specialty, location, and experience level that can aid in negotiating contracts and future employment opportunities.