2020 was an unprecedented year, and physician assistants (PAs) rose to the challenge. They mobilized to cover new specialties and adapted to expanded telehealth — all against a backdrop of a global pandemic, reduced hours and wages, and even job loss. The American Academy of PAs (AAPA) 2021 Salary Report, which surveyed more than 13,000 PAs in February 2021, offers unique insights into the forces that shaped PA compensation and their working environment in 2020.
COVID-19’s impact on PA salary
More than 64% of PAs surveyed reported that the COVID-19 pandemic impacted their work in one or more of the following ways: hours worked, bonus, annual merit/pay increases, base pay, professional development funds, paid time off and/or retirement benefits. A change was classified as either an increase or a decrease.
% of PAs that experienced employment impacts in 2020 due to COVID-19
In order to contextualize the data for this unique year in healthcare, AAPA posed follow-up questions to create new data points with 2019 and 2020 figures. Ultimately, while some PAs reported increases and others reported decreases, median PA compensation remained relatively stable during the pandemic with a smaller financial impact than expected.
PA median compensation in 2020
Overall, average compensation dropped slightly ($110,000 down from $111,000 in 2019). For full-time PAs paid an annual base salary, the median annual base salary was $110,000 in 2020, reflecting no change from 2019. However, for hourly wage and productivity-based PAs, the median hourly wage dropped from $62.73 to $61.00 and median productivity-based compensation dropped from $145,000 to $144,000. Further, among full-time PAs who received bonuses, the median bonus dipped to $4,500 compared to $5,500 the previous year.
Median compensation over time from primary employer by major specialty area
Highest and lowest paying states
When evaluating compensation by state, it’s important to consider cost of living. While it’s generally true that states with higher cost of living offer higher base salaries and hourly rates, there are exceptions to the rule.
The states with the highest cost-of-living adjusted median salary include Oklahoma, Texas, and Michigan, while Massachusetts, the District of Columbia, and Rhode Island rank among the lowest. For hourly wage earners, Kentucky, Oklahoma, and Kansas top the list for highest cost-of-living adjusted median wage, with Maryland, New Hampshire, and the District of Columbia coming in lowest.
Cost-of-living adjusted salary by state rankings
One unique advantage PAs have over other healthcare professionals is the ability to shift more easily between specialties, which allowed some PAs to shift to areas of greatest need during the pandemic.
“We saw PAs mobilize really quickly to in-demand specialties. In the first three months of the pandemic, we saw the same proportion of PAs change specialty as they typically do in a year,” says Tim McCall, AAPA’s associate director of surveys and analysis. “While some PAs may have shifted away from highly compensated specialties and experienced a dip in their compensation, others may have seen their compensation increase. So, it’s difficult to parse out exactly what mobilization did for compensation. But the ability to mobilize quickly was really good news for both PAs and the patients who received their care.”
Expanded telehealth opportunities
Another important factor impacted by the pandemic was the dramatic increase in demand for telehealth services. Nearly two-thirds of survey respondents said they saw patients via telehealth in their practice in 2020, compared to just 10 percent in 2019, which represents a 550% increase.
“With many patients who were not permitted to go into offices, we saw an explosion in this last year of PAs working in telehealth,” McCall says. “In many ways, telehealth has been becoming more popular over the past couple of years, so we expected there to be increases. However, we didn’t know that it was going to be this large of an increase and that it was going to be sustained. It looks like telehealth is here to stay.”
Highest paying work settings, specialties, and employer types
Work setting, employer type, and specialty all have bearing on a PA’s earning potential. In 2020, occupational medicine/worksites and hospital critical access, critical care, and intensive care units topped the list for highest paid work settings, and emergency medicine and surgical subspecialties are among the highest paid specialties.
Median compensation from primary employer by primary work setting: 3 highest-paying settings
PAs employed by the pharmaceutical industry, medical device manufacturers, or an HMO commanded the highest salaries, though these PAs comprised less than 1 percent of respondents and their years of experience are significantly higher than the national median. When considering these highly paid employers, McCall cautions, “In a relatively small sample size, a few highly-paid individuals can throw off the distribution a bit. And among the highest paid employer types represented, the median years of experience are also the highest compared to individuals employed by other employers.”
Median compensation from primary employer by employer type: 3 highest-paying employer types
PA compensation in context
“What I think is most important for PAs, especially young professionals, to consider is not only their career and their financial outlook but what their passion is in the profession. Compensation or your paycheck is only one part of the equation. Working in a medically underserved community may come with a smaller paycheck, but there are often ‘hidden benefits’ such as student debt repayment. When picking a specialty or work setting, there are ways other than salary to increase your benefits and compensation,” McCall says.
The full AAPA 2021 Salary Report is available to download for free for AAPA members and for $200 for non-members. The digital version also allows PAs to compare compensation based on specialty, experience level, and location across the U.S.