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John Watson; Mary McBride; Daniela Bastida; Emily Berry | June 25, 2021 | Contributor Information
What a difference a year makes. When Medscape first surveyed physician assistants (PAs) in early 2020, the US healthcare system was not yet in the grip of a pandemic. Conversely, this year's survey results fully reflect our shared "new normal," which is anything but.
This is the first of two reports on the findings of our second annual PA compensation survey (see the first annual report here). The following slides portray our findings related to income and the financial realities of working as a PA in the United States during the past year.
The second report, which focuses on career satisfaction, will have much to say about the impact of COVID-19 on health and well-being among PAs.
John Watson; Mary McBride; Daniela Bastida; Emily Berry | June 25, 2021 | Contributor Information
Beginning in November 2020, Medscape invited licensed PAs practicing in the United States to respond to an online survey. By the time the survey concluded in February 2021, 5826 PAs had responded, of whom 4859 practiced full-time. Although their responses captured harsh new realties about working through a pandemic, elsewhere overall trends showed an improving — if unequally distributed — landscape for overall PA compensation. Read on to find out the most important factors influencing income among PAs.
John Watson; Mary McBride; Daniela Bastida; Emily Berry | June 25, 2021 | Contributor Information
First, the bad news. Like those in most other occupations, PAs were not exempt from COVID-19's tumultuous impact on employment. Among PAs who are not currently employed (and therefore did not qualify for the survey's other questions), almost one fifth cited COVID-19 as the reason. These respondents were roughly equally split as to whether this decision was early retirement or the result of firing, furloughing, or being laid off.
John Watson; Mary McBride; Daniela Bastida; Emily Berry | June 25, 2021 | Contributor Information
Among PAs who remained in the workplace, the pandemic didn't appear to adversely affect total compensation, calculated as base pay, productivity or incentive pay, annual bonuses, and other income (eg, overtime). Since last year's survey, mean compensation significantly increased from $118,000 to $126,000.
Experience continues to translate to higher compensation, with PAs aged ≥ 45 years earning about 12% more than those < 45 years of age ($135,000 vs $121,000) and those working > 10 years significantly outearning their less tenured colleagues ($135,000 vs $119,000). Gender gaps in pay remain stubbornly in place, with male PAs earning $138,000 compared with $120,000 for their female counterparts.
John Watson; Mary McBride; Daniela Bastida; Emily Berry | June 25, 2021 | Contributor Information
The largest concentration of PAs can be found in the primary care setting, with family medicine and internal medicine alone accounting for 24% of reported positions, down slightly from 26% in last year's report. Other leading specialties include emergency medicine (14%), orthopedics (10%), and surgery (8%).
"With almost 10,000 PAs graduating each year and entering the workplace, I am not surprised to see more of them going into emergency medicine, orthopedics, and surgery," said Randy Danielsen, PhD, PA, director of A.T. Still University's Doctor of Medical Science Program. "PAs tend to follow the same patterns as supervising physicians. A lot of this is because of the higher salaries in these more procedure-based specialties."
John Watson; Mary McBride; Daniela Bastida; Emily Berry | June 25, 2021 | Contributor Information
What emerges from these findings is a sense that PAs work in nearly every facet of contemporary healthcare across the country. Our survey identified 16 specialties in which ≤ 1% of PAs practiced, and 12% of all PAs reported working in "other" settings, a category representing subspecialties and unique positions no less crucial to contemporary healthcare.
Danielsen noted that the presence of PAs in nearly every imaginable specialty is a trend that probably accelerated during the pandemic, "when states loosened their requirements as to how many PAs a physician could collaborate with in any given location." He added that it also probably reflects the unique capabilities PAs bring to the job. "PAs have been likened to 'stem cells,' meaning place them in any particular specialty (especially right out of school) and with a good onboarding program, they will thrive in that practice."
John Watson; Mary McBride; Daniela Bastida; Emily Berry | June 25, 2021 | Contributor Information
After analyzing data for specialties with 100 or more full-time PA respondents, Medscape found that critical care, surgery, dermatology, and emergency medicine are among the highest-paid. However, positive compensation trends were observed across the board, with overall income increasing among each specialty compared with last year's survey results.
John Watson; Mary McBride; Daniela Bastida; Emily Berry | June 25, 2021 | Contributor Information
The majority of PAs are employed in either a hospital setting or a medical office. A higher proportion of female PAs than male PAs reported working in medical offices (49% vs 40%). Just over half of full-time PAs are employed by medical groups. Only 6% reported that they worked for the US government (data not shown).
John Watson; Mary McBride; Daniela Bastida; Emily Berry | June 25, 2021 | Contributor Information
As expected from historical trends, PAs working in operating room/surgery settings, critical care, and emergency departments/urgent care are among those reporting the highest annual compensation, whereas those in academic and clinic settings reported the lowest. Yet, PA earnings for all work settings increased compared with the previous year's survey findings, a trend apparent across the earning spectrum. Annual reported incomes increased notably between 2019 and 2020 for PAs working in both surgery (from $123,000 to $139,000) and academic (from $108,000 to $121,000) settings.
John Watson; Mary McBride; Daniela Bastida; Emily Berry | June 25, 2021 | Contributor Information
Our findings indicate that an incentivized workforce reaps the most financial benefits. PAs whose hourly or salary wages were supplemented with productivity/incentive payments had the highest incomes. Among those without such compensation plans, hourly workers have a slight edge (4%) over their salaried counterparts. Again, our analysis showed increases compared with last year's survey for all categories of compensation.
John Watson; Mary McBride; Daniela Bastida; Emily Berry | June 25, 2021 | Contributor Information
The majority of PAs (83%) are employed full-time, with part-time and per diem work accounting for 14% and 3%, respectively. Full-time PAs experienced a moderate increase in their hourly wages compared with last year ($67 vs $65) and generated higher hourly base rates than their colleagues working part-time/per diem. PAs aged ≥ 45 years reported a significantly higher average hourly rate of pay than younger colleagues ($70 vs $65).
John Watson; Mary McBride; Daniela Bastida; Emily Berry | June 25, 2021 | Contributor Information
Compared with last year's findings, female PAs reported increases in average gross income ($120,000 vs $114,000) and hourly wages ($65 vs $63). Similar increases for male PAs over the same time period, however, kept their earnings significantly higher than those of their female counterparts (15% more for annual gross income).
Danielsen noted that the gender gap in compensation is concerning, given that "most PA classes today are 70% women and 30% men, so more women are entering the workplace than men." To address this inequity, he recommends that PAs work through their state and national organizations.
John Watson; Mary McBride; Daniela Bastida; Emily Berry | June 25, 2021 | Contributor Information
Male PAs had higher expected average gross income for all categories of earning, with the exception of "productivity/incentive pay only," for which the number of respondents was too low for analysis.
Again, trends pointed to increased wages between 2019 and 2020 for all income types, but male PAs experienced higher pay bumps than female PAs for the categories of "salaried" (8.3% for men vs 4.5% for women), "hourly" (9.2% vs 3.4%), "salary plus" (7.4% vs 5.8%), and "hourly rate plus" (9.7% vs 4.1%).
John Watson; Mary McBride; Daniela Bastida; Emily Berry | June 25, 2021 | Contributor Information
Just over one quarter (26%) of PAs reported holding a certificate of added qualification (CAQ). PAs most commonly hold CAQs in emergency medicine (7%), followed by orthopedic surgery (4%) and hospital medicine (3%).
PAs with CAQs earn slightly more than those without any CAQs, though both groups saw increases in their average earnings in 2020 compared with 2019 (from $119,000 to $128,000 for CAQ holders and from $117,000 to $126,000 for non–CAQ holders).
John Watson; Mary McBride; Daniela Bastida; Emily Berry | June 25, 2021 | Contributor Information
PAs with master's degrees represented the highest percentage of respondents (81%), followed by bachelor's degrees.
Because obtaining a higher academic degree is a significant expenditure and is often rationalized with the expectation that it will be offset by a boost in salary, PAs with master's degrees might be taken aback to see that they still trail their colleagues with bachelor's degrees in this area. However, a closer look at the data reveals that PAs with master's degrees have several other features linked to lower income: They are significantly more likely to be 45 years of age or younger (66% vs 11%) and to have worked less than 10 years (66% vs 11%), and they are more often female (69% vs 60%).
The good news is that from 2019 to 2020, compensation notably increased for all degree types with adequate data to analyze: from $122,000 to $135,000 for bachelor's degrees, $116,000 to $124,000 for master's degrees, and $125,000 to $138,000 for doctoral degrees.
John Watson; Mary McBride; Daniela Bastida; Emily Berry | June 25, 2021 | Contributor Information
Conversely, long-serving PAs can rest assured in the finding that more experience still translates to better compensation. PAs with 21 years or more of experience led the pack in terms of annual income, outearning colleagues with 6-10 years in practice by $7000 and PAs relatively new to the job with less than 5 years' experience by $24,000.
John Watson; Mary McBride; Daniela Bastida; Emily Berry | June 25, 2021 | Contributor Information
PAs with an eye to relocating may want to consider heading west. For the second year in a row, PAs in the Pacific region were the highest-paid in the nation, significantly outearning those in all other regions, including second-place New England. The Pacific region also boasted the biggest jump in average annual compensation compared with last year's report (from $128,000 to $141,000), although every region experienced significant increases in the interim, including East South Central, which has had the lowest reported annual incomes for both years of this survey.
John Watson; Mary McBride; Daniela Bastida; Emily Berry | June 25, 2021 | Contributor Information
A much-publicized economic side effect of the pandemic was the exodus of city dwellers, as square footage and backyards became considerably more alluring in the face of continued lockdown. That trend doesn't seem to have played out among our surveyed PAs, at least in terms of where they chose to work, with the rate of those employed in urban settings holding steady at 41% for the second year in a row. Both median and mean annual compensation continue to favor those in urban settings.
However, as Danielsen notes, PAs are increasingly needed in underserved rural settings. "In my opinion, the way to do this is to continue to partner with the National Association of Community Health Centers, using their sites to help educate our PA students," he said. "We also need to find ways to recruit from these areas (ie, hometown programs) to draw PA students from those areas who have a dedication to return to their communities."
John Watson; Mary McBride; Daniela Bastida; Emily Berry | June 25, 2021 | Contributor Information
PAs who feel fairly compensated earn an average of $131,000, significantly more than the $115,000 earned by those who do not feel fairly compensated. More male PAs (71%) also feel fairly compensated than do their female counterparts (65%).
Despite compensation increasing by nearly all metrics studied, PAs overall were less likely to feel that their compensation is fair compared with the previous year's poll (67% vs 74%). This is not unexpected. In the face of incredible work stresses, the job of a PA has probably never been more difficult than it was in 2020, which will be the topic of our upcoming Medscape Physician Assistant Career Satisfaction Report.
Hoping for a Higher Salary or More Perks? Here's the Best Way to Ask
Many physicians are worried about how to make a compelling compensation request without annoying their employer. Here's how to polish your skills, build your self-confidence, and get a positive result.Medscape News Features, Mar 2021
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John Watson
Freelance writer
Disclosure: John Watson has disclosed no relevant financial relationships.
Mary McBride
Associate Director, Market Research, Medscape
Daniela Bastida
Research Analyst, Medscape
Emily Berry
Editor, Medscape
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