Top 5 Highest Paying PA Specialties
APPs
Compensation
Workforce
Physician Assistants have increasingly moved away from general practice and toward specialization. Much like physicians, many PAs now choose focused clinical paths that offer stronger compensation, defined scopes of practice, and long-term career stability. Recent workforce data shows that surgical specialties surpassed family and general practice as the most common primary area of practice for PAs.
With more than 60 recognized PA specialties and growing variation in compensation and demand, understanding how PA specialties compare has become essential for today’s job seekers. This guide highlights the top five highest-paying physician assistant specialties based on recent salary data from the AAPA.
With more than 60 recognized PA specialties and growing variation in compensation and demand, understanding how PA specialties compare has become essential for today’s job seekers. This guide highlights the top five highest-paying physician assistant specialties based on recent salary data from the AAPA.
Highest Paying Physician Assistant Specialties
Salary is not the only factor in choosing a specialty, but it is an important consideration for many PAs. Below is a breakdown of the highest-paying physician assistant specialties.
Cardiovascular/Cardiothoracic Surgery
Surgical subspecialties are now the most common specialty area for PAs. Compensation in these roles tends to be higher than average due to procedural involvement and patient volume. Cardiovascular and cardiothoracic surgery ranked as the highest paying PA specialty in 2025, with annual salaries around $152,500.
PAs in surgical roles support surgeons through preoperative evaluations, assist during procedures, and manage postoperative care. Orthopedics and general surgery are also popular surgical paths for PAs seeking high earning potential and hands-on clinical work.
Cardiovascular/Cardiothoracic Surgery
Surgical subspecialties are now the most common specialty area for PAs. Compensation in these roles tends to be higher than average due to procedural involvement and patient volume. Cardiovascular and cardiothoracic surgery ranked as the highest paying PA specialty in 2025, with annual salaries around $152,500.
PAs in surgical roles support surgeons through preoperative evaluations, assist during procedures, and manage postoperative care. Orthopedics and general surgery are also popular surgical paths for PAs seeking high earning potential and hands-on clinical work.
Dermatology
Dermatology remains one of the most competitive and highest-paying outpatient PA specialties. In 2022, dermatology ranked as the second-highest paid specialty for PAs, with annual incomes reaching roughly $145,000.
Dermatology PAs treat a wide range of skin conditions and may assist with cosmetic and surgical procedures. These roles often offer consistent schedules and long-term stability, particularly in high-volume practices.
Dermatology PAs treat a wide range of skin conditions and may assist with cosmetic and surgical procedures. These roles often offer consistent schedules and long-term stability, particularly in high-volume practices.
Emergency Medicine
Emergency medicine is one of the most established and in-demand PA specialties. Annual compensation averages around $133,990. Many PAs are drawn to emergency medicine for the fast-paced environment and higher levels of autonomy, particularly in rural or smaller emergency departments. These roles provide broad clinical exposure and consistent demand across geographic regions.
Occupational Medicine:
Occupational medicine PAs earn a median total compensation of $133,120, according to the AAPA’s latest public report. The Association of PAs in Occupational Medicine notes that these providers treat work related injuries and illnesses, perform preventive and fitness for duty exams, administer DOT physicals, and support ongoing employee health management efforts. Because occupational medicine PAs are often tasked with assessing healthcare staff and helping employers manage risk, compliance, and workforce safety, many organizations offer higher compensation to match the responsibility of the role
Occupational medicine PAs earn a median total compensation of $133,120, according to the AAPA’s latest public report. The Association of PAs in Occupational Medicine notes that these providers treat work related injuries and illnesses, perform preventive and fitness for duty exams, administer DOT physicals, and support ongoing employee health management efforts. Because occupational medicine PAs are often tasked with assessing healthcare staff and helping employers manage risk, compliance, and workforce safety, many organizations offer higher compensation to match the responsibility of the role
Critical Care
Critical care is one of the highest-paying PA specialties, reflecting the high acuity environment and advanced clinical responsibilities associated with intensive care settings. PAs in critical care work closely with physicians to manage critically ill patients in intensive care units, step-down units, and specialty ICUs.
The average salary for critical care PAs is approximately $133,000, placing it among the top-paying physician assistant specialties. These roles often involve complex decision-making, procedural support, and shift-based schedules, which can include nights, weekends, and on-call coverage.
Critical care is one of the highest-paying PA specialties, reflecting the high acuity environment and advanced clinical responsibilities associated with intensive care settings. PAs in critical care work closely with physicians to manage critically ill patients in intensive care units, step-down units, and specialty ICUs.
The average salary for critical care PAs is approximately $133,000, placing it among the top-paying physician assistant specialties. These roles often involve complex decision-making, procedural support, and shift-based schedules, which can include nights, weekends, and on-call coverage.
Choosing the Right PA Specialty
PA specialties continue to evolve alongside changes in healthcare delivery, with procedural and hospital-based roles offering some of the highest earning potential in the profession. While salary is an important factor, specialty choice should also reflect clinical interests, work environment preferences, and long-term career goals.
Understanding how compensation varies across PA specialties allows Physician Assistants to make informed career decisions and identify opportunities that align with both professional and personal priorities as demand for specialized care continues to grow.
Understanding how compensation varies across PA specialties allows Physician Assistants to make informed career decisions and identify opportunities that align with both professional and personal priorities as demand for specialized care continues to grow.
FAQs
Are fellowships for physician assistants required in certain specialties?
Fellowships are not required for Physician Assistants to enter most specialties. The majority of PAs receive specialty training on the job through supervised clinical experience. However, postgraduate PA fellowships and residencies are available in areas such as surgery, emergency medicine, critical care, and psychiatry for those who want additional structured training or are transitioning into a highly specialized or high acuity role.
How many times can you switch specialties as a physician assistant?
There is no formal limit on how many times a Physician Assistant can switch specialties. One of the defining advantages of the PA profession is flexibility, allowing providers to transition between specialties throughout their careers without completing additional residency training. Many PAs change specialties multiple times as their clinical interests, lifestyle priorities, or job market opportunities evolve.
What is the typical starting salary for a new graduate in a PA primary care specialty?
The typical starting salary for a new graduate Physician Assistant in a primary care specialty is around $80,000, though pay can vary by location and practice setting. While primary care salaries start lower than many specialty roles, these positions often offer stable schedules, broad clinical experience, and long-term career flexibility.
Fellowships are not required for Physician Assistants to enter most specialties. The majority of PAs receive specialty training on the job through supervised clinical experience. However, postgraduate PA fellowships and residencies are available in areas such as surgery, emergency medicine, critical care, and psychiatry for those who want additional structured training or are transitioning into a highly specialized or high acuity role.
How many times can you switch specialties as a physician assistant?
There is no formal limit on how many times a Physician Assistant can switch specialties. One of the defining advantages of the PA profession is flexibility, allowing providers to transition between specialties throughout their careers without completing additional residency training. Many PAs change specialties multiple times as their clinical interests, lifestyle priorities, or job market opportunities evolve.
What is the typical starting salary for a new graduate in a PA primary care specialty?
The typical starting salary for a new graduate Physician Assistant in a primary care specialty is around $80,000, though pay can vary by location and practice setting. While primary care salaries start lower than many specialty roles, these positions often offer stable schedules, broad clinical experience, and long-term career flexibility.
