Orthopedic Surgery PA Pay: First-Assist Skills and the OR Premium

Orthopedic surgery employs more PAs than almost any other surgical specialty, and the role is genuinely surgical: first-assisting total joints and spine cases, running post-op care, reducing fractures, and covering ED call for the service. That OR-centered skill set keeps orthopedic PA compensation reliably above the all-specialty average in professional surveys.

According to the U.S. Bureau of Labor Statistics Occupational Employment and Wage Statistics (OEWS) program (May 2025), physician assistants in the United States earn an annual mean wage of $141,280 and an annual median wage of $135,880. The median is the midpoint — half earn more, half earn less — and it is usually the safer "typical" reference because the mean gets pulled around by the highest earners.

An honest note on the data: BLS publishes PA wages by state for the profession as a whole — not by specialty. The table below is the profession-wide baseline from the May 2025 federal survey. Orthopedic surgery roles generally sit above that baseline for the reasons covered here, but for specialty-specific dollar figures, consult the professional-association surveys linked in the references; we don't invent numbers the federal data doesn't contain.

Rank	State	Annual mean wage
1	California	$169,110
2	Washington	$164,430
3	New Jersey	$162,100
4	Oregon	$155,300
5	New York	$155,150
6	Vermont	$152,520
7	New Hampshire	$150,150
8	Alaska	$148,080
9	Minnesota	$147,630
10	Connecticut	$146,930
11	Hawaii	$146,780
12	Rhode Island	$146,630
13	Massachusetts	$146,480
14	District of Columbia	$146,230
15	Indiana	$144,260
16	Delaware	$143,840
17	Virginia	$142,630
18	Arizona	$140,850
19	Montana	$140,800
20	Iowa	$139,870
21	Maryland	$139,740
22	Colorado	$139,580
23	Oklahoma	$138,700
24	Missouri	$137,710
25	Wyoming	$137,320
26	Wisconsin	$136,750
27	Ohio	$136,560
28	Texas	$135,850
29	Nevada	$135,790
30	Maine	$134,690
31	New Mexico	$134,670
32	Florida	$134,470
33	Nebraska	$132,810
34	Idaho	$132,540
35	Utah	$132,530
36	Michigan	$132,140
37	South Dakota	$131,910
38	Illinois	$131,880
39	North Dakota	$130,930
40	Louisiana	$130,290
41	North Carolina	$130,030
42	West Virginia	$128,830
43	Kansas	$127,240
44	Pennsylvania	$125,160
45	South Carolina	$120,720
46	Kentucky	$119,990
47	Arkansas	$118,430
48	Tennessee	$117,300
49	Georgia	$112,090
50	Alabama	$110,860
51	Mississippi	$106,820

Figures are U.S. Bureau of Labor Statistics OEWS annual mean wages, May 2025 (51 states/territories with published data; BLS suppresses states with samples too small to publish, and those are omitted rather than estimated).

Why orthopedic surgery pays above the baseline

OR time and call structure are the levers. A PA spending three days a week first-assisting — especially in spine and arthroplasty — commands more than a clinic-only counterpart, and fracture call adds stipend income on top. Practices that bill for first-assist services have direct economic room to pay their surgical PAs well.

The baseline still matters. Specialty premiums ride on top of local market rates, so a orthopedic surgery PA in a high-baseline state generally out-earns the same role in a low-baseline one. Cost of living then reshapes the real value — compare any two states with our cost-of-living tool before treating a bigger number as a better offer.

See who's hiring. Browse open Physician Assistant roles on VitalPost — free for clinicians, and pay is shown on a listing whenever the employer posts it.

How to read these numbers

A few caveats keep this table useful instead of misleading.

Median first, mean second. The mean is sensitive to a small number of very high earners; the median is the midpoint and usually the better proxy for a typical offer. Read both to understand the spread in your market.

One number, many jobs. Each state figure blends employers, settings, and experience levels — a first-year attending and a 25-year veteran, a rural solo practice and a flagship academic center — into a single average. Expect your own market position to move you off the line.

The survey measures wages, not packages. Bonuses, productivity incentives, call stipends, benefits, retirement match, paid time off, and loan repayment sit outside OEWS. Evaluate offers on total value.

Self-employment is invisible here. Partnership income and 1099 arrangements are not fully captured, which is one reason real-world compensation in some markets runs above what a wage survey suggests. And because PA pay is frequently hourly or shift-based in this specialty, always reduce competing offers to an effective hourly rate — including differentials — before comparing.

References

• U.S. Bureau of Labor Statistics — Occupational Employment and Wage Statistics (OEWS), May 2025.
• BLS OEWS: Physician Assistants — the occupation series behind the table above.
• AAPA Salary Report — the profession's specialty-level compensation survey.