Registered Nurse vs Physician Assistant Salary: Which Pays More?

Salary Side by Side

Source for both medians: U.S. Bureau of Labor Statistics, May 2025 wage data.

Two cautions before you use these numbers. First, they are medians — the midpoint, with half of workers in each occupation earning more and half less. Mean (average) wages are published separately and usually read higher, because top earners pull the mean up. Second, they are national medians, not your state's. Check the state and metropolitan-area wage tables published for each occupation, plus your state workforce agency, before treating either figure as your own.

RNs are commonly quoted an hourly rate, especially in hospital, per-diem and travel work; PAs are more often quoted an annual salary. Don't convert in your head — an hourly rate only becomes an annual figure once you fix hours per week and paid weeks per year, and differentials, overtime and on-call pay change the answer. Ask for both numbers in writing.

Why the Pay Differs

Four things do most of the work in the $38,330 median gap.

1. The entry credential. BLS lists a bachelor's degree as typical entry-level education for registered nurses and a master's for physician assistants (U.S. Bureau of Labor Statistics, 2025), with PA programs built from postbaccalaureate classroom, laboratory and supervised clinical training. The whole 39% median advantage sits on the far side of that extra degree. RNs can also enter through hospital diploma programs, which take less time than the four years typical of bachelor's and associate's routes (U.S. Bureau of Labor Statistics, 2025) — faster to a paycheck, on the lower median.

2. Licensing and scope. RNs must hold a license from the state where they work, earned by finishing an approved program and passing a qualifying exam. All states and the District of Columbia license PAs, and after the qualifying exam a PA may use the credential Physician Assistant-Certified, or PA-C (U.S. Bureau of Labor Statistics, 2025). That license carries diagnostic and treatment responsibility employers pay for — but in most states PAs must also hold an agreement with a supervising physician, who need not be onsite at all times (U.S. Bureau of Labor Statistics, 2025). That requirement ties PA pay to practices with a physician available to supervise.

3. Demand. BLS projects 2025–2035 employment growth as faster than average for registered nurses and much faster than average for physician assistants (U.S. Bureau of Labor Statistics, 2025). Growth does not guarantee rising wages, but stronger projected demand supports the PA premium over the $97,550 RN median rather than eroding it.

4. Employer type. Most RNs work in hospitals — state, local and private — while the largest share of PAs work in offices of physicians (U.S. Bureau of Labor Statistics, 2025). Hospital RN pay often stacks shift differentials, overtime and on-call pay onto an hourly base; physician-office PA pay more often arrives as a flat salary with bonus or production terms. Two offers with the same base can end the year far apart.

Beyond the Paycheck

The $38,330 median gap is real, but it is not the whole comparison.

Start with the schedule. Registered nurses in hospitals and nursing care facilities usually work shifts so units are covered around the clock, including nights, weekends, holidays and on-call time (U.S. Bureau of Labor Statistics, 2025). Most PAs work full time, and their schedules vary too, sometimes including nights, weekends or holidays and on-call duty (U.S. Bureau of Labor Statistics, 2025). Neither role promises weekday-daytime life. The difference is where most people in each job sit: physician offices tend to run on clinic hours, hospitals do not. If you want predictable days, the office-based PA route is the likelier fit, and part of the premium is paying for a credential rather than for nights. If you want nights and weekends, RN differentials and overtime close some of the distance toward $135,880 — how much depends entirely on your employer's rates.

Then the physical side. Bedside nursing means standing, lifting, turning and long stretches of patient contact; clinic-based PA work is generally less punishing. If you expect to work into your sixties, body wear matters as much as the annual figure.

Finally the ceiling. RN pay is usually bounded by a band or step scale with differentials layered on, and moving well past it normally means leaving bedside work for management, education or advanced practice — more schooling again. PA pay is tied to specialty and clinical productivity, so it can climb within the same job title. Choosing at 22, the higher band compounds. Changing careers at 45, the tuition and lost earning years eat into whatever share of $38,330 a year you eventually collect.

Which Pays More in Your Situation

1. If you want to start earning within two or three years. Registered nurse wins. A diploma or associate's route gets you licensed and paid against a $97,550 national median (U.S. Bureau of Labor Statistics, 2025) while a PA candidate is still finishing a bachelor's plus postbaccalaureate study. The $38,330 PA advantage only begins once the master's is done.
2. If you are 20 and planning a 40-year career. Physician assistant wins. Every full year worked at the PA median rather than the RN median is $38,330 more, before any specialty or productivity pay, and it repeats for each year you practise.
3. If you live somewhere rural with few physician practices. Likely registered nurse. In most states PAs need an agreement with a supervising physician (U.S. Bureau of Labor Statistics, 2025), so PA jobs cluster around physician offices, their largest employer; hospitals are the largest employer of RNs (U.S. Bureau of Labor Statistics, 2025). A $135,880 median is no use in a county with no PA posts — check your state and metro wage tables first.
4. If you want nights, weekends and overtime. Registered nurse narrows the gap. Hospital and nursing-facility RNs work round-the-clock shifts (U.S. Bureau of Labor Statistics, 2025), with differentials and overtime added to the hourly base. Ask for those rates in writing, as a percentage or dollars per hour, before you count on them.
5. If you want per-diem or flexible work. Registered nurse is usually the more flexible of the two, because hospitals staff shifts and gaps that per-diem nurses fill. You trade the $135,880 PA median for control over your calendar, and often for benefits you buy yourself.