Physician Assistant Salary in Texas 2026,
$134,550 Median | BLS Data by City

Texas physician assistants earn a median $134,550 a year, $64.69 an hour, per BLS OEWS May 2025, essentially level with the national figure and with no state income tax withheld. The middle half earns between $122,720 and $156,000, and the full range is $102,650 to $169,000. Specialty and location both matter here, and in Texas location matters unusually much.

Midland leads at $158,200, then Killeen-Temple at $140,200, San Antonio-New Braunfels at $140,160, Lubbock at $137,510 and Houston-Pasadena-The Woodlands at $137,240. Three of the top five are west or central Texas markets paying to attract clinicians, which is the defining feature of the Texas PA market.

Graduate from an ARC-PA accredited PA programme, pass the PANCE, and apply to the Texas Medical Board, which licenses physician assistants and registers the supervising physician relationship. Texas also has a jurisprudence examination requirement, and licensure is separate from the prescriptive delegation arrangement that lets a PA prescribe.

Substantially, and it is one of the clearest effects in the data. Midland at $158,200 pays about twenty-four thousand dollars above the state median because west Texas employers compete for clinicians who could work in Dallas or Austin instead. The premium is durable, because the underlying supply problem does not resolve, and it is worth more in real terms given lower housing costs.

Very tightly with a cluster of western states: Iowa at $134,770, Utah at $134,740, Nevada at $134,660, Arizona at $134,650 and Colorado at $134,540 are all within a few hundred dollars. The differentiator is tax — Texas and Nevada withhold no state income tax, which puts them clearly ahead of Iowa, Utah, Arizona and Colorado on take-home.

Because the labour market there is not a healthcare market. West Texas energy-sector wages set a regional expectation that every employer has to meet, and healthcare employers must also overcome the reluctance of clinicians to relocate to a small, remote city. Those two forces compound. The premium moves with the energy cycle, which is worth knowing before treating it as a permanent figure.

Flexibility, mainly. Texas requires a registered supervising physician and a prescriptive delegation arrangement, which constrains independent practice models and gives employers leverage. It is less restrictive than it once was, but it is more restrictive than the states that have moved to broader PA autonomy, and it is part of why Texas pays at, rather than above, the national median despite a genuine shortage.

For a full-time new graduate in a metro primary care post, it is low but not impossible; more often the bottom decile mixes part-time and part-year practice. The 25th percentile of $122,720 is the better anchor for a first full-time Texas PA role, and new graduates who take a rural post frequently start above the state median outright.