Physician Assistant Salary in Virginia 2026,
$135,940 Median | BLS Data by City

Virginia physician assistants earn a median $135,940 a year, $65.36 an hour, per BLS OEWS May 2025, with the middle half between $120,580 and $162,790 and a full range of $98,330 to $213,010. That is level with the $135,880 national median, though the Virginia upper tail is strong.

Roanoke at $135,940, then Charlottesville at $133,540, Staunton-Stuarts Draft at $128,580, Richmond at $126,810 and Virginia Beach-Chesapeake-Norfolk at $126,430. Roanoke and Charlottesville outpaying Richmond and Hampton Roads reflects two academic and regional systems competing for a limited pool. Northern Virginia is counted inside the Washington-Arlington-Alexandria multi-state metro and is absent from any Virginia-only table.

Not in the direct-supervision sense. Virginia licenses physician assistants through the Board of Medicine and requires a practice agreement with a patient care team physician, which sets out the scope of collaboration rather than mandating on-site oversight. Prescriptive authority is part of the licence. It is a more permissive framework than a supervisory model, which is one reason rural Virginia sites rely on PAs so heavily.

Surgical subspecialties, high-acuity emergency medicine and procedural practice populate the upper part of the Virginia band, toward the $162,790 seventy-fifth percentile and the $213,010 ninetieth. Primary care sits nearer the $135,940 median even with a full panel. Call obligations, first-assist responsibilities and productivity arrangements are the mechanics behind most of that gap.

Virginia's income tax reaches its 5.75% top rate at seventeen thousand dollars of taxable income, so a $135,940 salary faces an effectively flat state rate and no local income tax. PAs living in Northern Virginia but working in the District of Columbia or Maryland are taxed where they earn, with a Virginia credit — a real complication for a market that straddles three jurisdictions.

Because pool size, not market size, sets the price. Carilion in the Roanoke valley and UVA Health in Charlottesville are large systems in comparatively small labour markets, recruiting PAs who must be willing to live there. Richmond and Hampton Roads have more programmes feeding them, more spousal employment options and more incoming candidates, so the same job clears at a lower rate. It is the same mechanism that makes rural Virginia PA posts pay above their metro equivalents.

The occupation code spans a huge range of clinical work and the $98,330 to $213,010 band reflects that more than it reflects career progression. A newly certified PA in a Southside primary care clinic and a surgical PA taking first-assist call at an academic centre both report here. The published figure also excludes production bonuses and call stipends, which in Virginia surgical and emergency practice can be a meaningful share of total compensation.

Specialty first, then call and location scarcity. Moving from primary care into emergency, hospital medicine, orthopaedics or another procedural specialty is the largest reliable step. Call coverage, first-assist responsibility and night and weekend obligations add layers on top. And Virginia's rural sites — in Southwest Virginia, the Eastern Shore and Southside — frequently pay above metropolitan rates because they cannot recruit otherwise, which is a real and often overlooked route to the upper half of this band.