Physician Assistant Salary in North Carolina: Pay by Experience, City & Take-Home

A physician assistant in North Carolina earns a median salary of $129,360 a year, or about $62.19 an hour, according to the U.S. Bureau of Labor Statistics (2025). Most PAs in the state land between $101,100 at the 10th percentile and $164,770 at the 90th percentile. That puts the typical North Carolina PA a little below the national median, but the cost of living and the state’s flat tax change the math in ways the headline number hides.

How North Carolina compares to the national PA salary

The national median for physician assistants sits at $135,880, per the U.S. Bureau of Labor Statistics (2025). North Carolina’s median of $129,360 trails that by $6,520, or roughly 4.8%. That gap is real, but it’s narrower than you’d expect for a state with housing and everyday costs well under the national average.

Here’s the practical read. A $6,520 difference in gross pay is a number you negotiate around, not one that dictates where you live. In high-cost coastal markets, a higher gross often gets eaten by rent and taxes before it ever reaches your account. In North Carolina, a slightly lower headline number frequently buys more house, a shorter commute, and a lighter tax bill. The next sections break down exactly where the dollars go.

It also helps to see the full spread rather than just the midpoint. The bottom 10% of North Carolina PAs earn around $101,100, the 25th percentile sits at $110,320, the 75th percentile reaches $140,030, and the top 10% clear $164,770. The state mean of $130,030 runs just above the median, which tells you the distribution is fairly tight with a modest pull from high earners at the top. There are about 7,490 physician assistants employed across North Carolina, a sizable workforce that gives you real bargaining power to compare offers between health systems.

One more way to frame the national gap: the $6,520 difference between North Carolina’s $129,360 median and the national $135,880 is about 5% of gross. North Carolina’s flat state income tax pulls $4,956 from a median salary. So in rough terms, the entire wage discount versus the national figure is close to what a no-tax state would save you on the same salary. Put differently, a North Carolina PA earns a touch less on paper but operates in a lower-cost environment, and the two effects largely cancel for most clinicians. That’s why chasing the highest gross number across state lines rarely improves your actual financial position. What moves the needle is the specialty you practice, the metro you choose inside the state, and the percentile you negotiate to.

Physician Assistant salary in North Carolina by experience

BLS doesn’t label its data by years on the job, but percentiles are a reliable proxy. New PAs and those in lower-paying settings cluster near the 10th and 25th percentiles. Mid-career clinicians sit around the median. Experienced PAs in surgical, emergency, or specialty roles push into the 75th and 90th percentiles. Here’s how that maps out in North Carolina.

The jump from entry to senior is $63,670, a 63% climb across a career. Most of that growth comes from two levers: moving into a higher-paying specialty and accumulating the years that let you negotiate from the 75th percentile rather than the median. A PA who starts at $101,100 and reaches the experienced band at $140,030 picks up $38,930 in annual pay, which is the typical trajectory for someone who stays clinical and adds a specialty certification along the way.

Worth noting: the early-career band is compressed in North Carolina. The gap from the 10th to the 25th percentile is only $9,220, so even your first PA job lands you close to six figures. The bigger money sits above the median, where the spread from the 50th to the 90th percentile widens to $35,410. That’s where specialty, setting, and negotiation do the heavy lifting.

Translate those annual figures into hourly terms and the picture sharpens. At the 10th percentile, $101,100 works out to roughly $48.61 an hour against the standard 2,080-hour work year. The median $129,360 is the $62.19 figure BLS reports directly. The 75th percentile lands near $67.32 an hour, and the senior band at $164,770 reaches about $79.22. For PAs weighing per-diem, locum, or hourly contract work, those numbers are the floor to benchmark against. A locum rate that doesn’t clear your equivalent salaried hourly rate isn’t worth the lost benefits and stability.

The progression between bands is worth studying if you’re planning a career arc. Moving from entry ($101,100) to early career ($110,320) is a $9,220 step, the kind of bump you’d expect from your first two or three years and a single job change. From early career to the median is a larger $19,040 jump, which usually requires either a specialty move or a switch to a higher-paying health system. The climb from median to experienced is $10,670, and from experienced to senior is $24,740. Notice that the two biggest single steps, early-career-to-median and experienced-to-senior, are the ones tied to specialty and scope rather than time served. That’s the clearest signal in the data: in North Carolina, what you do matters more than how long you’ve done it.

Physician Assistant salary by North Carolina metro

Where you practice inside the state matters more than most people assume. The five largest metro markets for PAs show a spread of nearly $9,000 between the top and bottom, and the highest-paying metro isn’t the biggest. Figures below are BLS OEWS 2025 medians.

Charlotte leads on pay at $133,140 and also employs the most PAs at 1,680, which makes it the deepest job market in the state. Durham-Chapel Hill comes in close behind at $132,670, propelled by the Duke and UNC health systems and the research-driven hiring around them. Asheville is the surprise: a smaller market at 460 PAs, yet a median of $131,260 that tops Winston-Salem and Raleigh, likely reflecting a wage premium to attract clinicians to the western part of the state.

Raleigh-Cary sits lowest of the five at $124,300, which is $8,840 below Charlotte despite a large workforce of 1,220. If you’re weighing a Triangle offer against a Charlotte one, that gap is worth raising in negotiation. The takeaway: in North Carolina, metro size and metro pay don’t track together, so compare the specific market, not the state average, when you evaluate an offer.

The employment counts tell their own story about where the opportunities are. Charlotte (1,680 PAs) and Raleigh-Cary (1,220) together account for roughly 2,900 of the state’s 7,490 PA jobs, so the two big urban markets hold close to 40% of all positions. The smaller markets are not insignificant, though. Durham-Chapel Hill (740), Winston-Salem (730), and Asheville (460) each support hundreds of PA roles and, in Durham’s and Asheville’s case, pay above the Raleigh median. For a clinician who values a shorter commute or a lower cost of living, these mid-sized markets can deliver both higher net pay and a better quality of life than the largest metro.

Here’s a useful way to combine the two columns. Charlotte offers the best mix of high pay and deep demand, which makes it the safest bet for a PA who wants options and bargaining power. Durham-Chapel Hill rewards specialists willing to work in an academic environment, with $132,670 medians at the Duke and UNC systems. Asheville is the contrarian play: fewer jobs, but a $131,260 median that beats two larger metros, so if you can land one of those 460 roles, the pay holds up. Raleigh’s lower median is the one number to push back on, because a $124,300 offer in a market with that much demand leaves room to negotiate toward the state median of $129,360 or higher.

Physician Assistant take-home pay in North Carolina after tax

Gross salary isn’t what hits your bank account. North Carolina applies a flat state income tax, and federal tax plus FICA take their cut on top. The table below shows estimated take-home at each percentile point for a single filer in the 2026 tax year, using figures from our paycheck model.

At the median, a North Carolina PA keeps $94,215 of a $129,360 salary, an effective tax rate of 27.2%. That works out to $7,851 a month. The entry-level PA at $101,100 nets $75,755, or $6,313 a month, at a 25.1% effective rate. The experienced PA at $140,030 nets $101,054, about $8,421 a month, at a 27.8% effective rate. At the top, the senior PA earning $164,770 keeps $116,912, or $9,743 a month, with the effective rate rising to 29.0% as more income hits higher federal brackets.

Look at how the deductions scale. Federal tax is the largest line at every level, and it grows fastest, climbing from $13,856 at entry to $28,792 at the senior band, because the federal system is progressive. FICA rises in a straight line with income, from $7,734 to $12,605, since it’s a fixed percentage until you hit the wage cap. North Carolina’s state tax is the smallest and most predictable line, moving from $3,755 to $6,461 across the range, because the state applies a single flat rate to taxable income rather than brackets. That flat structure is why the jump in your effective rate from entry to senior, 25.1% to 29.0%, is driven almost entirely by federal brackets, not by the state.

The practical lesson for budgeting: don’t plan around your gross. A mid-career PA who mentally banks $129,360 and budgets accordingly will be off by more than $35,000 a year. The real monthly number to build a mortgage, savings rate, and lifestyle around is $7,851 at the median, and proportionally less or more at the other percentiles. Set your fixed costs against net monthly, not gross annual, and you’ll avoid the most common pay-related budgeting mistake clinicians make in their first high-earning years.

Now the comparison that actually settles the no-income-tax debate. Take that same $129,360 median salary and run it through Texas, which has no state income tax. A Texas PA at the same gross nets $99,171. The North Carolina PA nets $94,215. That’s a gap of $4,956 a year, the exact amount North Carolina’s flat state tax pulls from your check. Over a decade, that’s nearly $50,000 in nominal difference.

But the net number is only half the equation. Net pay minus your local housing cost is the figure that actually decides how you live. A $4,956 tax advantage in Texas means little if it’s swallowed by higher rent in Austin or Houston, while a North Carolina PA in Winston-Salem or Asheville may keep far more of that net after the mortgage clears. Run your own numbers before you let a no-tax headline make the decision. To see your exact paycheck, use the North Carolina paycheck calculator, and when filing season comes around, TurboTax can model your state and federal liability so the withholding above matches reality.

ThePayGuide may earn a commission from links on this page at no cost to you. See our editorial policy.

How to earn more as a PA in North Carolina

The data points to clear levers. Moving from the median to the 75th percentile is worth $10,670 a year, and reaching the 90th percentile adds $35,410 over the median. Here’s how PAs in this state close that distance.

• Specialize where the premium lives. Surgical, emergency medicine, dermatology, and cardiology PAs cluster in the upper percentiles. The $164,770 figure at the top of the range is largely a specialty story, not a longevity story.
• Target Charlotte or Durham-Chapel Hill. Charlotte’s $133,140 median runs $8,840 above Raleigh’s $124,300 for the same credential. If you’re geographically flexible, the metro you choose is one of the fastest raises available.
• Add certifications that open specialty roles. CAQs (Certificates of Added Qualifications) in fields like emergency medicine or surgery signal specialty competence to employers. Self-paced coursework through platforms like Coursera can shore up the clinical and leadership foundations before you pursue a formal CAQ.
• Negotiate against the percentile, not the median. If you have specialty experience, anchor your ask to the 75th percentile ($140,030) and bring metro data to the table. Employers in Charlotte and the Triangle compete for experienced PAs.
• Pick up procedural and call responsibilities. PAs who take first-assist surgical duties, call shifts, or supervisory roles command pay toward the senior band. These responsibilities are often where the gap between $129,360 and $164,770 is earned.
• Consider the academic medical centers. Duke, UNC, Wake Forest, and Atrium Health anchor the highest-paying metros. Their PA roles often pair competitive base pay with strong benefits, which widens the gap between gross and true compensation.

Job outlook for PAs in North Carolina

North Carolina employs about 7,490 physician assistants, per the U.S. Bureau of Labor Statistics (2025), one of the larger state PA workforces in the country. The hiring is concentrated in the Charlotte and Triangle health systems, but Asheville, Winston-Salem, and the smaller markets all maintain steady demand, with Asheville notably paying a premium of $131,260 to draw clinicians west.

Physician assistant is consistently among the fastest-growing healthcare occupations nationally, driven by an aging population and the push to extend physician coverage in primary and specialty care. With nearly 7,500 PA jobs already in the state and multiple major health systems expanding, the practical outlook for a North Carolina PA is strong job security and real choice between employers. To watch live openings and benchmark current offers against the percentiles above, browse active listings on a board like ZipRecruiter.

Related and higher-paying roles in North Carolina

If you’re weighing the PA path against adjacent clinical careers, here’s how the pay stacks up in North Carolina using BLS 2025 medians. A physician assistant’s $129,360 median sits just $370 above a nurse practitioner, who earns $128,990, so the two roles are effectively level on pay in this state. The bigger spread is against registered nurses: a PA out-earns the $84,350 RN median by $45,010 a year, which reflects the additional training and scope a PA role carries.

Physician Assistant salary in North Carolina: FAQ

Datasets used: BLS OEWS 2025 (occupation SOC 29-1071), 2026 tax-year paycheck model. Last updated 2026. See our methodology.