PA vs MD: Who Builds More Wealth by Age 50?

When you walk into a hospital room, who do you assume is swimming in cash?

The attending physician with years of training under their belt? The surgeon who drives a luxury car and racks up high six-figure paychecks?

What if the real millionaire in the room isn’t the MD—but the PA?

Today, we’re pulling back the curtain and looking at real investment projections, salary timelines, and wealth trajectories to answer the ultimate money question:

Who ends up richer by age 50… a PA or an MD?

Let’s find out. 👇

The Head Start Advantage: PA vs MD Timeline

On average, PAs enter the workforce by age 26, while physicians don’t reach full attending status until around age 32–35, depending on specialty.

That’s quite the investing head start for the PA. While a physician may earn an income in residency or fellowship, it’s often barely enough for them to get by and investing isn’t an option.

Even if physicians make 2–3x more than PAs in gross salary once they complete training, the compounding effect of those early investing years matters… a lot.

Case Study 1: Dermatology PA vs Dermatologist

• Derm PA
  Starts working: Age 26
  Starting salary: $156K
  Investing 20% of gross: $2.5M by age 50
  
• Dermatologist
  Starts working: Age 32
  Starting salary: $480–500K
  Investing 20% of gross: $4.1M by age 50
  
  

Verdict? The MD wins, but the PA can do quite well if they address their contract structure.

Most dermatology PAs eventually move to percent-of-collections contracts. With this, their salary can jump to $250K+ by year 3, and even $400K+ with 10+ years of experience.

📈 With this trajectory, a high-earning derm PA could hit $3.4M+ by age 50, nearly matching the dermatologist’s $4.1M net worth.

Case Study 2: CT Surgery PA vs Cardiothoracic Surgeon

• CT PA
  Starts working: Age 26
  Avg salary: $157K
  Net worth by 50: $2.3M
  
  
• CT Surgeon
  Starts working: Age 35
  Avg salary: $926K
  Net worth by 50: $5.4M
  

The surgeon here comes out WAY ahead.

But remember: a $926K lifestyle also demands a much bigger nest egg to sustain in retirement. A CT surgeon likely needs to retire a decamillionaire plus to maintain their inflation adjusted current lifestyle. 

Case Study 3: Pediatrics PA vs Pediatrician

• Peds PA
  Starts working: Age 26
  Salary: ~$130K
  Net worth by 50: $1.8M
  
  
• Pediatrician
  Starts working: Age 30
  Salary: ~$239K
  Net worth by 50: $2.3M
  
  

Here we see the narrowest gap between PA and MD wealth outcomes.

For those drawn to pediatrics, this specialty creates one of the most level playing fields, especially when factoring in cost of education, work-life balance, and student loan debt.

Case Study 4: Orthopedic Surgery PA vs Orthopedic Surgeon

• Ortho PA
  Starts working: Age 26
  Salary: ~$150K
  Net worth by 50: $2.2M
  
  
• Ortho Surgeon
  Starts working: Age 32
  Salary: $700K+
  Net worth by 50: $5.9M
  

Again, the surgeon earns more. But the question isn’t just how much you earn, it’s how much you keep.

If the surgeon spends 90% of their income and invests little? They might end up broke.

If the PA is a disciplined investor? They’ll have financial freedom—and even potentially an early retirement.

Case Study 5: Primary Care PA (Locums) vs PCP

• Primary Care PA (Locums)
  Starts working: Age 26
  Avg salary with locums: ~$158K
  Net worth by 50: $2.3M
  
  
• Primary Care Physician
  Starts working: Age 30
  Salary: ~$300K
  Net worth by 50: $2.9M
  
  

Locum contracts make a BIG difference. For PAs who leverage PRN or hourly work, this path can help close the gap significantly, without taking on 6–10 years of med school, residency, and fellowship.

The Real Gamechanger: Strategy

Now let’s get spicy.

Say the cardiology PA makes $138K, invests 20%, and uses PSLF.

📉 Net worth at 50 with just straight salary? $2M.

But what if they:

✅ Add a $20K pharma or expert witness side gig
✅ Boost investing rate to 35%
✅ Slash student loan payments with PSLF + AGI lowering strategy

📈 Now their net worth jumps to $4M.
That’s just $2M less than a cardiologist earning over $500K a year.

It’s not the letters after your name. It’s what you do with your paycheck.

Final Thoughts: Who Wins?

There’s no universal “winner.” Both paths can lead to multi-millionaire status—or financial frustration.

Here’s the takeaway:

👉 You can and should become a multimillionaire as a medical professional, regardless of your specific role
👉 PAs and MDs can both create early financial independence, or spend their entire lives on the hedonic treadmill and never build wealth

In the end, income ≠ wealth. It’s how you use it that matters.

Watch full video here: https://youtu.be/vI38e2X9oB0?si=nDksdvYLRHo2KhPL 

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