The Epidemic of Politeness Costing PAs Tens of Thousands in Pay

Most physician assistants don’t earn less because they aren’t valuable.

They earn less because they’re too polite to ask.

I’ve seen it over and over again—smart, capable PAs leaving tens of thousands of dollars on the table simply because negotiation feels uncomfortable, intimidating, or “ungrateful.”

I’m Kristin Burton, PA-C, and I’ve been a PA for nearly a decade. I’ve negotiated primary jobs, per diem roles, investment deals, and business contracts. And I can tell you this with certainty:

Failing to negotiate doesn’t just affect your next paycheck—it compounds into decades of under-earning and lost wealth.

Why Negotiation Feels So Hard for PAs

I still remember my first PA job offer.

I was on rotation when the email hit my inbox. My heart was racing. I was thrilled. They could have offered me almost any number and I would’ve said yes.

I was just grateful to have a six-figure job as a new grad.

Negotiation wasn’t even on my radar.

And that mindset—“Where do I sign?”—follows many PAs throughout their careers.

We ask for one or two small things… then stop.
We don’t want to rock the boat.
We don’t want to seem difficult.

But there is a professional way to negotiate that allows you to win financially without burning bridges.

What Happened When I Asked Anyway

I once negotiated with a large hospital system—arguably one of the hardest places to negotiate.

The response I got?

“You should be grateful. You were offered more than we expected and more than others in the role.”

Most people would stop there.

Instead, I calmly replied:

“Thank you for the offer. I’m excited about the opportunity. Who would be the best person to discuss compensation further?”

No confrontation. No emotion. Just professionalism.

Because I came prepared with data, I increased my income by several thousand dollars—simply by asking and backing it up.

How PAs Justify Higher Pay (Even on Salary)

One of the biggest myths I hear is:

“I’m salaried, so productivity doesn’t matter.”

It does.

Whether you’re on RVUs, collections, or straight salary, billing data matters.

Why?

Because administrators and finance teams don’t view your value through patient care alone—they view it through revenue.

If you can show:

• patient encounters
• procedures
• revenue generated
  
  

…it becomes much easier to justify higher compensation.

Non-billing roles can negotiate too—but they often need:

• collective PA data
  
  
• physician support
  
  
• clear operational impact

Why Collective Negotiation Works

It’s hard for one PA to push past “market raises” alone, especially at a large medical center and in roles where PAs don’t bill.

But when PAs come together—with shared data—it changes the conversation.

I’ve seen:

• GI APP groups
• surgical PA teams
• hospital-based cohorts

successfully secure 10–15% raises, not 3% cost-of-living bumps.

The key - it took the collective group + physician leadership to step in and say:

“This role isn’t sustainable without our PAs.”

That combination—data + unity + professionalism—moves systems.

The Most Overlooked Factor: Total Compensation

Salary alone doesn’t tell the full story.

One of my best-paying jobs didn’t look great on paper—until I read the fine print.

I was getting paid a pretty average hourly rate. BUT - I was also set to receive time and a half for any hour worked over 40 in a calendar week. My schedule was seven on, seven off with 12 hour shifts. That meant I automatically received 44 hours of time and a half every single week. 

Once I calculated total compensation, it was a no-brainer.

A savvy PA evaluates:

• base salary
• bonuses
• overtime
• retirement contributions
• HSA funding
• CME
• PTO
  
  

Until you know your true total compensation, you can’t compare offers—or negotiate effectively.

Why Negotiation Isn’t Just About You

Negotiation isn’t aggressive.
It’s expected.
And it affects more than just your paycheck.

When PAs don’t negotiate, it sets a precedent that affects the entire profession.

So yes—ask professionally.
Prepare with data.
Have the conversation.

Because every time we don’t, we all lose.

Before You Negotiate… Make Sure You’re Not Already Underpaid

If you don’t know whether you’re underpaid, you won’t know what to ask for.

That’s why I created a free resource to help you figure it out.

👉 Check If You’re Underpaid as a Medical Professional (Free Guide)

Inside, you’ll learn:

• Compare your pay to national benchmarks
• Adjust for cost of living
• Factor in years of experience
• Identify where you should fall (not average — 75th percentile)
• Evaluate total compensation beyond salary alone
• Calculate your effective hourly rate so you know your true value

Before you ask for more… make sure you know your number.

👉 Get the free guide and find out if you’re underpaid.