From Hospitals to Telehealth: A Guide for PAs and NPs on Choosing the Right Setting
When people ask me how to make more money as a PA or NP, the conversation almost always jumps to specialties. Derm PA? Surgery NP? Urgent care PA? What pays the most?
But what you do is only half the equation. Where you work and who signs your paycheck can make just as big of a difference. Your schedule, pace, patient acuity, charting burden, and even how you practice medicine day-to-day will shift dramatically depending on the employer type. Some roles prioritize volume over high quality care. Others give you more space to connect with your patients, teach, and train future clinicians.
Whether you're optimizing for income, autonomy, or long-term sustainability, the type of employer you choose matters. How much you make as a Physician Assistant or as a Nurse Practitioner is just the start – benefits, PTO, retirement plans, malpractice coverage, and growth opportunities can vary dramatically depending on the organization.
Here are a few quick examples of how different employers align with different goals:
- If you're aiming for PSLF (Public Service Loan Forgiveness):
Look for nonprofit or government employers like academic centers, FQHCs, or the VA. Private practices won’t qualify. - If your goal is to maximize income:
Private practices, high-volume surgical centers, and aesthetics clinics with revenue-sharing or productivity bonuses often beat out hospital salaries. - If you want top-tier retirement benefits:
Large hospital systems and government employers like the VA may offer pensions, 401(k)/403(b) matches, profit-sharing, or access to 457(b) plans. - If you need flexibility:
Urgent care centers often offer 3-4 day workweeks with no call, and school-based or student health roles follow academic calendars with breaks or summers off. - If you want parental leave or sabbaticals:
Corporate, pharma, and health tech roles typically have more progressive benefits including extended PTO, paid parental leave, and sabbaticals after a few years. - If you're burned out and craving a slower pace:
Student health, integrative medicine, corporate health clinics, or niche telemedicine roles tend to involve lower acuity, longer visit times, and less charting stress.
It's not always about maximizing income. Sure, there are ways to earn $200k as an NP and there are many PAs who earn similar amounts, but it's important to optimize for what works best for your personal goals.
Help us bring transparency to medicine
Let’s walk through the most common employer types for PAs and NPs and break down what really matters beyond the base pay.
You can see average pay by different Employer Types on the PA Salary Trends page and on the NP Salary Trends page.
Hospitals & Health Systems
Academic Medical Centers
Pay: Salaried, sometimes with RVU bonuses in procedural or teaching roles.
Benefits: Excellent - 403b match, pension, strong health insurance.
Pros: Teaching environment, research exposure, access to innovation.
Cons: Pay can lag behind the private sector; slower promotions.
Best for: PAs & NPs who love learning, teaching, working in complex cases, or pursuing PSLF
Private Community Hospitals
Pay: Base salary + potential bonuses.
Benefits: Solid, but may vary depending on ownership.
Pros: Smaller teams, greater workflow autonomy.
Cons: May lack academic resources or prestige. potentially limited specialty support
Best for: PAs & NPs seeking a patient-centered community feel with less bureaucracy.
State-Run or Government Hospitals
Pay: Tiered salary scale, like GS or VA systems.
Benefits: Unmatched retirement plans (pensions), PSLF eligibility, job security.
Cons: Bureaucracy, slow to promote or change roles.
Best for: PAs & NPs focused on retirement benefits, job stability, and loan forgiveness
Medical Groups & Physician Practices
Solo or Independent Group Practices
Pay: Often collections-based or hybrid (salary + % of billing).
Benefits: Varies widely. Some offer profit-sharing; others offer nothing.
Pros: High autonomy, potential to grow a niche, close team.
Cons: Variable income, limited support, more business responsibility.
Best for: Entrepreneurial PAs & NPs who want ownership or business experience
Single Specialty Groups
Pay: Usually RVU or billing-based. High earning potential in procedural specialties.
Benefits: Competitive in high-income fields, especially private equity-backed ones.
Pros: Focused scope, efficiency, potential for income growth.
Cons: Limited skill diversity; higher burnout in volume-heavy clinics.
Best for: PAs & NPs who want to maximize income in a specific specialty like derm, ortho, GI, etc.
Multi-Specialty Groups
Pay: Often salary + bonus; some RVU-based.
Benefits: Stronger packages due to scale.
Pros: Room for internal transfers, cross-referrals, mentorship.
Cons: Still may be revenue-driven; productivity pressure can creep in.
Best for: PAs & NPs who want job security and internal mobility without a hospital system
Specialty & Outpatient Centers
Urgent Care Centers
Pay: Hourly or per shift, sometimes with performance bonuses.
Benefits: Vary depending on ownership.
Pros: Predictable schedules, no call, great for PRN income.
Cons: High volume, repetitive care, limited growth.
Best for: PAs & NPs needing flexibility, part-time work, or a secondary income stream
Ambulatory Surgery Centers (ASCs) & Specialty Centers
Pay: Higher hourly or salaried with bonus options.
Benefits: Can be very competitive in ortho, GI, pain, etc.
Pros: Predictable hours, no weekends, specialized skill growth.
Cons: Narrow scope, minimal upward mobility unless you become a partner.
Best for: Procedural PAs & NPs optimizing for pay, efficiency, and time
Mission-Driven Organizations
Community Health Clinics / FQHCs
Pay: Salaried, often lower than market average.
Benefits: PSLF eligible, solid PTO, decent retirement.
Pros: Deeply meaningful work, underserved populations.
Cons: Resource limitations, burnout risk if short-staffed.
Best for: PAs & NPs passionate about social justice and giving back, and those seeking student loan forgiveness or NHSC repayment
Non-Profits / NGOs
Pay: Varies by funding and grants.
Benefits: Often minimal unless large org.
Pros: Mission-focused, global health, or advocacy work.
Cons: High turnover, grant dependency, lower compensation.
Best for: PAs & NPs driven by global health, environmental work, or humanitarian missions who can accept lower compensation for impact
Public Health Departments or Government Clinics
Pay: Public pay scales or set salary ranges.
Benefits: PSLF eligible, pension options, government perks.
Pros: Daytime hours, prevention-focused care, strong job security.
Cons: Bureaucracy, fewer acute cases, slow systems.
Best for: PAs & NPs who want steady hours, long-term government benefits, and the opportunity to work in prevention or health policy
Military or VA Roles
Pay: Transparent salary scale (GS or VA) plus housing allowances
Benefits: Lifetime pension, PSLF, full health coverage
Pros: Rare stability, clear advancement, relocation perks
Cons: Less flexible, structured hours, potential relocation
Best for: PAs and NPs who want a mission-driven career with structured growth, strong government benefits, and the chance to serve in the military or care for those who have served.
Corporate & Non-Clinical Roles
Corporate Health Clinics (e.g., Amazon, Google, Apple clinics)
Pay: Competitive base salary, sometimes RSUs or bonuses.
Benefits: Great health insurance, sabbaticals, wellness stipends, PTO, parental leave.
Pros: Low acuity, employee-focused care, wellness emphasis.
Cons: Limited procedures, minimal advancement.
Best for: PAs & NPs seeking a stable, low-stress clinical role with excellent perks like parental leave, sabbaticals, and a strong emphasis on preventive care.
Pharma or Med Device Companies
Pay: Very high, especially MSL (Medical Science Liaison) or clinical education roles.
Benefits: 401k match, stock options, great perks, parental leave.
Pros: High travel stipends, professional growth, exposure to innovation.
Cons: Less patient care, may feel more corporate than clinical.
Best for: PAs & NPs who want to stay connected to medicine while gaining access to corporate benefits like equity, bonuses, and career mobility in the medical industry.
Remote & Flexible Work
Telemedicine
Pay: Per visit or hourly. Mostly 1099. Widely varies by speciality.
Benefits: Rare unless W-2.
Pros: Fully remote, flexible schedule, low overhead.
Cons: Tech issues, burnout from back-to-back visits, less mentorship.
Best for: PAs & NPs seeking autonomy, geographic flexibility, or a low-overhead role that complements caregiving, travel, or part-time lifestyles.
Retail Clinics (CVS, Walgreens, etc.)
Pay: Hourly. W-2 or 1099 depending on setup.
Benefits: Basic - may include 401k, PTO.
Pros: Low acuity, clear protocols, quick visits.
Cons: Repetitive care, lower pay than hospital-based roles.
Best for: PAs & NPs seeking part-time or low-stress roles, especially in transition seasons.
Before saying yes to a job with a fancy title or a juicy sign-on bonus, ask yourself:
- How is this job paid - salary, RVUs, revenue split, or hybrid?
- What’s the real total comp (benefits, PTO, retirement, and malpractice)?
- Does this support my long-term lifestyle goals - freedom, family, flexibility?
The best roles don’t just pay well - they fit who you are and where you’re headed. That’s why it’s worth looking beyond the salary to understand the full picture: schedule, responsibilities, benefits, and more. Check out the real, anonymized PA salaries or NP salaries on Marit to see how it all comes together, so you can see what’s possible.
About the Author
Wilson Liang, PA-C, MHA, MPH is an informatics PA and assistant professor who bridges clinical care, technology, and education. He is also a mentor to hundreds of PAs and NPs, guiding them through strategic career and financial decisions for lasting freedom and fulfillment. Follow him on Instagram @wilson_invests.
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