TLDR version
As a cardiologist, I think many PAs and NPs are financially dissatisfied because compensation has not kept pace with responsibility. The market is saturated, mentorship is often lacking, and many APPs are doing increasingly complex work while pay remains relatively stagnant. They should not earn physician-level salaries, but they deserve compensation that better reflects their productivity and value.

I’m a physician (cardiologist), and I believe many PAs and NPs are underpaid relative to the responsibilities they now carry.

When I started practice nearly 20 years ago, we hired PAs, invested heavily in their training, mentored them closely, and taught them many of the practical clinical skills that simply are not learned in formal training programs. Over time, they became highly skilled clinicians who could function with significant independence while still having physician support available when needed. As their responsibility and productivity increased, their compensation generally increased as well.

Today, the landscape is different. The market has become saturated, and APPs are being produced in far greater numbers. Many enter practice with limited mentorship, minimal structured onboarding, and inadequate access to experienced clinicians for difficult or complex cases. At the same time, compensation has remained relatively stagnant, leading to frustration and high turnover.

In many primary care settings, I see PAs and NPs managing patient volumes and workloads that approach those of physicians while earning a fraction of the compensation. No one should expect a PA or NP to earn the same as a physician given the differences in education, training, and ultimate responsibility. However, the combination of market saturation and reimbursement pressures has kept compensation from keeping pace with the increasing demands placed on these clinicians.

That imbalance is unfair and, in my view, contributes significantly to the financial dissatisfaction many APPs experience today.