How to become a physician assistant

1. 1Earn a bachelor's degree with science prerequisites

   Time: 4 yearsCost: Varies by collegeSources 1, 4

   Any major can work, but most PA programs require science coursework before you start, and the exact prerequisite list differs by school. Many programs set minimum overall and science GPAs; the University of Iowa, for example, requires 3.00 overall and 3.40 in science. Biology and other health-related majors are common because they cover most prerequisites. Check each target program's requirements early so you can fit the courses into your degree.

2. 2Get hands-on patient care experience

   Time: 1-2 years (often overlapping with college)Cost: Paid workSources 1, 4, 5

   PA programs expect experience caring directly for patients before you apply. The amount varies by program; both programs we checked, the University of Iowa and Charleston Southern, require 1,000 hours of direct patient care. Jobs such as medical assistant, EMT and paramedic are typical ways to build hours. Each program defines what counts as direct patient care, so read those rules before choosing a job to log hours in.

3. 3Apply through CASPA

   Time: One application cycle; deadlines fall months before the program startsCost: $185 first program, $65 each additionalSources 10, 6, 4, 5

   CASPA, the Centralized Application Service for Physician Assistants, is run by the PA Education Association and covers about 95 percent of accredited PA programs. You submit transcripts, patient care hours, recommendation letters and a personal statement once, then send it to each program. Some programs add supplemental applications or fees. Deadlines vary: Iowa's 2026 deadline is October 1 and Charleston Southern's is September 1 for a January 2027 start.

4. 4Complete an accredited PA program

   Time: About 24-28 monthsCost: $80,000-$110,000 total tuition (examples)Sources 1, 9, 2, 4

   PA school starts with classroom and lab study in subjects such as anatomy, physiology, pharmacology, clinical medicine and physical diagnosis. The second phase is supervised clinical rotations. ARC-PA standards require clinical experience in family medicine, emergency medicine, internal medicine, surgery, pediatrics, women's health and behavioral and mental health care. Only graduates of an ARC-PA accredited program can sit for the PANCE.

5. 5Pass the PANCE

   Time: From 7 days after graduationCost: $550Sources 2

   The Physician Assistant National Certifying Examination has 300 multiple-choice questions in five blocks of 60, with five hours of testing time. You can apply up to 180 days before you finish your program. You may take it once per 90 days and up to three times a year, and you have six years and six attempts after graduation to pass. Passing lets you use the PA-C credential.

6. 6Get a state license and start practicing

   Time: A few weeks to a few monthsCost: State license fees varySources 2, 1, 12, 7

   Every state and DC requires PAs to be licensed, and all of them rely on NCCPA certification as one of the criteria for licensure. Each state board sets its own application steps and fees. Most states also require a supervision or collaboration agreement with a physician. To prescribe controlled substances you need state authority and a DEA registration. Look up your state's requirements with the CareerOneStop License Finder.

Programs, tuition and graduates’ earnings

U.S. Department of Education, College Scorecard (most recent cohorts, released 2026-10-15). Scorecard groups programs by 4-digit field, so a row can include related programs. Tuition is the median published undergraduate tuition and fees of the colleges offering the program (shown only for undergraduate credentials); debt is the median of programs’ median federal loan debt at completion; earnings are the national median for the field and credential four years after completion.

Requirements differ by state. Check your state’s rules in the CareerOneStop License Finder (U.S. Department of Labor) before you enroll.

Clinical reasoning

PAs sort through symptoms, exam findings and test results to reach a diagnosis and decide what to do next.

Communication

Patients need diagnoses and medication plans explained in plain terms, and physicians need clear, quick case summaries.

Teamwork

PAs practice in collaboration with physicians, nurses and specialists, so knowing when to consult or refer is part of safe care.

Composure under pressure

In emergency and surgical roles PAs make treatment decisions while patients are unstable.

Commitment to lifelong learning

Certification requires 100 CME credits every two years and a recertification exam every decade, and medicine changes constantly.

O*NET 31.0 rates these skills as most important for the occupation: reading comprehension, critical thinking, active listening, writing, speaking.

Training cost

$80.7K–$111K

Before financial aid

Time

6-8 years

Typical path

Median pay

$135,880

All US jobs: $50,980

Payback once qualified

1.0–1.3 yrs

Pay above the all-jobs median vs. cost

Low: University of Iowa total PA program tuition for residents, $80,000, plus the PANCE fee of $550 and the CASPA fee for one program, $185. High: Iowa's non-resident total tuition, $110,000, plus the same fees; Charleston Southern's private program lists $96,000. Most applicants apply to several programs at $65 each after the first. Not included: undergraduate costs, program fees, equipment, living costs or state license fees. For a wider view, median federal loan debt for master's graduates in the College Scorecard program family that includes PA studies (allied health diagnostic, intervention and treatment) is $124,028.

Rough guide only: ignores taxes, aid, interest and earnings given up during training. How we calculate it.

• Specialty PA with a CAQ

  Experienced PAs can earn an NCCPA Certificate of Added Qualifications after logging required specialty hours and CME and passing a specialty exam; emergency medicine requires 3,000 hours.

• Healthcare administrator$123,860 median

  Experienced PAs can move into managing clinical teams or service lines; a degree such as an MBA or MHA can help for senior roles.

• PA program faculty$82,250 median

  Teaching in a PA program usually requires clinical experience, and some faculty add a doctoral degree.

• Physician$244,180 median

  Requires medical school (4 years) and residency (3 or more years); PA experience does not shorten that training.