High school student not sure between physician or physician assistant. Advice please?

[bgarc8]

I'm a senior in high school and have been thinking about what I want to be when I'm an adult. I brought up being a PA to my family but they don't agree with it. They say a PA is not a real doctor so I will not have the title of "Dr." and that I will be taking orders from doctors while the actual doctor makes all the money. I was thinking about being a PA because they have less debt and less schooling but they do pretty much everything a doctor does. The only appealing difference that I can see between PA and a physician is the salary. I've always wanted to be in the medical field and help people (in fact I'm volunteering at a hospital) but I don't want to give up my life for a higher pay and more schooling. I'm not sure if that comes off as selfish but... could i please have some advice on what i should do? I would really appreciate it :)

[EMEDPA]

go to med school. it's not just the money, it's the lack of respect, autonomy, and scope of practice, which at times is intolerable. 6+ years of post high school education( I now have 10 to the 11 the docs I work with have) and many folks think you are a medical assistant( 6 month course after high school). the prereqs are pretty much the same now. there are even several 3 yr med schools so the difference in training time is becoming less and less. yes, docs have to do a 3+ yr residency, but they get paid for this. think of it as a low paying first job. it's on the job training/experience.

also administrators will arbitrarily put limits on your scope of practice for no apparent reason, even forbidding skills you are really good at and do more than docs.A PA I work with is a currently licensed ultrasound tech and it took him a year to get credentialed to do u/s at my last er job because some GI doc on the credentialing committee felt "PAs shouldn't do u/s." This PA used to teach ER residents how to do u/s for a living!

I can't say this strongly enough. PA school is for folks already working in medicine(nurses, paramedics, etc) who want to take the next step, not folks starting out from high school. for these folks it is a great option as it allows them to buld on skills they already have. for folks without prior medical experience under age 25, the goal really should be medschool

only in primary care(family medicine, etc) do PAs and docs really do the same things. in almost every specialty docs have procedures they can do which PAs are forbidden from doing. I have been working in emergency medicine for 27 years and just last year got a job at which my scope of practice is exactly the same as the docs who work there because I work alone and staff the ER without a doc in house. they staff single coverage docs or PAs interchangeably. this place is very rural and not even close to convenient to a major metro area. this type of job is VERY rare in emergency medicine. there are probably 50-75 emergency med PAs in the country out of 10,000 who work in this kind of setting and they are all rural. I fought tooth and nail to get here, changing jobs every few years every time a better one came along and getting every cme course in emergency medicine and certificate that was available. this is my 7th job in emergency medicine as a pa, not counting prior jobs as an er tech and paramedic. almost 20 years as an em pa and I am finally doing what I thought I would be doing 2-3 years out of school. I live on the west coast and do admit there is some regional variability. it is much easier to get a good job as an EM PA east of the Rockies than west.

[DiggySRNA]

Time to educate your family on the role of Physician Assistants :) - they're probably mistaking the title for a medical assistant which is...sadly common. 

[zoopeda]

On the other hand, I've seen quite a few patients mistake PAs for Drs...

 

Also, if you're not certain which specialty you'll want (which there's no way you are), just note surgeons (and some specialties) are doctors. If you go orthopedics as a pa, you'll never lead in surgery. On the other hand, in family medicine (lower salary) you might hardly ever see you supervising doc. I'm inclined to point out how young you are and that the extra years you'll have earning an MD salary would far exceed the difference in loans you'd take out for two more years (difference) of school. Take a year off, and do tons of shadowing and volunteering, and talk to a dozen doctors and a dozen PAs (good long conversations about it all...healthcare in ten years will be a very different place, and they can show you how.). That alone will give you a leg up on the (intense) competition and give you the experience needed to make the right decision. Good luck!

[rev ronin]

I get called doctor all the time--big deal.  I make 40% of what the primary care doctors do, and am expected to have about 125% of the same output at the same acuity.  All the 1.0 FTE docs get a "flex day" for panel management, which usually means they stay at home and catch up on charts or complex patient calls for their paneled patients.  I'm expected to manage things that start with me, but I don't get any time at all to do so--just gotta work it all in between the patients.  So, after 2 1/4 years of no salary at all and 2 years on the job, I'm still making about 15% less than I did when I left my IT day job to enter PA school.

 

Having said that, I still get to take care of people.  While I don't officially have a panel of patients, there are 50+ who will only come to see me if I'm available, no matter who is on record as their PCP.  I work with a ton of great docs and senior PAs who are always there to help or teach--I work in a well-respected system with a great track record of using PAs appropriately.  In two years I've only ever had one patient refuse to see a PA--and he'd gotten moved to my schedule from a MD who was sick.  I get to do minimally invasive procedures like excisional biopsies, toenail removals, and large joint injections, and doing diabetic footcare for ~4 hours every 6-8 shifts is a real highlight, since I get to actually sit and listen to my patients while I work on their feet.  If there aren't any big financial surprises in my future, I should be paying off my student loans in about 6 months.

[UGoLong]

You are in the same pickle that we all were in when we were your age. Adults -- well-meaning ones like your parents (especially your parents!) and the people on this forum -- give you conflicting information and it’s your life to try to figure out.

 

Should you be a PA or a physician? Hard to say, really. I have known people in both jobs who love it and people who hate it -- and lots of people in between. One of the good pieces of advice that you’ve already been given is to get enough experience with both physicians and PAs to be able to make your own decision.

 

My point in all of this; each of us takes one of the many paths through our careers. There are alternate realities we don’t get to experience: working for other employers, in other jobs, and in other specialties. When you are young, you are a bit idealistic -- a trait that I have tried to keep alive in my aging body. Still, as a prospective scientist, you owe it to yourself to get as much first-hand knowledge as you can before the 18 year-old version of you makes a decision that the 50 year-old version of you will one day hopefully thank you for. And, if my life is any indication, you’ll get many more chances to make changes later.

 

As I would say -- if I could -- to the 18 year-old version of me: good luck! You don’t have to know all of the answers and you can change many of your decisions as you go. Still, you are now in a unique position to find out for yourself what direction feels right for you. Ask for advice, but do your own research by putting yourself into the situations you are considering. You are the only one who has to live with your decisions.

[rmathews619]

I'll be honest with you...go to med school. I'm a PA and I wished I went to med school. My friend is a resident now and I know few years down the line he will be making 3x what I will be making. Rest assure it is NOT always about the money, but there is that prestige and respect. You are in high school, so best advice is apply to those straight BS/MD programs which gets your into med schools without taking the MCATS. A lot of people think PA field is a "fallback" if they don't get into med school, I assure you it is harder to get into PA school now. So my best advice would be do to the med school route. I sure wish I did it. Good luck. 

[bgarc8]

Thank you all for your responses. I appreciate them. I'm still unsure what to do even though most said to go to medical school. It's just that spending pretty much the entirety of my twenties in medical school does not sound very appealing to me. People always say to relish my young age and I feel like I won't be able to if I go to medical school because everywhere I see, people make medical school out to be some stress filled hell hole. Also I've read that physicians have one of the most stressful jobs in the world. These factors kind of scare me away from the occupation

[zoopeda]

Whatever you do, don't make the decision until you've taken the time to learn about and experience first hand care under several practitioners. Taking a little time off to pursue healthcare interests can be a great way to build a unique background that helps you to stand out among a million 21 year old 3.7s while you enjoy your 20s. Good luck.

[JohnnyM2]

It saddens me to see experienced PAs recommend med school over PA school but I understand they have valid reasons. PAs often do not get the respect they have earned or the ability to practice autonomously, even when they have demonstrated full competency. Many PAs have the experience, demonstrated competence and productivity that would merit pay equal to many mds. Moreover, politics limit the ability of PAs to open their own practices in many states and many employers simply refuse to allow PAs to practice at the top of their license, instead imposing arbitrary restrictions.

Keep in mind, however, that there are also problems with becoming an md. Part of that is length of schooling and follow on training. Part of it is a health care system that increasingly seeks to limit the ability of physicians to design appropriate treatment programs suited to their patients, instead requiring them to follow treatment "pathways." I have a lot off friends who are mds and those who are oncologists, for example, feel that they are being turned into technicians following some other authority's recipe. Surgeons are somewhat less frustrated but they have plenty of complaints also as do internists, pediatricians and others.

Keep in mind, also, that as an md, when you finish med school, you must get matched into a residency. Although 90% of all med school seniors get matched into their specialty of choice, it is very difficult to get matched into some specialties such as dermatology because the residencies just aren't there. Although about 75-80% of seniors get matched into one on their top three choices, only about 50%+ get matched into their top choice. As a result, residency can require you to pull up stakes and move, which can be a problem for a working spouse.

Once you become a physician, it can become difficult to change specialties, requiring an additional residency and another move, not to mention losing patients and/or practice seniority.

 

 

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[EMEDPA]

Nice summary. keep in mind that docs can also do fellowships after residency if they want to change focus.

for example with a year of extra training at a reasonable rate of pay an em doc can become trained in sports medicine, pain management, critical care medicine, ems, global health, public health, geriatrics, education, research, forensics, hyperbaric med, etc

list of em fellowships here:

http://www.saem.org/membership/services/fellowship-directory

also if you do a flexible field like FP you can do extra cmes and start doing cosmetic derm, treadmills, scopes,vasectomies, etc in your office without having to do an added fellowship.

Docs have far more options than PAs if they get bored or burnt out.

[rlwpac]

I wish I had gone to med school myself. But, I think it highly depends on your situation and what you want to do. First, I did not know that in places such as the state of Florida, a physician can practice any area of medicine regardless of their training. I was very worried that if I went to medical school, I would be stuck in a specialty I didn't want if I didn't make it into a residency of a specialty I would have preferred. I work in and love aesthetics. If I had known I could have gone to be a family practice doc and still be doing this field, I would have. Second, a lot of people (employers, colleagues, patients) have no idea what a PA is or is trained to do and think it is like an MA or RN. Some PAs might not care about that, but I find the disrespect and the lack of understanding of my role very frustrating. My employers are happy to collect the money I earn but at the same time will assign me janitorial duties if they see me sitting still for a brief moment thinking I'm not doing anything even if I am charting or researching a patient treatment. I have seriously considered owning my own business to get away from dealing with people who do not take me or the practice of medicine seriously, which puts me and my patients in jeapordy. I really wish I didn't have to, but I cannot find an employer that treats me as I should be treated. However, I know dealing with vendors will be a nightmare because I will not be respected as a business owner (see the thread by the headache clinic owner). I can hire a medical director for my own business, who is therefore my employee, but all the vendors will require that his/her name is on the order slips as the authorized provider because they do not allow PAs to order things under their own name. Insane. Maybe in 10 or 20 years being a PA will be great if the AAPA ever gets their act together to assist in passing necessary legislation in each state and promote our profession to the general public so they know who the heck we even are... but for right now I wish I was a doc so I could simply do my job without being second guessed or demeaned all the time. The extra years would have been worth the trouble in hindsight. Good luck in your decision.

[EMEDPA]

I wish I had gone to med school myself. Some PAs might not care about that, but I find the disrespect and the lack of understanding of my role very frustrating. My employers are happy to collect the money I earn but at the same time will assign me janitorial duties if they see me sitting still for a brief moment thinking I'm not doing anything even if I am charting or researching a patient treatment. Maybe in 10 or 20 years being a PA will be great if the AAPA ever gets their act together to assist in passing necessary legislation in each state and promote our profession to the general public so they know who the heck we even are... but for right now I wish I was a doc so I could simply do my job without being second guessed or demeaned all the time. The extra years would have been worth the trouble in hindsight. Good luck in your decision.

^^^^^^^^^ ditto to all of this ^^^^^^^^

[PACdan]

The answer gets framed differently, depending on the qualities and circumstances of the person inquiring.

 

This individual has familial pressure introducing doubt, is young (not even out of HS) with plenty of time to decide. He's not 27, with past HCE and an undergrad already completed. There is definitely a tipping point (in my opinion) for when a person decides to enter medicine, what route is "best". And if the two main routes to practicing medicine are to become a physician or a PA, the cost/benefit of each needs exploring. At his age and opportunity, medical school would probably return more over a career than PA school. I think that dynamic shifts as the years (and the degrees) pass, and life accumulates. I stood at that crossroads, and weighed all my variables. In my late 20's, with my experiences, and my future goals, PA was the better choice for me to pursue medicine. For you, at this juncture, medical school should be a heavy favorite.

[PACdan]

My employers are happy to collect the money I earn but at the same time will assign me janitorial duties if they see me sitting still for a brief moment thinking I'm not doing anything even if I am charting or researching a patient treatment.

 

Do you then laugh at them and continue your reading/charting?

 

You need to go somewhere you're respected as a provider of medicine and pt. care.

[cinntsp]

My employers are happy to collect the money I earn but at the same time will assign me janitorial duties if they see me sitting still for a brief moment thinking I'm not doing anything even if I am charting or researching a patient treatment.

This probably has little to do with being a PA and a lot to do with being a pushover. Stand up for yourself or walk.

 

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[winterallsummer]

At this point it doesn't really matter because the beginning work for PA and MD/DO is the same: get the degree and pre-reqs, get experience working in health care.  I'd try to shadow both PA and MD/DO some time in the future.  And who knows you may end up deciding to go RN or MBA or engineer, who knows.  So I wouldn't stress about it too much at this time.

[EMEDPA]

unless the OP elects to do a direct entry bs/pa/ms or bs/md program.

[UGoLong]

If you elect to go to a 4 year college, it will be the last scheduled chance you have to take courses outside of your major and, perhaps, to live with people on alternate career paths. While going to a 6 year MD program straight out of high school may save some time, you have to be a lot surer than most of us were at 18 as to how we wanted to spend the next few decades.

[EMEDPA]

If you elect to go to a 4 year college, it will be the last scheduled chance you have to take courses outside of your major and, perhaps, to live with people on alternate career paths. While going to a 6 year MD program straight out of high school may save some time, you have to be a lot surer than most of us were at 18 as to how we wanted to spend the next few decades.

agree. I had the option to do BS/MD  and decided not to. in retrospect, I made the wrong choice. For others who are unsure, the traditional 4 yr route is the better option.

[patachok]

Thank you all for your responses. I appreciate them. I'm still unsure what to do even though most said to go to medical school. It's just that spending pretty much the entirety of my twenties in medical school does not sound very appealing to me. People always say to relish my young age and I feel like I won't be able to if I go to medical school because everywhere I see, people make medical school out to be some stress filled hell hole. Also I've read that physicians have one of the most stressful jobs in the world. These factors kind of scare me away from the occupation

Relish your young years...and do what? Get drunk or go bar hopping? You can have lots of fun in Med school and throughout your residency, you will get respect and scope of practice which now for you means nothing, but it will one day.

I am a second year PA student, but I wish i could drop a few years (and no, i am not that old :), and do it all over again, in medical school. I had my chance, but got no support from my husband, and i know it is stupid...but i regret not going to med school when i had a choice.

We cannot give you our experience, nor our brain. It is your choice, you have time, make it wisely.

 

Some of us have thousands of experiences, and some have the same experience a thousand times.

[zoopeda]

Relish your young years...and do what? Get drunk or go bar hopping? You can have lots of fun in Med school and throughout your residency, you will get respect and scope of practice which now for you means nothing, but it will one day.

I am a second year PA student, but I wish i could drop a few years (and no, i am not that old :), and do it all over again, in medical school. I had my chance, but got no support from my husband, and i know it is stupid...but i regret not going to med school when i had a choice.

We cannot give you our experience, nor our brain. It is your choice, you have time, make it wisely.

 

Some of us have thousands of experiences, and some have the same experience a thousand times.

Or you could go see the world, learn a language, do the peace corps, work in a clinic, fall in love, find a Purpose... Or sure, you could bar hop a little while you enjoy the hell out of your twenties in an 80-hr-per-week-(mostly-nights) residency... Don't let anyone else's baggage bog you down; just be sure (as you can be) before making such a massive decision...

[delco714]

I'm friends with a lot of med students, and for a year I rotated with hundreds... sure they're stressed and they need to be dedicated, but hell, they post pictures of what appears to be good life satisfaction every day. It's you who makes it what it is. How YOU handle the road

[rlwpac]

This probably has little to do with being a PA and a lot to do with being a pushover. Stand up for yourself or walk.

 

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I didn't say I actually do it. I'm just saying it is disrespectful that anyone even thinks that is appropriate.

[hlj25950]

I'll just say the grass is always greener on the other side. I'm applying to PA school. My husband is a surgeon. No way in hell would I ever want to do a residency. No way. I could have gone to med school, but residency is crazy. I could write a novel on this topic. Honestly, I don't think most PAs really understand how difficult residency or fellowship can be. The sacrifices and stress level are a lot higher for physicians.

 

As far as money? Like you said, it's not the most important thing. Plus there's a lot of extra debt involved in most cases with med school.

 

Respect? Can I roll my eyes any further? Your patients still all have degrees from WebMD and Dr. Google and your hospital administration only sees the bottom line.

 

Lateral mobility and flexibility in the PA profession are huge. I'd spend some time really talking to and shadowing lots of PAs and physicians.

 

First, though, get into college, take Anatomy and Physiology. Take Organic Chemistry. If you still want to do medicine as opposed to something easier, you will do great. You've got time. Choose wisely.