Medical School vs Physician Assistant School

[callmesubo]

I took both premed and prePA classes during undergrad and am currently working as a respiratory therapist.  I am 24 years old. I am still not sure what pathway to take(PA or MD). From your personal experience what are some pros and cons of being a PA. Do some of you guys wish you went for MD?  If yes why?

[Marinejiujitsu]

Your still young. Apply to medical school unless you have a family or planning to start one soon, then go PA. I would have been MD if I didn't have a family but I enjoy being a PA and still think its a great field and has its perks like lat moving from medicine to surgery and using the docs as an escape goat lol

[Febrifuge]

For me, it was a very smart move to get into the PA track, because I was in my 30s when I got serious about medicine, and the plan was in fact to start a family. But more importantly than that, my 3 or 4 years of experience as an ER tech before I started PA school taught me about my own priorities and values, such that I could make a decent prediction about how I would be happiest and most effective as a clinician.

 

Plenty of MDs start families in med school, during residency, and beyond, so don't let family be the one and only deciding factor... unless family is that much more important to you than other concerns. Likewise, don't choose MD because the money is so much better. I do happen to believe that PAs still have a decent amount of flexibility, while an MD with a quarter-million in loans due is essentially stuck doing whatever they thought they wanted to do, four years previous.

 

My school had both and MD and a PA program, and on a day-by-day basis, we always had more going on. More hours per day in class, more tests to study for, more papers to write. MDs had the option of self-study for almost everything, so in theory they only had to even be on campus on test days. Research how specific programs work, if you have a strong preference for a learning style. I would have been really happy as an MD student, and I'm confident I would have gotten in, but I think I might have crashed and burned without the PA school structure.

 

PA school is by some estimates about 2/3 of the material of 4-year med school; it's probably a bit more than half the time, if one actually counts up the hours spent in the classroom. The big difference is that 4-year med school is preparing newly-minted doctors for residency, and in theory, PA school is preparing clinicians to go out and learn hands-on as generalists, getting better all the time but starting out at a solid level of basic competence.

 

Personally, and speaking just for myself, I wanted to be a generalist all along. Too much specialization, too many patients in a row with similar issues, bores me. I like concentrating on one person at a time, then moving on. I have no interest in being the owner/ operator of a small business; I don't want to be a department head or the person people call when they have a particularly obscure or tricky case in my specialty area. It doesn't excite me all that much to drive a nice car, especially if the trade-off is having to drive it all over the city between various clinics and hospitals.

 

Not gonna lie, the ability to say "I'm a doctor" and the way that tends to satisfy curiosity would be really nice; everybody thinks they understand what that means, and there's still a certain mystique or cachet that comes with being able to say that. Having to explain what a PA is does get kind of old. Making less money for doing the exact same job than the MDs make when they fill in for a shift is vaguely annoying in the abstract, because in theory the service I provide is the same, but they did walk a longer road than the one I decided on, so it's not like I actually feel bothered.

 

Bottom line, the trick is to reflect carefully and talk to friends and loved ones enough to get a sense of what your priorities actually are, and assess your options inside a framework you can trust. You need to get to the point where you can explain to Aunt Matilda over Thanksgiving turkey why you've decided on Path A over Path B, because you can't do that without a solid understanding of what those paths entail, to you in specific.

 

Having that solid understanding is invaluable in the application process, too, and it's critical when you're lying awake at 3am wondering what the %$!@ you're doing with your life, and tempted to think it's all a huge mistake. Good luck.

[Maverick87]

I started PA school at 23 and finished 2 years ago. I disagree with many members of this board, in that I really like having physician oversight. In most cases, the buck doesn't stop with me and I like that. I also know PAs that have been practicing for 10 years that feel the same way. Sometimes, I wonder whether I should have just gone to medical school, but I'm happy to be 27 with no debt, making a good salary. Most of the docs that I know didn't get to this point until their mid-30s.

 

Sure, you may not have as much opportunities as a PA that you do as a doc, but you certainly have enough.

 

Also, OP, another factor that you have to consider is this: I was not strong in PA school. I finished in the lower end of my class. However, this will not prevent me from getting into a good speciality. These days, if you finish at the lower end of your class in medical school, you may not even get a residency.

 

So it really depends on what you want and what type of person you are. I'm happy as a PA. Maybe this will change in the future. If it does, then maybe I'll go back to medical school, go into administration, or leave medicine entirely. Who knows. But I'm thankful that I have so many opportunities as a PA in a day and age where most are just struggling to survive.

[EMEDPA]

I was a paramedic for 5 years before PA school. I worked with some great PAs with high levels of autonomy. What I didn't realize was that they had taken 20+ years to get to where they were. I assumed I would be able to get a high autonomy job with a great scope of practice soon after graduation. nope. took me 15 years. I should have gone to medschool. better scope of practice, better autonomy. more respect. money is fine as a pa but the other issues really made me hate many of my prior jobs. I knew I could do more. it just took a long time to convince others that this was the case. I am ok with indirect physician collaboration, but at this point don't feel that I should have to present pts in real time or before pts leave the dept (and I don't).

[ventana]

PA school - 2.5-3 years

LECOM and some other 3 year med schools - 3 years

 

 

Debt - PA - 100k   MD/DO - 150k

 

Earnings PA about 100-120k, MD/DO - 200-400k

 

 

 

All of that is of no value however, mostly comes down to autonomy and not being reliant on someone else for anything....

 

go to med school 

[DiggySRNA]

Take everything with a grain of salt here. 

 

Think long and hard about what you desire in a career and also your personal life. 

 

If you only care to practice the art of medicine in areas such as PC: pedis, adolescent med, internal, the burden and stress of Med School is not worth it, well, in my eyes.

If you want to run the show at all times and be the guy on the other side of the phone yelling "sorry, I want to speak to the MD/resident in charge about patient XYZ", then go to med school. 

 

Sincerely,

A naive Pre-PA. 

[SocialMedicine]

a note about the 3 year med schools .. many of those limit you to an IM residency .... in my experience few MDs are making much over 200 in primary care/internal medicine/pediatrics. So the 200-400K salary is more appropriate for a 4 year school when you include specialty and sub specialty practice. 

[EMEDPA]

a note about the 3 year med schools .. many of those limit you to an IM residency .... in my experience few MDs are making much over 200 in primary care/internal medicine/pediatrics. So the 200-400K salary is more appropriate for a 4 year school when you include specialty and sub specialty practice. 

if you do FP/PEDS/IM/ob as required by these schools you can then do a fellowship if you so desire....$$$$$

[PA2016!]

Prior to PA school I asked 5 MD's if they could chose again PA vs MD, what would they do? They all said they would go back and go to PA school. Asked the 3 PAs that I shadowed the same thing...They all said they would still prefer to be a PA. 

 

For what it is worth...I am also in one of the most PA friendly states in America...The birthplace of the profession.... 

[EMEDPA]

Prior to PA school I asked 5 MD's if they could chose again PA vs MD, what would they do? They all said they would go back and go to PA school. Asked the 3 PAs that I shadowed the same thing...They all said they would still prefer to be a PA. 

 

For what it is worth...I am also in one of the most PA friendly states in America...The birthplace of the profession.... 

NC is one of the best places to be a PA. many other places not so good...

[Guest Paula]

a note about the 3 year med schools .. many of those limit you to an IM residency .... in my experience few MDs are making much over 200 in primary care/internal medicine/pediatrics. So the 200-400K salary is more appropriate for a 4 year school when you include specialty and sub specialty practice. 

 

Nothing would prevent an MD trained in a 3 year school to do the IM residency, work a few years and then apply for a fellowship in a focused specialty such as cardiology. Then off to the bigger bucks and out of primary care.

[EMEDPA]

yup. and the 3 yr PA to DO bridge at LECOM allows 1/2 the class to do specialties and 1/2 has to commit to primary care:

APAP currently has 12 slots for this pathway. Six slots are designated as “undeclared” meaning students enrolled may take a residency of their choice. The other six slots are “primary care” requiring the student to commit to undertake a residency and practice for five years in family practice, general internal medicine, pediatrics or OB/GYN

[Guest Paula]

Nothing would prevent an MD trained in a 3 year school to do the IM residency, work a few years and then apply for a fellowship in a focused specialty such as cardiology. Then off to the bigger bucks and out of primary care.

 

Off to bigger bucks and doe.   LOL! I'm so funny!

[delco714]

For me, it was a very smart move to get into the PA track, because I was in my 30s when I got serious about medicine, and the plan was in fact to start a family. But more importantly than that, my 3 or 4 years of experience as an ER tech before I started PA school taught me about my own priorities and values, such that I could make a decent prediction about how I would be happiest and most effective as a clinician.

 

Plenty of MDs start families in med school, during residency, and beyond, so don't let family be the one and only deciding factor... unless family is that much more important to you than other concerns. Likewise, don't choose MD because the money is so much better. I do happen to believe that PAs still have a decent amount of flexibility, while an MD with a quarter-million in loans due is essentially stuck doing whatever they thought they wanted to do, four years previous.

 

My school had both and MD and a PA program, and on a day-by-day basis, we always had more going on. More hours per day in class, more tests to study for, more papers to write. MDs had the option of self-study for almost everything, so in theory they only had to even be on campus on test days. Research how specific programs work, if you have a strong preference for a learning style. I would have been really happy as an MD student, and I'm confident I would have gotten in, but I think I might have crashed and burned without the PA school structure.

 

PA school is by some estimates about 2/3 of the material of 4-year med school; it's probably a bit more than half the time, if one actually counts up the hours spent in the classroom. The big difference is that 4-year med school is preparing newly-minted doctors for residency, and in theory, PA school is preparing clinicians to go out and learn hands-on as generalists, getting better all the time but starting out at a solid level of basic competence.

 

Personally, and speaking just for myself, I wanted to be a generalist all along. Too much specialization, too many patients in a row with similar issues, bores me. I like concentrating on one person at a time, then moving on. I have no interest in being the owner/ operator of a small business; I don't want to be a department head or the person people call when they have a particularly obscure or tricky case in my specialty area. It doesn't excite me all that much to drive a nice car, especially if the trade-off is having to drive it all over the city between various clinics and hospitals.

 

Not gonna lie, the ability to say "I'm a doctor" and the way that tends to satisfy curiosity would be really nice; everybody thinks they understand what that means, and there's still a certain mystique or cachet that comes with being able to say that. Having to explain what a PA is does get kind of old. Making less money for doing the exact same job than the MDs make when they fill in for a shift is vaguely annoying in the abstract, because in theory the service I provide is the same, but they did walk a longer road than the one I decided on, so it's not like I actually feel bothered.

 

Bottom line, the trick is to reflect carefully and talk to friends and loved ones enough to get a sense of what your priorities actually are, and assess your options inside a framework you can trust. You need to get to the point where you can explain to Aunt Matilda over Thanksgiving turkey why you've decided on Path A over Path B, because you can't do that without a solid understanding of what those paths entail, to you in specific.

 

Having that solid understanding is invaluable in the application process, too, and it's critical when you're lying awake at 3am wondering what the %$!@ you're doing with your life, and tempted to think it's all a huge mistake. Good luck.

This is the most succinct and well thought out response to this well beaten question ive ever come across. Well done, sir.

[BruceBanner]

PA school is by some estimates about 2/3 of the material of 4-year med school; it's probably a bit more than half the time, if one actually counts up the hours spent in the classroom. The big difference is that 4-year med school is preparing newly-minted doctors for residency, and in theory, PA school is preparing clinicians to go out and learn hands-on as generalists, getting better all the time but starting out at a solid level of basic competence.

 

 

^True story.

 

A few other things to consider in addition to the above opinions:

 

-Lateral mobility is quickly going extinct. That's not to say you CAN'T change specialties, it just becomes very difficult to do so unless it is peripherally related; i.e., family med to endocrine, or hospitalist to cardiology. If you start in a specialty after school and spend a year or more there, it is going to be pretty difficult to make a categorical change should you not like it. With med school of course, it isn't realistic at all.

 

-Don't expect to land your dream job right out of PA school. You'll hear all kinds of enchanting stories, but most likely you will have to sort of "start from the bottom" like the rest of us. Expect to do a lot of scut work if you are in a hospital-based job, and expect to see a lot of back pain/URIs/STDs if you are in a retail or walk-in clinic.

 

-I think, hour for hour, PA school is harder than med school. The material is no different, it's the time-frame and the immense volume you are responsible for regurgitating in exams. It was not a relaxing 2 years.

 

-Being an MD lends itself better to creating career capital. By that I mean there are more avenues available to you simply because of your degree. You have the ability to become highly specialized, get into non-clinical business and consulting, and create a profitable niche with those rare and valuable traits everyone wants like autonomy, creativity, and impact. Yes, I'm sure someone will chime in saying they save the world every day as a PA, but the straight dope is that PAs have their limitations, both in business and in medicine.

 

-Our scope is similar in many ways to docs, but it depends on the job. In fact, the answer to pretty much all PA job-related questions is: it depends on the job, and it depends on the location. Most new grads want to work where they are from, and this can be limiting. Some areas are very PA-friendly, some are not. Some are highly over-saturated and no one will care if you have even 2-3 years of experience. Some gigs will offer you $100k+ and some will offer you $60k (seriously). Some gigs are low-stress with sane hours, and some gigs are glorified scut-slavery. A lot of employers will use the old bait-and-switch to get you in the door, because they need a PA for labor and we cost less than a doc. Retail clinics are exploding. Of course docs can get bad gigs too, but the big difference between us is docs do a residency. That's why they make the big calls and make big bucks, as they say. PAs can do a lot of cool, highly-skilled procedures, but it takes years to get enough experience to have that privilege. You can expedite this by doing a PA residency.

 

 

One big-picture question you need to ask yourself is "do I really like patient care??" Because that is what you will be doing, all day every day. Some PAs (and MDs) are drawn in by the medical/scientific aspects, or the money and professional respect. If you are one of these people, do yourself a favor and choose a different path while you still can, because you genuinely need to enjoy patient care on a heart level (most of the time) to do the job.

[SocialMedicine]

you know healthcare given your resp therapy profession.  what type of medicine do you see yourself in ?  if out patient pulm, primary care or another IM is a passion of yours that is something to consider in the decision. I have a couple where husband/wife are PA. The surgery wife envies that her primary care husband has full autonomy and is considered medical director of his clinic. They went to PA school together and she is still in the role of a senior resident many years after PA school in a specialty surgical field. 

[Febrifuge]

One big-picture question you need to ask yourself is "do I really like patient care??" Because that is what you will be doing, all day every day. Some PAs (and MDs) are drawn in by the medical/scientific aspects, or the money and professional respect. If you are one of these people, do yourself a favor and choose a different path while you still can, because you genuinely need to enjoy patient care on a heart level (most of the time) to do the job.

Quoted for truth.

 

I'm a reasonably smart person, but the "intellectual challenge" is never really what I liked about medicine. I don't do crossword puzzles. I'm not House, MD, and wouldn't want to be. I honestly don't care much about money, provided the bills are paid and I can eventually retire (but who am I kidding, I will work part-time until I no longer can, otherwise I live like a 9-year-old). I just like practicing, the day-to-day, patient-to-patient small challenges.

[tunafish]

You would have a more pleasant experience in med school for sure. In 10-15 years these extra 1,5-2 years would mean nothing. We are part of medical school, we take some of the classes together. Med students in class till noon, every day if they even feel like doing so. We are in class till 5. They have lectures on how to manage life and school, how not to get burned out. They have student societies with IM sports, movie nights, music listening parties hosted by their faculty. They do not have grades per se, they need 10% less to pass the classes compared to our graduation requirement. Right now we are taking same anatomy segment with them. Same exams both practical and written. Same material, we dissect in the mixed groups. The only difference, we have additional afternoons worth of classes and all the extra exams associated with them. I do not think there are many PAs who loved their didactic year, it is given. I know we all like hikers getting ready for a week long trip with only a daypack space for gear. No one will openly say that as a PA you do not need to know...X. I feel like the only part we are not covering in full is histology. There are very specific reasons why I chose PA path (lateral mobility being one of them), but I wanted to shed light on the "experience" aspect of your education and amount of extra gray hair upon graduation from different programs. There are clear changes in PA scope of practice and legal support that can make our profession even more attractive, question remains if PA body will push it through and AMA would allow that to happen...we shall see!

[ItRainsItPours]

It really depends on your situation. Are there more perks to being an MD? Yes, but it comes at a big price. It's easy to be envious of attendings but there's nothing glamorous about not having control of your life for seven years at the minimum. I would prefer to be a physician as I come from a legacy family, but I was a bad student my freshman year and am not competitive for MD. I thought DO would be my saving grace with their grade replacement, but I live in maryland and there aren't any here. I have a close knit family and didn't like the idea of not being able to get dinner with them regularly, go to birthday parties, impromptu movie nights. So while I would have preferrred the autonomy and the prestige that physicians get, I wasnt willing to sacrifice time with my family to do it. Also has anyone seen how much DO schools cost? 50k a year for many and thats not counting your loans for living expenses, loans from undergrad, and accumulating interest. Even if you went to a state school for UG you can rapidly approach 400k by the end of a three year residency. To pay that off in a ten year plan you'd be making $4k payments a month. Unless you're making north of $200k, your lifestyle after paying taxes and your loans wont be much different than the PAs working alongside you.

It's not as simple as MD > PA. Look at the cost, financial and emotional.

[PACdan]

-I think, hour for hour, PA school is harder than med school. The material is no different, it's the time-frame and the immense volume you are responsible for regurgitating in exams. It was not a relaxing 2 years.

 

This nails it.

 

My class is taking a course with the neighboring med school students, and they are in awe of how much time we're in class each day. The med students' typical day starts an hour later and ends 2-3 hours earlier than ours. And that's if they go to lecture; they optional attendance, unlike the PA students. They can also stay in the dorm/apt and watch the lecture via webcam from the comfort of their warm bed. That one gets me laughing.

 

But yeah, we're doing it all in 2.5 years, so our schedule is going to be more packed and, I FEEL, more strenuous in that regard. I've come across some that have this crazy notion that PA school is just a cake walk since you "only have to do it for 2-2.5 years". Luckily none of our future physician colleagues from this program will have that delusion.

 

Long story short, PA school is not an escape from the pressures or stressors of medical school. It has it's own unique challenges due to the volume of material and time constraints of learning it. Med school is stressful, but the pace is most certainly different from my observations.

[tunafish]

While I got carried away yesterday comparing the schedules too, I have to admit that not having step I is a great plus in PA school. While you are expected to know Chovstek's sign and underling possible causes of hypocalcemia, you do not need to know the facts about parathyroid embryology and dorsal wings of the third and forth pouch as well as functioning of Na/Ca exchange pumps, mechanism of synthesis of cAMP and action potential associated with that sign...

[AMS_ER]

And here I sit 4 years after graduation ... Thought I made the right choice. But now I spend every week considering going back to school. Frustrated with the ceilings of my role in the ED. And I can't tell the difference between burn out, narcicissm, or a true desire for more training.

It's never an easy choice.

[Guest Paula]

And here I sit 4 years after graduation ... Thought I made the right choice. But now I spend every week considering going back to school. Frustrated with the ceilings of my role in the ED. And I can't tell the difference between burn out, narcicissm, or a true desire for more training.

It's never an easy choice.

 

We've all been there.  It's a soul wrenching experience.  

[ventana]

While I got carried away yesterday comparing the schedules too, I have to admit that not having step I is a great plus in PA school. While you are expected to know Chovstek's sign and underling possible causes of hypocalcemia, you do not need to know the facts about parathyroid embryology and dorsal wings of the third and forth pouch as well as functioning of Na/Ca exchange pumps, mechanism of synthesis of cAMP and action potential associated with that sign...

 

 

And here I sit 4 years after graduation ... Thought I made the right choice. But now I spend every week considering going back to school. Frustrated with the ceilings of my role in the ED. And I can't tell the difference between burn out, narcicissm, or a true desire for more training.

It's never an easy choice.

 

 

This is my own issue

 

I am sure there is a TON more info in med school - that is presented and must be memorized - BUT how much of that makes me a better PCP?

I think residency would help, but honestly unsure the current residency is set up to benefit a community based PCP - I don't need to know how to manage vent patients, how to pull someone back from the brink of death in the ICU - but this is where the $$$ flows for residency training (although I have heard they are looking at that) - instead I would love a program that a PA could go though after a set number of years of experience that would allow them to be a legally independent provider and able to sign everything and order everything my patients needs.  I really don't care about a title at all (too old for that) but it frosts me with the wasting of my time and my SPs time to run around getting signatures....

 

We all practice as part of  a team, and for the first 5 years out of school I think PA and NP should have a collaboration agreement with a Doc, but after that in the Primary Care worlds, it really doesn't add anything but headaches, regulations (that if you don't meet can get you in trouble ie chart review, narcs review...) and a waste of time and energy.  Really after 5 years you are on your own and should be viewed that way - but boy would I love a one year Ddx and Txt course followed by the ability to take a national exam which once passed allows us to be legally independent and get paid 100%.