Medical School vs Physician Assistant School

[EMEDPA]

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.

do the lecom apap pa to do. 3 yrs. no mcat. just do it.

[primadonna22274]

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...

But I kinda liked learning all that stuff more than a decade after graduating and practicing as a PA.... ????

[AMS_ER]

do the lecom apap pa to do. 3 yrs. no mcat. just do it.

I just had the worst three over nights ever with a doc that wasn't as much of a team player. Three simultaneous codes, two of which were mine. Multiple DKAs. Multiple a fib rvrs. An adenosine push svt for good measure. 26 weeks premature twins in a 'I didn't know I was pregnant" scenario. GSW. Rollover MVCs. No one could stay in the tree stands hunting. Psychs were out in force. On nights like these, two providers for 30 beds isn't enough. This morning I thought damn that was both heartbreaking and i loved every minute of it ... And I could do a hell of a lot more with some more training.

 

It's happening :) just need to figure out the rest now.

[KMD16]

^ very concerning....was in similar predicament when I started out....not the exact scenario. What's resonate here lack of training/mentorship....bad setup. You don't belong there. You seem confuse....so many red flags. Make any mistakes... Your behind is out....best to resign now before it's too late.....my 2cents. Good luck!

[AMS_ER]

Every nights not like that. And I typically don't lack mentorship. Just the guy I was paired with this weekend.

Can't resign ... I'm hooked. What am I gonna do? Go sit in a clinic somewhere? Not this woman ...

Feel free to judge me or call me stupid.

[KMD16]

Suck it up and stay the course then! No need for " medical school vs physician school " title post.

[EMEDPA]

Every nights not like that. And I typically don't lack mentorship. Just the guy I was paired with this weekend.

Can't resign ... I'm hooked. What am I gonna do? Go sit in a clinic somewhere? Not this woman ...

Feel free to judge me or call me stupid.

just get up to speed as quickly as you can. if you have not taken these courses yet do so asap:

acls, atls, pals, difficult airway, fccs, abls

next round: apls, also

see if you can spend some time in the O.R. doing intubations and riding with the medics to see what the field is like and learning some down and dirty fast pt management skills.

 

2 providers for 30 beds is crazy. around 7-8 sick pts/provider it starts to get dangerous. you can not (no one can) manage 15 sick pts at once.

I worked at a place with 21 beds managed by me and a single doc for a while and it was dicey anytime it got really busy. I don't work there any more. not a safe environment.

now I have 3 jobs:

#1 solo 10 beds low to moderate acuity. rare to have 2 really sick folks at once, but it happens.

#2 solo 5 beds (very high acuity)

#3 double coverage 9 beds (very high acuity)

[AMS_ER]

just get up to speed as quickly as you can. if you have not taken these courses yet do so asap:

acls, atls, pals, difficult airway, fccs, abls

next round: apls, also

see if you can spend some time in the O.R. doing intubations and riding with the medics to see what the field is like and learning some down and dirty fast pt management skills.

 

2 providers for 30 beds is crazy. around 7-8 sick pts/provider it starts to get dangerous. you can not (no one can) manage 15 sick pts at once.

I worked at a place with 21 beds managed by me and a single doc for a while and it was dicey anytime it got really busy. I don't work there any more. not a safe environment.

now I have 3 jobs:

#1 solo 10 beds low to moderate acuity. rare to have 2 really sick folks at once, but it happens.

#2 solo 5 beds (very high acuity)

#3 double coverage 9 beds (very high acuity)

 

I have acls, pals, atls. My employer offers difficult airways courses yearly that I attend. The surgeons here had a sim lab, they are willing to work with me in often. And the majority of the physicians I work with are great mentors and have taught me a lot over the past 4 years.

 

Typically, some rooms close after midnight and there's a third provider until 1-2 am. But on nights like those 2-6 am can be a looong night for the two of you. I agree I guess my description sounds dicey. I assure you I'm not being as cavalier as it's sounds.

[ItRainsItPours]

I have acls, pals, atls. My employer offers difficult airways courses yearly that I attend. The surgeons here had a sim lab, they are willing to work with me in often. And the majority of the physicians I work with are great mentors and have taught me a lot over the past 4 years.

 

Typically, some rooms close after midnight and there's a third provider until 1-2 am. But on nights like those 2-6 am can be a looong night for the two of you. I agree I guess my description sounds dicey. I assure you I'm not being as cavalier as it's sounds.

If you just want more formal training in EM why not attend a PA residency? I'm genuinely curious as an EMT who wants nothing more to be an EM PA with the intention of attending one of those programs.

[ventana]

just get up to speed as quickly as you can. if you have not taken these courses yet do so asap:

acls, atls, pals, difficult airway, fccs, abls

next round: apls, also

see if you can spend some time in the O.R. doing intubations and riding with the medics to see what the field is like and learning some down and dirty fast pt management skills.

 

2 providers for 30 beds is crazy. around 7-8 sick pts/provider it starts to get dangerous. you can not (no one can) manage 15 sick pts at once.

I worked at a place with 21 beds managed by me and a single doc for a while and it was dicey anytime it got really busy. I don't work there any more. not a safe environment.

now I have 3 jobs:

#1 solo 10 beds low to moderate acuity. rare to have 2 really sick folks at once, but it happens.

#2 solo 5 beds (very high acuity)

#3 double coverage 9 beds (very high acuity)

 

last job I had in the ER as full time was a 30 bed ER with two of us that could, would, and did surge to 40 beds almost every night by using hallways, closets and anywhere a patient could sit.

 

After I left the company got fired, the director almost lost his license, (I think 2 year probationary period), and the provider they hired to replace me had already been sued once for sending a floppy baby home.....   I left ASAP truly afraid for my license.......

 

Be careful, no one is going to protect you except you - AMSER

[AMS_ER]

If you just want more formal training in EM why not attend a PA residency? I'm genuinely curious as an EMT who wants nothing more to be an EM PA with the intention of attending one of those programs.

I've considered a residency. But that vast majority of EM positions are structured around lower acuity and fast tracks.

[AMS_ER]

last job I had in the ER as full time was a 30 bed ER with two of us that could, would, and did surge to 40 beds almost every night by using hallways, closets and anywhere a patient could sit.

 

After I left the company got fired, the director almost lost his license, (I think 2 year probationary period), and the provider they hired to replace me had already been sued once for sending a floppy baby home.....   I left ASAP truly afraid for my license.......

 

Be careful, no one is going to protect you except you - AMSER

Thanks for the warnings....

 

I kinda regret even adding to the post now. My peers at work make me feel bad enough about having an interest in critical care. Posted here just to lament with OP about the choices between pa and md. Now I'm afraid to go to work! Jk.

[Acromion]

If you just want more formal training in EM why not attend a PA residency? I'm genuinely curious as an EMT who wants nothing more to be an EM PA with the intention of attending one of those programs.

 

If this is your ultimate goal, I'd recommend going to med school if it is feasible. All said and done the time difference and cost for you to get from where you are now to where you want to be won't be substantially different in the long run. The hoops you will have to jump through now for med school and residency will save you a lot of headaches down the road. A lot of hoops now vs. endless hoops for the rest of your career.

 

The things you probably love about emergency medicine as a paramedic: being the first responder,  swooping in and saving at the brink of death, the rush of a code, i.e. the true emergencies that define the specialty... generally won't be accessible to you as a PA, at least without many years of experience and additional training; even then you will face lots of barriers that you wouldn't have to deal with otherwise if you just spent the few extra years training to be physician.

 

Almost 1 year on my first job and the vast majority of what I see in ED is in no way an emergency. Actually was hard to adjust to this because on my rotations I was seeing the sickies- MI's, CVA's, ect . . . Now I mostly see URI's, rashes, back pain, chronic pain, abdominal pain. There's no time to help out during a code when the waiting room is full of ankle sprains, lacerations, and vag bleeds. My attendings give me a pretty wide latitude to see higher acuity patients but I steer clear of anyone remotely unstable. There's just too much room for error and no one has time to walk me through it. I don't mind this so much because I have more of a FM/IM mindset but if you like to be the one to save the day, you may want to reconsider going to PA school if your goal is to work in EM.

 

I hope I don't discourage you from your goals. Just want to give you the unvarnished reality of what you will be up against so you aren't disappointed later. I remember when I was a lowly nursing/medical/pharmacy assistant making $12 / hr and I thought the PA's were gods. From that perspective, I couldn't see the gulf that existed between the PA's and the docs. ... I wish someone had taken me aside and explained it to me sooner. I'm pretty happy with my career and I certainly have nothing to complain about. I just think you should be fully informed because your plan of PA + 1 year EM residency may not get you where you are hoping to be.

[db_pavnp]

Great post and a dose of realism for pre-PA/NP readers, myself included.

[SoCal_PA]

Those that are evidently upset/discouraged by your current job, what's stopping you from relocating? There are good jobs out there, go get 'em

[AMS_ER]

Those that are evidently upset/discouraged by your current job, what's stopping you from relocating? There are good jobs out there, go get 'em

I'm trying to tell the difference in being discouraged by my job and discouraged by my career.

[EMEDPA]

If this is your ultimate goal, I'd recommend going to med school if it is feasible. All said and done the time difference and cost for you to get from where you are now to where you want to be won't be substantially different in the long run. The hoops you will have to jump through now for med school and residency will save you a lot of headaches down the road. A lot of hoops now vs. endless hoops for the rest of your career.

 

The things you probably love about emergency medicine as a paramedic: being the first responder,  swooping in and saving at the brink of death, the rush of a code, i.e. the true emergencies that define the specialty... generally won't be accessible to you as a PA, at least without many years of experience and additional training; even then you will face lots of barriers that you wouldn't have to deal with otherwise if you just spent the few extra years training to be physician.

 

Almost 1 year on my first job and the vast majority of what I see in ED is in no way an emergency. Actually was hard to adjust to this because on my rotations I was seeing the sickies- MI's, CVA's, ect . . . Now I mostly see URI's, rashes, back pain, chronic pain, abdominal pain. There's no time to help out during a code when the waiting room is full of ankle sprains, lacerations, and vag bleeds. My attendings give me a pretty wide latitude to see higher acuity patients but I steer clear of anyone remotely unstable. There's just too much room for error and no one has time to walk me through it. I don't mind this so much because I have more of a FM/IM mindset but if you like to be the one to save the day, you may want to reconsider going to PA school if your goal is to work in EM.

 

 

agree with all of this. As someone only looking to EM and coming from a paramedic background I should have definitely gone the medschool route. I want to be the guy at the head of the bed making the calls and doing the procedures, not a helper bee keeping the patients who should have seen their dr in clinic happy.

If you are set on the PA route , however, a residency is a very important step to getting to that position of seeing high acuity patients who actually need your help or they might die right now. It took me almost 20 years to climb the ladder through fast track jobs to intermediate acuity jobs to the positions I have now where I can run the codes, cardiovert, delivery the babies, etc. If you want this type of job as a pa you will likely need to work very rural in a solo capacity like Boatswain and I. I don't know of any PA jobs in the country at major medical facilities where the PA is the guy at the head of the bed calling all the shots without a mother may I to the docs for everything.

Bottom line: much easier to do EM as a doc, but if you must do PA, do an EM residency so you have the skills and the procedure log to back them up. then when you graduate don't accept a crap job. hold out for the dream jobs, they are out there(way out there....)

[Acromion]

agree with all of this. As someone only looking to EM and coming from a paramedic background I should have definitely gone the medschool route. I want to be the guy at the head of the bed making the calls and doing the procedures, not a helper bee keeping the patients who should have seen their dr in clinic happy.

 

That said, you do have to be on your toes and know your stuff even if you are doing fast track. Yesterday I saw an otherwise healthy mid-40's guy with a hx of GERD who "vomited once and feels tired" who ended up having anemia secondary to a GI bleed. They took him for an EGD and he had a pulsatile upper GI bleed, he was immediately intubated and transferred to CCU. Had I sent him home he might have bled out. I see cases like that almost once per shift, and on my drive home it makes it all seem worthwhile. If I didn't, I would go absolutely nuts seeing diaper rashes and fibromyalgia patients all day. 

 

I'm strongly considering doing a fellowship ... soon. I have no financial obligations or commitments otherwise that would prevent me from doing it. I just hope that being 1 year out of school doesn't affect my chances.

[Joelseff]

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.

 

Hahaha! Best Post I Have read in a while on here. How true. 

[EMEDPA]

That said, you do have to be on your toes and know your stuff even if you are doing fast track. Yesterday I saw an otherwise healthy mid-40's guy with a hx of GERD who "vomited once and feels tired" who ended up having anemia secondary to a GI bleed. They took him for an EGD and he had a pulsatile upper GI bleed, he was immediately intubated and transferred to CCU. Had I sent him home he might have bled out. I see cases like that almost once per shift, and on my drive home it makes it all seem worthwhile. If I didn't, I would go absolutely nuts seeing diaper rashes and fibromyalgia patients all day. 

 

I'm strongly considering doing a fellowship ... soon. I have no financial obligations or commitments otherwise that would prevent me from doing it. I just hope that being 1 year out of school doesn't affect my chances.

the issue is, you got that pt due to bad triage. I want to see that pt because they know he is bleeding out and they send him to me because they know I can deal with it. You will learn a lot from bad triage. it's how PAs in fast track get to see acuity...

and doing a fellowship a year out of school is a great time to do it. I highly recommend this.

[ItRainsItPours]

If this is your ultimate goal, I'd recommend going to med school if it is feasible. All said and done the time difference and cost for you to get from where you are now to where you want to be won't be substantially different in the long run. The hoops you will have to jump through now for med school and residency will save you a lot of headaches down the road. A lot of hoops now vs. endless hoops for the rest of your career.

 

The things you probably love about emergency medicine as a paramedic: being the first responder,  swooping in and saving at the brink of death, the rush of a code, i.e. the true emergencies that define the specialty... generally won't be accessible to you as a PA, at least without many years of experience and additional training; even then you will face lots of barriers that you wouldn't have to deal with otherwise if you just spent the few extra years training to be physician.

 

Almost 1 year on my first job and the vast majority of what I see in ED is in no way an emergency. Actually was hard to adjust to this because on my rotations I was seeing the sickies- MI's, CVA's, ect . . . Now I mostly see URI's, rashes, back pain, chronic pain, abdominal pain. There's no time to help out during a code when the waiting room is full of ankle sprains, lacerations, and vag bleeds. My attendings give me a pretty wide latitude to see higher acuity patients but I steer clear of anyone remotely unstable. There's just too much room for error and no one has time to walk me through it. I don't mind this so much because I have more of a FM/IM mindset but if you like to be the one to save the day, you may want to reconsider going to PA school if your goal is to work in EM.

 

I hope I don't discourage you from your goals. Just want to give you the unvarnished reality of what you will be up against so you aren't disappointed later. I remember when I was a lowly nursing/medical/pharmacy assistant making $12 / hr and I thought the PA's were gods. From that perspective, I couldn't see the gulf that existed between the PA's and the docs. ... I wish someone had taken me aside and explained it to me sooner. I'm pretty happy with my career and I certainly have nothing to complain about. I just think you should be fully informed because your plan of PA + 1 year EM residency may not get you where you are hoping to be.

Thank you for taking the time to write this very thoughtful response, you've given me a lot of perspective.

[FcMike11]

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

This, I'm a 24 year old RN. I have a son and one on the way. I've taken all pre reqs for MD school but the commitment to bring my family through it is too much for me.

[Marinejiujitsu]

This, I'm a 24 year old RN. I have a son and one on the way. I've taken all pre reqs for MD school but the commitment to bring my family through it is too much for me.

Then go to PA school. You'll end up missing so much of your kids life in medical school. My kids are my little pals. Less time away is better.

[FcMike11]

Then go to PA school. You'll end up missing so much of your kids life in medical school. My kids are my little pals. Less time away is better.

I was initially all in for MD school, always have had my wife's support (is an RN also, which helps). Had my son in first semester of organic. I just can't fathom being away from him so much. Working night shift kills me already. I love what you said "my kids are my little pals" because I want to be there for everything I can be, and to be my sons best friend.

[SteveMC]

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?

 

If you are thinking about it, go to medical school. DO is a great route, especially if you can finish before 2020 (the tentative year for merging of the DO and MD residency match system). The core issue with medical school in general is, everyone who graduates with MD or DO is not guaranteed a residency and in most states that is required to practice. Additionally, you must be a good test taker with USMLE and COMLEX to score high to compete with very smart "gunners" including foreign medical grads competing for positions. This year ~1000 U.S. MD grads didn't match into residency. What will they do then? There are two applicants for every single residency slot and the numbers are growing against you the longer you wait (unless you can ACE the boards, particularly Step 1 and Step 2). The challenge for MD/DO is much different than for PA. Consider that.