Move out of state vs Medical school

[Joelseff]

I know this thread was from a while ago but I wanted to say thanks again to everyone who replied.  It really helped change my trajectory.  Decided to go to medical school.  I can always go back to being a PA if things don't work out.  Starting this summer.

Congrats on your decision! when you become a Doc please remember how it is for PAs and try not to $#!T on us! LOL

[PAtoB]

Could you show proof of these numbers?

To clarify, and I admittedly didn't know it in this context the first time I heard it: the 25% PA figure is based on a PA applicant only applying to one program, but the pct ticks upward the more schools one applies to, and the avg applied to is purported to be 8 programs, depending on the source cited. And even then I question how 25% is derived when many programs will have 8 or more applicants for every seat available ... I went digging one day after the know-it-all scribe/premed student at my job tried telling the attending she scribes for, who is chief of our service and is intimately involved with the adcom process for their med school and residency program, that less than 5% of med school applicants get into med school. He said that's not right, it's more like nearly 60% med applicants, and she argued with a logic that he ended up kind of believing but said he thought she was wrong. He polled the rest of us what we thought, and a couple of us thought it was closer to between 40-50% for med school, and a bit less than that for PA school.

 

PA school: PAEA semiannual report data: http://paeaonline.org/research/program-report/

 

Med school: https://www.aamc.org/data/facts/applicantmatriculant/ and parsing out that data with the logic spelled out here: http://www.doctorshadow.com/the-real-medical-school-acceptance-rate/#.WHqCWJKtqt8

[overthehorizen]

It is difficult to compare this data because the entrance requirements are different for PA and Medical school. PA schools generally require the GRE if a graduate program but if it is an undergraduate program, then no GRE. Medical schools (except for lecom) consistently require the MCAT. 

 

We should really switch all PA programs to start taking the MCAT for admission. It would demonstrate the intellectual power of the Physician Assistant and garner more respect than taking the PANCE/PANRE which physicians just laugh at. When PAs see that their MCAT scores were better than MD applicants, the PA applications would dry up.

[Hckyplyr]

I know this thread was from a while ago but I wanted to say thanks again to everyone who replied.  It really helped change my trajectory.  Decided to go to medical school.  I can always go back to being a PA if things don't work out.  Starting this summer.

 

Congrats! Where will you be going? How long did you study for MCAT?

[Ollivander]

Congratulations. I assume by "starting this summer" you mean you were accepted to a program. This confirms what I have been saying ad nauseum on this forum. No undergraduate should be considering entry into PA school any more. Medical school is equally competitive for admissions, cost nearly the same as PA school and has vastly superior opportunities when you are finished. Unless and until the PA profession wins independent practice and abandons unnecessary reboarding, everyone should forget about the PA career and choose medical school or NP school. The PA profession will be extinct in ten years. 

Yeah I just don't agree with this. I just finished my undergrad this past May and plan on applying to PA school in April 2018. Maybe I'm an outlier at 24 years old, but to say that anyone in their early to mid-twenties should just go ahead and apply to med school over PA school comes from a place of personal distaste with their own specific situation. I'm very open minded about what area of medicine I'd eventually like to go into. That leaves the door open to surgical PA positions, dermatology, etc. 

 

If I was to aim for medical school and I decided I wanted to pursue becoming an orthopedic surgeon, I'd have to get accepted into a MD school rather than a DO school because in all likelihood I'd match into family medicine via the DO route which I would not want. The average MCAT and GPA acceptances are 31-32 and 3.7-3.8 respectively for allopathic schools. Then you go through 4 arduous years and ultimately have to score high enough on steps 1 and 2 to be considered top of your class (among already brilliant people). Once you get accepted to this incredibly competitive residency, you can look forward to being in school for another 6 years, working 80+ hours a week. Then once you get out and start working as an attending you can finally start paying down your 250-300K in loans and regularly work those 60-80 hour weeks like you always wanted to. Because once you get out you'll need to work hard to justify being in school that long with your new income potential. This isn't accounting for what this kind of strain will do on your psyche along the way.

 

It's going to be much more feasible regarding time to take the PA school route versus the medical school counterpart for me, as I'm sure others who can relate. It's a great ROI, and doesn't require as many hoops to jump through to work in certain specialties of medicine.

 

I was previously aiming for dental school, but have refocused my aim towards becoming a physician assistant due to how long it would take me to pay off the 375K+ debt I'd be taking on for school including interest that accumulated while in school, and another 300-600K that it would cost me to buy out or start up a practice.

 

The truth is that if you can keep your debt at a reasonable amount at a cost efficient PA school it's an excellent career decision financially speaking. If you're willing to relocate to a state that compensates PAs quite well then it's even better of an investment. If you were arguing from a stance of career happiness in pursuit of becoming that MD I would understand where you are coming from, but speaking as someone who has a degree in finance I can assure you PA school is an excellent career investment financially.

[Hckyplyr]

Yeah I just don't agree with this. I just finished my undergrad this past May and plan on applying to PA school in April 2018. Maybe I'm an outlier at 24 years old, but to say that anyone in their early to mid-twenties should just go ahead and apply to med school over PA school comes from a place of personal distaste with their own specific situation. I'm very open minded about what area of medicine I'd eventually like to go into. That leaves the door open to surgical PA positions, dermatology, etc. 

 

If I was to aim for medical school and I decided I wanted to pursue becoming an orthopedic surgeon, I'd have to get accepted into a MD school rather than a DO school because in all likelihood I'd match into family medicine via the DO route which I would not want. The average MCAT and GPA acceptances are 31-32 and 3.7-3.8 respectively for allopathic schools. Then you go through 4 arduous years and ultimately have to score high enough on steps 1 and 2 to be considered top of your class (among already brilliant people). Once you get accepted to this incredibly competitive residency, you can look forward to being in school for another 6 years, working 80+ hours a week. Then once you get out and start working as an attending you can finally start paying down your 250-300K in loans and regularly work those 60-80 hour weeks like you always wanted to. Because once you get out you'll need to work hard to justify being in school that long with your new income potential. This isn't accounting for what this kind of strain will do on your psyche along the way.

 

It's going to be much more feasible regarding time to take the PA school route versus the medical school counterpart for me, as I'm sure others who can relate. It's a great ROI, and doesn't require as many hoops to jump through to work in certain specialties of medicine.

 

I was previously aiming for dental school, but have refocused my aim towards becoming a physician assistant due to how long it would take me to pay off the 375K+ debt I'd be taking on for school including interest that accumulated while in school, and another 300-600K that it would cost me to buy out or start up a practice.

 

The truth is that if you can keep your debt at a reasonable amount at a cost efficient PA school it's an excellent career decision financially speaking. If you're willing to relocate to a state that compensates PAs quite well then it's even better of an investment. If you were arguing from a stance of career happiness in pursuit of becoming that MD I would understand where you are coming from, but speaking as someone who has a degree in finance I can assure you PA school is an excellent career investment financially.

 

I too would have to disagree with many of your comments. Many comments are just erroneous. First off, I'm not attacking you, so I don't want you to think thats what I'm doing. Your entire outlook and comments are pretty typical of a pre-PA student who hasn't experienced any of this firsthand. 

 

1. Making the comment that DO = family medicine is so far off base. You are picking one of the most competitive specialities in medicine that most MD students who apply won't get, as you stated. Don't forget there are many DO ortho residencies, plus the few DOs who will get into the ortho MD residencies. It is very common for DO's to match into competitive residencies when you take into account they match both MD and DO residencies. Also, MANY MD residencies are very open to matching a DO, with the exception of the most competitive, like urology, neurosurg, ortho, derm. But again, there are also DO residencies for all of those. Is it "easier" for MD's to match, I'd say yes. But the DO = family medicine is way way off. 

 

2. By your comments, seemingly you would prefer ortho surgery or dentistry. Don't make the same mistake I feel many PA students make. They convince themselves that PA is better because its "less schooling, less time, less debt, and I'll be making a great income sooner." I think its obvious that med school or dental school would be, by far, the greatest ROI. You don't need a degree in finance to run the numbers. Even going to med school at age 35 will still far surpass the lifetime earnings of a PA. I'll just stop there, but if you're going into PA because you think its a better financial decision, you're sorely mistaken. Is PA a great job and good ROI, absolutely, but not when comparing to the other two. 

 

3. You mentioned some specialties where the doc will be working 60-80hrs a week. In most all these cases, if you're working for that doc, you'll be working the same, if not more hours than they are. Unfortunately, you'll forever be doing the scut/crap work they don't want to be bothered with. Don't get me wrong, there are great gigs out there, but I can assure you no matter how good they are, the physician will always have it better, as far as vacation, salary, respect, autonomy, decision making capabilities, etc etc. Why would the physician ever let the PA working for them have it better?

 

I think the point that many of the seasoned PAs are trying to make, is that if you're sincere about spending your career practicing medicine and you're relatively young, it makes far more sense going to med school for many of the reasons I listed above. You need to look at the big picture (your entire career) opposed to looking at a 5-10yr window. Although I agree, when you're young, its very difficult to look that far down the road, but it will come sooner than you could ever imagine. 

[Ollivander]

I too would have to disagree with many of your comments. Many comments are just erroneous. First off, I'm not attacking you, so I don't want you to think thats what I'm doing. Your entire outlook and comments are pretty typical of a pre-PA student who hasn't experienced any of this firsthand. 

 

1. Making the comment that DO = family medicine is so far off base. You are picking one of the most competitive specialities in medicine that most MD students who apply won't get, as you stated. Don't forget there are many DO ortho residencies, plus the few DOs who will get into the ortho MD residencies. It is very common for DO's to match into competitive residencies when you take into account they match both MD and DO residencies. Also, MANY MD residencies are very open to matching a DO, with the exception of the most competitive, like urology, neurosurg, ortho, derm. But again, there are also DO residencies for all of those. Is it "easier" for MD's to match, I'd say yes. But the DO = family medicine is way way off. 

 

2. By your comments, seemingly you would prefer ortho surgery or dentistry. Don't make the same mistake I feel many PA students make. They convince themselves that PA is better because its "less schooling, less time, less debt, and I'll be making a great income sooner." I think its obvious that med school or dental school would be, by far, the greatest ROI. You don't need a degree in finance to run the numbers. Even going to med school at age 35 will still far surpass the lifetime earnings of a PA. I'll just stop there, but if you're going into PA because you think its a better financial decision, you're sorely mistaken. Is PA a great job and good ROI, absolutely, but not when comparing to the other two. 

 

3. You mentioned some specialties where the doc will be working 60-80hrs a week. In most all these cases, if you're working for that doc, you'll be working the same, if not more hours than they are. Unfortunately, you'll forever be doing the scut/crap work they don't want to be bothered with. Don't get me wrong, there are great gigs out there, but I can assure you no matter how good they are, the physician will always have it better, as far as vacation, salary, respect, autonomy, decision making capabilities, etc etc. Why would the physician ever let the PA working for them have it better?

 

I think the point that many of the seasoned PAs are trying to make, is that if you're sincere about spending your career practicing medicine and you're relatively young, it makes far more sense going to med school for many of the reasons I listed above. You need to look at the big picture (your entire career) opposed to looking at a 5-10yr window. Although I agree, when you're young, its very difficult to look that far down the road, but it will come sooner than you could ever imagine. 

I'll address the points you brought up in sequence.

 

1. I was in no way intending to say that DO = family medicine for certain. I was merely pointing out that if you're aiming for one of the more competitive residencies that going to a DO school isn't doing yourself any favors because the majority of your class, most likely you included, is going to match into family medicine. Most, not all. There are a considerable number of DO students who go into other specialties like you pointed out. Although the truth is that most DO students tried to get into MD schools but couldn't. Do some choose DO over an MD acceptance? Of course, but it doesn't happen often. That's due to the match rate for the competitive specialties. It just depends what an individual's priorities and personal career goals happen to be.

 

2. I never contemplated going to medical school. I have no desire to spend the better part of a decade in a classroom and residency before I'm able to start living my life, accumulating earnings, and accomplishing things not related to my career that I want to do while I'm young. I don't need the title of a doctor to have a sense of fulfillment. I have other life and career goals outside of that. Would it be nice? Sure. Is it worth the time commitment it would take for diminishing returns? Not for me. Is medical school a good ROI though? Absolutely. My aim until the last 6 months was getting into dental school though. When I realized that my chances of being accepted to my state dental school (would have cost me less than 130K total) and other cost efficient dental schools were not what I hoped they'd be and my options were going to be private schools or expensive out-of-state schools that would have run me 375K+ and some even up to 450K, I no longer considered it a superior financial and career investment to other career paths that would offer me a similar or better ROI with a relatively high annual earning potential. Especially when you consider taking out 300-600K to buy out or start up a practice. A dentist who works well into his 60's will still earn more than a PA over a career earnings standpoint, but in my particular situation I wouldn't see those massive returns until my mid to late 50's as a dentist. Maybe early 50's or late 40's if I was very aggressive and lived well below my means. I personally don't want to be in debt for that long, and it's not worth the trade off for me.

 

3. Most PA's work 40-50 hours per week. I have no problem with working more myself though early in my career. I actually want to be aggressive and work more while I'm young so I can get more experience that may make me a more qualified applicant to future positions I will apply for. You're absolutely right though in saying that in most cases the physician will have the better situation in a vacuum. However, they also earned it by going to school for much longer, being in a residency for much longer (considering the PA even did one), and by testing better. Good for them. I'm not naive in the sense that I can admit I probably wouldn't test well enough to enter into something along the lines of dermatology if I even wanted to pursue it. However, I know that path is more of a possibility through PA school. I also know that surgery, if I ever considered pursuing it, is more of a possibility through the route of becoming a physician assistant.

[overthehorizen]

This was interesting exchange between Hckyplyr and Ollivander. A nice juxtaposition of views from opposite ends of the career spectrum. 

 

I just need to add something. Many pre-pa's seem to think they 1. won't have to work as many hours as physicians and 2. won't have as much strain. I think both presumptions are false. While it is true that physicians endure a rigorous training period in residency and some in fellowship, that doesn't mean that the PA doesn't have similar rigorous investments in his or her education after PA school. To be sure, I have met the occasional lazy PA who never reads outside of work hours and basically expects that he will be taught everything "on the job." These are the rare bad exceptions. Most PAs are diligent and serious minded. They recognize the differences between the blueprint to pass the PANCE versus the blueprint to pass USMLE step 1, 2, 3 and ABIM boards. Improving competency and knowledge requires excellent job experiences (which might require leaving a cushy job that is a cakewalk) and studying in mornings before work and evenings after work. If you are a Pre-PA who sees the career as a "Fred Flintstone 8-5 job at the quarry every day", it isn't the right field. Working as a PA is the same as working as an MD sans the respect, pay, better cases and career opportunity.

[EMEDPA]

This was interesting exchange between Hckyplyr and Ollivander. A nice juxtaposition of views from opposite ends of the career spectrum. 

 

I just need to add something. Many pre-pa's seem to think they 1. won't have to work as many hours as physicians and 2. won't have as much strain. I think both presumptions are false. While it is true that physicians endure a rigorous training period in residency and some in fellowship, that doesn't mean that the PA doesn't have similar rigorous investments in his or her education after PA school. To be sure, I have met the occasional lazy PA who never reads outside of work hours and basically expects that he will be taught everything "on the job." These are the rare bad exceptions. Most PAs are diligent and serious minded. They recognize the differences between the blueprint to pass the PANCE versus the blueprint to pass USMLE step 1, 2, 3 and ABIM boards. Improving competency and knowledge requires excellent job experiences (which might require leaving a cushy job that is a cakewalk) and studying in mornings before work and evenings after work. If you are a Pre-PA who sees the career as a "Fred Flintstone 8-5 job at the quarry every day", it isn't the right field. Working as a PA is the same as working as an MD sans the respect, pay, better cases and career opportunity.

actually agree with most of this. I have always worked more hrs than the physicians I work and many more nights/weekends/holidays and done more than my fair share of scut. the job I just left had the PAs doing the majority of the unpleasant tasks, seeing most of the drug seekers, etc and that is a prescription for burnout. 3 months into my new job I am happier than I have ever been as a PA

[Ollivander]

This was interesting exchange between Hckyplyr and Ollivander. A nice juxtaposition of views from opposite ends of the career spectrum. 

 

I just need to add something. Many pre-pa's seem to think they 1. won't have to work as many hours as physicians and 2. won't have as much strain. I think both presumptions are false. While it is true that physicians endure a rigorous training period in residency and some in fellowship, that doesn't mean that the PA doesn't have similar rigorous investments in his or her education after PA school. To be sure, I have met the occasional lazy PA who never reads outside of work hours and basically expects that he will be taught everything "on the job." These are the rare bad exceptions. Most PAs are diligent and serious minded. They recognize the differences between the blueprint to pass the PANCE versus the blueprint to pass USMLE step 1, 2, 3 and ABIM boards. Improving competency and knowledge requires excellent job experiences (which might require leaving a cushy job that is a cakewalk) and studying in mornings before work and evenings after work. If you are a Pre-PA who sees the career as a "Fred Flintstone 8-5 job at the quarry every day", it isn't the right field. Working as a PA is the same as working as an MD sans the respect, pay, better cases and career opportunity.

I agree with everything you just said. Although just so I'm not confused, you are pointing out the bold thoughts as a benefit of PA over MD/DO correct?

[Ollivander]

actually agree with most of this. I have always worked more hrs than the physicians I work and many more nights/weekends/holidays and done more than my fair share of scut. the job I just left had the PAs doing the majority of the unpleasant tasks, seeing most of the drug seekers, etc and that is a prescription for burnout. 3 months into my new job I am happier than I have ever been as a PA

Just out of curiosity, if you graduated from PA school today would you still go into emergency medicine over other specialties?

[Hckyplyr]

I'll address the points you brought up in sequence.

 

1. I was in no way intending to say that DO = family medicine for certain. I was merely pointing out that if you're aiming for one of the more competitive residencies that going to a DO school isn't doing yourself any favors because the majority of your class, most likely you included, is going to match into family medicine. Most, not all. There are a considerable number of DO students who go into other specialties like you pointed out. Although the truth is that most DO students tried to get into MD schools but couldn't. Do some choose DO over an MD acceptance? Of course, but it doesn't happen often. That's due to the match rate for the competitive specialties. It just depends what an individual's priorities and personal career goals happen to be.

 

Again, you would be wrong. Most MD school graduates actually go into primary care fields (family medicine, internal medicine, peds, +/- OBGYN), there simply isn't enough residency spots for all these MD students to go into specialties. I don't have time to check other schools, but I checked my school match rate for the past couple years, and it was about 17% matched into primary care. So your above stated is again, way off. Now, if you wanted to include other primary care areas, like internal med, peds, obgyn, then the match would be about 60% of the graduating class, which is prob more consistent with MD rates.  Do more MDs go into specialties than DOs, yes they do. 

 

actually agree with most of this. I have always worked more hrs than the physicians I work and many more nights/weekends/holidays and done more than my fair share of scut. the job I just left had the PAs doing the majority of the unpleasant tasks, seeing most of the drug seekers, etc and that is a prescription for burnout. 3 months into my new job I am happier than I have ever been as a PA

 

Agreed. It took you years to get to that point. It took years of time, training, studying, bouncing from different jobs, proving yourself time and again to get where you're at.  I feel like most young PAs think they will get these gigs and earn this respect and autonomy right away, which just isn't true. 

[EMEDPA]

Just out of curiosity, if you graduated from PA school today would you still go into emergency medicine over other specialties?

if I graduated PA school today I would likely do an EM residency and apply for the 3 yr LECOM physician bridge program after a few years in practice. I wouldn't want to repeat what I went through again. a residency would help with some, but not all of those issues, most of which involved flagrant disrespect from docs and nurses.

[overthehorizen]

I agree with everything you just said. Although just so I'm not confused, you are pointing out the bold thoughts as a benefit of PA over MD/DO correct?

Ollivander quoted my earlier remarks and bolded the following excerpt "Most PAs are diligent and serious minded. They recognize the differences between the blueprint to pass the PANCE versus the blueprint to pass USMLE step 1, 2, 3 and ABIM boards".

 

To answer your question, I think it is a fact that there is marked differences between PA and MD education. These differences are reflected in a series of exams for MDs vs one exam for PAs. At the end of Medical school, the Physician can practice independently while the PA endures a lifetime of dependent practice. Despite the previously stated facts, I am saying that PAs in this unenviable position should work diligently to study and find practice opportunities (jobs or residency) that eliminate the differences in education. However, after reaching the same point in education and experience as the Medical school residency graduate, the PA will never benefit from the rewards offered the MD graduate. Hence, the PA field is a terrible choice for an undergraduate today. For those already in the PA field, one cannot or should not simply stop working diligently to improve. I met some of those types of PAs as my preceptors. 

[LT_Oneal_PAC]

Yeah I just don't agree with this. I just finished my undergrad this past May and plan on applying to PA school in April 2018. Maybe I'm an outlier at 24 years old, but to say that anyone in their early to mid-twenties should just go ahead and apply to med school over PA school comes from a place of personal distaste with their own specific situation. I'm very open minded about what area of medicine I'd eventually like to go into. That leaves the door open to surgical PA positions, dermatology, etc.

 

If I was to aim for medical school and I decided I wanted to pursue becoming an orthopedic surgeon, I'd have to get accepted into a MD school rather than a DO school because in all likelihood I'd match into family medicine via the DO route which I would not want. The average MCAT and GPA acceptances are 31-32 and 3.7-3.8 respectively for allopathic schools. Then you go through 4 arduous years and ultimately have to score high enough on steps 1 and 2 to be considered top of your class (among already brilliant people). Once you get accepted to this incredibly competitive residency, you can look forward to being in school for another 6 years, working 80+ hours a week. Then once you get out and start working as an attending you can finally start paying down your 250-300K in loans and regularly work those 60-80 hour weeks like you always wanted to. Because once you get out you'll need to work hard to justify being in school that long with your new income potential. This isn't accounting for what this kind of strain will do on your psyche along the way.

 

It's going to be much more feasible regarding time to take the PA school route versus the medical school counterpart for me, as I'm sure others who can relate. It's a great ROI, and doesn't require as many hoops to jump through to work in certain specialties of medicine.

 

I was previously aiming for dental school, but have refocused my aim towards becoming a physician assistant due to how long it would take me to pay off the 375K+ debt I'd be taking on for school including interest that accumulated while in school, and another 300-600K that it would cost me to buy out or start up a practice.

 

The truth is that if you can keep your debt at a reasonable amount at a cost efficient PA school it's an excellent career decision financially speaking. If you're willing to relocate to a state that compensates PAs quite well then it's even better of an investment. If you were arguing from a stance of career happiness in pursuit of becoming that MD I would understand where you are coming from, but speaking as someone who has a degree in finance I can assure you PA school is an excellent career investment financially.

As to your last paragraph, there is empiric studies that disprove this. Unless you're a female who will take time off to have a family, you are better off financially to become a physician.

[CVTSPA]

Congrats! Where will you be going? How long did you study for MCAT?

 

LECOM- APAP.  Fortunately, didn't need to take the MCAT. 

[sas5814]

I understand that I am still early in my career so I expect oversight.  I welcome it because it is a big part of how I am learning on the job.  But I see PA's with over a decade of experience still being forced to have an unnecessary amount of oversight.  I think about what is best for my future.  I want to be knowledgeable, have a comfortable lifestyle, and not have to have someone have to approve every simple thing I do like pull chest tubes, put in a chest tube, start anti-coagulation, discharge a patient, etc.  Do you think that all this oversight and micromanaging is just because of where I work?  Or do you think things would be better in a different region of the country?  Or would all the time climbing up the ladder to not have this oversight be better served completing medical school?

 

I do think that maybe a specialty change to something like FP or IM would allow me some more freedom in a few years but I also don't want to regret not going to medical school when I have a similar knowledge base as the physicians I work with.

 

We do have a PA who completed a residency in the city and she is treated the same as me for not much more pay (she's one year out of residency).  She chooses this area because of family purposes and I respect her wishes in that regard.

 

BTW, Thank you for all your replies! I never expected so many responses!

Oversight varies by position and location. I'm Army trained and while on active duty had virtually none. Took care of 400 troops and their family members and saw my"Doc" rarely. The closest hospital of any size was 60 miles away. When I got out I was drawn to rural health in underserved areas because the supervision rules were much more relaxed and, because of demand, the pay was better. I worked rural ER solo with local docs on backup, family medicine in a rural health clinic, and several different somewhat remote urgent care centers.

Recently I moved to a different job in urgent care in a mid sized city (about 100k people). The work is low stress. I am actually an hourly employee with time-and-a-half after 40 hours a week and my hourly rate is generous, and have great benefits. My supervision consists of being able to call a doc if I need one.

My point is opportunities and supervision requirements vary wildly. If you are tied to a particular area of practice or location you limit your choices. If you are available to move around some opportunities abound. 

Good luck!