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Why PA over Med School?


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I've seen a lot of posts from younger people looking to directly apply to PA after graduation, and I'm wondering why? People up to ~45 would benefit financially by going to med school and would surely prefer the autonomy. Obviously there's a bit of a time and cost difference to get the show on the road, plus the residency, but you're golden after that whereas a PA will always be tied to a doc. Who knows what the future will bring, but that's the case for now.

 

Some of the PA programs are beyond competitive and maybe harder to get into than certain MD programs, and the tuition is certainly nothing to laugh at. On top of that, with seemingly everyone wanting to be a PA these days, how much will wages be driven down in the future? I've been checking out the student doctor forums and I've seen D.O applicants get accepted with less than stellar apps(<3.0 for ex). I know some of the respected and experienced posters around here have written they wish they went to med school. IDK, I guess I'm just looking for some thoughts on the big PA push.

 

 

 

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I'm under 45 (36) and consider myself pre-PA. Here are my thoughts:

 

1. You're assuming everyone "would surely prefer the autonomy," but I would respectfully disagree.  The desire for autonomy is a personal preference developed through experience.  As someone who has spent several years both as a scientist working independently and as a bachelor level scientist collaborating with a doctoral level scientist, I prefer the collaborative approach to one where the full weight of every single decision is on me and must be testified to in court (no exaggeration).  I like having the authority to put out my findings as well as the freedom to pursue learning opportunities or have support when dealing with clients who are less than cooperative.  I've seen this team approach work where I shadow a PA with a great SP.

2. That "bit of a time difference" is key when a person has other priorities.  In my case, it would be cheaper in total dollars to attend medical school (~$50K) than PA school (~$80K).  However, I have three kids age five and under and I want to maximize the time I spend with them before they are all in school.  Still, I want to learn in the meantime. So, I would rather spend four years of part-time schooling and trying out other roles in healthcare followed by 2.5 years of full-time day schooling before having the option of a shorter residency or going right into practice.  This sounds more appealing to me than diving blind into four years of full-time day schooling before going into a mandatory 3+ year residency in a specialty I must remain in for the rest of my career.

3. Lateral mobility is underrated. I have been extremely overspecialized for fifteen years.  I use the same instruments to analyze the same general types of samples, day in and day out. Curve balls are extremely rare and for someone who thrives on learning new things or exercising the trivia I automatically collect, this is not viable for another thirty years.  I look forward to having the freedom to choose a more wide-ranging specialty (IM, FM, EM), or even change between specialties.

4. Enough is as good as a feast.  Local job ads indicate that a PA can make twice the money I make now working full-time and MD/DO would make twice to four times my current salary. I grew up with an uncle who was a surgeon and although he was able to provide for them luxuriously, I know I won't be choosing a specialty that would take me away from my family quite as much as his did.  I will still be able to improve my family's income on a PA's salary and depending on which job I choose, spend more time with them than I do now. Night shifts are not an option in my current career, for instance.

 

My $0.02, for what it's worth.

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I don't think there are many people who would choose PA over medical school, if medical school is a viable option. Many who entered this field years ago where mostly non-traditional students with countless hours of healthcare experience. It seems as though after the 08 crash and the multiple articles talking about healthcare being recession proof and the amazing salaries of PA's, now younger and younger students are becoming interested in the field. I myself think it's crazy for a high school student or even someone in there mid 20's to aim for PA school and not med school. I think there is also a misconception associated with the PA curriculum being easier than that of med school. I believe the PA profession is a great choice for non-traditional students who have built up healthcare experience, maturity and the respect that this field demands and deserves. 

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Some good points by epangerl.

 

I was 26 when I started PA school, but unusual among my peers in that I also had over 8000 hours of patient care experience as a valued member of a hospital team prior to that. I knew, intimately, the difference between the two careers and made an informed choice to apply to PA school. I waited five years after I graduated college, working full time to finish my pre-req courses. I fully realize I could have gone to medical school. I chose PA.

 

It seems to me that older PAs are concerned that younger applicants lack the experience to really understand what they are trying to achieve. They worry that these young graduates will hit a ceiling earlier in their lives/careers and resent the limitations on their practice. This is a valid concern, IMO. However, every applicant no matter their age is an adult; their choices are their own, and they are due the respect of others assuming they know their own minds.

 

I often sigh to myself when I see posts on here from people with no HCE who claim to desperately want to be PAs because I don't understand it. Just like the OP doesn't understand why young applicants wouldn't want to go to medical school.

 

Just because we don't understand another persons reasoning doesn't mean they don't have a good reason. Just because we would make a different choice doesn't mean we get to dictate the choices of others. We can certainly recommend a different course of action, but eventually we may be colleagues and I think it's best to start working on professional respect now.

 

I'm getting too deep here. Out! :-)

 

 

Sent from my iPad using Tapatalk

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Granted, I live in the Northeast where the profession is older and well-integrated, but:

 

1) Six-figure salary w/ 2.5 years of graduate school

 

2) The ability to shape a young profession that is making SIGNIFICANT strides in terms of autonomy and scope.  I know the general theme on this board is less than zealous about the forward momentum of the profession and the relative stagnation of the AAPA, but really, talk to a PA who was practicing twenty years ago to get a sense of how far things have come.  The future is bright.

 

3) Lateral mobility-  it does still exist.  The reality is that many MD's will NOT get to practice in their chosen field.  How does that sit with you after investing several hundred thousands dollars and 4 years of time?

 

I would also add that the notion of true autonomy in any avenue of medicine is pretty subjective.  Of course some PA jobs will be more restrictive than others but this also holds very true for MD's- Hospital protocols and the confines of evidence based medicine can be every bit as constricting.  Just today for example I watched a team of supposedly autonomous physicians being shot down by a PA run interventional radiology department w/ regard to a PICC line they wanted placed due to hospital protocols.  Of course MD's IN GENERAL will have a bit more room, but the idea of the fully autonomous provider is a myth in my opinion. 

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I think folks put too much weight on lateral mobility in the pa profession. it is likely going to significantly decrease or go away entirely. hospital credentialing and organizations like the joint commission are demanding that clinicians have documented skill in an area with procedures logs, etc to do things now. on the job training opportunities are decreasing. docs don't have time to teach. they want to see their own pts and have you see yours.

I think the future for the pa profession is this:

1. 3 yr pa programs

2. required postgrad internship for 1 yr in primary care or a specialty

3. required board cerification/CAQ

4. phase out of cert/as/bs programs

5. all programs go to ms with option for doctorate.

6. more options for PA to DO/MD programs

this process is well on its way. programs are gradually getting longer. a few are 3 yrs already. CAQ exams already exist in several specialties and employers are already asking about them and mentioning them in job ads. there are currently at least 6 entry level doctorate pa programs in the works(that I have heard of).

 

I think 25 years from now or so it will take 8 yrs to become a fully licensed pa and 11 yrs(min) for the md/do(10 if you attend a newer 3 yr program). if you consider the residency to be a first job it will make more sense to go to md/do than pa. the difference will be 1 yr.

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Guessing about the future is just that: guessing. Who would have thought that RNs (a certificate program when my mother-in-law went through one in the 40s) would eventually be expected to become doctorates? I'm guessing that Mom wouldn't have.

 

There is a popular misconception that you should have all your ducks in a row when you are 18 or 22 or 25 or whenever, and then do what makes the best long term career sense. If you really want medicine for example, you should just drop everything and become a physician. Really? 

 

I have had several different careers in my life and am now doing something (being a PA) that didn't even exist when I started college (the first time). Along the way, I have met people who started doing something and eventually decided to do something else. Sometimes that sent them back to school. While I was moving from being an engineer to becoming a PA, I met an MD who was going into IT, A PA who was becoming an MD, a senior corporate VP who was becoming an education consultant for STEM high schools, a dental insurance salesman who was becoming a dentist, and a house painter who was becoming an entrepreneur. They were not being held back by believing that, once you make your first career bed, you just have to lie in it, no matter how lumpy it gets.

 

I think it can be useful to think of picking a job like you're picking your way across a stream by hopping from rock to rock. Can you reach the next rock? Is it closer to your goal (of getting to the other side)?,  Will it hold your weight? Is getting to it going to box you in a corner?

 

Who knows if "lateral mobility" for PAs is going away? I can tell you for a fact that lateral mobility in a larger career sense is getting far more common -- just look at many people spend their lives in the one career now compared to the past.  Got to take a new CAQ for a new job? Study and take it. 

 

If you want to be a physician, then by all means, go for it. Don't curse the darkness, or your age, or whatever impediments you feel are facing you. But, if you don't want to spend the time and money and/or don't like the family/life trade-offs, then don't do it. There will always be so-called mid-level jobs because economics demands it. We are like engineers: the mid-level in science, between physics PhDs and engineering techs. We are smart enough to be able to apply medicine to help our patients -- and smart enough to know when we really need to call in a MD specialist.

 

Bottom line: You are the captain of your ship. Now go sail it wherever you want to go. 

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I chose PA school at 27 years old. Had I had the financial means and the instruction/direction on how to apply to Med school at 21, things may have been different. Being from a small town where everyone struggles, I went to the college that awarded me the most academic scholarships and financial aid. It wasn't a matter of best fit, it as a matter of affordability. I have paid for every cent of my education on my own and time = money.  And I was taught to never bring a financial burden into a relationship, can you imagine marrying someone who has 200k in debt? (I realize that many people do, but from my upbringing this view is ludicrous and selfish). Regardless of how intelligent you are, If your parents barely make a combined income of 40k for a family of 5 (both with college degrees) you can probably understand this better. 

A lot of posters on here may view PA as settling when they should strive for MD. To me, PA was everything I could have ever wanted for career advancement and I could do it in less than 24 months. It was a way out of lower middle class that no one in my family had the opportunity. I applied to only 1 PA school, that only cost me 16k, I didn't have to relocate, and knew I could apply to dozens of hospitals within a metro area in any medical specialty, meaning once again not having to relocate for a job. From my POV, even if I had been accepted to a public MD program, it still would have been about 80k for the 4 years and who knows what specialty or area of the USA that I would have to move to.

 

For someone who has grown up always *battling* being poor and being somewhat envious of those that had money, no guarantees and no income for the next 4-8 years of school and residency was just not feasible, regardless of long term pay off. I am sure there are many very bright students that would both great MDs or PAs, but we have to live within our means. Just my .02.  

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  Got to take a new CAQ for a new job? Study and take it. 

 

Don't know if you have looked at the CAQ requirements. it's more than just a written test.

 for em for example you need :

18 mo working in the specialty

acls/atls/pals/difficult airway course

 a huge procedure list(central lines, intubations, etc) signed off by an em doc.

here is the list:

Airway Adjuncts: Invasive Airway Management

• Intubation

• Mechanical ventilation

• Capnometry

• Non-invasive ventilatory management

Anesthesia

• Local, digital

• Procedural anesthesia, conscious sedation

Advanced Wound Management

• Incision & drainage, wound debridement

• Superficial/deep wound closure

Diagnostic/Therapeutic Procedures

• Soft tissue and joint aspiration

• Lumbar puncture

• Slit lamp examination

• Thoracentesis, thoracostomy

• Tonometry

• Control of epistaxis

• Electrocardiographic interpretation

• Cardiac pacing

• Defibrillation/cardioversion

• Clearing a cervical spine

• Fracture/dislocation management

Hemodynamic Techniques

 

• Peripheral venous access

• Arterial access for diagnostics and placement of arterial lines

• Central venous access

• Intraosseous infusion

Radiographic Interpretation

 

• Chest x-ray

• Plain films (bone, soft tissues, abdominal series, etc.)

• CT scans, MRIs

Resuscitation

 

• Cardiopulmonary

• Fluid

 

 

if I wanted to switch to ct surgery for example there is a similar list of skills I don't have like endoscopic radial artery harvesting. I would pretty much have to do a residency to get the skills to meet the requirement. very few folks want to teach procedures to new grads or new clinicians switching from another field. as an em pa my lateral mobility TODAY is pretty much limited to primary care(or non-procedural IM subspecialties), urgent care, trauma, or hospitalist positions.

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EMEDPA,

 

You have a good point, but somehow I wonder if it's really any different than any other job.

 

When anyone enters the workforce, they compete with people who have more experience. The employer gets to decide if he or she wants a newbie or someone with experience. If they pick a newbie, they have to do some training. While it's easier to pick someone with experience, employers don't always do that because of the cost, or because they would rather mold someone into "their kind" of employee.

 

It's the old Shamu the Killer Whale story (from SeaWorld). Did they find him (really "them") by going out in a boat, holding a pole parallel and 10 feet above the surface of the water, and waiting until they found a killer whale who would jump over it?  Or did they put the pole in a training pool and gave the whale a fish every time he swam over the pole, which they gradually raised. The guys in the boat and the guys in the pool are two very different kind of employers. Jobseekers beware!

 

In spite of CAQ, I still see lots of new grads going into emergency medicine, and that's in a metro area of about 2 million people. If I wanted to transfer from my specialty to EM, I would expect to be paid less than I am now because I don't have the experience. I would be like a new grad again, unless I could somehow leverage what I've done up to now. Not convenient, not the wild west, but if I really wanted to do it, I could. Or I could take a relatively short (by MD standards) residency. Or I could pick another specialty. Other PAs in cardiology (where I work) have gone into pulmonology, rheumatology, EM, hospital medicine, etc. 

 

So yes, I suspect CAQs will slow down lateral mobility, but it still sounds better than what MDs have.

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I chose PA school over med school for several reasons. I just turned 29 and have an almost 3 year old. Time was a huge factor in not wanting to delay having more kids and getting back to the workforce. I'll be 31 when I graduate from PA school vs being nearly 40 after med school/residency/possible fellowship etc.

 

Another deciding factor was prereqs required by med schools. I have yet to hear a doctor tell me they are glad that they took 8 credits of ochem and that they use it regularly.

 

With all the uncertainty in medicine the time and financial commitment for med school just didn't make sense in my situation. All this in addition to the fact that nearly every physician I talked to about PA vs MD/DO recommended that I seriously consider PA school over med school.

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Because residency seems like hell on earth and a slap in the face when you figure out how much the residents are making, not to mention the dreaded loans.  My clerkship year of PA school was on average 80hrs a week with that easily going to 100 + if I had a 30hr call which was at least once a week for a lot of the rotations.  This was only for 1 year, I can't imagine being treated like that for an entire residency of 3+ years.  I realize as one moves from intern to senior resident the hours get a little better and the scut work diminishes, but please enough with the slave labor.

 

Bottom line, I work to live, not live to work.

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I know what I'm going to say echoes a lot of what's already been said. The most important thing at the end of the day is to be sure of your decision. For me the decision of choosing PA over med school, was purely about work/life balance. I'm 31, married and I'll be starting PA school next June. The idea of finishing a residency around 40 and not really being around to take care of our kids for around 8 years didn't really appeal to me. I'm sure some people do that, and more power to them. PA school allows me to be back in the job market much faster, hopefully allows my wife and I to buy a house much sooner and provides me with more time to be a dad in the future. Having said that, if you have the tools and desire to be a doctor, by all means go for it. If you're not sure of what you really want, then it's better to take time off to figure it out.

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Because residency seems like hell on earth and a slap in the face when you figure out how much the residents are making, not to mention the dreaded loans.  My clerkship year of PA school was on average 80hrs a week with that easily going to 100 + if I had a 30hr call which was at least once a week for a lot of the rotations.  This was only for 1 year, I can't imagine being treated like that for an entire residency of 3+ years.  I realize as one moves from intern to senior resident the hours get a little better and the scut work diminishes, but please enough with the slave labor.

 

Bottom line, I work to live, not live to work.

for most residencies(aside from surgery) the internship is hard and pgy-2 and 3 get easier. at my facility with an fp residency I am in house more hrs/week than the pgy-2 and 3 residents. get through the internship then it is coasting time. 45-60 hr weeks. night float coverage, etc.

I will finish my current academic doctoral program the year my oldest child becomes a teenager. if I went the med school route I would be training the entire time they were in their teens. I need to be around for them then(as well as my wife). if not for that I would probably go back to the PA to DO bridge, even in my late 40s.

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for most residencies(aside from surgery) the internship is hard and pgy-2 and 3 get easier. at my facility with an fp residency I am in house more hrs/week than the pgy-2 and 3 residents. get through the internship then it is coasting time. 45-60 hr weeks. night float coverage, etc.

I will finish my current academic doctoral program the year my oldest child becomes a teenager. if I went the med school route I would be training the entire time they were in their teens. I need to be around for them then(as well as my wife). if not for that I would probably go back to the PA to DO bridge, even in my late 40s.

 

Your doing a doctoral program while working as a PA right?  Hours wise... would you say it is better or easier than going to medical school or residency?

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my doctoral program is one course/semester for 4 years with required on campus time every summer. 61 credits total. I am doing the DHSc at nova southeastern with the global health pathway. see here for an ongoing discussion of the program and my progress through it: http://www.physicianassistantforum.com/index.php?/topic/1764-taking-the-dhsc-plunge/

much easier time wise than medschool or a residency which is why I am doing it. I work 180-220 hrs/mo at 3 jobs in 2 states while doing the program. some folks do it in 2 years by doubling up on classes but I could not work full time then. would probably have to work 20-30 hrs/week. each class requires 10-12 hrs/week of study/reading time/writing papers, etc. some a bit more, some a bit less.

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I chose the PA profession because I feel like it gives me the opportunity to be a part of medicine in a way that I will enjoy without making my career my life. I work to live. I don't live to work. I feel (just my own personal opinion) that to be a MD you have to want to be fully committed to medicine. My uncle is a doctor and that's all his life is about and he loves it. I'm not that way. So I feel PA is the perfect in between for me. It fits me better.

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In response to hiiamalysha, many PAs still work up to 60+ hour work weeks, while some physicians (including those at my ER) only work about 24 hours a week. So I don't think the work-life balance is necessarily any different than that of a physician. That depends on the type of job you take. I do agree that we should work to live, not live to work.

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In response to hiiamalysha, many PAs still work up to 60+ hour work weeks, while some physicians (including those at my ER) only work about 24 hours a week. So I don't think the work-life balance is necessarily any different than that of a physician. That depends on the type of job you take. I do agree that we should work to live, not live to work.

I just finished a string of shifts with 70 hrs in 1 week and 103 hrs in 10 days. not terribly atypical.

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If everyone truly believes you "work to live" , then why even bother to pursue any of these health professions such as PA, DO, MD, etc ? If the goal is to "work to live", then by pursuing any of these health professions, you are financially strapping yourself in which every life decision going forward will be somewhat dictated by the student debt you created to attain those degrees thus not enabling you to truly "live" as which was the goal of the statement "work to live.". My take is that if you truly want to "work to live" you will be content doing a job that many people think is "below" them(fyi: nothing is below anyone). Such as, ER tech, nurse, teacher, case manager, etc. All these jobs will enable you to truly "live" b/c you will take on minimal student debt and not lose much opportunity cost, while still having a steady job that pays bills and allows you the free time to enjoy life while still pursuing ur dream of working in healthcare.

 

 

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I'll be 28 when I apply and 29 a month into a program.  While I wouldn't be too young to go the medschool route, it would really sap the remainder of my physical prime years.  PA school will allow me to at least enjoy some of my early and mid 30's while I'd be doing back-to-back doubles in residency if I went to medschool.

 

...time constraint really

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 it would really sap the remainder of my physical prime years.  

don't assume  your 20s and 30s are by definition your "prime years".

I have been athletic my whole life and am in much better shape now in my mid 40's than I was in my 20's or 30's. ran my first marathon at 39. since then have run 12 others, a 50k, a 50 miler, and a 100 miler. I weigh 20 lbs less now than what I did at 30(and was not noticibly overweight to anyone but myself then). I am considering running a 200 miler(see tahoe 200 info in running thread) around the time I turn 50 in a few years after my DHSc is done. unless you have a significant injury your prime physical years are whenever you want them to be. I lose races to guys in their 60s all the time and I am not a particularly slow runner.

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