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PA vs MD, advice very much welcomed!


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*Reposting from a different forum hoping to gain more advice from those PA's practicing in the ED. However, please give any advice regardless of position or experience!*

 

Hey guys! So bear with me, this may be a bit long... but I really would like some honest, thoughtful advice from several different viewpoints.

 
I am 22 (often confusing it with being about 45), and began college at 17 after graduating high school early. I completed four years at a community college, and just finished a year at a university to complete my undergrad. I am tracking about another year, year and a half to completion. The reason for the four years of community college... trying to figure out what I wanted to do, finished an associates and started pre reqs for nursing, realized I wanted to go into medicine and needed a four year degree, thus, at a university now. I am pursuing a biomedical science degree which is taking slightly longer than other degrees, but I am fine with that. I joined the military at 17 and have been in the Army National Guard for the last 5 years. This is a few days out of the month commitment. I also worked as an EMT for 2 years on an ambulance and have worked the last 6 months as an ED tech in the ED, part time. I also babysit part time and have full time school. I manage this well most days. I work well under stress and prefer it that way.
 
I have traveled to Africa and Central America within the last year for medical volunteer work which I thoroughly love. This is something I would love to continue to do throughout my life as it brings me so much joy!
 
I have been in a serious relationship for the last five years (he's 24), and we both have always wanted children and a family. He is also an EMT as well as a firefighter; working on his bachelors as well. Although I know time will tell and you cannot plan everything, we have discussed marriage in the next few years post undergrad, and children after PA school. 
 
Now.... hopefully that is enough background, or maybe too much. But I am back on the PA vs MD debate. I have felt confident in my decision to attend PA school for the past 3 or so years now. However, once starting to work in the ED (fairly busy hospital, close to inner city but still suburbs area, average 200 patients a day with 4 trauma rooms), I have began to question that. All of the PA's that work in our ED are extremely nice and seem to enjoy their career. However, I see most of them doing things such as suturing/ fast track/ low acuity things. All of the big traumas that come in are run by the MD and the trauma surgeon, along with RN's, RT, techs (me :) ), etc. I'm not really sure how I feel about this. I am aware that this is very hospital dependent, but do I really want to be job searching for only specific hospitals in order to practice the way I want to? Also, the idea of a family and traveling is very important to me. Medicine is my passion but I don't want it to consume my life. I'm okay with it being a huge factor but I do crave that balance. The PA school I would like to attend is 3 years, and with med school only being a year longer, is there really any reason not to? I used to think of residency as still being in school and sort of this black hole where you can't do anything else with your life but I'm really seeing that that is not the case. Any insight on residency, or starting a family during it? I am a little worried about when I would be able to have children if I went the MD route. Post med school I will be about 27/28/29 depending on when I get accepted, and I really don't want to wait until after residency to start a family. This is where PA fit perfect as I will have graduated and be able to start my career, have children, buy a house etc....
 
But I really do worry about the scope. Another issue I had was that I wasn't sure how I felt about specializing. In my head, I would love to dabble in everything, ED, trauma surgery, peds, cardiothoracic, neuro.... but is that just me being young and inexperienced? I have shadowed in all of those departments and am so intrigued by them all. I'm afraid if I specialize I will wish I was able to try other things. This is where PA was a positive as it would allow me to switch within reason. I am okay with extra training for those specialties but unsure of how I feel on going back for a residency each time... I am not sure how heavily I should weight this as my main love is emergency medicine, and maybe with time I will realize that although the other specialties are intriguing, this is the one I want to pursue? 
 
Lastly, I really enjoy research. I have done a few research projects in genetics and micro and would love to continue this throughout my life. I have such a brain for research and am worried about the PA's place in this. I also would love to teach at the med/PA school's while still practicing. I know that PA's are able to do this but is it the same for MD?
 
I hope this doesn't sound too all over the place. I understand that I am young, but please know that my mindset is not always that of a 22 year old. I have contemplated this for several years, and am not still trying to "soul search". I have lived a much larger life than my 22 years show, and am at the point where I am trying to find the best fit for my future self and family. 
 
EDIT: I have never been interested in primary care. Aside from clinical trials and hard to crack cases, I have never taken much interest to working with the same patients long term. I would rather work with traumas or in the ED where you fix what you can in that time, and either discharge them or send them to a specialist. Don't get me wrong, I do enjoy patient care and talking to patients. I know those statements may be contradictory but if you saw me at work I have extremely good bedside manner. I really do love people. But my heart is in the biology of what's going on over everything else.
I also don't have an ego. I am not searching for that title of Dr. and am comfortable with having people over me. I am very focused on the hands on, though. I really don't want to feel limited in my practice and not able to preform procedures because they are more suited for a doctor. How much autonomy do PA's really have in emergency medicine, from your experience?  
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Go to med school. There simply isn't currently enough career headroom to keep a motivated individual like you interested for 20+ years, and while there are people looking to bust the glass ceiling for APPs, the fact is that MDs never, ever have one to begin with.

 

Note: Moving this to the Pre-PA section, and deleting duplicates.  We only allow one thread per topic (keeps it neater, trust me), and threads are placed in the section reflecting the person asking, not the target audience.  Specialist and practicing PAs interested in responding will see this article at its location.

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Go to med school. There simply isn't currently enough career headroom to keep a motivated individual like you interested for 20+ years, and while there are people looking to bust the glass ceiling for APPs, the fact is that MDs never, ever have one to begin with.

 

Note: Moving this to the Pre-PA section, and deleting duplicates.  We only allow one thread per topic (keeps it neater, trust me), and threads are placed in the section reflecting the person asking, not the target audience.  Specialist and practicing PAs interested in responding will see this article at its location.

Thanks for your input. I think I will do more shadowing before I make the huge switch. But that's what I am thinking too.

 

Thanks for that! Sorry, a little new to this. :) 

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The biggest thing about medical school in my opinion is the residency. You have to be willing to accept that theres only so much you can control. Which means you could end up in a less appealing location or speciality. But it sounds like theres an array of specialities you like and your boyfriend is flexible, so maybe that is not as big a deal for you.

 

Yes some PAs have very low acuity in the ER, but it really depends on the facility. There are PAs who have great scopes. Hell, there are PAs in ERs that have more scope than they want, like a solo ER PA who does not have OB back up during a complicated delivery. But yes scope is always a fear with PAs. My opinion is MD is the safe way to go. It assures you scope based on the letters behind your name. PAs can have nearly the same scope in the ER, but they have to fight for it more and not be afraid to change shifts or facilities either. I believe EMEDPA would agree with this. 

 

Ultimately, either way you can't go wrong. But based on what you said, I say go to Med school. 

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You never want to feel like you "settled" for something. If you have the heart to go to med school do it now! I've been a PA for seven years and never considered med school before that but a classmate had a lot of regret because she had debated between the two and wished she had taken the leap. Go for it!

 

 

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Eh. It's honestly what you prefer. In the end scheme of things, pick a career that you will be happy with. If you think PA will do it then go for it! If you think med school then that's a good choice too. Medical training was just too long for me. I don't care about it that much to go. It seemed more like a chore to go the med school route. It's incredibly expensive and seemed like such a taxing experience.

 

PA was the diamond in the rough career that was way better than both med and nursing in my opinion. Don't do what others tell you. Do what YOU think it's best.

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