SHOCKandAWESOME

Making the switch from PA to MD

32 posts in this topic

Hey all, 

Long-time reader, first-time poster clear.png I've done a fair bit of searching on this topic and nothing truly addressed my specific situation! Also cross posted this on SDN.

I'm currently a practicing PA x4.5 years on the west coast with my time split 50/50 between ER and ICU (our hospital is trialing an "upstairs care downstairs" model, so there's a lot of crossover). I have a fair bit of autonomy ranging from the initial resuscitation, lines, running codes and (rarely) airway management. It's great and all but often feels a bit protocolized at times with LOTS of physician oversight (as it should be in this environment); some individuals at the hospital refer to us as "the tacticians, not the strategists." Nevertheless, it's a good gig--sounds crazy to want to leave and take on a huge financial/time commitment, right? Hear me out.

I wanted to go to med school initially in undergrad. Graduated with chem degree, 4.0 GPA and completed all pre-reqs for med school. I was killing it. My husband and I were married pretty young (20) and we (intentionally) had a kid at 23. All was well until little one was unexpectedly dx'd with T-21 the year before I graduated (lots and lots of doctors, therapies, surgeries...).

Everything was overwhelming at that time and the thought of entering med school/residency/fellowship was pretty much impossible in my mind. I abandoned my dream, bit the bullet and used my prereqs to get into PA school so I'd be able to finish faster, support our little one and have time to be home. In hindsight, was this the smartest choice? Probably....definitely not. I'm aware of the mistakes I made but it's done and it made perfect sense to me at the time.

Now that I'm in my 30s, I find myself completely dissatisfied with my work life. I can give 500 logical reasons/arguments if needed but I really don't want to take the thread in that direction. The bottom line is that I'm just not happy and I KNOW that I want to go the MD route (and have for a long time). Love the patients, love the medicine but I feel like I hit a glass ceiling at 2 years; I certainly can't do this forever. 

I gave up on my dreams.

Now that I'm older/wiser, have more support & the little one is more self-sufficient I feel ready to start again. Anyone else out there make the PA-->MD switch? 

Next steps will be refreshing all that basic science knowledge and studying for the MCAT...

Someone tell me I'm not crazy.

0

Share this post


Link to post
Share on other sites

PM primadonna here at the pa forum. she is currently a 2nd yr resident and did the pa to physician bridge program at lecom. you could do that and not have to take the mcat and save a year.

do an online search search for lecom apap bridge program. 3 yrs. no special prereqs for pas and no mcat. I would if my situation allowed me to move...

1

Share this post


Link to post
Share on other sites

Live your dream, you only get one chance at life.....

 

Then be an advocate for a PA--MD (DO) bridge with a reasonable time frame.....

5

Share this post


Link to post
Share on other sites

You are not crazy.  You could also consider looking for a 3 year medical school.  There are several in the country, some in Texas and New York and probably other states. 

LECOM is a good option as well and is a DO program. There are several Forum members who have gone to or are now attending LECOM.

0

Share this post


Link to post
Share on other sites

Follow your heart. Some of us were meant to be PAs, others MDs. Especially if you love a field with a low ceiling for PAs. For example I couldn't imagine being a PA my entire career in surgery. Some will disagree, but for me the ceiling is too low. I want to be able to call the shots. Fortunately for me, my love is a field where PAs have comparable MD autonomy and that is important to me. Dont blame you what so ever for wanting to further your career and increase your scope. Best of luck. Keep us updated. 

 

Is it possible to block this thread from Rev? He is just going to use it as more ammo in his argument for all 20-30 year olds to go the MD route. 

0

Share this post


Link to post
Share on other sites

Go!  So very not crazy.  My stepmother went for her MD in her 30s with 3 kiddos at home.  

 

I'm 53 now and finishing my didactic.  At this age, I like this path to clinician (although with all that's happening with MOC and MOL and the other barriers to practice, I am considering considering going for NP as well when I'm done - I'll have my PA education with the all the practice options available to an NP!).  

 

As for Rev, I'll put money down that his advice to the younglings is going to prove very very sage in 10-12-15 years, depending on what happens to the PA profession.  :)  

 

There are a lot of people who really do know their professional passion at a young age.  No argument there.  My veterinarian husband was one of them ... from somewhere around the age of 6.  But if you accept the physiology / developmental psychology lessons we're taught, our brains don't fully develop until age 25-26, especially that frontal cortex ... so what you "think" you "know" at 20-25 is certainly subject to change.  Ever stop to wonder where the whole 'mid-life crisis' stories come from?  Back to my ex, he [mostly] always loved the medicine side of it ... but what he thought he wanted, as a veterinarian, at 20-25, was a LOT different when he was 35-40, and changed again closer to 50.  

 

Fortunately, he is in a profession that allows him to freely make changes.  The PA profession as it exists today does not.  Yes, there are no legal barriers, AT THIS TIME, to changing specialties / environments ... but making that move laterally isn't all that easy.  The recertification challenges today are daunting for many who are in specialties, and it's worrisome the direction that is going!  The corporate health care perceptions of the administrivia associated with PAs and the mandatory oversight is a barrier.  Physicians moving more into corporate employee roles and questioning why they should be in "supervisory" roles creates its own challenge.  The significant increases in the cost of PA education and the associated debt burden on the growing population of PAs is putting many new PAs in the position of taking less desirable compensation packages out of financial necessity.

 

Back to the OP's question - just as you're never to old to become a PA, you're never too old to become an MD.  I doubt anyone loves 100% of what they do professionally, but you spend enough of your waking hours in your profession, make sure you're loving more of what you do, than not.  If that's not the case, make the change!

0

Share this post


Link to post
Share on other sites

Go for it.  BUT, as a MD, you're not going to be able to work in both the ED and ICU (unless you get double board certified in emergency and pulm/critical care).  Trauma surgeon is the closest single specialty I can think of that resembles your current job.

0

Share this post


Link to post
Share on other sites

Really appreciate the advice & support everyone..

 

 

Go for it.  BUT, as a MD, you're not going to be able to work in both the ED and ICU (unless you get double board certified in emergency and pulm/critical care).  Trauma surgeon is the closest single specialty I can think of that resembles your current job.

 

I thought so too, but a friend of mine showed me this the other day. Things are changing.. see here:

 

http://emcrit.org/critical-care-fellowship-faq/ http://emcrit.org/ed-intensivist-roles/

0

Share this post


Link to post
Share on other sites

Really appreciate the advice & support everyone..

 

 

 

 

I thought so too, but a friend of mine showed me this the other day. Things are changing.. see here:

 

http://emcrit.org/critical-care-fellowship-faq/http://emcrit.org/ed-intensivist-roles/

An intensivist where I work also is an ED attending at another major metropolitan teaching hospital. It can be done.

0

Share this post


Link to post
Share on other sites

An intensivist where I work also is an ED attending at another major metropolitan teaching hospital. It can be done.

We have several attendings in my shop who completed CC fellowships. They work both in the ED, and as attendings in the MICU, SICU and Neuro ICU.
0

Share this post


Link to post
Share on other sites

Go for it. BUT, as a MD, you're not going to be able to work in both the ED and ICU (unless you get double board certified in emergency and pulm/critical care). Trauma surgeon is the closest single specialty I can think of that resembles your current job.

Board certified EM physicians can now do fellowships in CC and be board certified.

 

ETA: sorry, I see someone already brought this up.

0

Share this post


Link to post
Share on other sites

Sounds like you want to have more respect and autonomy and are hoping that having the MD initials after your name will get your there.  It also sounds like the culture in your hospital promoted this within you, with, as you mentioned "lots of physician oversight at times" and being seen as the "tactician" etc.... But before going into several hundred thousands of dollars of student loan debt, 7 years of lost wages (another 700K-1M lost), not to mention all the lost time with your family since you're going to see them much less over the next 7 years or so, and the possibility that after all that you might end up in some residency that you don't like and doesnt give you the respect and prestige you dreamed of earning (everyone dreams of being the cardiologist or surgeon, yet very few make it there due to lack of residencies - are you going to be happy in family medicine or will seethe with envy when you see your classmates in high prestige specialties?), I would first try a different PA job that offers you more autonomy and respect.  It seems to me that the PA's who are most dissatisfied are the one's who feel like they are relegated to an inferior status based on the work setting they're in, and this could be the case with you.  So running an UC or going into a clinic where you're essentially the sole provider may satisfy your urge to feel on top and get respect without having to go through all the above mentioned hoops.  Also, since when did only PA's have a glass ceiling and not physicians? With that mentality, it sounds like you run the risk of feeling limited even by becoming a doctor.  Ok, so their glass ceiling might be higher than yours but the cardiologists glass ceiling is higher then the FP physician and FP may be right were you land, you just never know.  So unless you're going to be ok always having someone above you, with more prestige and power, as well as always having a glass ceiling, than you'll probably be unhappy wherever you are, because that's just how it is.  At the end of the day, whether you're a physician or a PA, the only one's who are really experiencing the thrill and freedom of not having a glass ceiling are the one's who are creative and are able to be innovative and entrepreneurial with their work. I cofounded a weight loss clinic as a lowly MA and was the one telling the docs what to do.  Hard work and innovation trumps over everyone in every field.  

At the end of the day dreams are good and without them we wouldn't accomplish nearly as much, but sometimes they aren't to be taken literally, and to do so would be foolish.  Dreams often serve as sign posts, guiding us in the right direction of our life's purpose. Without your dream of becoming a doctor you never would have become a PA. But as they say, shoot for the moon and if you missed you'll land on a star. The fact that you didn't become a doctor doesnt mean you gave up on your dream, rather you landed on a star, which is a good place to be, maybe even better than the moon.  To wrap it up, you obviously want more respect and autonomy, but there are other ways to get that.  So before you spend the amazing amount of time and energy (and $$$$) that it will take to do it all over again, I would first invest a year or so in CREATING the type of PA career that you dreamed of having when you first started.  Good luck!

4

Share this post


Link to post
Share on other sites

well, why don't you describe for us what you think about

  1. expected timeline - your age and that of your kids
  2. expected financial cost and source of money 
  3. how much support your spouse is willing to provide (<100% will be a problem) and his situation
  4. reasonable competitiveness of the residency you want to compete for
  5. how well you plan to do in the cutthroat environment of med school, and STEP exams
  6. where you expect to move your family to both med school and residency, four years each
  7. fellowship likelihood, another move
  8. whether you think your marriage will survive (or if you want it to)

This is a nine-year poverty plan from where you are...minimum.   People do it, and more power to them.

But...MOST people who consider this think (here come the rose colored glasses) they are going to get accepted at the medical school of their choice or in their city, and get a residency and job where they want as well.  This does happen from time to time - a relative of mine never left the city - but generally only in high demand specialties like FP.  Not ONE of the residents where I worked until very recently is from here, as far as I know.

Unless I am mistaken, and this happens a lot, LECOM and other shortcut paths are pretty much purpose-designed to produce FP physicians.  I don't know if it would be an issue if someone professed a desire to move on, which again does happen, but that is a really tough row to hoe as well.  I know some guys who have taken incredibly horrible jobs (on the rez, etc), or fellowships to break into something else.  

One mistake, one bad rotation, one bad day on an exam, over ten years - things could change.

But if you are willing to make these sacrifices, take these risks and gamble these long odds, then I say go for it.

0

Share this post


Link to post
Share on other sites
On 6/21/2016 at 3:38 PM, cbrsmurf said:

Go for it.  BUT, as a MD, you're not going to be able to work in both the ED and ICU (unless you get double board certified in emergency and pulm/critical care).  Trauma surgeon is the closest single specialty I can think of that resembles your current job.

Actually there are now multiple options for EM/Critical care. We have two attendings that are double boarded. 

0

Share this post


Link to post
Share on other sites
7 hours ago, south said:

well, why don't you describe for us what you think about

  1. expected timeline - your age and that of your kids
  2. expected financial cost and source of money 
  3. how much support your spouse is willing to provide (<100% will be a problem) and his situation
  4. reasonable competitiveness of the residency you want to compete for
  5. how well you plan to do in the cutthroat environment of med school, and STEP exams
  6. where you expect to move your family to both med school and residency, four years each
  7. fellowship likelihood, another move
  8. whether you think your marriage will survive (or if you want it to)

This is a nine-year poverty plan from where you are...minimum.   People do it, and more power to them.

 

how do you get 9 years? they could probably get into Lecom for next year's class. 3 yrs to DO. 3 more years for EM or IM. 1 more year for critical care fellowship prn. I see that as 7 yrs max. and they could likely work a bit in medschool(Primma did) and also moonlight as a resident and fellow to makwe 100k or so/yr from pgy-2 on. . If I was 30 there would be NOTHING stopping me from going back. much harder in my late 40s with a nonworking wife and teenaged kid. another option for the OP would be a PA residency or, as mentioned by others, a change of job. still, even as a senior EM PA with 30 yrs experience in EM I still can get talked down to by an FP attending 1 y out of residency who can't find his a$$ with both hands.  

0

Share this post


Link to post
Share on other sites
5 hours ago, EMEDPA said:

how do you get 9 years?

I'll admit it's conservative / pessimistic but it's not on purpose.  OP says they are starting back up after being a PA for 4.5 years.  Figure a year to get the MCAT (studying...it has changed since OP undergrad), any pre-reqs that need re-taken and applications done and any other life prep out of the way.  How many spots are there for LECOM bridge and other 3-year programs if they exist?  12?  15?  No offense, but OP seems pretty competitive, but they are not the utmost galactic #1 pick of the universe, so it's not a shoo-in or sure thing.  

I would stipulate 8 years 1...3...3...1...if OP was accepted tomorrow and everything happened in perfect order, the first time.  Not accepted somewhere for the 3 year and they have to do a 4 year?...or there is some sort of gap there due to life, another pregnancy?, kid gets sick?, spouse issues?  ...it adds from there.

The ultimate #1 pick for school who is ready today could do it in 7...but stuff happens to us mere mortals.  I had a very firm conservative doable 5 year plan for PA school and it took me 7, and that was acceptance first try with ample financial support.

There are people who sail through it with room to spare in all categories, and to be perfectly honest, I hope OP becomes one of them.  Just a reality check.  

1

Share this post


Link to post
Share on other sites
8 hours ago, EMEDPA said:

how do you get 9 years? they could probably get into Lecom for next year's class. 3 yrs to DO. 3 more years for EM or IM. 1 more year for critical care fellowship prn. I see that as 7 yrs max. and they could likely work a bit in medschool(Primma did) and also moonlight as a resident and fellow to makwe 100k or so/yr from pgy-2 on. . If I was 30 there would be NOTHING stopping me from going back. much harder in my late 40s with a nonworking wife and teenaged kid. another option for the OP would be a PA residency or, as mentioned by others, a change of job. still, even as a senior EM PA with 30 yrs experience in EM I still can get talked down to by an FP attending 1 y out of residency who can't find his a$$ with both hands.  

Critical from EM or IM is 2 years. So if you do 4 year med school 3 year residency and 2 years CC then its 9 years. If you are in a 4 year EM residency its 10. LECOM would take 1 year off that. 

1

Share this post


Link to post
Share on other sites

If you have all the facts, understand the path and sacrifices, and are willing to do the work then go for it. I am an Army trained PA but still had 2 people in my class that went from graduation day at PA school to medical school. I don't know how they fared because I lost contact with them but I suspect they did and are doing fine.

1

Share this post


Link to post
Share on other sites

Everybody has different factors in the "equation" when making decisions, and these factors are all weighted differently. For many of us, time is a major factor. For others, it is professional "respect." And for some, it is purely a thirst for knowledge. These are just some factors. Like sas stated, you need to lay out all the cards in front of you and make the best decision you can at the time. However, like AliB stated, your priorities and weighting of different factors can and likely will evolve of time. 

For me, the ultimate factor is time. When I read posts like EMED's about moonlighting as a resident and fellow, that just seems unfathomable to me, but I can see why some people do it or are drawn to that lifestyle. That's just not my lifestyle. The way I see it, if you want to be a physician these days, you have to really want it. More so than anything else in life. The road to get there is very time consuming. If you don't have the passion for it, life is better spent doing something else. If you do have the passion for it, though, then you'll never regret it. Not an easy to decision. Unfortunately, I think a lot of people who get into it don't really think too much about it. 

3

Share this post


Link to post
Share on other sites

Time is probably the major factor, because no matter how you try you can never get that back. The expense - when coupled with the lost wages - is also potentially huge.

I'd also look at what you hope to get out of it. If it is autonomy, you may be in for a rude awakening. I was sitting in a hospital Tuesday and happened to enjoy witnessing a 60ish year-old physician screaming at a 25ish year-old MBA  in admin about why the physician could not do something. The physician lost the fight.

0

Share this post


Link to post
Share on other sites
On 9/6/2017 at 10:18 PM, EMEDPA said:

how do you get 9 years? they could probably get into Lecom for next year's class. 3 yrs to DO. 3 more years for EM or IM. 1 more year for critical care fellowship prn. I see that as 7 yrs max. and they could likely work a bit in medschool(Primma did) and also moonlight as a resident and fellow to makwe 100k or so/yr from pgy-2 on. . If I was 30 there would be NOTHING stopping me from going back. much harder in my late 40s with a nonworking wife and teenaged kid. another option for the OP would be a PA residency or, as mentioned by others, a change of job. still, even as a senior EM PA with 30 yrs experience in EM I still can get talked down to by an FP attending 1 y out of residency who can't find his a$$ with both hands.  

And that FP attending gets talked down to by a cardiologist and so on....sense a trend? 

 

1

Share this post


Link to post
Share on other sites
14 hours ago, ndpa09 said:

And that FP attending gets talked down to by a cardiologist and so on....sense a trend? 

 

 

 I've  seen ER Docs gets talked down by surgeons and other specialists as well. 

 

1

Share this post


Link to post
Share on other sites
28 minutes ago, PACali said:

 I've  seen ER Docs gets talked down by surgeons and other specialists as well. 

 

I've seen surgeons get talked down by their wives. The wheel of Karma will eventually roll over everyone.

7

Share this post


Link to post
Share on other sites
25 minutes ago, CJAdmission said:

I've seen surgeons get talked down by their wives. The wheel of Karma will eventually roll over everyone.

Lol

0

Share this post


Link to post
Share on other sites
5 hours ago, PACali said:

 I've  seen ER Docs gets talked down by surgeons and other specialists as well. 

 

The surgeons where I work are too short to talk down to me :-D.  Same with the one Internist - only specialist on par with me height wise is one of the rads.

SK

0

Share this post


Link to post
Share on other sites

Yea, if someone wants to be a doc for "more respect", I suggest they go into another field.  I have watched ER docs be dressed up one side and down the other by specialists and surgeons.  I've seen FP's be yelled at by consulting IM guys.  And I have watched first hand as surgeons belittled anyone that does not "cut and heal".  It's a never ending circus.  Also remember, some of the most brillant and respected doctors of all time have still caught crap from their colleagues.  Dr. Jonas Salk?

0

Share this post


Link to post
Share on other sites

There should be a big sign at the entrance to medical schools the world over - "Check your ego at the door".  Respect is always a two way street and you'll never get any if you don't give it.  I get you need a healthy ego to do what many people in our fields do - you have to have a lot of self-confidence and testicular/ovarian fortitude to open up someone's head and root around in their brain or open up a clogged artery in a beating heart or do an ER thoracotomy and cross clamp someone's aorta...but being humble about it is the true sign of a healthy ego.  Medicine has a way of humbling most, if not all of us, at one point or another - if it doesn't/hasn't, you're a psychopath or a robot...or you're not trying hard enough.  IMHO, if you're simply looking for respect, be good at what you do, in how you treat your patients and colleagues, and be humble...but be prepared to turn on a dime at people that disrespect you and your colleagues and stand up for yourself and them as well.  Standing up for yourself and your colleagues goes a long way in gaining respect...a couple letters in front of and after your name gives you little more than some courtesy.

$0.02 Cdn

SK

1

Share this post


Link to post
Share on other sites

A happy person will be happy as a PA or an MD. An unhappy person will be unhappy as either. The whole "if only I would of been this, or done that" is really just finding an easy scapegoat for your unhappiness.  The mind is tricky and convinces us that the grass is always greener,  but the dissatisfaction never ends.  There's never enough money and never enough respect.  The FP is miserable that he's not a surgeon, the surgeon is miserable that he's not in derm, and the derm is miserable cause all his neighbors are investment bankers and lawyers making twice as much as him.  We all know the moral of this story.....

5

Share this post


Link to post
Share on other sites
On 9/11/2017 at 3:09 AM, NimbleMind said:

A happy person will be happy as a PA or an MD. An unhappy person will be unhappy as either. The whole "if only I would of been this, or done that" is really just finding an easy scapegoat for your unhappiness.  The mind is tricky and convinces us that the grass is always greener,  but the dissatisfaction never ends.  There's never enough money and never enough respect.  The FP is miserable that he's not a surgeon, the surgeon is miserable that he's not in derm, and the derm is miserable cause all his neighbors are investment bankers and lawyers making twice as much as him.  We all know the moral of this story.....

I think we all understand the moral, but I have heard this argument so many times as a reason to simply try and be happy with what you have. If you aren't willing to change and you don't take a chance to see if the grass is any greener, you will never know. 

0

Share this post


Link to post
Share on other sites

I too had the option to go to medical school. 

The ONLY time I sort of wish I had is when I see how much my MD colleagues are getting paid for doing the same work (FP/college health). But I knew that going in. I dont think I'd be any happier, so honestly there is no regret.

I think there is a (very) small subset of PAs who are so unbelievably type A and called to medicine that they wont be happy with anything but MD after their name. 

0

Share this post


Link to post
Share on other sites
On 9/14/2017 at 10:48 AM, printer2100 said:

I think we all understand the moral, but I have heard this argument so many times as a reason to simply try and be happy with what you have. If you aren't willing to change and you don't take a chance to see if the grass is any greener, you will never know. 

Hearing the argument a million times doesn't detract from it's truth.  The challenge is internalizing the lesson, and only then can you know whether it's a valid argument or not.  BTW, I never meant to imply that you should never make a career change, rather a person just needs to be honest about their motivations for wanting to switch and then ask themself if the cost of making the change (i.e. the debt and lost time of going back to medical school) is worth the perceived benefits, and if those benefits are even realistically going to be achieved.  There are certain things that career, money, and prestige, are not going to help with, so there is a definite risk into going into more debt and losing more time and then realizing too late that it was a mistake.  In regards to the OP, it just seems too hasty for him or her to decide based on several years of working in one job that being a PA is not going to grant the satisfaction that he or she is seeking. There are so many fields and work environments that a PA can go into.  I would at least take advantage of the flexibility that a PA degree offers by working in another job or two before making the switch, cause that switch sure as heck ain't free.

0

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!


Register a new account

Sign in

Already have an account? Sign in here.


Sign In Now