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PA for a young male applicant?

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pa56 - the below is not directed at your or your son, but some of the talk in this thread I believe has led to some confusion.

 

Just to make things clear, PA SCHOOL IS HARD, but of course doable.  It has been by far the worst two years of my life in many ways because of the sacrifices I have had to make.  I hope nobody chooses PA school because they believe it is somehow easier than medical school.  It is different.  Medical school is obviously difficult as well, but due to the in depth understanding that is required to progress (and ultimately much of this is not really needed to successfully practice medicine).  PA school also has some of that depth, but is mostly difficult because of the speed.  By Wednesday of my first week I felt behind, and never actually felt caught up.  It feels like you are treading water in the middle of a hurricane for 2+ years.  Your head is above water, but there are times when a wave submerges you and you have to fight to get back to the surface.  Yes, I took time away from studying, but it's always there in the back of your mind gnawing at you with the calculation of how much knowledge you could learn during this weekend you are spending with your ____ (fill in the blank, for me it was my wife and dogs).

 

But know, it is doable, just like medical school is doable.

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Boats- getting some white in the beard....

anyway in answer to some questions above. some of my issues were likely related to my personality. when folks disrespected me I didn't take it well and gave it back.  I'm a bit of an alpha professionally. some of my jobs sucked too.

with regards to FP doing work outside of their field- it really depends how they managed their residency. if they got qualified for procedures as residents it's not hard to find a place post-residency to utilize those skills. FP can work hospitalist service almost anywhere. FP's in the ER tend to work in rural areas as urban areas wwant em boarding. FP docs are my main competition for rural em jobs. a lot of these go to PAs as they can pay us 30-50% less to do exactly the same work.

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Oh, maybe I'm exaggerating slightly, and if I may digress briefly, pardon me for speaking frankly, but I can kinda do without the lecture on immigrants.  It is unnecessary, as I happen to know this quite well, personally, thanks very much, and I will leave it at that.  

 

I stand by my numbers.  It's basic math.  Medical schools tuition ALONE is around 200k.  4 years of living cost, let's say you suck it up pretty extremely and draw 12k per year x 4 = up to 248k.  The next 3-4 years after you will be unlikely to make significant payments, so that compounds.  

 

Without a single other expense, that's a little more than $325,313 at 6.8%.  (because I skipped over the first 4 years of interest to make it easier to calculate). (Again your first FP job is likely to pay you $165k or so, unless it falls even further. _

 

That is absolute bare minimum, and keep in mind you have to buy things like exams and fees and interview travel.  

 

To be honest, I kinda didn't believe it either, until I worked with a couple of students from the local state university, both of whom had chosen the Air Force to pay for their medical education.  One kid jokingly said his dad (a CPA) would disown him if he tried to attempt it with loans and such.  They laid it all out for me over a couple of night shifts.  And this was a middle of the road state university.

 

A friend of mine came out of her anesthesia fellowship owing about $600k.  She was then struck by an illness and paralyzed, leaving her unable to work so I helped her with Go Fund Me stuff.  Last I heard they were thinking about forgiving some of that after 4 years of paperwork, another story I suppose.

 

Are there kids who do it on less?  Of course.  I knew plenty who had someone else to foot the bill.  Or had the government pay or something.  In which case that's a different conversation. 

 

I helped my newly minted DO relative with her moonlighting contracts as she attempted (unsuccessfully) not to lose her house after signing a FP partnership requiring her to see 62 patients per day before getting personally paid a single dollar.  It was the best offer she could find within reasonable commuting distance as her husband had to go back to work part time (as a financial adviser).  Her student loans = $360k.  This was a few years ago.  She is still there, but doing better as she paid some of her partnership down.  She charts for about 11 hours every Saturday and takes every Sunday off.  As far as I know, she hasn't taken a vacation or day off since she started.

 

Fully trained and experienced docs (say average 6-8 years past residency) in my field make about $420k.  The break-even point, debt paid off wise, for most, was about 6-7 years out of residency.  So does it happen? Yes.  But that is a long time, man.

 

And I'm talking about conditions NOW, not someone who came up 10 or even 7-8 years ago.  It has changed dramatically.  

 

 

Every single MD at my program told us repeatedly that the situation was completely unworkable (this is when the new reimbursement rules for the next few years were coming out).  

 

I never worked for a preceptor that didn't work quite a bit more than 40 hours a week, most far more than I'm even capable of, much less would do voluntarily.

 

To reiterate, if someone wants all of that so that they are willing to do all of that, then more power to them, and my hat is absolutely off to them.  But it isn't for me, that's for sure.

 

I liken it to being a pilot.  The young looking guy flying you on your domestic flight might be pulling down minimum wage, getting jerked around like you can't imagine, and had to pay for all of his training and uniforms out of pocket.  If he waits it out, can he eventually get that cush route to Europe on the Dreamliner and make the big bucks working a few days a month?  Absolutely.  But...

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I am also a 23 year old male, currently in the middle of my first year of PA school. I chose to go to PA school for similar reasons as your son, and because I don't care about prestige, money, or being in total control. Just want to make a difference and help patients. However, I know a lot of people these days are paying well over 100k just to attend PA school in the first place. Luckily, I go to an instate program where the total cost is under 40k. Need to consider the amount of debt for school as well, he might as well consider med school if he is going to be paying the same price for it.

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medschool debt is reasonable if you approach it reasonably and don't buy a porsche and a mansion your first day as an attending.

take the case of a friend of mine: finished residency, started making em doc salary. stayed in his old appt, drove his old car and threw 50+% of his salary to debt. paid it ALL off in 2 years. now he takes off 3 months/year to surf. it can be done if you can hold off on the toys for a while and live reasonably(even paying > 50% of his salary to debt he still was living on a typical pa salary...).

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Without a single other expense, that's a little more than $325,313 at 6.8%.  (because I skipped over the first 4 years of interest to make it easier to calculate). (Again your first FP job is likely to pay you $165k or so, unless it falls even further. _

 

That is absolute bare minimum, and keep in mind you have to buy things like exams and fees and interview travel.  

 

 

 

A friend of mine came out of her anesthesia fellowship owing about $600k.  She was then struck by an illness and paralyzed, leaving her unable to work so I helped her with Go Fund Me stuff.  Last I heard they were thinking about forgiving some of that after 4 years of paperwork, another story I suppose.

 

Are there kids who do it on less?  Of course.  I knew plenty who had someone else to foot the bill.  Or had the government pay or something.  In which case that's a different conversation. 

 

 

 

Fully trained and experienced docs (say average 6-8 years past residency) in my field make about $420k.  The break-even point, debt paid off wise, for most, was about 6-7 years out of residency.  So does it happen? Yes.  But that is a long time, man.

 

And I'm talking about conditions NOW, not someone who came up 10 or even 7-8 years ago.  It has changed dramatically.  

 

 

Every single MD at my program told us repeatedly that the situation was completely unworkable (this is when the new reimbursement rules for the next few years were coming out).  

 

 

 

 

 

EMEDPA has a point. Saying you are 'exaggerating slightly' is a little bit of an understatement seeing as you said,

 I have talked to new docs who owe close to $800k.  Compounded daily.

 

"docs" imply several. And statistically, you meeting that many docs that owe that much is staggering as well.

All the debt amount you mentioned here average about $350k. the $600k was due to extenuating circumstances. So where are these doctors you talk to all the time with 800k in debt? that sounds outlandish to me also. 

 

anyway, I think either way can be done. Just make sure its something you want to do. I've talked to doctors as well, never heard of it one time as well. If there is someone out there with that kind of debt ($800k), they made a huge misstep somewhere. 

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I went to PA school at a much older age than most, after several careers. The one factor that I don't think has been addressed in this thread is that many people will actually change their minds as to what they now want out of life.

 

Some people are "river people" -- they know their route and follow it to the sea. Others are "portfolio people" and may do lots of different things to build their lives. To them, a career decision isn't "what do I want to do with my life?" but rather "what do I want to do now?"

 

If medicine is a calling to you and you are young -- and relatively certain that you're a "river person" -- then med school might be right for you. While some docs do leave medicine later to do other things, I have talked with many who don't feel all that flexible in that regard.

 

The PA route is more flexible -- less sunk costs associated with training, probably easier to change jobs/specialties (for now), probably more room for a life not dominated by the demands of your job, etc. And, if you change your mind,  you can follow some PAs in their late 20s and early 30s I've known who decided that, they really would like to be docs and did it. Did they waste time and money following the PA path? I don't think learning who you are is a waste of resources.

 

I see nothing wrong with letting a 23 year-old go for his dream. He may change his mind later, but my guess is that he'll handle that too and be a better person for it.

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You're right - my estimates may be inaccurate.  They may be a little on the low side.  The first school I thought of when the OP mentioned DO program was Midwestern University in like Arizona someplace.  Their yearly tuition is now $63,218.  I've never been there, don't know if they are amazing or just expensive or what.  But it's right there in black and white.  

 

Of course, since I'm clearly making all of this up, definitely don't go to this link and see for yourself:

 

 https://www.midwestern.edu/course_catalog_home/glendale_az_campus_/glendale_campus_overview/student_financial_services/glendale_tuition_and_fees.html

 

63 x 4 is 252k in tuition alone, and I was figuring drawing $1,000 per month for 4 years for survival such as housing, food, reliable transportation, gas, insurance, books, fees, equipment, medical care, interview travel, aren't those exams hundreds of dollars each? 

 

So since I was $50k too low, let's say you get out of your residency with over $400k in debt, setting increased interest cost to zero because I'm lazy, and I've already mentioned that I also ignored the first 4 years of compound interest at 6.8%.  

 

Can $400k after 4 years turn into $800k after the next 4-6 years?  Apparently it can, and since I can't provide names of docs I have talked to, just for the hell of it I googled "800k in medical education debt".  All THOSE people are also making it all up!  

 

Why do I even say 6 years?  Every specialist - meaning non-FP physician - I worked for in PA school - somewhere between 8 and 10 of them - did at least one post-residency fellowship.  These pay a little better than residency - here's a chart that I just totally made up as well.  

 

Infectious Disease Fellow Salaries
Job Title Salary University of Kansas Medical Center Infectious Diseases Fellow $51,137 Boston Medical Center Infectious Diseases Fellow $70,021 Beth Israel Medical Center Infectious Diseases Fellow $71,550 Emory University Infectious Diseases Fellow $58,420

I think a little less than half of docs work in non-FP, right?  You could definitely make a few payments during this time.  But could you make enough to not be losing ground?  (Those of us who have lived in Boston and NYC know that these places may not be paying near enough for that).  

 

But hell, don't believe any of this.  I mean, I'm just using basic arithmetic and verifiable information - based on ideas gleaned from being surrounded by fellow medical type students for the past several years.  Yep, definitely just making it all up.  Nothing to see here.

 

Again - my assumptions are just that.  Do people get help from various sources or make payments while in medical school or residency?  Do people moonlight while doing these things?  Do people pay off this stuff in a small fraction of the time.  

 

YES THEY DO.  I'm talking about the ones who don't do these things, which by the way how common is that?   I've never heard of someone pulling AFGCE standard 80 hour weeks, 1:3 call, and/or 24 hour call shifts (with 6 hours non-patient contact time to follow, quite allowable by law) .... and being able to take a few shifts someplace else.  Maybe people do that, I don't know.  Every resident I've ever known works like a dog.  

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I'm 3 years out and hitting the income wall. this is mainly geographical but is frustrating to watch docs leave and get more money (in corporate) while we have to fight for 10-15k increases due to the way these corporations view us.

 

I love being a PA and do enjoy medicine. I don't like the way we are being stifled when it comes to our income potential. I generate income, i am not a staff issue like a nurse or a RT. i am a provider who bills and makes money.

 

I think this is the first time i have questioned becoming a PA. Watching other people make the money i am making doing non medical jobs. What worries me is that it will only get worse the more everyone in medicine becomes employees 

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Take it for what it's worth.... but many, many, many of the younger PAs now a days were directed to PA school by their physician parents. Something about the grass always being greener on the other side maybe? 

 

At the end of the day, we can always train up. My mentor was a cardiothoraic surgical PA who is now a board certified dermatologist. But going in reverse (MD/DO -> PA) just doesn't really happen. 

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it is harder than you think going from PA to Doc. yes, folks do it. typically it involves being single or married with a spouse with a good income and no kids. I've tried twice to go back, took all the prereqs wirth good scores while working full time, and just can't swing it because I am married with kids and a non-working spouse(at present). I have a mortgage, etc. Yes, we could sell our house and live off the proceeds while living in a crap apt for 6 years( 3 yr bridge+ 3 yr residency), but I'm not willing to do that to my family. also, with almost all my debt paid off I don't want to assume 200k in loans in my late 40s.

If I was single I would probably STILL go back to medschool.

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To the original poster:

 

You've stumbled upon perhaps the longest running debate on this forum. There will always be PAs that wished they were MDs. Those individuals also tend to use a larger microphone than the rest of us to voice their dissatisfaction. That's perfectly fine and I think those are important voices to be heard. That being said, I truly believe the vast majority of PAs are quite content with their decision to not go to medical school. PAs make plenty of money to live comfortably. Better than most jobs. It's also a flexible profession, and no matter how far down a specialty rabbit hole we go, we can always fall back on primary care. 

 

The whole "lifestyle" debate is more about personal preferences and tradeoffs. Probably even more so related to personality. It's a choice we all make. For every story of "one of my colleagues only works X and still makes Y," there is a counter-example. One of my biggest requests in a job is at least 6 weeks PTO. I'll take a salary cut for it, and I want the option of additional unpaid time off. That's my choice. We live in a modest house, drive economy cars, and my two kids go to public school. Going through medical school + residency + fellowship just doesn't interest me. That's just more time away from my family, my three dogs, and my kayak. 

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Your son sounds a lot like me except I chose to pursue the PA career back when I was 17. I chose PA over MD for several reasons. Important reasons were that I didn't want to be forced to pick one field and I wanted to enjoy my early adult years living my life instead of spending an extra two years in school and then 100+ hours weekly in a residency and fellowship. I also liked the idea of having an SP to consult with. At my job, I'm the frontline/go-to person for my surgeon, nursing staff and our patients. It's a cool role to have and it's fulfilling and rewarding. It'd be nice to have the income and scope of a physician, but I felt and still feel that the PA route is the choice for me. We'll see what the future holds, but so far I'm very happy.

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Becoming a physician assistant was my first career choice because I wanted the ability to switch fields so that I could have versatility down the road. I wanted to be able to start my career at 24 instead of 34. Also with loans and the delayed start of making money, the average PA will make almost as much as the average physicians by retirement. Obviously that depends on the specialty though. I think the people who want to be doctors need to really really love one specific field and enjoy having many years of training. For some of us, that's not appealing.

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