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The Future of The PA Profession


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I think the title speaks for itself. I have been following a thread similar that was started but was kind of turned into a roast of a PA turned MS3 who was seeing PAs as inferior practitioners. I respect that he chose to further his training but the defensive stance he seemed to take made it seem like his 'waste' smells like roses. I am only an EMT and finishing my bachelors but seeing some things tossed around in that convo, and also some things I've just heard around I wanted the opinion of those on here. I am strong in my hopes of becoming a PA as it seems like an excellent profession. I have seen people say that they think the future of PAs could be in trouble for a few reasons and maybe someone could debunk of further put me at ease before I jump ship and go the med school route! ha. I'll just make a list of the things I've noticed being tossed around that kind of turn me away when added up:

NPs being chosen of PAs due to doctorate or other reasons
Autonomy(even though it's known PAs don't practice independently) is becoming even slimmer than it already is for PAs
The market is and will continue to become over-saturated with PAs and NPs so 
Lateral mobility could begin to disappear and specializing with residencies may become a thing

All of those things are what I've seen/heard tossed around from different threads. I do not know how credible those sources are, but as someone looking very very VERY deep into the profession, it does concern me when these things are said. If the market is already becoming oversaturated due to PA programs popping up all over and whatnot, what does that leave for the future? Lateral mobility was an attractive selling point for me when looking at this versus having to pick a specialty in MD/DO professions. NPs being chosen over PAs seems kind of odd to me considering the training, when you compare the education between the two, I would believe that healthcare companies and physicians would feel better having someone that studied the same model that they did, to practice with them.

I'm 26, almost 27... have 1.5 years of school left, and then I'll have PA school to look at. If these hypothetical things do continue I may further entertain the option of going to medical school, but hopefully some professionals can weigh in on this and tell me their thoughts on the things I've listed above. Thanks

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I appreciate your feedback, Marinejiunitsu. I reiterate that I cannot vouch for my sources being credible or not, but the way they expressed their argument is what concerned me. They seemed to know what they were talking about but it was in a sense of giving a gloomy look for the future of PAs. I live in quite a bit metropolitan area, and we have two major healthcare systems. Both very reputable, and when looking at their different sites and job sites, they seem to advertise a lot for PA or NP for nearly all mid-level jobs, but I suppose that's part of being a big hospital setting?

I'm more concerned for what I should expect in the future since I have yet to even start a program. I know predicting the future is tough, and I certainly don't pretend to know what I'm talking about when I'm still in undergrad. I have looked at BLS.gov and their statistics show PAs as faster growing than doctors over the next decade. No idea where I'll wind up work-wise, but I like the idea of coming back to my hometown after PA school.


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I believe PA saturation will become quite noticeable within the next 5 years or so. 

Pharmacy is heavily saturated but my friends that graduated pharm school are still getting job offers. They had to go out there and make connections during their schooling but it is possible. If you network, you will have no problem acquiring a job. If you are willing to relocate, your prospects are even better. 

There will always be negative people in every profession who want to push doubts onto everyone.

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On ‎7‎/‎21‎/‎2017 at 7:10 PM, Michael Stone said:



NPs being chosen of PAs due to doctorate or other reasons
Autonomy(even though it's known PAs don't practice independently) is becoming even slimmer than it already is for PAs
The market is and will continue to become over-saturated with PAs and NPs so 
Lateral mobility could begin to disappear and specializing with residencies may become a thing

 

I've personally not seen NPs beating out a PA for a position because of a doctorate.  Of all the NPs I've worked with, I know of only one who even has a doctorate.  PAs dominate certain specialties and NPs others.  I don't see that changing. 

Autonomy isn't becoming slimmer at all.  Just the opposite.  We will gain independence eventually.  it is just going to be a slower process for us. 

I sometimes think about the market getting oversaturated, but then also think about how an increase in demand can arise as we do gain more independence.  There will always be areas with constant saturation because people want to live there. 

I haven't run into a lateral mobility issue yet.  For me I'm ER.  So, jumping into FP/IM/UC are pretty easy.  Now if I wanted to go into surgery, I could have a tough time getting in not having any OR time since school.  If the CAQ thing ever takes off, then maybe, but I haven't seen a CAQ requirement but maybe once in a job posting. 

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I really appreciate y'all's input on this! I saw you on the other thread with the MS3, dizzyjon. That thread is what concerned me a little but not so much as that guy was being pretty negative about the entire profession. Sounds like he didn't do the research enough before hopping on-board for PA school if he had that much bad to say about it. Since I'm just an EMT in undergrad, I have no idea what the rotations will be like and what I will like, but surgery does sound intriguing; particularly cardio-thoracic. Obviously, that could change. But it seemed like legitimate topic to bring up, especially after seeing people going after the NCCPA vs AAPA fpar stuff. The saturation seemed to be my biggest concern, since I live in a big city with those two big healthcare systems I talked about. But, with it being so big, and the inevitable need for healthcare for baby-boomers and the growing population, maybe the issue won't be that bad. I'm just being a worry wart about what I'm investing my life into ha.

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Guest HanSolo

Mike,

I would recommend getting a job or at the very least doing some shadowing in an environment where you can see MDs and PAs (and preferably some NPs, too) working together. Try to feel it out in a few different clinical settings. You'll see that the vast majority of time there is professional respect between the different groups. Respect gets respect. If you never give it you won't get it - doesn't matter what title you have. You'll see the good, bad and ugly on this board. 

 

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Mike,
I would recommend getting a job or at the very least doing some shadowing in an environment where you can see MDs and PAs (and preferably some NPs, too) working together. Try to feel it out in a few different clinical settings. You'll see that the vast majority of time there is professional respect between the different groups. Respect gets respect. If you never give it you won't get it - doesn't matter what title you have. You'll see the good, bad and ugly on this board. 
 

Yea, I would love a job in a clinical setting. I've been trying to get into one of my hospitals as an er tech, but they don't let EMTs do that here, so I may have to get my CNA so I can get that experience around other medical professionals besides other EMTs and paramedics. And I've been a member for a while but that was my first instance of seeing it get like that. I feel bad that it didn't satisfy him and hope that the move the doctor fulfills him, but also that he grows more respect for his former title. It was an experiment, it's worked, and PAs continue to grow so something must be going right. :) I appreciate the feedback


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It all depends what your end game is and what you'll be most happy with. I was in the process of applying to PA school (hence why I joined this forum) but eventually ended up going to NP school. The reasons for me were simple:

1. Nurses, as a whole, have significant lobbying/legislative power to help them reach their goals. PA's will never have that (there truly is strength in numbers). It's a numbers game and PA's have less numbers. NP's have full independence in 20+ states. And counting. Do I entirely agree with this? Not really. Though, it is really quite impressive what they've been able to do. 

2. Primary Care and Psych are great specialties for nurse practitioners. Many PA's go into primary care but going into Psych is much harder. I was interested in Primary Care and Psych so it was a no brainer for me. If you want to do ortho or cardiothoracic, PA is the way to go (along with EM). 

3. PA's have a much harder time obtaining leadership positions within hospital organizations (there is no chief PA officer, etc.). So many nurses have high leadership positions in many major hospitals. The opportunity to branch outside of clinical practice is endless (academia, administration, insurance, teaching, etc.). 

4. I practice as an orthopedic physical therapist, and I was grateful to receive really good training during my residency in orthopedics, primary care, and pain management. With that background, I felt like I had a good foundation to help offset the poor NP curriculum that is found in most programs (or at least inferior to PA school). If you don't have a good science background that might not be the way to go.

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On ‎7‎/‎21‎/‎2017 at 8:55 PM, Michael Stone said:

I really appreciate y'all's input on this! I saw you on the other thread with the MS3, dizzyjon. That thread is what concerned me a little but not so much as that guy was being pretty negative about the entire profession. Sounds like he didn't do the research enough before hopping on-board for PA school if he had that much bad to say about it. Since I'm just an EMT in undergrad, I have no idea what the rotations will be like and what I will like, but surgery does sound intriguing; particularly cardio-thoracic. Obviously, that could change. But it seemed like legitimate topic to bring up, especially after seeing people going after the NCCPA vs AAPA fpar stuff. The saturation seemed to be my biggest concern, since I live in a big city with those two big healthcare systems I talked about. But, with it being so big, and the inevitable need for healthcare for baby-boomers and the growing population, maybe the issue won't be that bad. I'm just being a worry wart about what I'm investing my life into ha.

Surgery is a great field and was an interest of mine in school.  It would be one of the more dependent specialties.  You willfrequently be working side-by-side the surgeon.  However, outside of the OR you could see office follows up independently, rounding on pre/post-op patients (often then re-rounding with the surgeon later), and perhaps minor procedures (non OR) on your own. 

7 hours ago, 2234leej said:

It all depends what your end game is and what you'll be most happy with. I was in the process of applying to PA school (hence why I joined this forum) but eventually ended up going to NP school. The reasons for me were simple:

1. Nurses, as a whole, have significant lobbying/legislative power to help them reach their goals. PA's will never have that (there truly is strength in numbers). It's a numbers game and PA's have less numbers. NP's have full independence in 20+ states. And counting. Do I entirely agree with this? Not really. Though, it is really quite impressive what they've been able to do. 

2. Primary Care and Psych are great specialties for nurse practitioners. Many PA's go into primary care but going into Psych is much harder. I was interested in Primary Care and Psych so it was a no brainer for me. If you want to do ortho or cardiothoracic, PA is the way to go (along with EM). 

3. PA's have a much harder time obtaining leadership positions within hospital organizations (there is no chief PA officer, etc.). So many nurses have high leadership positions in many major hospitals. The opportunity to branch outside of clinical practice is endless (academia, administration, insurance, teaching, etc.). 

4. I practice as an orthopedic physical therapist, and I was grateful to receive really good training during my residency in orthopedics, primary care, and pain management. With that background, I felt like I had a good foundation to help offset the poor NP curriculum that is found in most programs (or at least inferior to PA school). If you don't have a good science background that might not be the way to go.

Number 1 pretty much sums up most PA vs NP arguments about why that are ahead of us. 

It's a shame, but I agree there are fewer and fewer PA leadership positions.  It is my desire to become that "chief PA officer" and one of the reasons I got a doctorate.  I've taken the chance and applied for many RN leadership positions (like ER director) in which I met all their desired qualification except not being an RN....of course I never received a call, but it was worth a shot. 

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The future of this profession is bright.  OTP/FPAR aside, PAs are poised to fill gaps in healthcare access in even larger ways than we have before.  There will not be a danger of having no jobs in my lifetime, probably.  Of course, we do not have crystal balls to look into on these things. 

Much of the negative that you read comes from PAs who have not found the right fit.  A vast majority of PAs are happy in their work.  We make a difference.  And regarding independent practice - until more medical students go into primary care residencies (we have vacant family practice residency slots locally) - there will be need for us to fill the role of PCPs, growing our abilities along the way.  I think it will be necessary, before long, for seasoned PAs to be independent.

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Again, thank you to everyone who has contributed to my post. I always appreciate the feedback. I've actually had to opportunity to speak with the MS3 which I brought up above. He's a good person and I think he just felt unfulfilled and wanted more. I respect that and his decision to further his education. He made it clear that he believes that PAs and NPs do have an integral role in medicine, and that with what happened in that other thread, things may have gotten lost in translation and out of hand.

Anyway, after conversing with him and others on the SDN forum and even my own doctors, I have entertained the idea of MD/DO, and since I still have time before I graduate I will say it does cross my mind from time to time. I always begin to wonder why I go back and forth once in a while, and it gets somewhat frustrating, but the nice part is that every time I have, I gain more knowledge about both by those around me, and almost seem to find a new avenue to go down and give me more things to consider that I might not have before. Each time this does happen I wind up back at square one with wanting to stay on the PA route, and feel it in a confident way; more and more stronger each time. 

Today I was over on SDN and I thought about something that an ER doc had told me one time. Well, actually 3 in the same hospital on different occasions, since I'm an EMT, and between calls and finishing PCR's, I would have a few moments to shoot the bull with someone if things weren't hectic. I remembered 3 ER docs who were very well-seasoned in their careers, tell me pretty bluntly that if they could do it again they would either choose PA or not go into medicine. Two of the three told me that, sorry. The third doctor told me she thought because of my attitude and indecisiveness, plus my age and other things I wanted out of life (more family time, etc) that PA seemed best. 

I remembered those conversations today, and how each of them struck me and gave me a sense of "jump ship while you still can!" Not that they were bashing their profession, but they said they had missed out on so much of what I was wanting, and that I could have the longevity and flexibility with PA, and to try and not get hung up on that title because at the end of the day, we're both wanting to accomplish the same thing and use nearly identical methods to solve the same thing. 

One of the docs got a little into detail about her experience in med school. She went to Stanford, and she had a nice and modest, gold class ring that she was wearing and I don't blame her! That's quite an accomplishment. But she told me that three people in her graduating class, either before graduation, in residency or in fellowship had committed suicide. She spoke about one person in-detail and I couldn't believe it. It was unreal. He had accomplished so much, was just finishing his neuro residency but had had enough. That's all I will say about him, to hold respect to him and his circumstances. 

All of the stories that these doctors, plus others have told me made me think today, ironically while I was on my laptop, "is it worth it?" And as I said that to myself, a lightbulb sparked on in my head and I went over to SDN and typed in the search bar "is it worth it" and long, long, LONG threads... I'm talking 10 year long threads were up there. The same thing over and over: "would you do it all over again?" There would be the occasional yes but there was a profound no, almost hell no in their responses. There was a lot more put into it than that, and some would explain their reasoning such as losing friends, time with family and loved ones they won't get back, missing special occasions, divorces, the incredible debt and so on. 

I think from all of the reasons that have had me feel confident in wanting to stay PA, with all of it accumulating, today's events definitely set my decision in-concrete to choose PA. It's not about the money, the title, any of that. I want to help people. I won't be the smartest person in the room at times and I'm humble enough to say that, but my heart will be big enough to care for these patients and I'll be good enough for the job, for sure. I respect every medical profession, certainly doctors and their sacrifice, but come the good and the bad, the frustration from being misunderstood as a medical professional and all the other bs that will inevitably come with it, the not always having the last say, and maybe hitting my cap in pay really early on... I'm going to say PA is what I will feel most content. :)

And if I get on here again asking opinions about it.. please remind me of what I said before and tell me to shut up.. I've already made up my mind! Lol. 

Thanks again, y'all. I'm excited to keep chipping away when the fall semester starts back in a month. Will definitely be on here more and more as I continue to accomplish more. 

I also love this environment more compared to SDN. I'll jump in there from time to time to see different topics, but the support and good vibes are definitely felt here. Sorry SDN! This is my home.

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15 hours ago, dizzyjon said:

Surgery is a great field and was an interest of mine in school.  It would be one of the more dependent specialties.  You willfrequently be working side-by-side the surgeon.  However, outside of the OR you could see office follows up independently, rounding on pre/post-op patients (often then re-rounding with the surgeon later), and perhaps minor procedures (non OR) on your own. 

Number 1 pretty much sums up most PA vs NP arguments about why that are ahead of us. 

It's a shame, but I agree there are fewer and fewer PA leadership positions.  It is my desire to become that "chief PA officer" and one of the reasons I got a doctorate.  I've taken the chance and applied for many RN leadership positions (like ER director) in which I met all their desired qualification except not being an RN....of course I never received a call, but it was worth a shot. 

That's awesome that you still applied for those positions anyway. Keep trying until you reach your goals.

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11 minutes ago, Acebecker said:

I think the way you have weighed this is really excellent.  You have enough exposure to make a solid and informed decision.  Good luck. 

Thank you very much, Ace! I wish I was closer to the finish line, well, I guess the start, if we're talking about PA school. But I'm sure it'll come soon enough. I have no doubts that I'll get in. I feel intelligent enough and compassionate enough, and hopefully the schools I want to go to the most will notice that  as well when the time comes. I'll still be on here, though! And even after I graduate, so I can help others in my position now. 

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Okay so I'll throw my two cents in here as I have and still go through asking myself if I'm picking the right career path pretty often. It's not so much that I'm wavering on my decision. I think I'd make a good PA. I just sometimes think if I'd be better off pursuing something other than healthcare entirely. I actually switched from pre-dental originally due to the outrageous cost of attendance out-of-state and private schools were going to run me.

I definitely think PA is going to hit a point of saturation. All mid-levels are. If you doubt this, just look at the BLS and HRSA projections of supply/demand (Link to HRSA projections). There were 146 PA schools accredited in 2010. There are 225 accredited in 2017. That's scary. The same situation happened with pharmacy. You have these for-profit schools opening to make a quick buck off delusional students who pay absurd tuition prices and further saturate the market. First the job market begins to shrink like we've seen in pharmacy. Next is when salaries begin being driven down which we'll probably see happen to pharmacists within the next 5-10 years. I don't think PA will reach that point as quickly as something like pharmacy will, as the demand in primary care is still very much there for mid-levels. That might not be the case a decade from now though. Like another poster mentioned though, as long as you network, tailor your resume to stand out, interview well then you should have no problem landing a job even in a bad job market. My biggest fear is I don't want salaries slashed, but I don't think that'll happen (if it even does) until I'm close to retirement. I could be wrong though. This is just what I've concluded from doing lots of thorough research of my own.

As far as you considering the medical school route, I'd say it really depend what you hope to gain from it. I'd say that you should wait and see how competitive you are once you near completion of your bachelors degree. At that point you'll know where you stand GPA wise, and entrance exam wise. If you so decide to take both the MCAT and GRE that is. I myself debated medical school. The truth is though I really don't want to be in school and residency for another 7-11 years. Also given my GPA, my options would be going the DO route. Odds are you'd end up matching into family medicine as a DO. It's not a given by any means, but the majority of DOs match into FM or IM (Link to 2017 DO match list). I definitely did not want to have FM as my only option for going through 7 years of schooling and residency, as family physicians are vastly underpaid. It's a bad ROI for what you're putting in. I'd probably aim for one of the more competitive specialties, and those are very very difficult to break into. 

Let me give you an idea of what kind of schooling it takes to get into a surgical specialty (plastics, neuro, ortho), dermatology, ophthalmology, radiology. First you start with a top tier medical school that's average MCAT and GPA acceptances are 34 (on the old scaling) and 3.8 respectively. 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 3-7 years, working 80+ hours a week (getting less than 5 hours of sleep a night). But hey, once you get out and start working as an attending you can finally start paying down your 300K in loans and regularly working 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. Don't get me wrong. I feel confident in myself and my intellect, but the competition you'll be facing in medical school is fierce and there is definitely a gunner-type of mentality. I wasn't so sure I wanted to compete with that or bet the house on me scoring high enough on those exams when I could just become a PA and get into a specialty I'd enjoy simply by networking and interviewing well.

Also if you ever get burnt out as a PA, it's currently a relatively affordable degree that can be paid off much more quickly and if you need/want to transition into a different career you're able to. If you decide to do that with something like medicine or dentistry you're not able to because there's nothing else at that point in your life that you'll be able to afford the loan payments you took out for your schooling. You're not handcuffing yourself to a massive debt burden that you won't be able to pay back with PA. As a risk averse type of person, that appeals to me. Especially when we're dealing with decisions concerning hundreds of thousands of dollars.

Sorry for the long post. I just thought it might be helpful. Back to studying for this upcoming EMT exam I have in a couple hours haha.

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I thought a lot of those same things that you had mentioned, which never really sounded appealing to me compared to PA school. I appreciate your input and good luck on your EMT test. It's not as bad as it seems! A lot of us have had to go through it. I recently went through mine in May, and my state exam as here they prefer for over NREMT. Good thing I don't plan on going anywhere lol. But I have definitely had all of the same thought you've shared, and then some. I feel good and sleep better at night with the PA decision, with all of the circumstances included.


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12 hours ago, Michael Stone said:

All of the stories that these doctors, plus others have told me made me think today, ironically while I was on my laptop, "is it worth it?" And as I said that to myself, a lightbulb sparked on in my head and I went over to SDN and typed in the search bar "is it worth it" and long, long, LONG threads... I'm talking 10 year long threads were up there. The same thing over and over: "would you do it all over again?" There would be the occasional yes but there was a profound no, almost hell no in their responses. There was a lot more put into it than that, and some would explain their reasoning such as losing friends, time with family and loved ones they won't get back, missing special occasions, divorces, the incredible debt and so on. 

I think you touched on the real x-factor of your decision, and that is how much you will enjoy (or not) this type of work and your quality of life.

When I was a pre-PA I too got really entwined in the prognosis of the PA profession. I think it's necessary and a natural step for thinking people. But what I learned is that ultimately this stuff takes a back seat to the WORK of medicine (because it is work, in every sense of the word), and how well this fits my personality and goals in life.

Training is tough, it sucks, and working in medicine can suck even more if you have the wrong fit or the wrong job. All of those sacrifices made in physician training are present in PA training, just to a lesser degree and duration.

The irony of medicine is that there really is no way to know how well you will like it until you are actually credentialed and doing the work. Distance lends enchantment to the view, as the saying goes, and while school can give you a good idea of what to expect, it isnt a prefect model.

That said, I believe if you have a strong enough interest in medicine and a service profession, most PAs can find a good fit eventually. So the bigger questions you need to be asking yourself are do you really want a service job with a high degree of responsibility, and if you want to take on $100K or more in debt to do so. Dont bank on things like PSLF. Assume you will have to pay back every penny plus interest, and assume it will take you longer than you thought.

The saturation thing is real but it is also regional. Like pharmacy, you will still be able to find work, you just may need to relocate or have some luck in networking to find the right work.

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I've spent a lot of my life as a patient... way more than abnormal person, so I've seen that aspect of it in just about every specialists' office, and as an former engineer, when certain situations arised, such as my sisters sudden death, as well as my father's with the PE... if I had known at the time how to help I could've done something and that always ate ate me. I did care for my grandpa the last 3 years of his life.. I did EVERYTHING for him. He had a CABG 5 bypass and was given 3 years to live. I was 17 at the time, so it was a lot to take in at first.

I learned different things from his 90 day stay in the ICU, CCU and his continued care in the nursing home for rehab. Yes, I slept at the hospital as a teenager and had many sleepless nights at the nursing home from hearing the screams from others throughout the halls. I saw things such as people coding and other instances with old people and osteoporosis having accidents, that when my grandpa came home. I was incharge.

I measured his fluid intake, out take, had to learn about CHF and his meds. Administer them to him. Document every. Single. Thing; from what he ate, when he took his meds... when I would walk him, holding him with a belt around his waste so he could gain strength but I was there to hold him for stability. He used a walker as well.

I took him to the heart failure clinic, his nephrologist, and so on... throughout that process I became extremely intrigued. I would see other families in these waiting rooms and we would have the longest, heart-felt conversations, knowing this was close to the finish line but we were squeezing every ounce out that we could.

When I learned what the DNR was, and that he had signed one (he died 3 times on the OR table and twice in the ICU and came back) I was upset at first but I realized why as time went on.

There is a ton Im leaving out, but that whole process, plus being an EMT and literally bringing people back and even just making someone feel better knowing that they're going to be ok.. all of that was so rewarding. I changed from engineering to follow this path. I had to push myself in engineering. It hasn't been the same with this process; I genuinely enjoy learning more and more about the human body and different things along my biology degree.

I think my past life experiences set me up and solidified my niche in healthcare. The debt doesn't scare me. It'll suck for a little while but I'll still live a decent life and get to make a difference is a big payoff. I won't have to be in school until I'm 40 (I'm close to 30 now) so PA has been appealing to me since I found out about it.

The saturation is part of reality but also our population will continue to grow, and so there will always be a need for healthcare providers, so it doesn't worry me too much.

I feel like I'm passionate and unique enough that the right people will surround me and we will help eachother, and I will bust my butt to my preceptors and future employers to show why I deserve to be a PA.

I have no crystal ball, so the future for everyone is a little bit unknown, but all I can do is my best and focus on what I want to do and believe it will work out. I've come this far and I don't intend to stop now :)

Also, thank you for your feedback! I sincerely appreciate everyone's input.


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