Deciding on PA vs MD

[Ellis]

Good Afternoon,

I'm currently a college student taking pre-med courses.  However,  I'm unsure about whether I want to go to medical school or Physician Associate school.  Regardless of which career path I take I know I want to work in emergency medicine.  I've talked to a couple of doctors, and presented them with my dillema.  Both gave me very different answers.  However, I havent spoken with a Physician Associate and I was hoping that you would be willing to answer some of my questions.  If so, I will post the questions below.  Thank you for your time.

1) One of my primary concerns with choosing to be a PA is the thought of not having enough autonomy, or feeling like I want to know more to better help my patients.  Is there any time that you have felt this way?  Do you ever find yourself wanting to go to medical school in order to obtain the additional knowledge?

2) Through the research I've done, I've learned that PA's have a lot of lateral mobility in that they can move between specialties.  The way it seems is that you can pick whatever specialty you are interested in and work within that specialty until you want to change.  However, after talking to a trauma surgeon the lateral mobility seemed less flexible than I orignally thought.  He told me that you apply to a practice and they pretty much place you where ever they need you.  Is that true?  How difficult is it to go into your desired specialty?  Are you really a slave to the needs of the company in which you apply?

3) Lastly, what's the difference between working in trauma vs emergency medicine.  Do you have to be employed by a dedicated trauma center in order to work in trauma, or is it part of being in emergency medicine?

Again, thank you for your time.  Any information and perspective that you could offer would be extremely valuable.  Happy Holidays!

[lancer_dancer01]

So I would recommend if you are younger with no prior healthcare experience go the MD/DO route, in the long term have higher earning potential and have actual autonomy. 

1. Autonomy can vary greatly from position to position. I for example am in pulmonary and my supervising physician is only in clinic here 1 day a week. I have my own patient panel and can order everything I need on my own. As far as knowledge goes, well that comes with time, effort and experience. There is a steeper learning curve for a newly minted PA vs Residency Trained Doc as they had at least 3 years of hands on experience to hone in on their craft. If you put the time in with learning and reading and soaking as much as you can, you will get there. 

2. Lateral mobility is a nice feature of PAs but I feel is going to be harder and harder to do (especially in desired areas and specialties). Look at most job ads and you will see they want 1-3 years experience minimum. This is where residencies come in to play but then again you are looking at taking a pay cut for experience, which to some is worth it, to others kind of defeats the whole purpose of the PA model. 

Hope this helps. The bottom line I feel is if medical school is a real option for you, go that route. I like being a PA but do get frustrated with other MD/DO not taking me serious because I am "just a PA", or patients not listening to my opinion because I am "just a PA" (then see the doc who agrees with me). 

[camoman1234]

You can also do a residency in EM/Critical Care as a PA, there are lots of programs for this, see http://appap.org/. I work in rural FM and my CP comes into the office 4 hours every 2 weeks. If you want to go to PA school and not having any prior HCE (health care experience) then I would suggest EMT-P, RRT, RN so you can gain some VERY important knowledge and skills prior to PA school. I do not think being a MA, phlebotomist, EMT-B remotely prepares one for the rigor of being a PA-C. This HCE is not that important for the program itself, but more importantly for the newly minted PA-C so they are not just thrown to the wolves day 1. Good luck in your future endeavors and keep us updated.  

[mmiller3]

I am in agreement with lancer. a lot of the benefits choosing PA versus MD/DO have eroded as lateral mobility becomes increasingly restricted, and the cost of PA school increases.

Autonomy certainly varies by state, specialty, and practice. In my Family Medicine practice , there is no difference between what I do and what the MD/DOs do. In other specialties, there is certainly going to be a larger gap. 

Short answer--if you are younger and concerned about autonomy, MD is probably your best bet. Just realize you will always be a slave to insurance and your organization, no matter what your degree.

[camoman1234]

54 minutes ago, mmiller3 said:

I am in agreement with lancer. a lot of the benefits choosing PA versus MD/DO have eroded as lateral mobility becomes increasingly restricted, and the cost of PA school increases.

Autonomy certainly varies by state, specialty, and practice. In my Family Medicine practice , there is no difference between what I do and what the MD/DOs do. In other specialties, there is certainly going to be a larger gap. 

Short answer--if you are younger and concerned about autonomy, MD is probably your best bet. Just realize you will always be a slave to insurance and your organization, no matter what your degree.

Your short answer - you will be a slave comment is not accurate, look at all the direct patient care clinics popping up around the country, you do not work for the big corp monster nor do you take insurance! :)

[Joelseff]

PA school is almost 3 years in most cases. There are Med Schools that are 3 years (LECOM, UC Davis Primary Care etc) Lateral Mobility is going away in the future in my opinion plus once you have established yourself in one specialty I do not see a good reason to move to another (Just my opinion). I agree with everyone else that if you are young (under 30) and have little to no medical experience (shadowing and scribing dont count IMO) go to med school. 

[south]

You don't say in your post so I'm assuming you are the typical direct-entry college student in your early to mid 20s.  It's a good question.

Briefly, I'll make this all about me and tell you that I was on the path to medical school in my 40s when I started looking into PA and it was a done deal, no contest.  Three years, one test, and out.  Yes please.  I am not a competitive or sensitive sort of person and don't have master identity issues, so I could give a crap what you think about what I do as long as those checks keep coming in.  I do think the name needs work but I'm not losing sleep. 

The classic answer is if you are young and bright and can get real good at being a student, then go MD.  I don't necessarily disagree with this and there are people who definitely belong there.  

The downsides to this are the lack of POSSIBILITY of lateral movement and the risk involved.  I read an article the other day that pointed out that the medicare-backed residency slot numbers were frozen in 1997.  The number of schools and graduates continue to increase, and in 2015 the number of students exceeded the available number of slots.  This means that perfectly good medical school graduates are unable to find medical training anywhere.  More each year.

Residency slots are competitive based on test scores (and GPA I think) so one bad day, one bad test, and you could be done - or done for your chosen field and have to settle for another.  In fact, the classic case for that is not achieving a EM residency and setting for FP.  Many of these eventually back their way into the ED after several years of considerable effort.  I don't know what a MD with no residency would do.

Anyway:

1.  I do think about this from time to time.  But again, I am in my late 40s as a new PA and I have done big things in the past so I'm pretty over it.  For you, this is knowing and defining yourself.  Becoming MD is a non-stop race that requires real dedication for years and years.  If that is you, then by all means go and get it and then wear the title and responsibility with pride.

2.  Lancer covered this quite well, but no, you don't just apply to a faceless entity and they place you whereever.  You apply to a job like any other.  If you want to be a hospitalist, or a ortho person, or a EM or FP type, you apply for and interview for those select jobs.   I do think lateral mobility is declining, mainly due to the increasing supply of PAs.  Why would someone hire someone new to the field when they have 5 or 6 experienced ones to choose from?

3.  I have done both, and you can check out my comments on this here 

https://www.physicianassistantforum.com/topic/44571-trauma-surgery-residency-as-a-background-for-rural-em/

But briefly, Trauma is sort of a subset of EM.  Patients qualify for Trauma intervention when certain criteria are met (mechanism of injury, any penetration in "the box", certain medical criteria, etc).  When a trauma is called, the Trauma team (usually headed by a certified Trauma surgeon) comes in and assumes care, and then takes the patient off the ED's hands for whatever course of treatment (surgery, admission, etc) is required.  Most - probably not all - of this is found in the classic Level 1 Trauma center, but I've heard of a Trauma person in a lower-acuity setting as a sort of expert.

What's that job like?  A lot of them are long hours, or lots of call, or both, but I admit that some of it is pretty wild.  I managed to avoid the crazy hours and call as I was a Surgical Hospitalist, doing everything but the actual surgery itself and my contract limited me to 40 hours per week.  But yeah, there was a definite "well, I've never seen that before" factor, to put it mildly. 

Hope this helps some.  Good luck!

[AlteredBeast]

There can be significant difference between an MD and PA or very little depending on the practice.  In EM if you want to work on the really sick patients, the traumas, what others may perceive to be the exciting stuff, MD is the sure fire route.  Assuming you match, etc.  You can do that as a PA but it will require additional effort and time post graduate.  Read: residency, experience, finding the right hospital, etc.

The cost between PA and MD is significant in my opinion.  With the most valuable cost being time, followed by money . I went to school for 23k, tuition is a lot higher now so it may be a wash.  Regardless you need to consider 4 years of med school + x years of residency (if you match) and however that will affect your personal relationships and your quality of life.  That is the true cost in my opinion.

[corpsman89]

You're concerned about autonomy? Go to medical school. Also, you're in college, and assuming you are college aged you probably don't have a terrible amount of experience--another reason to go to medical school. 

[lkth487]

Just wanted to put my two cents in terms of residency.  The total number of US Graduates is way less than the total number of US residency spots and will remain this way for a while.  Residency spots do go up, but not by that much.  There is a lot of justification that has to go on and every residency program has to demonstrate that they give their trainees a good experience.  So that's a good thing, plus it also means virtually no field in medicine (maybe except pathology) is super saturated.  

Now just because you can get a residency, doesn't mean that you can get ANY residency.  It is very specialty and location dependent. US graduate from a US MD school?  You will get for sure internal medicine or family medicine spot somewhere.  And probably a few other specialties too.  And then subspecialties tend to be varied in competitiveness. But the most competitive internal medicine program are as competitive as neurosurgery.  So it depends.  On the other hand, every neurosurgery spot is competitive so you have to excel in med school vs people most of whom have all been amazing students for their whole lives.  So you can't assume you'll get the specialty you want.  If you can only see yourself doing dermatology and absolutely nothing else, med school may not be right for you cause that's a hard residency spot to land and a MD without residency is essentially useless.  However, very few people in my experience are THAT into just one specialty.  I personally chose pediatrics but I know I would have been happy with OB/Gyn, Anesthesiology or Emergency Medicine as well.  

I was 27 when I started med school and I'm finishing my residency now. I would do it again in a heartbeat and wouldn't choose another career.  Others feel differently.  I just love what I do. 

One of my best friend did the same post bacc with me and he is VERY happy working as a PA in orthopedic surgery. I'll leave it to people on this forum to tell you the pluses and minuses about the PA route.  

[MT2PA]

One note only because I didn't see it addressed here, not necessarily to sway you one way or another, regarding the trauma surgeon that told you that 'PAs are just put wherever they are needed'.  Not true.  They may only be HIRING in areas they need - so those are the open positions.  But hospitals don't just hire a PA and randomly put them in the department they are lacking.  We aren't float providers like there are float nurses.  If there is a need for a PA in an EM, they hire a PA for EM - so only people wanting to work in EM will apply.  If they need a FM PA, they post a job for a FM PA.

In that regard I would say that PA > MD.  As many stated above med students have to compete for residency spots.  My entire class could want to go into neurosurgery and as long as there were jobs, we could all work in neurosurg - the 'best' student all the way to the 'worst' student.  We aren't limited or competing in that manner.

That said, if you are the traditional aged undergrad, this is another vote for MD/DO.

[newton9686]

I was younger when I started PA school at 24 and recently graduated. We will see how I feel in a couple years but right now I am extremely excited with my decision. I am coming out making a 6 figure salary in a low cost of living area working at an ER with tremendous opportunity for 1 on 1 education for the first 3 months and training plus opportunities to perform high level procedures up to transcutaneous pacing for heart blocks. I will also be cross trained and credentialed as a hospitalist as well during that time. All of this experience will allow me to demand an even high salary after completing my 2 year contract and have the lateral mobility to work in an ICU, hospitalist, ER, primary care or urgent care with relative ease. 

As for education, I am a formal believer that even though I did not go to medical school, my patients relay on me to be as well trained as any MD or DO colleague. So I take it upon myself to constantly read and increase my medical knowledge, also I purposely choose a challenging field of medicine at a facility that respects PAs and understands their value. 

So again, talk to me in a couple years but for now I am extremely excited about my future as an ER PA and would not change anything even if I could.

[Guest HanSolo]

My decision for PA or MD was not about whether or not I could, rather whether or not I should. For me, medicine was never "my passion." I highly enjoy it, love interacting with people (even difficult people - I don't know why I enjoy this but I do), and like to contribute to a greater goal. However, my passions lie outside of my job. Having worked for about a decade outside of medicine before making the switch, I learned through experience how much money and responsibility I needed in a career. You can only make the best decision for you with the information you have at this time. My advice? Do all of the pre-reqs for both paths while still in college and work for two years in the medical field before making a decision. I believe our society often forces one to make life/career decisions early on with little experiential knowledge. There is no rush. 

[lkth487]

I agree with the above.  I had another career before choosing medical school and I'm glad I did.  I went into medicine without the second thoughts that a lot of younger students may have.  

 

If if you're not sure, take a few years and work somewhere to figure it out.  Not only it will boost your resume for whichever field you go into, you'll go in knowing you're sure.  Medicine is a minimum of seven, often as long as twelve plus years of commitment after college. You need to be sure.  A lot of physicians are unhappy because they had blinders on all the way from high school to the end of fellowship. That's almost two decades of just single minded focus - and then they get done and start their job and finally take a deep breath to realize they are miserable.  At that point it's too late and you either deal with it and get burnt out or look for non clinical positions.  You don't want to be that person. 

Take your time, be sure!  They are both great careers!

[philllyvee]

In regards to Trauma vs EM.  Emergency departments are classified based on their capacity to treat medical emergencies.  This classification system will designate a hospital as a certain "trauma level."  As far as I know there are 5 different trauma levels and every emergency department will fall into one class. A level 1 trauma center would be an emergency department that is equipt to handle virtually any medical emergency. As their level decreases so do their capacities to treat medical emergencies.  

So to answer your question.  You'll see traumas at most any emergency department.  The difference just lies in how severe a trauma.