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Pre-PA concerns. PA vs MD.


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I'm currently a pre-PA student and I'm planning on applying this upcoming cycle. These past two years I've been struggling to come to terms with my decision to go PA and relinquish my dreams to go to med school. I recently graduated from UCSD with a BS in neuroscience and physiology. I have the lab experience, clinical experience, and GPA to go to med school. However, as wonderful as becoming a MD would be, PA is more lucrative temporally and financially. When considering the amount of time/money you save with PA, it seems worth it to give up the prestige, power and knowledge you obtain as a MD (especially if you grew up as a poor 1st gen college student). I've been feeling depressed lately as the physician I work for keeps pushing me towards med school and tells me that I am wasting my potential by going to PA school (please don't hate me, his words not mine). I was hoping that I might be able to answer some questions and find some reassurance about my decision through this forum. I'm probably going to get a lot of hate from people with these questions, but please understand that I want to have my mind changed regarding these topics, so kind education is appreciated over backlash. 

1. One of my biggest concerns is the lack of respect PAs seem to get from patients/physicians. I work in an office with a PA, however, I am the medical scribe of the physician. Multiple times throughout the day our PA has to transfer patients to our side because the patients don't want to see "an assistant". And the MDs obviously see the PAs as inferiorly trained. Sometimes it's hard not to agree with them as I seem to have a more comprehensive knowledge of physiology than the PA in our office just by having a BS in physio. Ultimately, I'm sure the amount of respect you command from both parties will depend upon your skill. But is it really ever possible for a PA to reach the depth of knowledge/provide the same quality of care as a physician? Even if I can't be an MD by title I don't want to restrict my practicing capabilities by receiving a lower caliber of education. Obviously anyone can expand their education by studying on their own outside of school. But my question here is: will the MD always "hold the upper hand" (in regard to the topics above) over a PA, no matter how many years of experience the PA may have. Additionally, how do PAs deflect/handle the disrespect they might experience simply because of their title? 

2. Another large concern is the lack of post-PA prospects. MD seemed very appealing because I've always planned to eventually retire into research. The actual science of physiology has always appealed to me more than working with patients. What options does a PA have when they've decided they've gone as far as they can in their career. PA seems to be kind of a dead end. As someone who constantly needs to be working towards a new goal, the idea of remaining in the same position for the rest of my life terrifies me. Of course I have the option of abandoning PA altogether after I'm bored of it and go get my MD/PhD so I can pursue research. But other than going back to obtain another degree, what options do PAs have for "climbing the career ladder". And more specifically, what prospects, if any, do PAs have in research. 

Thank you very much for taking the time to read my questions. Once again, no disrespect intended. I just want to be shown that PA is still a great career choice so I can fully commit to myself to it and stop worrying about what I might be missing out on as a MD. 

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I've commented long and loud before but it was PA for me no contest.  Then again, I'm not young with a solid science background.  

I also could frankly give a crap about what people think.  If they don't know what it is that I do, or what a PA is, I can tell them, and sometimes they get it and sometimes they gloss over and/or say something stupid.  There are people out there who still think DO isn't a real medical doctor, so who the hell knows what they think about PA.  Either way...moving on.  Not a factor.

If I want to acquire and use new skills, I'm going to find a way to do that.  That may mean finding a different job with people who know how to use personnel effectively and efficiently.  Same with respect and knowledge of co-workers' training and skills.  Go where you are supported. It may take some doing.

It's going to be a rare case of a PA functioning at the level of an MD and it takes longer when it does happen.  That's just common sense.  

Your "same position for life" - a comment.  There is almost zero lateral mobility in MD - once you are a ortho or Derm guy, that's it (there are a couple of exceptions).  We do still have that.  Keep that in mind - as a PA, if you are doing IM and you fall in love with CT surgery, you can get over there.  There may be a fellowship involved, but that's only a year.  Maybe that would keep you from getting bored. 

Bored or dead end for me is not getting the MD residency I wanted because I got a bad grade/rotation or had a bad test day once and fell out of the race.  Now I'm a quarter mill in debt and settled for a job I don't like.

PA options as you define them?  Pretty limited.  Just being honest here - the field is designed to create clinicians for patient care.  Are there a few other things out there?  Oh, sure.  Just like 1% or maybe less.

I think you are capable to do the MD/PhD but not sure if you want that.  The real question - my opinion only - is whether you want to do PA first.  PA school is not free in time or money, by any stretch.  

1.  PA first - you should sail into a program and be a very good student.  Let's say you exit with $100k in debt.  You work in a couple fields for say 5 years.  Now you are what - 32 years old, with fantastic experience.  Do you have a spouse and kids at that point?  Own a home? Do you really want to attack the MCAT at that point and go back to school and training for another eight years plus?

2.  MD / PhD now - attack the MCAT now, longer program and time for your first paying job - a vow of relative poverty and high debt.  Eight years plus the PhD stuff - you're working at what, 32 - 34 years old, with massive debt.  Do a single field for a while, get yourself into research as opportunity presents itself.  

I don't know.  You're asking the right questions and they are tough ones.  Knowing and defining yourself ain't easy.

It does seem like you are trying to talk yourself into PA for whatever reason.  Like you want to do PA but not sure if the naysayers have a point.  If you decide on PA, then commit to it and don't listen to anyone else or the internet, which includes me.  Even though my opinions are (obviously) always 100% correct, you do you.  The people telling you stuff don't have to live with your decision.  You do.

There's an old trick I've used.  Decide, just in your head - tell no one and take no action - what to do and live with that for a few days.  See how that sits.  Maybe try the other way.  Or use the coin trick.  Heads one way, tails the other.  Are you disappointed or excited or relieved at the outcome of the coin flip?

Hope this ramble helps.  Good luck and let us know what happens.

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2 hours ago, south said:

I've commented long and loud before but it was PA for me no contest.  Then again, I'm not young with a solid science background.  

I also could frankly give a crap about what people think.  If they don't know what it is that I do, or what a PA is, I can tell them, and sometimes they get it and sometimes they gloss over and/or say something stupid.  There are people out there who still think DO isn't a real medical doctor, so who the hell knows what they think about PA.  Either way...moving on.  Not a factor.

If I want to acquire and use new skills, I'm going to find a way to do that.  That may mean finding a different job with people who know how to use personnel effectively and efficiently.  Same with respect and knowledge of co-workers' training and skills.  Go where you are supported. It may take some doing.

It's going to be a rare case of a PA functioning at the level of an MD and it takes longer when it does happen.  That's just common sense.  

Your "same position for life" - a comment.  There is almost zero lateral mobility in MD - once you are a ortho or Derm guy, that's it (there are a couple of exceptions).  We do still have that.  Keep that in mind - as a PA, if you are doing IM and you fall in love with CT surgery, you can get over there.  There may be a fellowship involved, but that's only a year.  Maybe that would keep you from getting bored. 

Bored or dead end for me is not getting the MD residency I wanted because I got a bad grade/rotation or had a bad test day once and fell out of the race.  Now I'm a quarter mill in debt and settled for a job I don't like.

PA options as you define them?  Pretty limited.  Just being honest here - the field is designed to create clinicians for patient care.  Are there a few other things out there?  Oh, sure.  Just like 1% or maybe less.

I think you are capable to do the MD/PhD but not sure if you want that.  The real question - my opinion only - is whether you want to do PA first.  PA school is not free in time or money, by any stretch.  

1.  PA first - you should sail into a program and be a very good student.  Let's say you exit with $100k in debt.  You work in a couple fields for say 5 years.  Now you are what - 32 years old, with fantastic experience.  Do you have a spouse and kids at that point?  Own a home? Do you really want to attack the MCAT at that point and go back to school and training for another eight years plus?

2.  MD / PhD now - attack the MCAT now, longer program and time for your first paying job - a vow of relative poverty and high debt.  Eight years plus the PhD stuff - you're working at what, 32 - 34 years old, with massive debt.  Do a single field for a while, get yourself into research as opportunity presents itself.  

I don't know.  You're asking the right questions and they are tough ones.  Knowing and defining yourself ain't easy.

It does seem like you are trying to talk yourself into PA for whatever reason.  Like you want to do PA but not sure if the naysayers have a point.  If you decide on PA, then commit to it and don't listen to anyone else or the internet, which includes me.  Even though my opinions are (obviously) always 100% correct, you do you.  The people telling you stuff don't have to live with your decision.  You do.

There's an old trick I've used.  Decide, just in your head - tell no one and take no action - what to do and live with that for a few days.  See how that sits.  Maybe try the other way.  Or use the coin trick.  Heads one way, tails the other.  Are you disappointed or excited or relieved at the outcome of the coin flip?

Hope this ramble helps.  Good luck and let us know what happens.

I truly appreciate the amount of time and effort you put into answering this. The responses I've received have given me a lot to think about. Ultimately, the overall theme here is me trying to come to terms with giving up my dreams and convincing myself I'll still be happy being a PA. However with what I'm hearing, I fear I'm trying to convince myself to believe something delusional. From what I'm hearing I don't think PA will challenge me in the way I like to be challenged, I think I'll be wasting my UCSD neuroscience education, and I think ultimately I'll be leading a less satisfactory life. My dream life lies on the other side of medical school but it's the path of getting to the other side that is stopping me. It's very difficult for me to see the people that I tutored, people who looked to me for leadership, starting medical school while I'm still working as a medical scribe to get patient hours for PA. The concern for me has always been: can I sacrifice all of the above in exchange for less debt and less time in school. It seems that in this generation medical school isn't worth it anymore financially/temporally. I think I'll need to ask these same questions in a MD forum. Because when you read the responses of people in medical school many seem to regret it immensely. Eventual happiness at the cost of financial stability and a miserable 8 years in school vs always regretting never pursuing your dreams. What a choice. 

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4 hours ago, south said:

 

2.  MD / PhD now - attack the MCAT now, longer program and time for your first paying job - a vow of relative poverty and high debt.  Eight years plus the PhD stuff - you're working at what, 32 - 34 years old, with massive debt.  Do a single field for a while, get yourself into research as opportunity presents itself.  

 

Just chiming in for this part. MD/PhDs tend to be extremely competitive (I don't think I could've gotten in).  One of the major reasons they tend to be so competitive is that even though it takes longer, they are usually free PLUS you get a stipend for living.  So you graduate debt free.  Which is pretty huge.  If I could do it again, I'd have studied a little harder and gotten that 4.0 to apply to those so I could graduate debt free haha. 

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21 years into being a PA I still wish I was a physician almost every damn day....and I probably have the best em pa job within 500 miles of where I live. Mind you, it is very rural. it has to be to be a good em pa job because anywhere urban or suburban is flooded with physicians doing all the fun stuff. Often a good pa job means going where physicians don't want to go.

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