Soon to graduate PA student looking at three possible paths

[Wildmed-PA]

The situation:

Hey folks, I am just a few months out from graduation and I feel like I am about to make a big career decision that will shape the next stage of my life.

I want to practice in EM and my intention one year ago was to go to a residency program after graduation. I have been accepted into one program and have interviews at two others already which is very exciting. At the same time I have been in contact with a recruiter and the Army is looking very good at the moment with the training opportunities they can provide (EM residency in Texas, TCCC courses etc.) Finally, after hanging out with residents on clinical rotations for the past year I am feeling envious of where they are and thinking about going back to full on med school.  

Some Possible options:

1. EM PA residency-  I don't know if this needs to be justified on this form. There are obvious trade offs that come with this, but significant rewards. Upon graduation from such a program I would likely seek employment in MT, ID or AK in a small rural trauma center, ski and hunt elk extensively.

2. Army-> PA residency down the road- Understanding the deployment implications and intrinsic sacrifices, the training opportunities here are particularly unique. It is something that I have always been interested in, and my background before PA school had some parallels to the culture of the Army. ( I also see guard/ reserve as a way to blend this in and still keep some options open.) The AD route also opens up GI bill funding to pay for med school too.

3. Lucrative urgent care to save for med school- I have been offered an urgent care job for $130 k/yr for working 15 shifts per month with a doc whom I respect very much. This would build up the bank in a big way for a future med school option, and get me experience as a PA, while still giving me some experience as a PA in EM if I choose to not pursue med school. I could also take some of that extra income and put it towards extra training like POCUS courses, ATLS, or even paramedic certification.

 

The goal:

To be a bad mo fo. To have opportunities practicing an extensive scope of EM in many different settings not limited to overseas, rural, remote settings, and high acuity trauma centers.

 

Any thoughts would be appreciated, though I am thankful to this forum for allowing me to think out loud.

 

-E

[PAtoMD]

I initially had the intentions of pursing a residency after graduation but I think my intentions were because I wanted to function like an MD.  I worry that you may be doing the same. If I were you, I would take the UC job and spend time figuring out what you would like to do while enjoying that salary. 

 

Congratulations on receiving both a residency spot and an awesome job offer. 

[lkth487]

Do you want to be a doctor?  That should be the thing you have to figure out.   It will be difficult to be completely independent in EM in a major trauma center in an medium to large city.

With that said, most people who come into med school 'knowing' waht they want stil change their minds.  Maybe you'll love neurosurgery or pediatric interventional cardiology or dermatology, etc.

I think you just have to figure out if you want to make that 6-10+ year commitment to formal education and training.

[EMEDPA]

something else to considser...it's hard to give up a job that makes 130 k to become a student again....lots of folks say " I will do a residency in 2 years or go back to medschool"....and never do because they end up buying a house and a fancy car, getting into debt, having kids, etc and getting stuck in that high paying job....

my take: do the residency, work for a year or 2 as a residency trained em pa. if you are happy with that life, great. If not, go back to medschool then and seriously consider the lecom bridge(no mcats, smaller applicant pool,1 year less, etc)

[DizzyJ]

Agree with EMEDPA on doing the residency and working a couple years before thinking med school.  The military could provide some unique experience for sure and if serving is your calling, that may be the way to go.  

[lkth487]

8 hours ago, EMEDPA said:

something else to considser...it's hard to give up a job that makes 130 k to become a student again....lots of folks say " I will do a residency in 2 years or go back to medschool"....and never do because they end up buying a house and a fancy car, getting into debt, having kids, etc and getting stuck in that high paying job....

my take: do the residency, work for a year or 2 as a residency trained em pa. if you are happy with that life, great. If not, go back to medschool then and seriously consider the lecom bridge(no mcats, smaller applicant pool,1 year less, etc)

The only thing is there is still a little bit of a stigma against DO schools (my residency, for example, I don't believe has ever taken a DO).  It's unfair and changing, but there's still a bit of a stigma.  So if you can swing it, you may just want to consider spending that extra year to keep your options open maximally, especially if you're going to be interested in one of the more competitive specialties (neurosurg, derm, plastics, etc).

[PAtoMD]

I think there is much to be said about completing the residency, work and reconsider.  Completing the residency makes you a more competitive PA and would probably look good to an AdCom.  However, you have to taken in account time to study for the MCAT because it is a beast of its own.  Scores also only last for I believe three years.

[ALC0313]

Do you have loans from PA school?

[Wildmed-PA]

36 minutes ago, ALC0313 said:

Do you have loans from PA school?

About 25 K in loans

[Wildmed-PA]

Thank everyone for the input. I think that the residency route right out of PA school would be best, then re-evaluate after completion of the program. This would make me an especially good candidate for med school if I chose that path, especially if I went to med school at the same teaching institution that I complete my residency. During that time I could do reserves if my program allows to keep one foot in that world as well.

[lkth487]

I don't know how much a residency would help in med school admissions honestly.  I wouldn't really care one way or the other if I was on the committee.

Do it if you enjoy it and are trying to figure things out and may end up practicing instead of going back to med school.  But if you're thinking about it purely from helping the admissions process, there's other much higher yield things you could do.  

[PAtoMD]

8 minutes ago, lkth487 said:

I don't know how much a residency would help in med school admissions honestly.  I wouldn't really care one way or the other if I was on the committee.

Do it if you enjoy it and are trying to figure things out and may end up practicing instead of going back to med school.  But if you're thinking about it purely from helping the admissions process, there's other much higher yield things you could do.  

What do you consider more high yield?   Volunteer?  MCAT?   (mostly for my use in the future) 

A residency will definitely diversify and intensify the OP's PCE, talking points, essays, etc.  But PCE should never be the backbone of an application.   

[lkth487]

Research experience.  

 

If you went to PA school, you probably already had volunteer experience. And clinical experience isn't really important (especially if you went through entire PA school curriculum...so that's way more than enough).  Honestly, when I interviewed kids for med school, I didn't care even a little bit about what their past clinical experiences were.  As long as you had enough to know you kind of knew what you were getting into.

Obvously the MCAT is important because a low score will essentially doom your chances.   You want to be at least the 25th percentile for score for matriculating medical students.  Ideally at the 50th.  People who score below that and get in have other compelling attributes (PhD in a hard science with multiple publishes, 4.0 GPA etc). 

[PAtoMD]

9 minutes ago, lkth487 said:

Research experience.  

 

If you went to PA school, you probably already had volunteer experience. And clinical experience isn't really important (especially if you went through entire PA school curriculum...so that's way more than enough).  Honestly, when I interviewed kids for med school, I didn't care even a little bit about what their past clinical experiences were.  As long as you had enough to know you kind of knew what you were getting into.

Obvously the MCAT is important because a low score will essentially doom your chances.   You want to be at least the 25th percentile for score for matriculating medical students.  Ideally at the 50th.  People who score below that and get in have other compelling attributes (PhD in a hard science with multiple publishes, 4.0 GPA etc). 

I wasn't aware research experience was that heavily waited.  Thanks for clearing that up.  

Would you say its make or break? 

[lkth487]

Depending on the school.  Many schools want future researchers and it's make or break.  Some schools don't care much.  It's nice to have SOMETHING though.  Obvously GPA and MCAT are by far the most important, but after that.  

If I was evaluating an application, I'd probably rank the importance of attributes in the following order: 1) MCAT/GPA 2) Research 3) Volunteering/leadership experiences 4) Clinical experience. 

Note: this is all for med school, I have no experience or knowledge about PA school admissions. 

[PAtoMD]

6 minutes ago, lkth487 said:

Depending on the school.  Many schools want future researchers and it's make or break.  Some schools don't care much.  It's nice to have SOMETHING though.  Obvously GPA and MCAT are by far the most important, but after that.  

If I was evaluating an application, I'd probably rank the importance of attributes in the following order: 1) MCAT/GPA 2) Research 3) Volunteering/leadership experiences 4) Clinical experience. 

Note: this is all for med school, I have no experience or knowledge about PA school admissions. 

That makes sense. I have heard that med school adcoms don’t always look highly on PAs. Can you speak on this?

 

also thank you for answering my questions. Sorry for flooding the thread.

[lkth487]

I don't know.  I don't see why.  When I was doing it, I never came across an ex PA so I am not sure.  

[LT_Oneal_PAC]

If you want to be a great provider, don’t go AD army. You will get very good at a lot of things medically, but little is applicable to the civilian world.

if it’s about being a bad a mofo, then a residency is all you need. My residency is incredibly PA friendly and the graduates are getting awesome jobs. If it’s about salary or prestige, go to med school. If it’s about having cool stories and having people *think* you’re bad A, go into the military.

[TheFatMan]

11 minutes ago, LT_Oneal_PAC said:

If you want to be a great provider, don’t go AD army. You will get very good at a lot of things medically, but little is applicable to the civilian world.

if it’s about being a bad a mofo, then a residency is all you need. My residency is incredibly PA friendly and the graduates are getting awesome jobs. If it’s about salary or prestige, go to med school. If it’s about having cool stories and having people *think* you’re bad A, go into the military.

To add to this: Don't be fooled by the recruiters...for example, TCCC is a pretty low level first responder course. It is a lot of fun and helpful but not a good reason to join.

As a military PA, you'll see mostly 20-somethings who are almost 100% healthy with a zebra every once in a while. Being in the Navy, I believe that they use PAs pretty extensively though, with very little if any supervision (from what I've seen, correct me if I am wrong LT).

[lkth487]

26 minutes ago, LT_Oneal_PAC said:

If you want to be a great provider, don’t go AD army. You will get very good at a lot of things medically, but little is applicable to the civilian world.

if it’s about being a bad a mofo, then a residency is all you need. My residency is incredibly PA friendly and the graduates are getting awesome jobs. If it’s about salary or prestige, go to med school. If it’s about having cool stories and having people *think* you’re bad A, go into the military.

Hey man, there's other reasons to go to med school :p

[EMEDPA]

10 hours ago, lkth487 said:

The only thing is there is still a little bit of a stigma against DO schools (my residency, for example, I don't believe has ever taken a DO).  It's unfair and changing, but there's still a bit of a stigma.  So if you can swing it, you may just want to consider spending that extra year to keep your options open maximally, especially if you're going to be interested in one of the more competitive specialties (neurosurg, derm, plastics, etc).

I know some folks at Lecom. everyone in the first class got their first pick of specialty residency, including some "competitive" ones.  so not too much of an issue. PA students tend to do fairly well when they go through the program there and the PA group had much better scores than the standard track students, so they really stood out. A DO student from a different program who I precepted recently matched into a competitive ophtho residency, so I think some of the stigma may be fading at places outside the Ivy league affiliated programs. It is my understanding that the md and do match is having a combined application process in the next year or 2.

[EMEDPA]

10 hours ago, SR0525 said:

I think there is much to be said about completing the residency, work and reconsider.  Completing the residency makes you a more competitive PA and would probably look good to an AdCom.  However, you have to taken in account time to study for the MCAT because it is a beast of its own.  Scores also only last for I believe three years.

Lecom doesn't require that pa applicants take the mcat.

[EMEDPA]

54 minutes ago, lkth487 said:

Hey man, there's other reasons to go to med school :p

yup, scope of practice, autonomy, international practice potential, and respect. Those are the reasons I would go back...

[lkth487]

37 minutes ago, EMEDPA said:

I know some folks at Lecom. everyone in the first class got their first pick of specialty residency, including some "competitive" ones.  so not too much of an issue. PA students tend to do fairly well when they go through the program there and the PA group had much better scores than the standard track students, so they really stood out. A DO student from a different program who I precepted recently matched into a competitive ophtho residency, so I think some of the stigma may be fading at places outside the Ivy league affiliated programs. It is my understanding that the md and do match is having a combined application process in the next year or 2.

Yeah you're right. It is definitely fading.  I don't know how it's going to turn out in the future with the combined residencies - I'm sure it will fade further. 

[LT_Oneal_PAC]

1 hour ago, hmmmm3 said:

To add to this: Don't be fooled by the recruiters...for example, TCCC is a pretty low level first responder course. It is a lot of fun and helpful but not a good reason to join.

As a military PA, you'll see mostly 20-somethings who are almost 100% healthy with a zebra every once in a while. Being in the Navy, I believe that they use PAs pretty extensively though, with very little if any supervision (from what I've seen, correct me if I am wrong LT).

 

1 hour ago, lkth487 said:

Hey man, there's other reasons to go to med school :p

I did over simplify my post a bit. 

I cant speak for other beaches, but a huge benefit was that I was as independent as one could possibly be. It doesn’t so much work that way in the ED though. Still pretty independent. Plus military EDs are pretty boring with little exciting stuff going down. You’ll be very independent on deployment, but like hm3 said, 99% of what you see is boring.

 

and yes, there is a lot of other reasons to go to medical school. It certainly makes life easier as far as scope of practice in more practice settings. Certainly even other things I don’t feel like listing. I always was wanting to go back to med school, but this residency has me doing so much that I’ve really stopped :) pretty darn happy