Soon to graduate PA student looking at three possible paths

[camoman1234]

29 minutes ago, LT_Oneal_PAC said:

 

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

Awesome to hear man! I have thought about doing a residency as well as I do not always feel fulfilled with my education and rotations. 

Wildmed-PA: I think you should do the residency as stated above, work a few years to see if you still like being a PA, and you can always pay off your student loans and stock some away for medical school if that is your path you would best fill happy. Good luck!  

[SERENITY NOW]

@ikth487, I find it very hard to believe that already having successfully completed a residency side by side with physician residents wouldn't be a HUGE plus to admissions committees.   One of the main goals of medical school is to prepare medical students to become successful residents, and having this on his resume would demonstrate that he's already capable.  If research and publications are more heavily regarded, I've found that I had more opportunities at clinical research and publishing in residency than I ever did in school, with a resident budget for this purpose to boot.  What's more, he'd bring with him the huge network that comes with the residency, and letters of rec from a residency program director, which must carry huge weight compared to the crap that many applicants scrap together for their applications.  So, in my (biased) opinion, I think that your choice is a no-brainer: go with the residency.  It will give you a great training environment, a closer look into many specialties working hand in hand with physicians (to help you decide if its really for you), and if in the end you do decide to go on to become a physician, I think having that on your resume will help you so much more than anything else you could do.  You're only 25k in debt so I wouldn't sweat passing on the urgent care treadmill.  

[lkth487]

56 minutes ago, SERENITY NOW said:

@ikth487, I find it very hard to believe that already having successfully completed a residency side by side with physician residents wouldn't be a HUGE plus to admissions committees.   One of the main goals of medical school is to prepare medical students to become successful residents, and having this on his resume would demonstrate that he's already capable.  If research and publications are more heavily regarded, I've found that I had more opportunities at clinical research and publishing in residency than I ever did in school, with a resident budget for this purpose to boot.  What's more, he'd bring with him the huge network that comes with the residency, and letters of rec from a residency program director, which must carry huge weight compared to the crap that many applicants scrap together for their applications.  So, in my (biased) opinion, I think that your choice is a no-brainer: go with the residency.  It will give you a great training environment, a closer look into many specialties working hand in hand with physicians (to help you decide if its really for you), and if in the end you do decide to go on to become a physician, I think having that on your resume will help you so much more than anything else you could do.  You're only 25k in debt so I wouldn't sweat passing on the urgent care treadmill.  

So obviously I am not on an admissions committee right now, but so this is just my opinion but I think you mistake what admission committees look for.  That is true that theoretically one of the goals of medical school is to prepare you for residency, but that is NOT how medical schools think when they admit or train students.  They don't think (whether they should or not is a different story) 'Hey this guy already knows how to put in chest tubes.  That's nice!'  The way medical schools think is that it's the residency's job to make the person into a competent clinician in that specialty. 

The school (again I have limited experience from only 1-2 places where I've been peripherally involved) wants people who are leaders in the field, i.e researchers or something like that.  It's a different skillset.  I NEVER, not ONCE, heard about a potential students 'clinical skills' when talking about them as a candidate for admissions (and we had people who were nurses for a decade, or paramedics, etc).  They figure you'll learn the clinical skills in due time.  They like people who have shown leadership potential, have done something that requires critical analysis in a scientific setting, etc.  

But again, this is just anecdotal evidence, so maybe you are right, and it is not generalizable.

In the end, I think he should do the residency if he actually wanted to do it, was my only point.  And if you can get involved in research projects and publish during residency, then absolutely that's a no brainer.

[PAtoMD]

6 hours ago, EMEDPA said:

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

Right, I just wouldn't put all my marbles in LECOM.  Getting into medical school is too hard to only apply to one school.  Pending a good MCAT OP potentially wouldn't have to move far, there are like 8 medical schools just in the state of Texas.  

[lkth487]

Not to mention CHEAP.  I think Texas state medical schools are so cheap, compared to LECOM, that it might be worth the extra year to come out with less debt.

[PAtoMD]

19 minutes ago, lkth487 said:

Not to mention CHEAP.  I think Texas state medical schools are so cheap, compared to LECOM, that it might be worth the extra year to come out with less debt.

A fellow classmate of mine was accepted into a Texas Medschool and described the whole process for Texas.  Its actually pretty cool.  They highly look at Texas Residents and I believe almost only accept them.  You then rank each individual school(after interviewing) much like the match and they do the same for interviewees.  Then all the Texas schools release their ranks and acceptances at once.  

 

EMPA makes great points about smaller applicant pool.  OP would only have to out shine other PAs instead of premeds.  

OP the MCAT it is do able if you take the time! But also keep in mind LECOM.  You could have a good list of schools to apply to. 

[HMtoPA]

12 hours ago, hmmmm3 said:

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).

Don't forget that a big part of the job (at least in the Navy) is seeing not only the Active Duty population, but dependents and retirees. The potential complexity of that patient population is no different than what I see at my part-time civilian job.

I'm a huge fan of the TCCC curriculum. I think it's revolutionized military medical training. I even went out of my way to become an instructor. But it's certainly no reason to join as a PA, as you are not the target audience - it's essentially an EMT-Intermediate (is that still a thing, lol?) course. Great training, but you can enlist as a corpsman and go FMF if that's what you really want to do. C4 is a good course, overall, IMO. You get ATLS certification out of it, which is a plus.

Really, for a direct entry PA, the biggest benefit of joining is student loan repayment. Get in, do 4 years, maybe deploy and/or serve at an overseas hospital, then get out and get on with your life, debt-free. No shame in that, as far as I'm concerned. It's what most of the doctors do (except they usually have longer obligations than 4 years). For us prior-enlisted guys who commission through IPAP, the calculus changes big time. I just finished my 4-year service obligation for PA school (8 days ago!), but I'm also only 6 years from retirement, so it looks like I'm sticking around...

[LT_Oneal_PAC]

2 hours ago, HMtoPA said:

Don't forget that a big part of the job (at least in the Navy) is seeing not only the Active Duty population, but dependents and retirees. The potential complexity of that patient population is no different than what I see at my part-time civilian job.

I'm a huge fan of the TCCC curriculum. I think it's revolutionized military medical training. I even went out of my way to become an instructor. But it's certainly no reason to join as a PA, as you are not the target audience - it's essentially an EMT-Intermediate (is that still a thing, lol?) course. Great training, but you can enlist as a corpsman and go FMF if that's what you really want to do. C4 is a good course, overall, IMO. You get ATLS certification out of it, which is a plus.

Really, for a direct entry PA, the biggest benefit of joining is student loan repayment. Get in, do 4 years, maybe deploy and/or serve at an overseas hospital, then get out and get on with your life, debt-free. No shame in that, as far as I'm concerned. It's what most of the doctors do (except they usually have longer obligations than 4 years). For us prior-enlisted guys who commission through IPAP, the calculus changes big time. I just finished my 4-year service obligation for PA school (8 days ago!), but I'm also only 6 years from retirement, so it looks like I'm sticking around...

You see dependents and retirees during shore duty, then you lose skills on deployment and during your operational tour. Or you could be sent OCONUS where every dependent was prescreened and healthy. Dependents with chronic diseases that are significant are placed on EFMP and stuck near the major centers, which you likely won’t get on first or second tour. I certainly saw plenty of pathology in my FM clinic during AD, but it’s not like the civilian world that I’m currently in.  Prior enlisted, he would likely be forced into being operational first which is where the need is. Hell, they are sending new grads who aren’t prior enlisted operational for their first tour now, which is ridiculous.

C4 is a good course and the military certainly get you very good at trauma, but that’s a very very small part of what makes a good ED clinician.

loan repayment is a huge benefit and agree there is no shame in that. Wouldn’t do it for 25k though.

[StevenBrule]

25 minutes ago, LT_Oneal_PAC said:

You see dependents and retirees during shore duty, then you lose skills on deployment and during your operational tour. Or you could be sent OCONUS where every dependent was prescreened and healthy. Dependents with chronic diseases that are significant are placed on EFMP and stuck near the major centers, which you likely won’t get on first or second tour. I certainly saw plenty of pathology in my FM clinic during AD, but it’s not like the civilian world that I’m currently in.  Prior enlisted, he would likely be forced into being operational first which is where the need is. Hell, they are sending new grads who aren’t prior enlisted operational for their first tour now, which is ridiculous.

C4 is a good course and the military certainly get you very good at trauma, but that’s a very very small part of what makes a good ED clinician.

loan repayment is a huge benefit and agree there is no shame in that. Wouldn’t do it for 25k though.

What about residency opportunity?  I've read that ortho and em residencies are available to Navy PA's.  Is this something OP could count on if electing the military route (Navy) or is this not a realistic expectation?

Also, OP could go the military route, score high on the MCAT and apply to USUHS.

[LT_Oneal_PAC]

 

I think joining with the expectation you could do a residency is viable. I rotated at the ortho residency and they said they got about 8 applicants per year at the time. All the residency trained PAs I met were very sharp. I will give the caveat that after the navy EM residency many of them were put into operational billets (NOT special forces) and were not able utilize the skills they had learned. Not sure about the army residency.

You can apply to usuhs as a civilian, then join before you start as part of the process. Last I checked it was about 1/2 of their students are prior military and the rest civilian only.

[HMtoPA]

9 hours ago, LT_Oneal_PAC said:

You see dependents and retirees during shore duty, then you lose skills on deployment and during your operational tour. Or you could be sent OCONUS where every dependent was prescreened and healthy. Dependents with chronic diseases that are significant are placed on EFMP and stuck near the major centers, which you likely won’t get on first or second tour. I certainly saw plenty of pathology in my FM clinic during AD, but it’s not like the civilian world that I’m currently in.  Prior enlisted, he would likely be forced into being operational first which is where the need is. Hell, they are sending new grads who aren’t prior enlisted operational for their first tour now, which is ridiculous.

C4 is a good course and the military certainly get you very good at trauma, but that’s a very very small part of what makes a good ED clinician.

loan repayment is a huge benefit and agree there is no shame in that. Wouldn’t do it for 25k though.

My experience has been the opposite. I agree that sea duty is pretty limiting in many ways, but I find that I'm better at Derm and Ortho than many of my clinic-only peers. Plus, there's something about the autonomy of an operational assignment that I think can be a real instigator of growth. RE: shore duty, I guess I got lucky and landed at an EFMP Category 5 (i.e., essentially unrestricted) location, even though it is fairly remote. There are actually a good number of small hospitals and clinics that are Category 5 (see here). We also have a huge retiree population, so really, I see a little bit of everything.

3 hours ago, LT_Oneal_PAC said:

 

I think joining with the expectation you could do a residency is viable. I rotated at the ortho residency and they said they got about 8 applicants per year at the time. All the residency trained PAs I met were very sharp. I will give the caveat that after the navy EM residency many of them were put into operational billets (NOT special forces) and were not able utilize the skills they had learned. Not sure about the army residency.

You can apply to usuhs as a civilian, then join before you start as part of the process. Last I checked it was about 1/2 of their students are prior military and the rest civilian only.

I think a PA who was committed to the idea of doing a residency (or fellowship, as the Navy calls them) would have no problem, so long as they made some effort. My understanding is that there aren't a ton of applicants for these seats, and last time I checked it was 4 for Ortho, 4 for EM, and then there's the new General Surgery program - maybe only 2 seats for that one, I forget. The new DUINS instruction should be out next month.

I'm tentatively planning on doing the EM fellowship, but I have been concerned about the assignment to Marine battalions. Last I checked, that wasn't actually happening, and everyone was going to one of 7 EDs (Balboa & Pendleton on the west coast, Jacksonville, Camp Lejeune, & Portsmouth on the east coast, and Guam or Oki OCONUS). I have two buddies that graduated the program, and they each went to one of those places.

[LT_Oneal_PAC]

41 minutes ago, HMtoPA said:

My experience has been the opposite. I agree that sea duty is pretty limiting in many ways, but I find that I'm better at Derm and Ortho than many of my clinic-only peers. Plus, there's something about the autonomy of an operational assignment that I think can be a real instigator of growth. RE: shore duty, I guess I got lucky and landed at an EFMP Category 5 (i.e., essentially unrestricted) location, even though it is fairly remote. There are actually a good number of small hospitals and clinics that are Category 5 (see here). We also have a huge retiree population, so really, I see a little bit of everything.

I think a PA who was committed to the idea of doing a residency (or fellowship, as the Navy calls them) would have no problem, so long as they made some effort. My understanding is that there aren't a ton of applicants for these seats, and last time I checked it was 4 for Ortho, 4 for EM, and then there's the new General Surgery program - maybe only 2 seats for that one, I forget. The new DUINS instruction should be out next month.

I'm tentatively planning on doing the EM fellowship, but I have been concerned about the assignment to Marine battalions. Last I checked, that wasn't actually happening, and everyone was going to one of 7 EDs (Balboa & Pendleton on the west coast, Jacksonville, Camp Lejeune, & Portsmouth on the east coast, and Guam or Oki OCONUS). I have two buddies that graduated the program, and they each went to one of those places.

I can tell you unequivocally, even with my brief time in the civilian world, the pathology incidence is not remotely the same compared to the military. It’s closer to the same in the family medicine spectrum, but EM is a different world even at the larger centers like Portsmouth. Go look at any of the threads on SDN and look at the complaints about skill atrophy. I’m not the only one that feels this way. I’m not saying it is necessarily bad. With so much autonomy I was managing things my civilian friends wouldn’t think of handling. The independence factor cannot be overlooked, I agree, but there are plenty of solo ED positions that can provide the same level of autonomy in the civilian world with much more applicable experience. And deployment and working in a battalion seeing sick call causes skill atrophy except maybe some sports med. There is no question about that.

If you want to join the military, do it because you want to serve your country. Anything else will leave you disappointed. The money and loan repayment are good, but not high enough for what they ask. The medicine is good, but largely non-applicable to civilian practice. As a PA you can’t stay clinical for more than a decade of your career before you hit a promotion wall and have to be an administrator.

[HMtoPA]

57 minutes ago, LT_Oneal_PAC said:

I can tell you unequivocally, even with my brief time in the civilian world, the pathology incidence is not remotely the same compared to the military. It’s closer to the same in the family medicine spectrum, but EM is a different world even at the larger centers like Portsmouth. Go look at any of the threads on SDN and look at the complaints about skill atrophy. I’m not the only one that feels this way. I’m not saying it is necessarily bad. With so much autonomy I was managing things my civilian friends wouldn’t think of handling. The independence factor cannot be overlooked, I agree, but there are plenty of solo ED positions that can provide the same level of autonomy in the civilian world with much more applicable experience. And deployment and working in a battalion seeing sick call causes skill atrophy except maybe some sports med. There is no question about that.

If you want to join the military, do it because you want to serve your country. Anything else will leave you disappointed. The money and loan repayment are good, but not high enough for what they ask. The medicine is good, but largely non-applicable to civilian practice. As a PA you can’t stay clinical for more than a decade of your career before you hit a promotion wall and have to be an administrator.

The military EDs just don't have the volume to be comparable to the civilian sector, from what I've seen. And a military ED isn't going to be dealing with a bunch of homeless people, etc. But a family medicine clinic is a family medicine clinic is a family medicine clinic. Where I work, on an air station, the majority of the AD patients are seen by Aviation Medicine, and we get all the dependents and retirees (with a few of the shore command Sailors as well, of course). They get sick in exactly the same ways as anyone else. And believe me, some of these retirees have been out of the service for longer than they ever spent in, and the years have not been good to them. But the patients I see out in town aren't really different in any way.

[LT_Oneal_PAC]

8 hours ago, HMtoPA said:

The military EDs just don't have the volume to be comparable to the civilian sector, from what I've seen. And a military ED isn't going to be dealing with a bunch of homeless people, etc. But a family medicine clinic is a family medicine clinic is a family medicine clinic. Where I work, on an air station, the majority of the AD patients are seen by Aviation Medicine, and we get all the dependents and retirees (with a few of the shore command Sailors as well, of course). They get sick in exactly the same ways as anyone else. And believe me, some of these retirees have been out of the service for longer than they ever spent in, and the years have not been good to them. But the patients I see out in town aren't really different in any way.

Then we agree! I was mainly speaking about the ED differences since that’s what the OP interested in. Family medicine in the navy, if it’s your jam and you get the right station (recommend Pendleton or Lejeune where they have a FM residency), is awesome.

[HMtoPA]

Yeah, I realized after I posted that you and the OP (and everyone else in this thread, lol) were mainly focused on the EM angle. I wouldn't say FM is my jam, but it's pretty much the bread and butter of a Navy PA, and I do think it's a great background to have, overall. I also think it's important that folks talking about entering the service as a PA understand that the military skews strongly towards generalist practice, at least early on. People think "military" and they automatically assume 24/7 trauma, or something.

I still plan on doing the EM fellowship because (1) I have to do something to make it the next few years to retirement, so it might as well be something I'm interested in, (2) no civilian residency will pay me what the Navy will to train, & (3) after training I will owe one 3-year tour and then be retirement eligible, and probably a pretty attractive candidate for employment in a civilian ED. Seems like a no-brainer, as the only other option at this point seems to be bouncing around FM clinics.