Why PA over MD?

[cemetra]

Okay, I know this is such a basic question, but I’m genuinely curious and it’s good to hear different perspectives. Plus, everyone situation is diffferent. I’m currently going the a Anesthesiologist Assistant route (for now), but I’m kind of iffy about possibly going to med school. Currently 24 and just started working on my undergrad 

 

What made you choose PA over MD/DO?

[Boatswain2PA]

1/3 the pay.  Always wanting to change my work-up and treatment to meet the whim of the physician I am working with that day/shift.  Getting lectured by some 25 year old resident about how I should have done "x, y, and z" before transferring or admitting...of course right after hearing from my SP that we don't need to do "x, y, and z".

Did I mention 1/3 the pay?

Go to med school!

 

[EMNP]

Go to Med school!

1- 1/3 the salary
2- Lack of respect
3- Knowledge Gaps
4- Opportunities




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[cemetra]

@Boatswain2PA so you’re not liking being a PA? How long have you been in the field? 

[cemetra]

1 hour ago, EMNP said:

Go to Med school!

1- 1/3 the salary
2- Lack of respect
3- Knowledge Gaps
4- Opportunities




Sent from my iPhone using Tapatalk

I can’t tell if you’re joking or not, are you really not liking being a PA so far? The pay isn’t as important of a deciding factor for me, but it still is obviously one. I know doctor’s make more, but AA’s have a better schedule and can actually have a life outside their work too. If I went the MD route, I would definitely want to be a surgeon, which sounds like ungodly hours, but I’ve heard that plenty of your schedule is more on you. You can be a PA and work 80 hour weeks or you could be a MD and work 50. Or vice versa. Ultimately I want to provide the best care for my patients, I just want a life and family that’s healthy outside of work as well. Are you not liking being a PA so far?

[cemetra]

@EMNP I didn’t mean to only say surgeon. Just to clarify, if I went the MD route, it would be to either be a surgeon or anesthesiologist. I want to be in an OR setting and both seem nice. I’ll try to shadow both, but I’m still curious to know what you’d think.

[lkth487]

Everyone definitely knows what they want before med school.  Everyone changes their mind in med school.  You can choose to make less and work less, even as a surgeon, if that's what floats your boat.  Generally surgeons don't, but a lot of that has to do with the type of personalities that go into surgery not because they can't.  The residency in many (though not all) surgery specialties is crushing and absolutely brutal though.  No way around that.  80 hours a week for 5-7 years, plus any fellowship time.  As an anesthesiologist, you can work 8 hours a week (which still comes out to be decent money, believe it or not) or 80 hours a week - that's up to you.

[PAtoMD]

If you’re still in undergrad most posters on here will tell you to go to medical school.

 

i am into my second year as a PA student with regrets and plan to apply to medical school after I graduate. 

 

[UGoLong]

I enjoy the give and take here. The real issue is that everyone is different with different interests and needs. And, to complicate matters, your interests and needs will probably change as you get older.

Eyes wide open is the key, no matter which way you go. On the professions and on your personal values. 

Good luck!

[Boatswain2PA]

8 hours ago, cemetra said:

@Boatswain2PA so you’re not liking being a PA? How long have you been in the field? 

I love being a PA.  Just wish I had gone to med school at 22 years old.  Instead I did a 20 year military career, THEN went to PA school.  I was just too old at that point to go to medical school.

[Acebecker]

Many reasons.  The primary one is that my kids were young and I didn't want to miss their younger years.  I would not give up those years for anything.

Medicine as a PA is the same as medicine as an MD.  Same standards of care, same guidelines, same consequences.

There are unnecessary restrictions on me based on the system in which I work - hospital will not credential me for same day procedures (IV fluids, transfusions, etc).  So, I collaborate with the docs I work with and they cosign and my patients get what they need.

It's a very rewarding field, a very rewarding way to get to practice medicine.

I often point out, though, that if I could go back and do medical school before I was married, I would consider it.

 

Andrew

[BruceBanner]

Many of us dont regret becoming PAs. But there are limitations, as noted above.

I went the PA route because of expediency and lower cost, but the lower cost is offset by the lower pay.

Knowing what I know now, I may have chosen the MD-radiology route or perhaps a non-medical PhD.

But there is no way in hell I'd go back at this point due to additional cost and "living life" time lost.

[lkth487]

They won't credential you to give IV fluids?

[JMann]

If you're young, go to med school.

If you want to work in a surgical field, go to med school.

If you want to work in emergency medicine, go to med school.

Reasons for med school have been listed above. Primary 3 reasons that I would have gone to med school if I were younger and didn't have kids: $$, Respect and Opportunity. 

It's not that being a PA isn't great, because I do enjoy what I do. Getting 1/3 to 1/2 the pay for the same work sucks! Having to deal with hospitals and other employers who don't like PAs or don't understand our abilities and scope is frustrating. Having to deal with the whole NP argument is a drag, though the physicians are dealing with that as well with the attempts at independent practice. 

Educate yourself and make a decision knowing all sides of the issue. 

[lkth487]

7 minutes ago, Acebecker said:

5 minutes ago, BruceBanner said:

Many of us dont regret becoming PAs. But there are limitations, as noted above.

Knowing what I know now, I may have chosen the MD-radiology route or perhaps a non-medical PhD.

But there is no way in hell I'd go back at this point due to additional cost and "living life" time lost.

 

I guess someone has to do it.  I'd quit medicine if I had to do radiology.  :p

 

Hey, everyone has regrets.  I still think about maybe going the Ob-Gyn-->Gyn/Onc route and becoming a full time surgeon.   I'm still very happy with what I did and would do it again, but it's fun to think about.  And it's hard for physicians to switch fields, so that's something to think about that as well.

[sas5814]

My decision was pretty strait forward. I was an Army medic and wanted to advance. I had worked with and loved the PAs I was stationed with. The Army had its own PA school (now joint service and even includes some civilians) so I applied and was accepted. It served me well in the military and since providing me and my family a nice living.

I have been fortunate in many ways in that I had no desire to be in a big city or a big medical center so I have had little of the frustrations my colleagues express. I have been treated a s a colleague and generally well paid because I went places most physicians didn't want to go and was happy to be there. recent life events has compelled a move and I am working for a giant corporation now which I find quite a bit more frustrating but I am still well treated and well paid...I just sometimes have to deal with consultants who are less than friendly...though even that is rare, and the leadership of the organization could not be less interested in anything I think. I am a worker bee and the organization is controlled by physicians and nurses.Work, eat, sleep, lather, rinse, repeat. It is what it is and I try to enjoy it (and do most of the time).

If you are young and want to do something surgical or be an anesthesiologist that is the way I would go. You will have more demands put on you, more stress, and start your professional career with a lot more debt.

You will also be a member of the elite club...large and in charge and the captain of your own destiny at least in the practice of medicine. So it really boils down to how much time and money and effort you are willing to expend for the benefit.

[Acebecker]

54 minutes ago, lkth487 said:

They won't credential you to give IV fluids?

I give fluids in my office all the time and in the back of the ambulance.  However, when I have a Pt who has chemotherapy induced vomiting to the point of significant dehydration and I want her to receive 2 liters of crystalloids, I cannot order it through the same day surgery unit of the hospital because of credentialing.  It's the dumbest restriction I have ever faced.  It's a hospital thing, not anything to do with our practice.

[MidwesternTexan]

I agree with basically all that's been stated already.

For me- it was less yrs. school to 'practice', which ~ ='s less pay, etc.

I do enjoy being a PA-C though- now my 24th yr.- second full profession change for me also.

 

[SedRate]

Reasons for me: although annoying and frustrating, I'm ok with being the "assistant" and making a PA salary; ability to switch fields easier; have the "backup" of my supervising/collaborative physician; don't have to worry about getting a "good" residency spot, step scores, or boards; a lot of doctors I talked to were unhappy and told me they wouldn't do it again; and I didn't want to do a three-to-five-year residency (especially five years of ortho residency hell).

As I got older, the doctor appeal became less important to me. I had spent my youth working and working hard to get good grades and such, and honestly by the time I did all that and eventually chose to go to PA school, I was already feeling burnt out. I really just wanted to get into my career and start enjoying my life for once, and I didn't want to wait until I was middle-aged to do so.

I've been a PA for nearly four years now and don't regret it, at least not yet. I also wanted to be a part of an orthopedic practice, and becoming a PA has afforded me the ability to do so with all the above benefits as well. I'm happy where I've ended up thus far and am satisfied and feel fulfilled by my work. 

If I ever decide being a PA is no longer enough, I'll probably just go back to medical school. We'll see. It will be harder for sure but it wouldn't be the end of the world and there are PAs out there who've done it. 

Hope this helps. Good luck with your decision!

[Anachronist]

Expediency, lower cost, and flexibility. 

I'm in my early 30's and don't want to be a student for 7-10 more years, I also don't want to have to compete at an extremely high level for a GPA again and residency slots. Was too old for that when I went back to college but busted out a 3.95 GPA, probably don't have the stamina to do it all over again and with tougher competition.

With speed comes 1/3rd the debt and higher earning for at least 5 years before the MD route superasses it. I'm also coming from a field where PA will be a pay cut, I've had MD pay before, and lived in a 5k sq ft house, it's very overrated.

My fiancee is in a PhD program, and her field is limited, so I'll be going where she goes (and moving when she moves), so not having to specialize and being able to find work in a variety of environments even in small towns is very important to me.

As for the complaints about respect/autonomy, I think it is a "they want what they don't have, or haven't had" kind of thing. And that is a very real phenomenon that affects people, especially when it comes to a power dynamic. But I've been-there-done-that when it comes to command and control, and even MD's have their hands tied by insurance companies, hospitals, partners, etc etc. Freedom is mostly an illusion, and the respect/independence is what you make of it.

[Guest ERCat]

Heck no, I don’t regret my decision. I am new at this and graduated in 2015 but still going strong with no regrets.

1) The money is great. In EM I can make close to what a family physician makes. Last year with a normal 40 hour work week (sometimes less) I pulled in 175K with my bonuses. This year it will be more, maybe closer to 190-200K. it’s not all about money of course but why would I try to go to medical school at this point - say I matched into family medicine and did that route; I would be making the same money I do now roughly.

2) I had a life in my 20s. PA school was challenging but relatively enjoyable, not as cut throat as I expected it to be. My friends who have gone to medical school were beaten down in undergrad with Applications and trying to beat the MCAT, beaten down in their four years of medical school, and tired as heck during their four years of residency. Lower time investment as compared to MD.

3) Cost. My degree cost me 30K when all is said and done as I went to a public program and got some money back. Plus living expenses of course but it was easy to pay it off during the first year of working. Low money investment as compared to MD. 

4) Knowing that I can jump ship at anytime if I get burned out on medicine is a comforting fact. My time and financial investment into being a physician assistant has been a lot, but low compared to a physician. Therefore if I ever found medicine to be too much for my soul I feel like I could get out guiltlessly knowing that it had been a good run.

4) Flexibility. I love the fact that I could do emergency medicine now and then literally go and do dermatology or family medicine. Some people on this board say it’s not easy to move like that but from what I am seeing it isn’t too hard especially if you have experience.

5) I have autonomy but I have back up.  Yes, it can be annoying as BoatSwain described to cater to the physician you work with but you have their back up. It protects you and it’s a source of comfort when you don’t know WTF you are doing. When I don’t know the answer to something and I don’t know how to best take care of a patient, I can ask one of the doctors and get an answer within seconds. I cannot imagine being an M.D. in a situation where you don’t know what the hell you’re supposed to do. I don’t envy that. I like the team approach of our profession.

Overall I adore being a PA. I am proud to do what I do and take care of people...and I think there’s a lot of negativity surrounding our profession these days. If you’re going to be bitter that you’re making less than a doctor then you should go to medical school but you should fully be aware of the sacrifices you’re going to make to get there.

[cemetra]

@ERCat where do you live? That kind of pay is ridiculous, I’ve onky heard of around $150,000 after maybe 3-5 years. Ultimately, money isn’t the biggest concern obviously. I want to work in medicine, help others, and I’m super interested in participating in studies - just not as my career. Anyways, the main concern with PA is that they do all the same work as a Physician (so it seems and I’ve been told) and make 1/3 as much, etc. I know you said you make a lot, but I think you got super lucky. I’ve never heard of that kind of starting pay and most job listings around me are $90 - $120k for new graduates. Regardless, I’m still on my undergrad and trying to decide. I would say PA would be a backup plan. I’m more interested in Anesthesiologist Assistant or MD. I like surgeries and anesthesia and the OR setting, like I have absolutely no interest to work in family care. The only thing outside of surgery I would consider is something like internal medicine. As crazy as it sounds, I’m not the biggest people person, but I love helping them. I just can’t deal with trivial stuff like colds and the flu all day and writing prescriptions. I’d prefer my patients under general anesthesia. ;) Or just less patients and in internal medicine possibly. Regardless, I want a good work/life balance too. I want a family and kids. Your post was SUPER insightful though, so thank you for it. It seems like you have a great gig. 

[Guest ERCat]

You can get this kind of pay in the Southwest part of the country from what I have seen. Actually our ER pays less than a lot of the other ERs in surrounding towns. PAs in an ER a half hour away are clearing 200K. One kid in my class was making 100.00 an hour straight out of school in a rural ER. But ER is where the money is. In family medicine in my town I would expect to make in the low 100s. Urgent care people make around 130K. I plan to go into those fields in the future as ER is a really stressful career for long term.  

[camoman1234]

10 hours ago, ERCat said:

You can get this kind of pay in the Southwest part of the country from what I have seen. Actually our ER pays less than a lot of the other ERs in surrounding towns. PAs in an ER a half hour away are clearing 200K. One kid in my class was making 100.00 an hour straight out of school in a rural ER. But ER is where the money is. In family medicine in my town I would expect to make in the low 100s. Urgent care people make around 130K. I plan to go into those fields in the future as ER is a really stressful career for long term.  

Yes but you have to realize @cemetra that COL (cost of living) is a HUGE factor in this. I have family that lives in Phoenix and the COL is crazy there compared to the mid west. So do not think everyone makes that money. Learn to use a COL calculator. The same house I have (except has 2 1/2 less acres than mine) in Phoenix cost $315,000 MORE. 

[Rocksteady]

On 4/17/2018 at 11:29 AM, JMann said:

If you're young, go to med school.

If you want to work in a surgical field, go to med school.

If you want to work in emergency medicine, go to med school.

Reasons for med school have been listed above. Primary 3 reasons that I would have gone to med school if I were younger and didn't have kids: $$, Respect and Opportunity. 

It's not that being a PA isn't great, because I do enjoy what I do. Getting 1/3 to 1/2 the pay for the same work sucks! Having to deal with hospitals and other employers who don't like PAs or don't understand our abilities and scope is frustrating. Having to deal with the whole NP argument is a drag, though the physicians are dealing with that as well with the attempts at independent practice. 

Educate yourself and make a decision knowing all sides of the issue. 

I am a new grad going into emergency medicine, i did a rotation at the site i will be working at and it seems like a great gig/really glad i didnt have to do med school+residency first to do it...why do you think i should have?