Why PA over MD?

[JMann]

7 minutes ago, Rocksteady said:

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?

If you find a great teaching job straight out of school that will really train you well, you are in the great minority I believe. I am a big proponent of residency training because I did one and can see the benefits. That is not for everyone though, because a lot of folks don't want to work at the top of their license. If you want to work to the top of your license in EM, you'll wish you had gone to med school at some point. An EM physician can work solo jobs across the country without issue. A PA cannot do that. There is a small ER about 1-1.5 hrs from me, sees 8K pts/yr with decent amount of trauma since it's right off a major interstate, staffed by one single physician. They won't hire me for that job. They won't hire any PA for that job. That's why I say you should go to med school if you have the option. 

BTW, not all EM physician residencies are created equal. Several have pretty good work/life balances and don't stay beat down all of the time. It's all about working hard and getting the correct fit. Difficult with the match process, but possible. 

[Endeavor]

Hindsight is 20/20.. Many physicians tell me they would've done PA/NP route and that's the "route" to go. Lots of PAs here have Med School regrets which is fine. Grass is always greener, but I believe the decision is situational and person specific. 

Med school is cool if you're younger and have no "obligations" that is nobody depending on you to bring a paycheck home. Cause as you know you have 4-5 years of under grad, 4 years of med school, couple of stressful board exams, and residency placement, residency is 3-7 years, then the possibility of a fellowship. Some people can manage to grind it out and make it through, others get burnt out quickly. BUT I think what many people are kind of downplaying here is the INTENSE competition of even getting into med school! You need high gpa from the get go and need to maintain that high cumulative GPA and sGPA throughout undergrad, if you fail a class or get a C boohoo they average it and move on. 3.7 is average... then you have the 8 hour MCAT that you have to somehow study for while you're going ham in ur classes, and hope to at least hit a 75% to get ur app looked at then schools want to see research, extra currics etc. The scary part is there a lot of horror stories of many people with very competitive GPAs and MCAT not get in, it's like a lottery. I personally know a guy 4.0 science and cum GPA 90% MCAT applied to 12 schools only got into one and he was already in a "med start" program with them straight out of high school... So even though many people here would've done med, the question is would they even get accepted? It's easy to say I would've done this and that but when your actually put in the position its a different story. 

It sounds scary and it should but some people are able to manage even with marriage kids, etc. Most of the  docs (or med students) that I know were bookworms in high school and immediately succeeded in college. Lots of them love the sacrifice, some didn't sacrifice at all. They came from affluent families who paid for med school and nice car, marriage etc. so it only made sense they"go all the way" while others regret their decision and say they would've been happy as an engineer or something.

Personally, I chose PA for many of the reasons that were stated before me. I enjoy the flexibility of the profession, I enjoy that I only need to go to school for two years and make a great living (especially being raised below the poverty line), I enjoy I can get a head-start get married, buy a house and stuff in my 20's. Unfortunately, I really liked the tuition of PA school as well but thats changing dramatically, I'm glad that I will be attending an amazing program with very cheap price tag. I enjoyed spending my time working low-end PCE making my own money and enjoy my free time with friends vs. pointless extra currics and BS research to fill some checkmarks. I didn't want to take a couple more years to"beef" up my application, study months for an exam to possibly get into med school, and instead use those couple years to be a provider. And after working as a CNA for couple years, I sure as heck don't care of having the "final call" on matters.

So there's a lot to consider and it's not an easy decision to make by any means, but again hindsight is 20/20. I think the cool part of choosing PA is that if I'm 30 and I want to go back to medschool I can (and can probably afford it to lol). But if i were to spend all this countless time to go to med school, I can't "go back". Again thats my stance on it and to each their own.

But to enter the PA field, I feel like it is a must to answer "why not physician" and if you cant answer that confidently than good chance PA isn't the route for you. And I don't mean that if you can answer it at an interview, but you should be able to answer it deep down within yourself so you don't have those "med-school regrets"

 

[SoCal_PA]

Depends on what you want. 

I graduated PA school in my mid twenties and was immediately in the top 5% income in my area (a large city). It gave me the freedom to do what I wanted without worry. It has not even been 2 years now since I graduated but I have a large amount saved for a downpayment, vacations planned, an upcoming wedding, and I enjoy what I do. 

[lkth487]

So I can talk about why med school was right for me.

1.  I am a non traditional applicant and I was in accounting for about 12 years prior to med school.  I didn't have any clinical or biology background.  So I wanted to take the full amount of time and really learn stuff in detail - from anatomy to biochemistry to pathophysiology.   

2.  The time commitment I knew going in was substantial, but I was ok with that because I liked the formalized pathway to practice.  I know there are starting to be PA residencies now but there were fewer of them 8 years ago when I was applying to med school, and even now there isn't a formal, board sanctioned pathway, with set standards and requirements, to practice in a field. 

3.  I like the autonomy.  I'm currently on pedi BMT Transplant service and i finished PICU in march. Both of those services have lots of PA/NPs and they are wonderful, intelligent and capable people.  But I practice in a state with full practice autonomy for NPs and they will never run a PICU without oversight of an attending (at night sometimes they are alone but that's quickly changing around the country as more and more attendings move in house overnight as well).  There's even a pediatrician who has been doing PICU for 25 years without a fellowship and they tried taking away his ability to be solo - the other PICU docs had to threaten to leave because he's so great - and finally they relented.  But no one who isn't a BE/BC PICU Physician will be hired again.  Maybe that's fine for some, but I think it would get old for me after a while especially if I've been doing this for 20 years and I have people hovering over me when I clearly know what I'm doing and changing things based purely on style.  I also wanted to do surgery prior to med school (until I did my rotations and fell in love with peds) and I know independence is iffy in that field as well. 

 

4. The lower salary during residency and fellowship didn't matter to me.  I grew up close to the poverty line and $54k/year (my first year residency salary) was more than enough for me.  But I'm married and my wife is a teacher also making similar money to a resident, so we could absorb the decrease in income.   We live well, do everything we want, take vacations, etc even while in residency so I can't really complain about anything. 

[sas5814]

That makes perfect sense to me and I think your summation of the various team members is spot on.  Both the content and tone of your post is the kind of dialogue we should all be having about our various places in the medical food chain(s). 

Everyone should able to practice at the top of their training and experience and all the anger on every side of the discussion doesn't bring much to the table.

[PAtoMD]

4 hours ago, lkth487 said:

So I can talk about why med school was right for me.

1.  I am a non traditional applicant and I was in accounting for about 12 years prior to med school.  I didn't have any clinical or biology background.  So I wanted to take the full amount of time and really learn stuff in detail - from anatomy to biochemistry to pathophysiology.   

2.  The time commitment I knew going in was substantial, but I was ok with that because I liked the formalized pathway to practice.  I know there are starting to be PA residencies now but there were fewer of them 8 years ago when I was applying to med school, and even now there isn't a formal, board sanctioned pathway, with set standards and requirements, to practice in a field. 

3.  I like the autonomy.  I'm currently on pedi BMT Transplant service and i finished PICU in march. Both of those services have lots of PA/NPs and they are wonderful, intelligent and capable people.  But I practice in a state with full practice autonomy for NPs and they will never run a PICU without oversight of an attending (at night sometimes they are alone but that's quickly changing around the country as more and more attendings move in house overnight as well).  There's even a pediatrician who has been doing PICU for 25 years without a fellowship and they tried taking away his ability to be solo - the other PICU docs had to threaten to leave because he's so great - and finally they relented.  But no one who isn't a BE/BC PICU Physician will be hired again.  Maybe that's fine for some, but I think it would get old for me after a while especially if I've been doing this for 20 years and I have people hovering over me when I clearly know what I'm doing and changing things based purely on style.  I also wanted to do surgery prior to med school (until I did my rotations and fell in love with peds) and I know independence is iffy in that field as well. 

 

4. The lower salary during residency and fellowship didn't matter to me.  I grew up close to the poverty line and $54k/year (my first year residency salary) was more than enough for me.  But I'm married and my wife is a teacher also making similar money to a resident, so we could absorb the decrease in income.   We live well, do everything we want, take vacations, etc even while in residency so I can't really complain about anything. 

Really enjoy having you on the board.

1. You shed a new light on topics

2. Youre a PA advocate which is great

 

i really like hearing how you’re able to have a life while in residency. Which is something my SO and I debate over when I discuss the potential for medical school. My SO is also in accounting. I’ll have to show them your post to help them make sense of my decision lol.

[lkth487]

It's not easy.  My residency is not like a surgery residency though.  It's not derm level easy but I stay between 70-75 hours a week on most weeks.   You just have to make the time you have count.  And you have to have total buy in from the spouse - they have to go in with eyes wide open. Otherwise it will never work. 

[Joelseff]

Really enjoy having you on the board. 1. You shed a new light on topics

2. Youre a PA advocate which is great

 

i really like hearing how you’re able to have a life while in residency. Which is something my SO and I debate over when I discuss the potential for medical school. My SO is also in accounting. I’ll have to show them your post to help them make sense of my decision lol.

 

Seriously! I love this guy! LKTH: Please continue your balanced approach to the team aspect of Medicine and your support for PAs.

 

BTW:My wife is (was, now she's director of finance) an accountant and put me through school. In our families it's either Medicine or Accounting lol

 

Me:PA Wife: Accountant

My Parents: Retired Atty turned Accountant and my Mom was a Nurse.

Her Parents: Dad is a retired CLS and Mom is a retired accountant.

 

Sent from my SAMSUNG-SM-G891A using Tapatalk

 

 

 

 

 

[CAAdmission]

Read up about physician suicide:

https://www.kevinmd.com/blog/2017/10/ive-learned-547-doctor-suicides.html

[EMEDPA]

go to medschool. I didn't because I was afraid of the mcat,  o-chem and biochem. they were not PA prereqs in 1991. probably the biggest mistake of my life. 

[lkth487]

49 minutes ago, CJAdmission said:

Read up about physician suicide:

https://www.kevinmd.com/blog/2017/10/ive-learned-547-doctor-suicides.html

Those numbers are very sad.   But it's very high for other healthcare professionals too.  I don't think a PA working 15 shifts a month in the ED is necessarily at a lower risk of stress, burnout or depression compared a MD working the same hours?   There's a lot of factors - stress obvously but also the expectation of having to be perfect, being "on" all the time, not being able to take time for yourself, etc.  I haven't seen the numbers for PAs but I'm sure all of us in this field are  at very high risk of things like depression.  

[sas5814]

This is just speculation but based on experience...physicians are less likely to say "I don't know" than we are and that creates more pressure. Generally they are expected to know more do more and ask for help less which, I would think, makes for a heavier emotional burden. 

Several years back I was on the board of directors of a hospital district and we were discussing consultants resisting coming to the ER to see patients when called and I asked why the ER docs didn't just ask for guidance so they could care for/admit/discharge the patient without the specialists having to come in as often. We had a very wise retired urologist as an adviser and he said "this is where your training makes you more efficient than physician training. They generally won't admit they don't know and ask for guidance."

So I think that culture and mindset, along with the fact they naturally have more opportunity to handle more complex problems puts a bigger burden on them and by our very nature we ask for guidance when we need to.

Your mileage may vary....

[CAAdmission]

18 hours ago, lkth487 said:

Those numbers are very sad.   But it's very high for other healthcare professionals too.  I don't think a PA working 15 shifts a month in the ED is necessarily at a lower risk of stress, burnout or depression compared a MD working the same hours? 

I have some grouchy coworkers, but nothing like what physicians experience:

https://www.thedailybeast.com/how-being-a-doctor-became-the-most-miserable-profession

Going into medicine everyone is told how utterly important, special and elite they are. As pre-meds they they participate in a horrifying rat race climbing over each other to get into med school. They then repeat that rat race to get into a choice residency. It's all me, me me. It's like the system was designed for the very purpose of creating terrible human beings. Then they get out into practice and find to their horror the effort was not worth it, "autonomy" is an illusion, and that they are a little cog on a corporate wheel.

PA school there's a rat race to get in, and an ongoing struggle for respect. But I've never had to talk a colleague off a ledge. Mostly we just bitch about the terrible interpersonal skills of our supervisors.

[lkth487]

You don't have to convince me that there are systemic reasons as part of our healthcare system that result in high levels of physician burnout and depression.   I agree with that.  

I'm not convinced though that the rates are necessarily higher for physicians compared with PAs or NPs who might be working in the same area.  From what I've seen, everyone is under the same stress of RVUs,  press ganey, corporate rules, etc.  Unless there is some data on the subject that shows otherwise that I'm not aware of...

[ApolloPA]

2 hours ago, CJAdmission said:

I have some grouchy coworkers, but nothing like what physicians experience:

https://www.thedailybeast.com/how-being-a-doctor-became-the-most-miserable-profession

Going into medicine everyone is told how utterly important, special and elite they are. As pre-meds they they participate in a horrifying rat race climbing over each other to get into med school. They then repeat that rat race to get into a choice residency. It's all me, me me. It's like the system was designed for the very purpose of creating terrible human beings. Then they get out into practice and find to their horror the effort was not worth it, "autonomy is an illusion, and that they are a little cog on a corporate wheel.

PA school there's a rat race to get in, and an ongoing struggle for respect. But I've never had to talk a colleague off a ledge. Mostly we just bitch about the terrible interpersonal skills of our supervisors.

I think using pop culture news sources may be a bit misleading to illustrate your point considering most news sources, and the general population, don't know what a PA is or does.  I can give anecdotal evidence of PAs hating their job, telling students they probably wouldn't do it again or recommend it to others.   

Also, you don't think that the certain types of personalities that the "special and elite" physician profession attracts has anything to do with it's predisposition to dissatisfaction and suicide?

[lkth487]

I think there is always a lot of 'grass is greener' type posts.  I see on this thread many people say to do MD.  When people ask this same question on a physician forum, you get a lot of ('you should do finance or investment banking instead').  I've been in finance, it's pretty shitty.  But they don't know that.  Everyone thinks everyone else has it great.  

 

 

[Adrien]

On 4/17/2018 at 10:55 AM, Boatswain2PA said:

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.

Well,  if you love it so much, what can you love better? MD is on your mind, are you discouraged you didn't get to have a chance to become a position higher in the medical field, MD is more stressful i suppose. Please let me know, i'll appreciate it.

[CAAdmission]

8 hours ago, ApolloPA said:

Also, you don't think that the certain types of personalities that the "special and elite" physician profession attracts has anything to do with it's predisposition to dissatisfaction and suicide?

I think you are absolutely right. For good or for ill, I also think that a profession that has "assistant" in its title will generally help deter the interest of pompous aholes.

[EMEDPA]

My personality would fit an MD/DO career much better. I don't tolerate being condescended to or disrespected very well (and yes, I know physicians are disrespected as well, but it's not in the same ballpark as what PAs deal with on a regular basis), which is why I have sought out rural and solo positions where I am judged based on my abilities and not the initials after my name.

[GetMeOuttaThisMess]

10 hours ago, EMEDPA said:

My personality would fit an MD/DO career much better. I don't tolerate being condescended to or disrespected very well (and yes, I know physicians are disrespected as well, but it's not in the same ballpark as what PAs deal with on a regular basis), which is why I have sought out rural and solo positions where I am judged based on my abilities and not the initials after my name.

Oh lord E, just wait till you have another 10 years on your body and you start looking and talking like Clint Eastwood telling folks to "get outta my ED" or "get outta my ambulance bay" as you swing your stethoscope at them.  People tell me that I've developed a tic because I'm always nodding my head.  It's actually a conscious shaking to keep me from asking them to "make my day".