Do you still recommend people going to PA school? If so, why?

[SoonToBePAC]

Just a Pre-PA who will be starting PA school next year, so I'm sure my voice has no place here...

However, I think everything you do loses its spark after a while honestly. Whether it is a hobby, an organization, or a profession, the wonder and excitement eventually fade. I know plenty of docs who wish they were PAs and as evident by this post the reciprocal is true as well. Medicine definitely has its downsides. But, if you talk to folks in other professions, they will tell you the downsides of that as well.

I hope that instead of warning people off of the PA profession that you all can encourage them highly research what they are getting into and make an informed decision based on what they want for themselves. I've been warned off of med school by doctors, nursing school by nurses, and PA school by PAs. There is always going to be something else you can do that makes more money and seems easier from an outside perspective. The grass is always greener!!!!

At the end of the day, there is more to find joy in than your profession or money. At 23, I know that being a PA is what I want for myself. And I personally am a firm believer that if something makes you that miserable then you'll find a way to move, no matter where you are in life.

But.... I know I'm young and have a lot to learn so what do I know !  Just my two cents 

Signed,

A highly enthusiastic and excited soon to be PA-C

[EMEDPA]

I believe something like 73% of PAs work in a non-primary care specialty at this point and don't think a majority have done primary care for over a decade.

the 2017 NCCPA report includes this gem:

26 .7%

of Certified PAs

work in primary care:

family medicine/general

practice, general internal

medicine, and general

pediatrics. The percentage

of Certified PAs practicing

primary care has slightly

decreased in the past

five years. In 2013, 27.7%

of Certified PAs reported

they worked in a primary

care specialty.

 

[Joelseff]

I believe something like 73% of PAs work in a non-primary care specialty at this point and don't think a majority have done primary care for over a decade.
the 2017 NCCPA report includes this gem:
26 .7% of Certified PAs work in primary care: family medicine/general practice, general internal medicine, and general pediatrics. The percentage of Certified PAs practicing primary care has slightly decreased in the past five years. In 2013, 27.7% of Certified PAs reported they worked in a primary care specialty.  

Ok my bad lol. I must have read the report wrong. Thanks E!



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[EMEDPA]

7 minutes ago, Joelseff said:

Ok my bad lol. I must have read the report wrong. Thanks E!



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FP is still the single specialty with the most folks in it (20% of all PAs), but primary care overall is < 30% of all PAs.

[Joelseff]

FP is still the single specialty with the most folks in it (20% of all PAs), but primary care overall is

Right on E, thanks. That's what prob stuck to my mind.

 

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[hlj25950]

[mention=74630]hlj25950[/mention]
 
I agree mostly with this except for the part about NP being more suited to Primary Care than we are. I disagree. PA education is much more thorough in preparing one for Primary Care in my opinion. Primary care isn't just sniffles and punting to specialists. I think Primary Care requires a lot of depth and breadth that most specialties don't cover/require (say ortho or derm for instance) and it can be a minefield from a medical standpoint so you need to know your stuff.
 
I think if you meant that NPs have a better political position which gives them an advantage in more job postings etc in Primary care then you may be right, but as far as medical acumen, I disagree an NP is better suited to Primary Care.
 
Remember PA education is primary care and though it may seem we have as a profession in general, trended away from that (prob because of less Private Primary care offices nowadays so the whole finding an SP thing has become more problematic? And maybe more advertising for NPs vs PAs in PC job listing? I dunno) Primary Care PAs (yes we still exist) are not as rare as it is portrayed to be (mostly here on the forum). According to AAPA, Primary Care PAs still make up a large part (if not the majority) of practicing PAs if I remember the source correctly.
 
I agree with the rest though.
 
But I still don't recommend medicine as a profession to folks who ask me anymore [emoji16]
 
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I meant that there is a political and hiring bias in favor of NPs, not that we aren’t suited for it.

I’m in FP right now, and I had to fight this perception all the time.

[Joelseff]

I meant that there is a political and hiring bias in favor of NPs, not that we aren’t suited for it.

I’m in FP right now, and I had to fight this perception all the time.

Gotcha. Totally agree. I'm in FP also looking for alternatives now.

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[BirdDogPA]

I recommend being a PA to those who are seriously interested in the profession. I for one still think that it is the greatest in HEALTHCARE. Not gonna lie, if I had it to do over again Id probably look at some type of business/entrepreneurship route.

However, I think for the smart and motivated PA the sky is the limit. For example, the hospital system I work for is also a poison control center and are having a very difficult time getting another toxicologist (only 2 left in the state). I went up to the director and told him that I was interested. The first conversation was "thanks but I don't think a PA would help us very much because of accreditation standards"... So I did my research and showed him he was wrong. Now they're head over hills recruiting me.   

My point to that story is when there is a will there is a way. It all comes down to what an individual wants out of life and how motivated they are. Bottom line it's my personal opinion considering time commitment, opportunity, starting salary PA is still a great option. 

[cg02186]

I would.  I think it all depends on your personality though and having a good job where you’re respected.  If you have to be the top dog then no, PA is not for you.  It also depends what you want out of life.  I love medicine and my job but it is not my life. If you feel like that then you probably should go MD.

I wouldn’t change it if I could go back.  Being in my 20s, making $125K+, married, kids, new house, with half the debt of an MD, and having the backup of a collaborating physician if I need to sounds pretty good to me. Grass always looks greener.

[Cideous]

1.  The docs I have known and worked with are some of the most unhappy people I know.  They are also very down on medicine in general.  They are suffering from the same, "shut up and dance monkey!" mentality from Admins and corporate medicine companies.

The problem is not the MD, DO, PA or NP.  The problem is medicine in America.  The "squeeze every dime out of a patient until they are bankrupt, and then drop their ass" mentality.  The providers who do the work are making the least, while corporate admins rake it in all while not seeing or treating one patient.  Drug companies that constantly F*** patients over.  Insurance companies that have entire divisions setup to find a way to deny a claim.  On and On...

The problem is the mentality of the country we live in and practicing under that mentality.

 

I'll leave you with this before the flaming starts.

NO ONE SHOULD BE MADE TO GO BANKRUPT BECAUSE THEY BECOME SICK OR INJURED.    PERIOD.

Capitalism is great if you're making burgers.  When applied to medicine it just sucks.

[PrePA94]

On 10/1/2018 at 5:46 AM, hlj25950 said:

I’ve only been a PA for just over a year, so take that for what it’s worth.

Being a doctor, for me, is definitely NOT worth it. Those of you who think doctors have it so good are missing the point.

https://www.ncbi.nlm.nih.gov/m/pubmed/26599310/?i=19&from=physician%20satisfaction%20job&sort=[relevance]

“Of 68 publications reviewed, 29 met criteria and were categorized in a Job Characteristics Model. Most studies report a high degree of job satisfaction when autonomy, income, patient responsibility, physician support, and career advancement opportunities are surveyed. Age, sex, specialty, and occupational background are needed to understand the effect on job satisfaction. Quality of studies varies widely.”

https://www.ncbi.nlm.nih.gov/m/pubmed/29101932/?i=2&from=physician%20career%20satisfaction&sort=[relevance]

I’m telling you most physicians I know wouldn’t do it again. I’ve been married since undergrad to an ortho surgeon, and it influenced my decision not to do medical school. Physician residencies are hell beasts that cannot be compared to PA residencies or practice.

Physicians have higher liability. They have decreasing autonomy (due to hospitals buying them out and little to no choice in the matter) because they can’t negotiate favorable contracts with insurance companies and stay in business anymore. There are more administrators in medicine. Who know nothing about taking care of patients and just see $$$. Debt to go into physician practice is much greater.

On balance it was well worth going to PA school rather than medical school. Yes, there are definitely disadvantages, but at least we have some lateral mobility. Physicians do not. Not without doing another residency. We have the ability to practice in the field we want for the most part. Physicians have less ability to do this. For residencies, they are matched by a computer (if they match - there are fewer residencies than applicants). Some specialties are highly competitive and only the top 10% in classes and on boards need apply. So you wanted to do______? And if you don’t match or finish a residency? You cannot work as a physician.

I know several doctors who have committed suicide. I know a few who were not advanced in their residencies. A few were able to transfer to a new residency and start over in a completely different field, not their preferred field, and a few have jobs completely outside of medicine and are unable to pay their school debts, end up teaching Anatomy at a community college or something similar.

Even if you do make it through, the at a bare minimum, triple the training, is not always worth it. And often, wasn’t worth it. You miss out on life. You sacrifice a lot.

If you graduate, as a PA, however, and pass your PANCE? You can change fields if you really want to. It’s hard to change fields, no doubt, but you can without doing 3-10+ years of 80-120 hour work weeks. That is, if you can even rematch in a different field.

I’m not sorry I chose PA over med school. Are there things that are worse? Sure. Worth it to be a PA and not a MD/DO? Absolutely.

Thank you. As someone who is starting PA school in May, I sincerely thank you. 

[sas5814]

Great post. Good info from the "inside" as it were.

One comment about this: 

10 minutes ago, PrePA94 said:

Yes, there are definitely disadvantages, but at least we have some lateral mobility. Physicians do not. Not without doing another residency.

In Texas a physician can work in any field they want within reason. My first SP after I retired was a pediatrician who didn't want to do peds anymore so he started an allergy practice. He couldn't call himself an allergist but he did everything allergists do. I also worked for a FP doc that changed to asthetics only. So there is some laterality. Clearly you can't go from FP to gen surgery or anything like that but, arguably, your husband could work in another non surgical field as long as he didn't call himself a specialist in that field.

Was that confusing enough?

[JMann]

If you are <30 and have no kids or other weird life situation, go to med school. Hard stop, end of talk. The plusses far outweigh the minuses in the long run. Most docs I know are happy enough with their decision. Sure being a FedEx pilot is definitely more ideal!

If your >30, have kids/spouse or other life responsibilities, then you gotta look at pro vs con of time, $ etc. I was 35 when I started PA school. I looked into med school, but wouldn't have started until 36. Having 3 kids <10, I didn't want to miss large chunks of 4-5 yrs of their lives. Going the PA route, I still missed 2yrs for school and another 1.5yrs for residency. I'm happy with how it turned out, but had I been younger or different life circumstances then med school would have definitely been the route I would have gone. I also knew I wanted to do EM which plays a factor in that thinking I guess. 

[EMEDPA]

yup, lots of mobility for docs. An FP boarded doc can do all of the following and more:

clinic, ER, hospitalist, OB with sections, treadmills, all scopes, vasectomies, derm, hormone replacement , sports medicine, psych, ICU coverage, etc

Essentially the only thing an FP doc can not do is operative stuff (other than c-sections) or administering anesthesia. 

[lemurcatta]

On 10/1/2018 at 8:45 AM, FiremedicMike said:

Nontrad Pre PA/MD/DO/NP student here..

For the mid-level position, if you could do it over again but it was 2018 with the current climate, would you still choose PA over NP? 

I speak as someone who will, at the time of matriculation, have 25 years of experience as a firefighter/paramedic/EMS Instructor, which IMHO is more than enough to compensate for a lack of RN experience if I were to venture into a direct entry NP program.  My question for you guys is, why would I choose PA over NP?  As I look at the prerequisite course load for both programs, the time investment while in both programs, and then the practice environment post graduation (which appears to be identical for both pathways), I struggle to find a reason to go the PA route over the NP route.

 

I truly and honestly didn't post this to start an NP vs PA war, but it is truly a decision that I struggle with.  UGoLong and I have had coffee together and can attest to my genuine interest in this topic.  I know his thoughts, but I'd love to hear from the rest of you!

I’m also a medic who chose the PA route over NP. I’ll tell you why I’m happy with that decision. And I am not bashing anyone or any role, simply saying why I went where I did. If you want a Mac, you go to an Apple store and not a Microsoft store. 

Over my career, I have obviously interacted with hundreds and hundreds of nurses. Probably in the thousands. I see how they think, and while I love them, I don’t want to be trained to think that way. Nursing is a silo at universities (generally, obviously exceptions exist). They seperate themselves from medicine by definition. When I looked at Np programs and PA programs, that was something that stood out: many PA programs (obviously exceptions exist) are parts of medical schools and share classes and faculty with the MD programs. That is what I wanted. Nursing programs (obviously exceptions exist) generally are their own thing with their own faculty. They even have textbooks written for APNs by APNs. It seems very different.

Now in my first year, I’m pretty happy. We are not limited here. Our lectures often are the same subject experts that teach the medical students. We have a real anatomy lab with our medical students. That is something I valued. We are already put into early patient care at our academic medical center. There are grand rounds and specialty talks, and a generally intellectual and team based atmosphere. I’m literally sure it’s not all sunshine and roses but at the same time, it’s most of what I envisioned. I can’t imagine getting the same experience from a lot of the local online/hybrid DNP FNP programs that are not affiliated with academic centers and ask you to find your own rotations. But you do get to work while going to school that route. Definitely not possible in our program.. 

[EndBulbsOfMouse]

2 hours ago, EMEDPA said:

yup, lots of mobility for docs. An FP boarded doc can do all of the following and more:

clinic, ER, hospitalist, OB with sections, treadmills, all scopes, vasectomies, derm, hormone replacement , sports medicine, psych, ICU coverage, etc

Essentially the only thing an FP doc can not do is operative stuff (other than c-sections) or administering anesthesia. 

Theoretically he could, but I guess no hospital would give him privileges.  But, legally speaking, he could open up his own practice if he was crazy enough and took on the liability.  I do know of one old FP doc who does appys in a very rural area but I think that won’t happen anywhere anymore. Which amounts to the same thing hah.

[ravenspac]

No. Too many administrators  who have no interest in healthcare...and PA's have little voice

 

If I was young and cared about school instead of sports and girls, I would try in HS and college and then either go MD or just be a Vet. At least then you have more mobility and leverage 

[TWR]

Back to the original question.  I can no longer recommend being a PA to anyone.  Corporate medicine is taking over all of medicine.  The CEO of LIJ/NSH made 9 million last year!!   HMMM maybe they do know more than those that practice it!  There will be plenty of jobs for PA's and you will be told when to turn right or left, up or down.  Autonomy will definitely be gone.  Even physicians see the handwriting on the wall and who pays for all this nonsense in the end are the patients.My first years of practice in Family medicine in Queens, NY from 1986-2004 were the absolute best years of my life in medicine.  I was treated with respect by physicians and 2 hospitals.  From 2004-present  absolutely down hill on a slow but steady decline   (in Houston the past 14 years).

[EMEDPA]

On 10/2/2018 at 11:39 AM, EndBulbsOfMouse said:

Theoretically he could, but I guess no hospital would give him privileges.  But, legally speaking, he could open up his own practice if he was crazy enough and took on the liability.  I do know of one old FP doc who does appys in a very rural area but I think that won’t happen anywhere anymore. Which amounts to the same thing hah.

I know of 2 groups of fp docs in the rural communities in which I work who do all of these things and have hospital privileges. they just needed to demonstrate training in these procedures. for most of these procedures(with the exception of c-sections which one can pick up in residency) that means attending a short weekend to 1 week course. at my last job I had to get hospital credentialing to do exercise stress tests in our obs unit. this involved showing my acls card,  observing 10, reading a short article, and taking a test.

[EMEDPA]

44 minutes ago, TWR said:

Back to the original question.  I can no longer recommend being a PA to anyone.  Corporate medicine is taking over all of medicine.  The CEO of LIJ/NSH made 9 million last year!!   HMMM maybe they do know more than those that practice it!  There will be plenty of jobs for PA's and you will be told when to turn right or left, up or down.  Autonomy will definitely be gone.  Even physicians see the handwriting on the wall and who pays for all this nonsense in the end are the patients.My first years of practice in Family medicine in Queens, NY from 1986-2004 were the absolute best years of my life in medicine.  I was treated with respect by physicians and 2 hospitals.  From 2004-present  absolutely down hill on a slow but steady decline   (in Houston the past 14 years).

to be fair, this probably has a lot to do with it. TX is known for not being particularly PA friendly.

[lkth487]

Maybe I am in the minority, and I am definitely in one of the happiest specialties in medicine but I love what I do.  I'd go back and do medical school again in a second if I had to do it again.

[ravenspac]

17 hours ago, lkth487 said:

Maybe I am in the minority, and I am definitely in one of the happiest specialties in medicine but I love what I do.  I'd go back and do medical school again in a second if I had to do it again.

Derm?

[EMEDPA]

2 minutes ago, ravenspac said:

Derm?

he is an MD Neonatologist

[GapLustrum]

I'd be curious to see research on burnout/regret with more detailed questionnaires. Like what specialty, what hours, nights?, call?, what gender, what age, what previous careers, what city, what monthly expenses, what political views, how many children and how old, how much sleep do you get, how often do you exercise, how often do you meditate, how often do you spend time with friends, how often do you volunteer etc. It seems like such an individual thing that people really shouldn't be too swayed by any one opinion unless you consider yourself very aligned with that person both circumstantially and philosophically.

[lkth487]

1 hour ago, GapLustrum said:

I'd be curious to see research on burnout/regret with more detailed questionnaires. Like what specialty, what hours, nights?, call?, what gender, what age, what previous careers, what city, what monthly expenses, what political views, how many children and how old, how much sleep do you get, how often do you exercise, how often do you meditate, how often do you spend time with friends, how often do you volunteer etc. It seems like such an individual thing that people really shouldn't be too swayed by any one opinion unless you consider yourself very aligned with that person both circumstantially and philosophically.

I haven't seen it broken down that, much, but here it is by specialty:

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/212212

Highest percentage in "very satisfied" category:  Geriatrics, Neonatology,  Derm and Pediatrics.  

 

Interestingly, Neonatology has a lot of hours.  And Geriatrics and general pediatrics are amongst the lowest paid specialties in medicine.   Derm is no surprise with low amount of work hours and good pay.  But overall, there seems to be no relationship whatsoever between pay and satisfaction (most surveys rate the surgical specialties as very low satisfaction despite high pay).  There is some relationship between hours and satisfaction but not a strong one.   I've seen other surveys but geriatrics, derm and pediatrics (and pedi specialties like PEM and neonatology) tend to always be at or near the top.  And 3 out of those top 4 specialties are pretty easy to match into (derm is super hard) - even people who well below average in med school match into them.   I was an 'average' med student in terms of boards, grades, class rank, etc (I think my class rank was around 75-80, out of around 140 total).  I had ZERO issues matching into very well regarded places for both residency and fellowship for neonatology (matched by #2 pick for residency and #1 pick for fellowship).

 

6 hours ago, EMEDPA said:

he is an MD Neonatologist

Only a fellow so far!