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Hey there,

I know there are a bunch of other LECOM/APAP posts but anyways here we go! I was just accepted into next years APAP (PA>DO 3 year) program as an undeclared seat. I applied to the program almost a year ago when I was very frustrated, working at an urgent care and receiving little respect, autonomy, and poor pay.

Now I work in Family Med, practice with near autonomy, and am compensated incredibly well given that it’s FM (150-180k). I love my job and for every 1 ignorant patient I have that “wants to see the real doctor”, I have 10 that refuse to see anyone but me. 

Me: 29yo, practicing 3 years, living in Florida, newly engaged, no kids. 

The APAP program consists of 2 years that must be done in Greensberg, Pennsylvania and year 3 of clinicals can be done near home. Then it’s 3+ years of residency that I guess could end up being anywhere. I would choose either Emergency Med or Family Practice  

Money: not really a factor. Between lost income, tuition, living expenses, I would look at a cool $1 million I estimate over 6 years. And if I remain in family med, the salary increase isn’t huge. EM would be significant though  

Scope: I work autonomously, but in a team setting, which I believe medicine should always be. Docs consult with docs, PAs with NPs; it’s team based but still autonomous. Of course in EM, the scope would be greatly increased (at least in Florida)

Respect: some patients would stop being idiots about how they treat me, and I would have less push back from insurance, hospitals, etc. And administration would stop treating me as a “mid level” (a phrase i detest).

Knowledge: I believe experience = knowledge, not schooling. I have learned much more in 3 years of practice than in 2 years of PA school. Residency would be very valuable, but I’m exposed to new things daily as it is and am always expanding my knowledge and skills. 

The decision to go or not is huge and it’s eating me up. I’m hoping some outside opinions from fellow PA’s might help. I have to give a decision in 2 weeks! 

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1. Where on earth in Florida are you that you are making those numbers?? I’m in south Florida and that is very high for the area. Pay here is abysmal  

2. Agree with above..continue with med school if you plan to do EM.  

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Tough descion, if you plan to do FM in the future, esp with an ongoing OTP movement. If PA's can  soon get to practice Primary care without supervision, going back to med school to practice family med would be a terrible idea (while losing one million dollar in the process). For EM, no brainier.  Go to med school. Either way, since you're only 29 and single,  you should go back to school

Edited by ArmyVetDude

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Go or you will regret it. If you decide it's not for you, there's always a return to the PA profession. You've worked hard for this, it's a wonderful opportunity and in the long term, will afford you more opportunities. Good Luck!

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3 hours ago, ArmyVetDude said:

Tough descion, if you plan to do FM in the future, esp with an ongoing OTP movement. If PA's can  soon get to practice Primary care without supervision, going back to med school to practice family med would be a terrible idea (while losing one million dollar in the process). For EM, no brainier.  Go to med school. Either way, since you're only 29 and single,  you should go back to school

agree with this sentiment , but doubt it would be "soon" in Florida. It might be soon elsewhere(ND, MI, WA, MT, VT, ME, AK, NM), but FL is not very PA progressive and will likely be slow adopters.

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Thanks everyone for the input. But, I’m not single - I’m newly engaged and will be married within the next year. I was very fortunate to find a Primary Care group that I love and pays me by productivity and very (unusually) generously. There are NO residency options in the area so the 3 years of residency would absolutely be away from home. The possibility of future regret seems to be legitimately the only reason to do it. It’s as impossible to predict what regret I would feel in 5-10 years as it is to predict where the PA profession will be. Ugh, this is the toughest decision...

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The feeling doesn’t go away if that’s what you want. I’m in my first year of medical school now after 4 years as an EM PA. You’ve got a great opportunity on your plate, having been accepted somewhere. Feel free to PM me if u have any questions about the first year! 

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Granted, I'm just graduating and entering the workforce but I wouldn't do it unless I was 100% sure I wanted to go into EM. I have too many other passions in life to give up 6 years to wind up back in virtually the same place.

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12 hours ago, guiriguiri said:

Granted, I'm just graduating and entering the workforce but I wouldn't do it unless I was 100% sure I wanted to go into EM. I have too many other passions in life to give up 6 years to wind up back in virtually the same place.

Except 2-3x more pay.  Don't care much about respect. Money is the sole factor here. 

But if he does go into FM, he won't be making that much more than he is now. that would not be worth it for me.

Edited by ArmyVetDude

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16 hours ago, canada202 said:

Thanks everyone for the input. But, I’m not single - I’m newly engaged and will be married within the next year. I was very fortunate to find a Primary Care group that I love and pays me by productivity and very (unusually) generously. There are NO residency options in the area so the 3 years of residency would absolutely be away from home. The possibility of future regret seems to be legitimately the only reason to do it. It’s as impossible to predict what regret I would feel in 5-10 years as it is to predict where the PA profession will be. Ugh, this is the toughest decision...

I am sure there are plenty of residencies in FL for family med or em. you need to dig a bit deeper. 

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1 hour ago, ArmyVetDude said:

Except 2-3x more pay.  Don't care much about respect. Money is the sole factor here. 

But if he does go into FM, he won't be making that much more than he is now. that would not be worth it for me.

FM MD does not equal FP PA. an FP MD can do ob with c-sections, work as a hospitalist, cover a rural ER, do treadmills, vasectomies, scopes, cosmetic derm, sports medicine, etc. A smart primary care physician can make > 300k/yr. 

If the OP only wants to do primary care in a clinic, then I agree with your statement, but family medicine as a specialty for docs allows so much more than that. 

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34 minutes ago, EMEDPA said:

FM MD does not equal FP PA. an FP MD can do ob with c-sections, work as a hospitalist, cover a rural ER, do treadmills, vasectomies, scopes, cosmetic derm, sports medicine, etc. A smart primary care physician can make > 300k/yr. 

If the OP only wants to do primary care in a clinic, then I agree with your statement, but family medicine as a specialty for docs allows so much more than that. 

I have worked with FM docs that do OB mostly involving spontaneous vaginal delivery,  ER and hospitalist coverages and sports medicine. However all of them were in rural areas. In LA or NYC many of them do not even perform war removals or I&D. Have not met heard about any FM in NYC delivering any baby. But you are right, they are trained to be able to do all that. In fact I would say that they are even better suited to run urgent care centers than EM docs for various reasons. 

Edited by ArmyVetDude

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9 minutes ago, ArmyVetDude said:

I have worked with FM docs that do OB mostly involving spontaneous vaginal delivery,  ER and hospitalist coverages and sports medicine. However all of them were in rural areas. In LA or NYC many of them do not even perform war removals or I&D. Have not met heard about any FM in NYC delivering any baby. But you are right, they are trained to be able to do all that. In fact I would say that they are even better suited to run urgent care centers than EM docs for various reasons. 

yup, I can't imagine doing FP in a big city. you would just be a referral machine. 

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It depends on how much emphasis you want to put on your career and what your life looks like outside of that. I don't think it's a clear cut "go for it" like some are suggesting. Sounds like you already have a pretty sweet gig with exceptional pay. Personally, I'd just ride that gravy train for awhile, save/invest a lot of your paycheck, and try to retire early...

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1 hour ago, HanSolo said:

It depends on how much emphasis you want to put on your career and what your life looks like outside of that. I don't think it's a clear cut "go for it" like some are suggesting. Sounds like you already have a pretty sweet gig with exceptional pay. Personally, I'd just ride that gravy train for awhile, save/invest a lot of your paycheck, and try to retire early...

Have to agree here. I am going to play Devil’s Advocate for a second...

You are a good enough candidate that you should look in to other med schools that are closer if you really want that route. The money may be better, but you have to consider the possibility of totally locking yourself in to medicine also. Once you invest another 6 years and 200k, you are pretty much doing FP or EM medicine for a good 10-15 years longer to even consider it really paying off. You’ve already seen the frustrations of medicine elsewhere. I will give you a hint, there are FAR more places/experiences like the urgent care where you worked than the job you have now (i.e. with respect, good pay, location & specialty you want) or potentially your job in the future. 

Edited by printer2100

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Do you trust the opinion of any of the physicians you work with currently?  That they’d give you advice that was in your best interest, not theirs? They may be able to give you a perspective you don’t have and they are already familiar with what you are working in. 

 

The grass always looks greener... but your pasture seems to be pretty damn green already. 

Edited by anewconvert
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It sounds to me like you have it pretty good currently.  How much do you want this?  Can you be happy as you are now?

I'm not a fan of these bridge programs in general.  It's like telling people, "look, being a PA isn't the best choice.  And once you figure that out you can go on to be a physician, which is what everyone really wants anyway - am I right."  Good PAs should stay PAs and try and improve that profession.  Not leave it for a "better" one.

It sounds like you've got it cushy and have high ratings in the aspects of medicine that matter - money, lifestyle, respect, autonomy.  So, unless this is the burning desire of your heart, I say stay put and be content. 

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On 12/3/2018 at 12:06 PM, PAC94 said:

1. Where on earth in Florida are you that you are making those numbers?? I’m in south Florida and that is very high for the area. Pay here is abysmal  

2. Agree with above..continue with med school if you plan to do EM.  

I started at 150k in FL internal med. 

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Really well thought out opinions. 

-I won't ever be working rural @EMEDPA, so "standard" FM practice would be the plan. Based on my searches, the nearest DO EM residencies are miami/orlando which is 3 hours. There is one residency near me and it is internal med with 12 spots.

- @ArmyVetDude, yes 2-3x more pay in either FM or EM. The docs in my practice clear 300-400k seeing 30 pts/day which is incredible IMO. BUT factoring in the ~$1mill in lost wages, tuition, etc over 6 years, money becomes less significant.

- @HanSolo, the quick/auto answer is go for it, which PA friends/colleagues say. Once they think about it, you're right, I have a sweet gig that would be tough to improve upon. 

- @printer2100, this is probably the most significant reason why I chose PA in the first place. I love the flexibility of being able to drop everything and go start a career in another specialty or move to another state and fairly easily slide into a practice. As a FM doc, it's very different and requires building a practice. Being "stuck" in the whatever specialty I went to med school for is scary. 

- @anewconvert, the two docs I work closest with wrote me glowing recommendations for school and one of them who is a mentor to me has been telling me since the day I entered PA school that I should be a physician. Not because he thinks PAs/NPs are lesser, but rather that he knows I wouldn't have an issue getting through med school and that he believes residency is invaluable, so in his mind it's a no brainer. But you nailed it. The grass IS always greener... I could easily picture myself as a physician in 6 years working my butt off thinking why the $#@$ did I not keep the cushy PA lifestyle I had!

- @Kaepora, this is basically what my fiance told me. I could be a good doctor, or I could work towards being the best PA I could be. 

Really, really leaning towards declining. Everyone is echoing my sentiments exactly. 

 

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As a DO you can apply for the MD match. In fact, they are combining all the md/do match lists in the next few years anyway. 

As an FP doc it is easy to not own a practice and make your practice whatever you want to do from hospitalist to em, etc, locums is a good option as well. work 3 months on, 1 month off, etc. 

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Curious as to why you're tied to where you are in Florida? Most physicians and PAs had to move for school, residency and/or work. Better to do it now before you have kids and live in a "good school district". 

Another possibility to explore is to ask LECOM if you can defer your acceptance for a year. I don't know if med schools do this or not, but a lot of colleges at least allow this.

I would generally agree with the consensus here: you didn't apply to med school for the money back when you were working in urgent care, and you were lucky enough and talented enough to get a slot in a 3 year program. You'll never regret having gone to med school, especially if the money isn't a big factor for you. You might be miserable while you're in school and residency, but I guarantee you're not going to be a fully autonomous practicing physician making north of $300K and be like, "darn I wish I would've just stayed a PA". The possibility that you regret NOT taking this opportunity though is huge. Pascal's Wager dictates you should take the safer bet.

I would say I'm sorry you have to make this tough decision, but I'm not.

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21 minutes ago, EMEDPA said:

As a DO you can apply for the MD match. In fact, they are combining all the md/do match lists in the next few years anyway. 

For what it’s worth, the AMA said today that they will view the USMLE and COMLEX equally too. Which was a big concern for DOs going into the new match. 

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One point; what happens when these docs are no longer around or retire? Reality is PAs are tied to a physician and as long as you have a great relationship everything is rosy. That could all change unless PAs gain full independent practise (unlikely to happen soon) or you get to buy into that practise as a full partner. 

If you're worried about the lost income, live like a resident now, during school, residency and post residency. If you can manage it, work a day or two while in school. Recouping that 1 million is achievable if you dont spend like a sailor and feel the need to keep up with the joneses. In the end, you'll have more options as a MD/DO vs PA including higher income, the credentials for advancement (in many fields) and the portability of your degree internationally. 

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20 minutes ago, montanapup said:

One point; what happens when these docs are no longer around or retire? Reality is PAs are tied to a physician and as long as you have a great relationship everything is rosy. That could all change unless PAs gain full independent practise (unlikely to happen soon) or you get to buy into that practise as a full partner. 

If you're worried about the lost income, live like a resident now, during school, residency and post residency. If you can manage it, work a day or two while in school. Recouping that 1 million is achievable if you dont spend like a sailor and feel the need to keep up with the joneses. In the end, you'll have more options as a MD/DO vs PA including higher income, the credentials for advancement (in many fields) and the portability of your degree internationally. 

agree. I have several PA to md/do friends. they all worked during medschool and residency and none regret their decision to go back to school. as an em resident you can make about 100k/yr by moonlighting 2nd and 3rd yr. add that to an em resident salary and you are around your current salary. do FP instead and you could get loan repayment. 

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