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Hello everyone,

I’m not sure if this is the right sub-forum to post this under (and I also apologize if it posts twice), but I’m hoping to gain advice and perspective from current and seasoned PAs.

I recently graduated from undergrad with a BS in Biology and have been torn in the classic MD vs PA debate in which path to follow. Recently, I have been leaning towards PA with the biggest reasons being less time in school, more flexibility in terms of specialities, being able to enjoy and be working during my 20s and hopefully having a better work-life balance. The idea of physician supervision or collaboration doesn’t bother me, but I have been interested in seeing how that would be affected by the current Covid-19 pandemic.

After much googling, watching the news, and reading discussions upon discussions posted here, I am confused and conflicted even more so. I have seen multiple discussions lamenting the lack of support and recognition for all the PAs out there and it makes me scared I may be making the wrong choice.
 

To sum, looking for advice from current or seasoned PAs if taking this path versus any others (MD, NP, etc.) is worth it given the way things are going during this pandemic and the way they might go post-pandemic?

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10 minutes ago, Cideous said:

MD first, NP second and PA distant 3rd at this point in medicine.

 

I take no joy in recommending the fields in this order.

I agree.  The winds are not blowing the right direction for the PA option unless something dramatic were to change.  Even though things timed out perfectly for myself, EMEDPA and myself have played the game of "what if" with regard to attempting med school.  Back in my window, late 70's early 80's I would've had to be MENSA caliber to get in with the way the competition was.  There weren't med schools on every street corner.

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I think you should look at each of your reasons to consider PA vs physician separately:

  • Better work/life balance: completely false.  PA's schedules match those of the physicians or are often slightly worse.  I do EM and have for 7 years.  My shifts have always been similar to the docs until now.  Now, I do solo overnight coverage while the doc does solo day coverage at my hospital.
  • Ability to switch areas of medicine: currently true, but becoming less so as more employers are looking for in field experience.
  • Less time in school: very true - 2.5 years of a master's program vs 4 years of medical school plus 3-many years of residency for a physician.
  • Starting work sooner: yes, due to the above

Other things that are relevant:

  • Earning power: as a PA you're lucky if you're making 45% of what a physician in your field makes and the gap is much wider in specialties, especially surgical ones.  This is the reward for a much higher front end investment in education.
  • Getting the 1st job as a PA is getting harder, for all the reasons you've seen here: rapid growth in the number of new grad PA's every year, and the massive increase in new NP's every year coupled with less restrictive supervisory rules.  The job market for experienced PA's is still good - mostly for changing jobs within their area of experience.

PA is my 3rd career, so there weren't enough years left in my work life to make physician pay out.  I have a job I really enjoy.  However, had I started down the same path 10 years earlier, I would have pursued medical school - probably as a DO.

The key you should focus on, and this is the same that I advise all PA hopefuls who shadow me, is to carefully consider the upfront investment in becoming a physician and the much higher payout in terms of responsibility and compensation vs the more rapid transition to work as a PA.  Decide which is best for you.

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7 minutes ago, ohiovolffemtp said:

I think you should look at each of your reasons to consider PA vs physician separately:

  • Better work/life balance: completely false.  PA's schedules match those of the physicians or are often slightly worse.  I do EM and have for 7 years.  My shifts have always been similar to the docs until now.  Now, I do solo overnight coverage while the doc does solo day coverage at my hospital.
  • Ability to switch areas of medicine: currently true, but becoming less so as more employers are looking for in field experience.
  • Less time in school: very true - 2.5 years of a master's program vs 4 years of medical school plus 3-many years of residency for a physician.
  • Starting work sooner: yes, due to the above

Other things that are relevant:

  • Earning power: as a PA you're lucky if you're making 45% of what a physician in your field makes and the gap is much wider in specialties, especially surgical ones.  This is the reward for a much higher front end investment in education.
  • Getting the 1st job as a PA is getting harder, for all the reasons you've seen here: rapid growth in the number of new grad PA's every year, and the massive increase in new NP's every year coupled with less restrictive supervisory rules.  The job market for experienced PA's is still good - mostly for changing jobs within their area of experience.

PA is my 3rd career, so there weren't enough years left in my work life to make physician pay out.  I have a job I really enjoy.  However, had I started down the same path 10 years earlier, I would have pursued medical school - probably as a DO.

The key you should focus on, and this is the same that I advise all PA hopefuls who shadow me, is to carefully consider the upfront investment in becoming a physician and the much higher payout in terms of responsibility and compensation vs the more rapid transition to work as a PA.  Decide which is best for you.

I don't have anymore likes/thumbs up for today, but I concur with the above.  

To the OP, what I will add is that if you're female, sincerely think hard about becoming an "assistant." You will encounter biases in the medical field as a woman, even as a physician, but especially as a PA and doubly so as a young female PA. NPs get to at least call themselves "doctor." 🙄 Sad but true. Also, male PAs are paid more than female PAs. This seems to be across the board in a lot of fields, however.  

Also, consider the additional schooling required for doing NP vs PA at this point. You'd have to get your BSN, etc, unless I'm mistaken.  

Looking back, I would've still gone PA given my circumstances and desires, but more and more nowadays do I think of "what if" I quit being a PA and went to med school. It's on the back burner for now. 

Think long and hard about it. Doing med school now would be much "easier" than later but not impossible. But there are sacrifices and consequences as there are with any decision. Do what's best for you. 

@CVTSPA practiced for a couple years as a PA before doing med school and he's finishing up this year. A few others on here as well. Perhaps he can provide additional insight. 

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1 hour ago, ohiovolffemtp said:

I think you should look at each of your reasons to consider PA vs physician separately:

  • Better work/life balance: completely false.  PA's schedules match those of the physicians or are often slightly worse.  I do EM and have for 7 years.  My shifts have always been similar to the docs until now.  Now, I do solo overnight coverage while the doc does solo day coverage at my hospital.
  • Ability to switch areas of medicine: currently true, but becoming less so as more employers are looking for in field experience.
  • Less time in school: very true - 2.5 years of a master's program vs 4 years of medical school plus 3-many years of residency for a physician.
  • Starting work sooner: yes, due to the above

Other things that are relevant:

  • Earning power: as a PA you're lucky if you're making 45% of what a physician in your field makes and the gap is much wider in specialties, especially surgical ones.  This is the reward for a much higher front end investment in education.
  • Getting the 1st job as a PA is getting harder, for all the reasons you've seen here: rapid growth in the number of new grad PA's every year, and the massive increase in new NP's every year coupled with less restrictive supervisory rules.  The job market for experienced PA's is still good - mostly for changing jobs within their area of experience.

PA is my 3rd career, so there weren't enough years left in my work life to make physician pay out.  I have a job I really enjoy.  However, had I started down the same path 10 years earlier, I would have pursued medical school - probably as a DO.

The key you should focus on, and this is the same that I advise all PA hopefuls who shadow me, is to carefully consider the upfront investment in becoming a physician and the much higher payout in terms of responsibility and compensation vs the more rapid transition to work as a PA.  Decide which is best for you.

Agreed.  This sums it up very well.  I would also reinforce that getting a job now as a PA fresh out of school is getting harder and harder for the reasons mentioned.  If I was 25 and doing it again, I would become a NP and star in my own show with their autonomy victories they have won in now over 30 states.  PA's have what...one state with OTP?  This is a no brainer to me.  Not to mention less debt.  You can work as an RN while going to NP school.  Can't do that as a PA hence PA's graduate with a LOT more debt.

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1 hour ago, ohiovolffemtp said:

I think you should look at each of your reasons to consider PA vs physician separately:

  • Better work/life balance: completely false.  PA's schedules match those of the physicians or are often slightly worse.  I do EM and have for 7 years.  My shifts have always been similar to the docs until now.  Now, I do solo overnight coverage while the doc does solo day coverage at my hospital.
  • Ability to switch areas of medicine: currently true, but becoming less so as more employers are looking for in field experience.
  • Less time in school: very true - 2.5 years of a master's program vs 4 years of medical school plus 3-many years of residency for a physician.
  • Starting work sooner: yes, due to the above

Other things that are relevant:

  • Earning power: as a PA you're lucky if you're making 45% of what a physician in your field makes and the gap is much wider in specialties, especially surgical ones.  This is the reward for a much higher front end investment in education.
  • Getting the 1st job as a PA is getting harder, for all the reasons you've seen here: rapid growth in the number of new grad PA's every year, and the massive increase in new NP's every year coupled with less restrictive supervisory rules.  The job market for experienced PA's is still good - mostly for changing jobs within their area of experience.

PA is my 3rd career, so there weren't enough years left in my work life to make physician pay out.  I have a job I really enjoy.  However, had I started down the same path 10 years earlier, I would have pursued medical school - probably as a DO.

The key you should focus on, and this is the same that I advise all PA hopefuls who shadow me, is to carefully consider the upfront investment in becoming a physician and the much higher payout in terms of responsibility and compensation vs the more rapid transition to work as a PA.  Decide which is best for you.

Agree with all this. I would have done the physician route as well with everything I know now. I would not have ever chosen the NP route. I've been in a master's nursing program and I'm very happy I changed to the PA route. I don't mean to offend any NP poster's we have here, and my anecdote is only from one NP program, but I learned way more in PA than I would have in the NP program. 

That said, I'm really happy in my position now. I work at a facility with that loves me and the EM knowledge I bring from residency, a really awesome EM director who truly treats me like a colleague,  great hours, full scope EM, good pay, great benefits. I don't think I could be much happier even as a physician. 

Further, I just spent 3 months trying to get a friend who is a FNP new grad a job in my state where they have independence, while I got 2 more inquiries about other positions. A huge part of that is my experience, but just goes to show the grass isn't always greener on the other side. 

 

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2 hours ago, LT_Oneal_PAC said:

Agree with all this. I would have done the physician route as well with everything I know now. I would not have ever chosen the NP route. I've been in a master's nursing program and I'm very happy I changed to the PA route. I don't mean to offend any NP poster's we have here, and my anecdote is only from one NP program, but I learned way more in PA than I would have in the NP program. 

That said, I'm really happy in my position now. I work at a facility with that loves me and the EM knowledge I bring from residency, a really awesome EM director who truly treats me like a colleague,  great hours, full scope EM, good pay, great benefits. I don't think I could be much happier even as a physician. 

Further, I just spent 3 months trying to get a friend who is a FNP new grad a job in my state where they have independence, while I got 2 more inquiries about other positions. A huge part of that is my experience, but just goes to show the grass isn't always greener on the other side. 

 

Don't take this the wrong way...it's actually a compliment, but you are the exception...not the rule.

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13 minutes ago, Cideous said:

Don't take this the wrong way...it's actually a compliment, but you are the exception...not the rule.

I have no illusions that my situation is easy to attain. I’ve worked pretty damn hard to get here. I could have finished the NP route. It would have been way easier. I would not have been happy though missing out on the broader knowledge of general medicine. I could have gone straight from the military to EM. My director even asked why I would come back to residency after working independently, that anyone would hire me. But I wouldn’t have been happy until I was doing full scope EM, which may have taken years or never happened without residency. I’m not sure what my DMS is going to bring, but more education has done nothing but bring me good fortune so far. 
 

my point is, one has to know what’s important to them. For me, that was knowledge and for that knowledge to be recognized with an appropriate scope. I didn’t want to be granted that scope without that knowledge. I wouldn’t have gotten here really any other way other than the path I took or being a physician. Hopefully the profession will continue to push and jobs like mine will be easier to come by. 

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7 hours ago, ANESMCR said:

I’m going to give you the best advice you’ll ever get right now. Don’t be a PA, NP, or MD. Go get your BSN within a year. Work on the floor for a year or two. Go to CRNA school.

Again, it depends on what you want. If you want to just make some good money CRNA all the way. High pay and generally low stress. I was in a CRNA program for 22 months before I left. 
 

just to list some things people don’t see until you’re in it

- if you are working in an academic center, you’re always going to play second fiddle to the MDA. You’re not going to get the big cases. You’re not going to have the last say in the anesthetic plan. More than likely the MDA is going to always be present when you push induction meds and intubate. Just like NP and PA, you have to go away from the big cities to run the ship. Depending on the state, you may also be competing with AAs at bigger centers. 

- you are there to facilitate surgery. Unless you’re doing pain management, patients aren’t there to see you. So you are de facto at the will of the physician. He can’t tell you what to do, but you can’t just do whatever anesthetic plan you want. It’s a partnership between you, and surgeons in my experience aren’t the chilliest people. You may love regional, but your surgeon likes everyone out. It may take convincing to try new things. When the chips fall, the hospital will side with the person that makes them money.

- right now, a lot of CRNAs are being furloughed. Elective cases are way down. Some people outright let go. These people have one option find another CRNA job or go back to the bedside. No job is perfectly secure, but generalists are better able to adapt.

- since no one understands what you do, you catch a lot of blame for weird complications. It’s a highly litigated field.

 

 

 

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On 4/7/2020 at 2:49 AM, ANESMCR said:

I’m going to give you the best advice you’ll ever get right now. Don’t be a PA, NP, or MD. Go get your BSN within a year. Work on the floor for a year or two. Go to CRNA school.

 

21 hours ago, LT_Oneal_PAC said:

Again, it depends on what you want. If you want to just make some good money CRNA all the way. High pay and generally low stress. I was in a CRNA program for 22 months before I left. 
 

just to list some things people don’t see until you’re in it

- if you are working in an academic center, you’re always going to play second fiddle to the MDA. You’re not going to get the big cases. You’re not going to have the last say in the anesthetic plan. More than likely the MDA is going to always be present when you push induction meds and intubate. Just like NP and PA, you have to go away from the big cities to run the ship. Depending on the state, you may also be competing with AAs at bigger centers. 

- you are there to facilitate surgery. Unless you’re doing pain management, patients aren’t there to see you. So you are de facto at the will of the physician. He can’t tell you what to do, but you can’t just do whatever anesthetic plan you want. It’s a partnership between you, and surgeons in my experience aren’t the chilliest people. You may love regional, but your surgeon likes everyone out. It may take convincing to try new things. When the chips fall, the hospital will side with the person that makes them money.

- right now, a lot of CRNAs are being furloughed. Elective cases are way down. Some people outright let go. These people have one option find another CRNA job or go back to the bedside. No job is perfectly secure, but generalists are better able to adapt.

- since no one understands what you do, you catch a lot of blame for weird complications. It’s a highly litigated field.

 

 

 

 

On 4/6/2020 at 9:20 AM, mj12789 said:

Hello everyone,

I’m not sure if this is the right sub-forum to post this under (and I also apologize if it posts twice), but I’m hoping to gain advice and perspective from current and seasoned PAs.

I recently graduated from undergrad with a BS in Biology and have been torn in the classic MD vs PA debate in which path to follow. Recently, I have been leaning towards PA with the biggest reasons being less time in school, more flexibility in terms of specialities, being able to enjoy and be working during my 20s and hopefully having a better work-life balance. The idea of physician supervision or collaboration doesn’t bother me, but I have been interested in seeing how that would be affected by the current Covid-19 pandemic.

After much googling, watching the news, and reading discussions upon discussions posted here, I am confused and conflicted even more so. I have seen multiple discussions lamenting the lack of support and recognition for all the PAs out there and it makes me scared I may be making the wrong choice.
 

To sum, looking for advice from current or seasoned PAs if taking this path versus any others (MD, NP, etc.) is worth it given the way things are going during this pandemic and the way they might go post-pandemic?

Some hospitals are taking contracts with CRNA companies over MD contracts due to cost. CRNAs can practice independently in some states and may only have an MD for appearances or big cases. While some companies have the tiered structure like the one you describe above, a couple companies I am familiar with in a big metro (non-university hospitals), the CRNAs do the cases they want to do and defer more complex cases to MD instead of the MD dictating which cases the CRNAs do. In fact, one CRNA co is run by a CRNA, just won a contract with a busy hospital and is employing MDs. I'm not sure if this is a recent change than the above info or a regional thing. This would be a good point that the OP should look into if interested.

To the OP, look into perfusion. There's a large need for perfusionists across the nation. Although right now elective cases are being cancelled, urgent and emergent heart surgeries still go on. 

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1 hour ago, SedRate said:

 

 

Some hospitals are taking contracts with CRNA companies over MD contracts due to cost. CRNAs can practice independently in some states and may only have an MD for appearances or big cases. While some companies have the tiered structure like the one you describe above, a couple companies I am familiar with in a big metro (non-university hospitals), the CRNAs do the cases they want to do and defer more complex cases to MD instead of the MD dictating which cases the CRNAs do. In fact, one CRNA co is run by a CRNA, just won a contract with a busy hospital and is employing MDs. I'm not sure if this is a recent change than the above info or a regional thing. This would be a good point that the OP should look into if interested.

To the OP, look into perfusion. There's a large need for perfusionists across the nation. Although right now elective cases are being cancelled, urgent and emergent heart surgeries still go on. 

There have been lots of CRNA owned companies for a while. There is no doubt the money is great especially if you can get a partner track.

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52 minutes ago, LT_Oneal_PAC said:

There have been lots of CRNA owned companies for a while. There is no doubt the money is great especially if you can get a partner track.

Interesting, thanks for sharing. CRNA-owned companies are more prominent than I thought. I only have an n of 2 that I'm familiar with. 

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@Ohiovolffemtp and @SedRate gave excellent advice and I agree with what they have said, especially the bullet point list @Ohiovolffemtp did!  Just as a little background, I graduated from PA school then went into practice in cardiothoracic and vascular surgery for a few years.  During that time I would moonlight in the ED on weekends before I enrolled in LECOM's APAP program (PA to DO in 3 years instead of 4).  I am now in my last year of med school and graduate in May.  Heading off to a residency in Anesthesiology in July.

The decision to do PA vs MD/DO is one that I thought about for probably 8 or 9 years before finally starting my first day of medical school.  Some of the reasons I went the PA route initially was because I thought it was the fast track to medicine with a high level of respect and autonomy early on, the quality of life would be better, and I would be be able to make similar money because I wouldn't have all the debt of medical school plus I would be able to take advantage of an extra 7 or so years of compound interest from investing.

Turns out, the fast track to medicine comes with some pitfalls.  The PA's I saw while shadowing before going to PA school were the best of the best who had been doing it for at least a decade.  They knew how to manage vents, put in central/arterial lines, take vein/radial pretty quickly, could close the chest without the surgeon in the room, manage patients in the ICU, etc.  Looking back, I was thinking I was just going to do all that cool stuff with one or two years of on-the-job training after I graduate while getting paid twice that of a resident.  Nope.  Turns out there isn't much incentive to teach you that kind of stuff at most places, even at the community hospital I worked at which was constantly short on staff.  There was already a PA to do that stuff, so we can teach you at a leisurely pace over 10 years!  Plus, the respect that the other staff (physicians, nurses, RT, etc) have for you comes with working with them and being good at what you do over a long period of time.  You don't just walk on the floor after you graduate and have swoons from everyone around you just because you have graduated from PA school.  You have to earn it from being good at what you do.  So what happened to that fast track with loads of respect from colleagues?  Takes at least 5 years when you could be finishing medical school and residency in the meantime.

Next was the quality of life.  "PA's work less hours than docs and have less responsibility!"  At least where I worked, every PA I worked with and talked to was working the same or more hours than the physicians.  The PA would pre-round, then go around with the doc (a handshake and review of the plan), then the doc would leave and the PA would do all the notes and orders.  So the PA might pre-round for an hour or two on 10 patients, the doc would round with the PA for 30-40min (sometimes less) on those same 10 patients, then the PA would do notes and orders for another hour after the doc left.  Who was rounding longer and needed to wait to get home to their family with less control over their schedule? The PA.  Same with surgery.  The PA consents the patient in the PACU and sees if there are any issues, gets the patient into the OR, updates the surgical H&P, maybe puts a few preliminary orders in, helps set up, (in my case) starts the vein harvest, then the doc comes in.  The PA first assists during the surgery (still can be fun) but the doc will leave to talk to the family while the PA closes.  The doc usually goes to relax in the break room or round with one of the other PA's on the floor while the PA in the OR transports the patient back to PACU or ICU and pre-ops the next patient. Rinse and repeat. Who was in the OR longer and did more of the paperwork and grunt work?  The PA.  Granted, the doc does the surgical note so that's paperwork too.  In regards to responsibility, yes, the doc is ultimately responsible but you are still at risk for what the doc chooses to do.  Operate on a risky patient that you think is unnecessary?  You don't get a say.  Unhappy with how a surgery was performed? Doesn't matter.  Your name is still tied to the case.  Again, you'll probably not get sued or have severe repercussions for those examples but it sure would be frustrating to go to court over something you knew was dumb to begin with.  Also, remember, if the hospital administration has to pick between who to fire, the PA or the doc?  They will try to pick the PA as they are much easier to replace and don't have as much of an ability to fight back thus the physician profession is more stable.

Furthermore on quality of life, at least where I was in one of the most saturated parts of the country for PA's, the family medicine residents at the hospital got more vacation and CME money compared to the PA's.  They also worked less hours than the CT surgery PA's!  The surgeons I worked with were making at least 4x what I was (25% of their salary) with 9 more years of training but 8 weeks of vacation versus my 2 weeks as a first year PA and the 4 weeks of our senior PA who had been there for 20 years or so.  The hospitalist PA's were getting paid about $100k with a patient load of 15-20 while the docs would not see any patients by themselves and get paid north of $250k.  Who rounded on the weekends, holidays, and took first call except for emergencies?  The PA.  Obviously, the road is much longer for the doc and the benefits as a PA are pretty good compared to your average American job.  But if you're smart, young, don't have a family to tie you down, don't plan on practicing part time until you are at least in your fifties, and are motivated enough to do some sort of specialty, the quality of life increases dramatically for just a few extra years of your youth.

In regards to the financial incentives, the Medscape reports of physician salaries are pretty accurate now that I've talked to multiple physicians across many specialties about their income.  Before PA school, I thought those salaries were inflated and I had to pay for malpractice insurance and other overhead.  They definitely aren't inflated and most physicians are employed now and thus malpractice is taken care of by the hospital you work for so it isn't a factor so much.  Also, remember there are bonuses for physicians.  At least for most PA's I've worked with, the bonuses are much smaller or non-existent for PA's like myself.  Yes, it disappoints me that I will not be maxing out my 401k and and IRA to take advantage of some sweet, sweet compound interest for an extra 8 years with most of those years being in my twenties but it's the price I have to pay for more freedom, independence, stability in my position, and future annual income.

With all that being said, I still really enjoyed my time as a PA.  I learned a lot, did some cool stuff, made some friends who changed my life, and was proud of what I did.  It just made sense for me to go back as I was young, had no family to tie me down, planned on working full time for as long as I can, and just wanted to know more about why we do the things we do.  In the time it would take for me to become the superstar PA I wanted to be, I could have just gone to medical school and did residency and gotten it over with.  Plus, I wouldn't have to deal with the never ending confusion between myself and a medical assistant which happened all the time with both patients AND the hospital that employed me!  No one doesn't know what a physician is.  

If you are similar to me, young, smart, good academic record, not a whole lot to tie you down, and don't plan on being part time immediately upon finishing training, it's probably is better for your own career and bank account to just go to medical school!  If you want the freedom to start living your life as soon as possible with a house, picket fence, and dog with the option of working part time with a good income while your spouse works full time, PA is probably the way to go and there isn't anything wrong with that!  Ultimately, what should influence your decision is how much you are okay with medicine controlling about 8 years of your life.  If those 8 years are much too valuable, then PA is the way to go.  If you are going to be a superstar anyway, might as well get the superstar training.  So far I've learned a lot and look forward to my first year as a physician in July.  Wouldn't change a thing about my life.

If you want to DM me specific questions, feel free!  I get them all the time.

Happy choosing! It's a big decision!

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CVTSPA said it extremely well: " If you are going to be a superstar anyway, might as well get the superstar training."  

If you can spend the up front time, do it, the rewards are definitely there.  Perhaps not in primary care, but certainly in EM, and even more so in specialties.  The other thing to think of is that as a PA you will always run into arbitrary restrictions keeping you from doing things that you could easily do.  In my case, EM, it's things like procedural sedation, medication assisted intubation, and signing mental health holds.  Never mind that as a paramedic I've done medication assisted intubations in the field, the meds for procedural sedation are the same ones as are used for intubations, and I do way more psyche pt's than the docs and just hand them the forms to sign.

I totally respect their additional training and they are invaluable resources for the most complex patients (that's not the same as the most sick).  Just as CVTSPA said, you have to learn the skills and earn the respect.  In a physician residency, that process is built in.  When a doc walks in the door, they walk in to the assumption that "they can".  When a PA walks in the door, they walk in to the assumption that they have to get the doc to do the hard stuff.

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