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Should I go back to Medical school AFTER becoming a PA?

Specialties interested in: Internal or Emergency Medicine

Here are my personal thoughts:

I don't like to disparage my profession, but the way we learned medicine was through memorization of algorithms and buzz words. We were not taught the basics of science from a molecular level working upwards. We basically skipped step 1 and went straight into step 2 clinical knowledge. Doctors can see and understand things we cannot. And make connections that we cannot. I think this is what I am craving for. To be that kind of an “expert.” To understand medicine at that level and solve complex cases. I think the funny stereotypical word for this is “mental masturbation” or “intellectually stimulating” haha. I have the personality type of being the best in whatever I do. I feel limited in that sense as a PA.

Financially, I would say I am kind of lucky. I wouldn’t normally tell this to people, but just to give you guys an idea of my situation. I actually don’t have any loans or interests at the moment after PA school. I paid out of pocket. But I was given some personal loans from close families and friends. I do have to pay them back eventually, but there is no time limit. And they would understand if I decide to pursue medical school. I would still have to take the MCAT, apply, do interviews, and then start the following year (this could take 2-3 years; here I could work as a full time PA and save money for medical school). The medical schools in my state are $100k for 4 years. Which is not bad compared to the crazy $200-400k type of other medical schools.

For family life, wouldn’t it still be possible to have? Instead of working 8 hours a day, I would be studying or going to lectures. And then spend time with my family. Especially since I am not a typical pre-med student. I will be entering with a stronger background knowledge from PA school. However I do understand that the residency years will take a huge toll on my work/life balance for 3 years. (My mom or future wife would still have an income during the 4 years of medical school).

But at the end of it all, won’t I truly be knowledgeable in a field of medicine, from basics to advanced. With the reward of earning a higher income and becoming a doctor (not what I’m going for, but still a benefit). I will be done around age 35 and can work 30 more years until 65. Won’t the money gain as a doctor in that time cover any expenses I had? And then be able to teach the next generation as well, confidently. I have a desire to teach as a professor at PA or MD/DO programs. And precept as well.

This is my current thought process, BUT if you guys think that I am delusional or crazy, please call me out on it! Give me reasons why staying as a PA from age 26 will be better for my life in the long-run. And to not make the mistake of going to medical school for 7 years, with unnecessary stress. I want to hear both sides and arguments really well.

How different is the autonomy in internal or emergency medicine between PA and MD/DO? Can I learn step 1 on my own while working as a PA, and be just as knowledgeable and happy? Or is the in-depth training of medical schools and residencies unmatched? And no amount of clinical experience as a PA can ever replace that? (I have my own thoughts of course since I have done clinical rotations, I just want to hear from what you guys think).

 

***Here are some more of my thoughts that I just private messaged someone:***

Thank you so much for replying, I really need guidance in my life. I am confused and don't know WHAT path is actually WORTH taking.

I love medicine. I have grown super passionate about it. I also love academia. I watch a lot of medical school vlogs and wish I went through the rigorous schooling like they did. PA school felt like a joke to me. It was mainly memorizing buzz words, without understanding the "why's". 

Now, I know I can learn the why's using third party resources on my own - like sketchymedical, boards and beyond, pathoma, premade anki decks, etc. However, if I am going to do that, why not do it through medical school and get rewarded with prestige, money, and autonomy? 

But that does come with its cons - such as a losing lost income as a PA, family time, and basically life. For 7 years. 

I am interested in Internal medicine (hospitalist) or Emergency Medicine. What I want to really know is if there is a huge difference in autonomy, day-to-day job/tasks, etc. Because if it's 90% of the same job, then I am not sure if 7 years of medical school is worth it for me. I know people recommend PA to MD if you want to go into either surgery or a specialization of some sort. 

Basically, is 7 years of medical school worth it for me (I am single and 26 years old; I only need the MCAT to most likely get into this DO program in my home city; this way I can be with family and friends and not miss out on life events). It seems like a fun journey to me, something that I would look forward to.

But there is this other easier, more convenient, and relaxing path - which is to remain as a PA and practice medicine. Earning a six figure salary. Living life. And also studying step 1 material with the resources I mentioned earlier.

*sigh* Do you see my dilemma here. Like what is the right path for me - in terms of happiness, life, money, etc. 

If I were to redo my years of schooling, I would 100% choose medical school. But because I finished PA school and am interested in specialties that might not be that different as a doctor, is it worth it? Because I do realize I will have to go through numerous standardized examinations - MCAT, Step 1, Step 2 CK, Step 3 CS, and residency boards. Also the stress of interviews, applications (both initial and for residency), research papers, etc.

Or will I always regret not going back for medical school?

Edited by SouthUStudent
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I read everything until the halfway point, and stopped myself. 

I really can't speak on work life balance at all because i'm not even a PA student yet. However, the best advice I got from a DO was "if PA is your second pick, then don't do it - and vice versa" (in the context of a similar crisis where I couldn't bear family pressures making me switch from PA to MD/DO). Basically, you'll always have a glimmer of regret if you don't do it. 

If it's the prereqs that will take you longer, there are online ones. There are also MD programs, like Hofstra (where I went for my MPH/Post bacc) where they don't have a set pre req list. If it's beyond the whole mental stimulation thing, there's also the DSMC option after PA school to get the "doctor" title for an extra year of schooling (lynchburg has a good one).

If you end up trying to go back to do MD/DO out of regret that you're already forseeing, I feel like you'd be spending even MORE time in school redoing what you know + a little more. 

 

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Im not sure if you are a still a student or a new grad. But sounds like you have doubts in your current path. It also sounds like you have not traveled long enough to fully explore the PA field. If you really want to ‘master’ medicine (a very specific part of medicine), the MD path is the way to go. We need more physicians! Our name (Assistant) says it all but a lot of colleagues has always seen this as a bad thing. We need to encourage and support those who may be working with in the future. Our profession would not exist without them. 
Our profession however is unique and I have taken advantage of this. After getting a thorough education in the vast field of medicine, we are pretty a Swiss army knife of the medical field. We can jump around from each type of medical field. I have worked in primary care, surgery, pharma, mental health, correctional health, international clinical trials, and disaster relief. It’s like I’m doing my clinical rotations throughout my career. I guess I get bored too easily and enjoy learning the different fields of medicine. 

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It sounds like you have your mind made up, and if you truly want to be a physician I say go for it! I agree, there are loopholes in our training when compared to that of our physician colleagues.  The good news is you can fill those loopholes...but it will take some time!  Just because you've graduated from PA school doesn't mean you stop reading, learning and training.  There are PAs I work with that outperform our physician colleagues.  It's not necessarily the degree that gives you the knowledge. It's a voracious appetite for information and a desire to perform at the highest level possible.  That is what propels you to continue to read and study year after year. You don't need MD behind your name to do that.  Now if you want to practice independently without supervision, or if you want to be called doctor in the clinical setting you'll have to go to medical school.  And just be honest with yourself.  Because at the end of the day you want to be happy with the decision you've made. I've always wanted to pursue doctoral level education, in part because I want to achieve a certain level of scholarship, but I want to be a doctor...period.  I want that level of expertise in a field of study.  I'm honest about that with myself.  I have no interest in being a physician; my work as a PA, especially in the setting I work in, allows me to do all the things I could ever want to do as a PA, all while freeing me up to do the millions of other things I do like own and operate two businesses, volunteer, work professionally as an artist, serve on the BOD at a local non-profit, etc. My physician colleagues could never do all of this. They are married to medicine in a sense.   Some of us would say our world revolves around medicine.  I'm not in that camp.  I love medicine but I love so many other things, and being a PA gives me the best of all worlds.  Think about what you want your life to look like and go from there. No answer is the wrong answer, unless you are not being honest with yourself.  You are young and you have time to think on it.

Good luck to you!

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45 minutes ago, EMEDPA said:

3 yr PA to DO. No Mcat.

https://lecom.edu/academics/the-college-of-medicine/accelerated-physician-assistant-pathway/

Would still do it if I was single after 23 years as a PA. 

 

I would do it for the extra money only now and more job opportunities. I do everything I’ve ever wanted after residency.

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If you want to do EM: as a PA either through a residency or extensive OJT and self directed learning you can do pretty close to full scope EM in a very few very special locations, making probably 35-45% of what a EM doc (boarded or highly experienced) makes.  Most EM PA's make less and don't have near that level of skill or responsibility.  You'll be searching and fighting for those few unique opportunities.  As an EM boarded doc, you'll be starting by default at the goal line we strive for, making 2X or more what we make.  To get there you will have spent 3-4 (in most cases 4) years in medical school and 3-4 years in an EM residency.  You will have way more knowledge: some because of the basic sciences in the 1st part of medical school, way more because of the guided experiences including off-shift rotations in residency.  Most EM docs I know say that 90%+ of what they know they learned in residency.  Lot's of lost income,  strain on relationships, etc.  Only you can determine if the increased rewards are worth the up-front investment.  

Why did chose PA: my age.  I started PA school at 53.  It was the right choice given my life path.  Had that path brought me to medicine 10 or more years earlier, I would have pursued DO school.

You're way younger.  It's up to you to decide if you want to make that trade-off.  There are posters here who have gone to medical school and some are now practicing physicians.

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8 hours ago, PAtoMD said:

image.gif

Hahaha woah are you already on this path? Would you mind sharing your background and why you decided to go back for medical school after becoming a PA? What is your thought process? What are you benefiting? What are you sacrificing? 

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48 minutes ago, SouthUStudent said:

Thank you for the in-depth responses guys! I am reading them all and taking them into consideration. Can I ask for input on the day-to-day job differences as a PA vs MD/DO in internal or emergency medicine? (If there are any).

I work at 4 EDs. At 2,  I am solo and completely independent and interchangeable with an ED physician.

At the other two,  I work double coverage with ER boarded docs seeing every other pt. By state law,  a physician needs to be "involved" in every real trauma. What that amounts to is I say, " Hey Scott, I am transferring the trauma in room 5, they have a liver lac". and he says "ok".

In my note I write " case d/w ED attending physician who is aware of pt and agrees with the assessment and plan. "

He makes more than twice my salary and is more than a decade younger than I am. would I trade with him? you bet. 

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Here are some more of my thoughts that I just private messaged someone:

Thank you so much for replying, I really need guidance in my life. I am confused and don't know WHAT path is actually WORTH taking.

I love medicine. I have grown super passionate about it. I also love academia. I watch a lot of medical school vlogs and wish I went through the rigorous schooling like they did. PA school felt like a joke to me. It was mainly memorizing buzz words, without understanding the "why's". 

Now, I know I can learn the why's using third party resources on my own - like sketchymedical, boards and beyond, pathoma, premade anki decks, etc. However, if I am going to do that, why not do it through medical school and get rewarded with prestige, money, and autonomy? 

But that does come with its cons - such as a losing lost income as a PA, family time, and basically life. For 7 years. 

I am interested in Internal medicine (hospitalist) or Emergency Medicine. What I want to really know is if there is a huge difference in autonomy, day-to-day job/tasks, etc. Because if it's 90% of the same job, then I am not sure if 7 years of medical school is worth it for me. I know people recommend PA to MD if you want to go into either surgery or a specialization of some sort. 

Basically, is 7 years of medical school worth it for me (I am single and 26 years old; I only need the MCAT to most likely get into this DO program in my home city; this way I can be with family and friends and not miss out on life events). It seems like a fun journey to me, something that I would look forward to.

But there is this other easier, more convenient, and relaxing path - which is to remain as a PA and practice medicine. Earning a six figure salary. Living life. And also studying step 1 material with the resources I mentioned earlier.

*sigh* Do you see my dilemma here. Like what is the right path for me - in terms of happiness, life, money, etc. 

If I were to redo my years of schooling, I would 100% choose medical school. But because I finished PA school and am interested in specialties that might not be that different as a doctor, is it worth it? Because I do realize I will have to go through numerous standardized examinations - MCAT, Step 1, Step 2 CK, Step 3 CS, and residency boards. Also the stress of interviews, applications (both initial and for residency), research papers, etc.

Or will I always regret not going back for medical school?

Edited by SouthUStudent
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I started out in a rural ED straight out of PA school.  I had to drive 1 1/2 hours one way to get there and I was scared to death during every shift, but it was the best decision I made coming out of school. I was there for almost three years before we moved, and then  I took a job in a larger ED and found out quickly that I had been spoiled.  In the rural ED I had a lot of independence but a lot of support. I had great docs and great guidance.  In larger facilities I felt like a cog in a wheel, relegated to fast track to move bodies in and out as fast as possible and I knew my skill set was much broader than that. I'm now back in a smaller ER and I'm currently looking for prn work at another rural ED.  I am contracted to work 9 days a month; I have the flexibility to take more shifts..or not. This gives me great freedom but ensures that I make the salary I want.  My docs are great and we all work together as a team.  I consult with them on patients as needed, and they often ask my opinion about how to proceed with patients. There is a lot of mutual respect.

So I share all of that to say finding your place in medicine is just as important as your title.  You can be a great physician and be miserable if you haven't rooted yourself in the right place.  The same goes with PAs; it is important that we choose our specialties and our work environments very, very carefully.  As a ED PA I'm able to carve out the life I want.  The ED lends itself very well to those of us who wear many hats outside of medicine.  There are months when I feel like working a bit more, and there are other months (pre-pandemic) where I'm globetrotting for three out of the four weeks.  My best advice: live your life by design as much as you can.  Decide now what is most important to you, make a plan, work the plan, and keep working the plan until you've achieved the intended goal.  Don't chase money or titles; money is a tool to buy you necessities and experiences, and as a PA you will always have the means to make decent money.  Chase happiness, comfort, contentment.  Put your focus there and I think it will be easier for you to make the right decision.  

 

 

Edited by chiaroscuro27
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14 minutes ago, chiaroscuro27 said:

I started out in a rural ED straight out of PA school.  I had to drive 1 1/2 hours one way to get there and I was scared to death during every shift, but it was the best decision I made coming out of school. I was there for almost three years before we moved, and then  I took a job in a larger ED and found out quickly that I had been spoiled.  In the rural ED I had a lot of independence but a lot of support. I had great docs and great guidance.  In larger facilities I felt like a cog in a wheel, relegated to fast track to move bodies in and out as fast as possible and I knew my skill set was much broader than that. I'm now back in a smaller ER and I'm currently looking for prn work at another rural ED.  I am contracted to work 9 days a month; I have the flexibility to take more shifts..or not. This gives me great freedom but ensures that I make the salary I want.  My docs are great and we all work together as a team.  I consult with them on patients as needed, and they often ask my opinion about how to proceed with patients. There is a lot of mutual respect.

So I share all of that to say finding your place in medicine is just as important as your title.  You can be a great physician and be miserable if you haven't rooted yourself in the right place.  The same goes with PAs; it is important that we choose our specialties and our work environments very, very carefully.  As a ED PA I'm able to carve out the life I want.  The ED lends itself very well to those of us who wear many hats outside of medicine.  There are months when I feel like working a bit more, and there are other months (pre-pandemic) where I'm globetrotting for three out of the four weeks.  My best advice: live your life by design as much as you can.  Decide now what is most important to you, make a plan, work the plan, and keep working the plan until you've achieved the intended goal.  Don't chase money or titles; money is a tool to buy you necessities and experiences, and as a PA you will always have the means to make decent money.  Chase happiness, comfort, contentment.  Put your focus there and I think it will be easier for you to make the right decision.  

 

 

I agree with all of this, especially the underlined and bolded above. Been there, done that. Fast track sucks. Never again. I did more as a paramedic than as a fast track PA.. Moving the meat is not satisfying in any way. Knowing you could be replaced at a minutes notice by a new grad sucks. 

This may be one of the best posts I have ever seen here on the forum. 

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Thank you, EMEDPA! I have great respect for you, so that means more than you know.  It's forum members like you and others that make this platform so valuable.  Many of us have become PAs and have achieved success in our respective specialties because of the guidance and insight you all have provided over the years.  I'm just doing my part to pay it forward. I hope to shake your hand someday soon, sir!

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20 minutes ago, chiaroscuro27 said:

Thank you, EMEDPA! I have great respect for you, so that means more than you know.  It's forum members like you and others that make this platform so valuable.  Many of us have become PAs and have achieved success in our respective specialties because of the guidance and insight you all have provided over the years.  I'm just doing my part to pay it forward. I hope to shake your hand someday soon, sir!

Join me in Haiti someday and we can call it even 🙂

www.globalhealthteam.org

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      What do I personally think of standards? I believe that standards are a very positive modifier of our practice protocols and approaches to medicine. I see the patient as the ultimate winner when a profession has high standards. Standards lead to increased study and competence. Standards are set and maintained by academia, education secured at conferences, and CME provided by associations. They are enhanced by experience and certified by procedural attestation such as those through residency rotations. There will, in the near future, be a mandated procedural attestation required within all institutions of medical care. When looking at medical specialties, we note that either a residency or a specialized track of education and experience defines what an institution requires for an NP or a PA to be hired.

      Most of the specialty areas need highly experienced, highly motivated, and extremely well-educated PAs and NPs and are willing to provide a mini residency. Some of these specialties require additional education, CME, preceptorship, and a specialized curriculum in addition to an advanced degree. I will repeat a sentence that I wrote ten years ago: “The time is quickly coming upon us that will no longer place on a resume ‘PA seeking a hospitalist role, ---- willing to learn, seeking physician willing to teach.’” That time became a reality more than five years ago. Physicians are engaged in their own fight for survival, focused on issues which affect their profession, leaving little time for the altruism of the past when they sought to be the “teacher” to a nonphysician. The economy, new health care laws, insurance mandated reimbursements, malpractice issues, and the huge financial debt incurred while becoming doctors have caused them to protect their own turf and areas of responsibility.

      What will possibly be the standard for the PA in the next few decades? PAs will be a graduate of a doctoral program, be highly intelligent, and have the interest to further their education by means of residencies of various lengths to best prepare for the arduous task of caring for an additional 31 million patients in a decade with decreasing numbers of physicians. The PA will be a team member that possesses a team attitude and team spirit as the care of patients will be delivered by highly trained team members.  Personally, I see this as a positive move and will be comforted as a patient to realize that all of the medical personnel with whom I have a relationship share a unified approach and attitude that will enhance my treatment, wellness and outcome. I think that the nursing profession will continue to grow in this same direction as they are recognized experts in so many specialties today.

      This shared approach to patient care will require many signatures and notes on the EMR which can become tricky for many clinicians. With a team approach, opportunities for medical error will require heightened vigilance. And when errors occur - who is responsible - the institution, or the clinician? It is and has always been the clinician, and these errors are often due to the exhaustion felt by providers: reading every note, reviewing every test, and reconciling every new medication order. Prior to my own retirement, I began to feel the exhaustion of doing the detective work and realized that I was becoming a relic. As malpractice exposures rise, so too the need for a personal malpractice policy. Younger clinicians are much better suited to the demands of this ever-increasing administrative multi-tasking than those of us from an earlier vintage. This new era makes a malpractice instrument essential, now more than ever. Be careful and refrain from choosing based on cost alone, without fully understanding the policy terms and the provider’s history in the healthcare market. “New” companies with new perks come and go and may not exist in a few years, when you might need them. Make your own educated decision to prevent hardships in the future.

    • By patelp
      I would love to get some guidance of previous or current Canadians applying to PA schools in USA. 
      Thank you! 🙂
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