Is Medical school worth it AFTER becoming a PA? [PART TWO]

[Yasuo]

Hello, I recently made a post yesterday and got some great feedback. You can read more about my background and thoughts there. Feel free to give more insight. I am reading all comments and using it sort of as a guidance in making a serious life decision. You can check it here: 

However for the professional PA's who are currently working, my main question for you today is:

 Are you satisfied as being a PA? What are some things that Physicians do that you can't in your specialties? Give me concrete examples!

A lot of people say autonomy, wide scope of practice, vertical mobility, etc. But what exactly are those day-to-day job differences or limitations that you have noticed in your specialty as a PA? Or do you feel like you have full autonomy? 

I am interested in either Internal Medicine (Hospitalist) or Emergency Medicine. But if it's pretty much 90% of the same job as Physicians, then I am not sure if 7 years of medical school is worth it for me. I know people usually recommend PA to MD mostly if you want to go into either surgery or a specialization of some sort.

Can't wait to read your thoughts! Hopefully your comments and answers will give me and others in similar situations a strong resolution. 

 

Edited August 13, 2020 by SouthUStudent

[Cideous]

it depends on 3 things.

 

1.  What is your age?  Will the time you spend in Med school, residency and fellowship be worth it based upon how many years you have left to practice?

2.  What are your commitments.  The divorce rate is insane in medical school and residency.  If you are married, consider this GREATLY.

3.  What are you resources, if you don't have much money to put into it and plan on. borrowing $250k, you could wind up saddling yourself with debt that lasts a lifetime and that you may never be able to repay.

 

One more incidental note.   As an informal poll, over 75% of the docs I have worked with over the last 10 years would absolutely 100% not do it again.  The days of hanging your shingle are over.  You will be an employee with half a dozen AP's to supervise and an MBA as your boss, and that is IF you match to a residency.

 

Good luck.

[EMEDPA]

26 minutes ago, SouthUStudent said:

 

 Are you satisfied as being a PA? What are some things that Physicians do that you can't in your specialties? Give me concrete examples!

 

satisfied? sure. Happy beyond measure/this job is everything I ever wanted or imagined? No

things a doc (any doc, even the worst one out there) can do that I can't:

get a license without needing someone else to agree to sponsor me

make 200/hr for doing the same job I do right now

be universally respected as a top expert in my field, no matter how good I am

see any patient, anywhere, any time. As a doc I could walk to work for a great job. As a PA I drive > 1000 miles/mo to 4 rural EDs for good autonomy, respect and scope of practice

Have hospital admins and peer review folks assume at baseline that I am a qualified and talented medical provider. A PA makes an error and they are stupid and under trained. they didn't know what they didn't know. doc makes the exact same mistake and "it was a complicated case". 

don't get me wrong- after 33 yrs in EM I am the happiest that I have ever been with my work life. I probably work at the best rural EDs in 2 states and make a top 5% PA salary.  It took > 25 years to get to this point. They were not easy years. I almost quit several times. I tried to go back to medschool, took extra prereqs, etc and my family life made it impossible. Wife lost job, dad died, etc. 

Go to medschool. Do it now. Don't look back. The one decision I regret more than any other in my life was going PA instead of MD/DO. 

[EMEDPA]

6 minutes ago, Cideous said:

 

 

One more incidental note.   As an informal poll, over 75% of the docs I have worked with over the last 10 years would absolutely 100% not do it again.  The days of hanging your shingle are over.  You will be an employee with half a dozen AP's to supervise and an MBA as your boss

But yet you can still work 20 hrs/week and make more than a PA working 60 hrs/week and everyone will know what your job entails. Oh, you are a doctor? I get that. You are an assistant? you take bps for the doctor and hand them instruments? 

[mgriffiths]

I believe I responded your original thread on reddit.  But, I'll respond here for this one...

Are you satisfied as being a PA?   Very much so...it's not perfect, but I am of the firm belief that no job or career path is.  We live in an imperfect world...end of story. 

What are some things that Physicians do that you can't in your specialties? I work in ortho, so the differences are much more stark.  In clinic I do everything my CP does, except for offer surgery until I have spoken with him.  But surgery...well, I am not allowed to do surgery on my own, he is.  But, I work autonomously putting in orders, rounding on patients (we split the list and each do half), closing cases, and for many cases I have been integral.  For example, a couple of months ago we had a humeral head fracture that displaced to where the humeral was literally sitting against the subclavian artery - fracture side against the artery.  He did not have the angle to grab it well so he handed me the clamp and said, "be careful."  You can imagine how tight my anus was during that...thankfully went well.  I also now do pretty much all of our distal radius fractures.  He is there and makes the initial incision, but then I takeover and he sits there and watches.  I have done that for a few femoral shaft fractures as well.

During my primary care days, my day-to-day was no different than any of the physicians I worked with, except I didn't have to take call and I didn't have charts to review from us lowly PA/NPs at the end of the day.  We had the same patient population and there was no steering of more difficult cases to the physicians.  Now this was also personality and my skill level.  All three of the NPs I worked with (never worked with a PA in my office) would send their more difficult cases to me or the physicians.  I never felt the need to do that.  When I first started I would ask questions, research, read, etc. and after several months it got the point that if something was beyond me, then it really meant it needed a specialist.  As for the quality of medicine that I provided in comparison to the physicians...I don't know?  I feel like I did a good job, and that was supported by having the best numbers for improving A1Cs, % of patients with controlled HTN, highest colon and breast cancer screening adherence rates.  The only metric that was tracked that I didn't lead was cervical cancer screening adherence rates.  I'm a 235lb powerlifting male...not exactly the person most women want putting their speculum in...because of this I actually stopped performing paps and other vaginal exams because I just didn't do them frequently enough (we had three female providers in the office that I spoke with before making this decision and they all fully supported it).  So, what do those numbers mean?  I was proud of them (and still am). While I wouldn't say those numbers mean that I am better than the physicians I worked with, I would say they do mean I was more effective.  More knowledgeable and better understanding does not necessarily equal better provider.  There is more to medicine than knowledge.  It is the ability to apply that knowledge in developing a treatment plan (founded in evidence based medicine) that a patient can understand and buy into themselves.

A lot of people say autonomy, wide scope of practice, vertical mobility, etc. But what exactly are those day-to-day job differences or limitations that you have noticed in your specialty as a PA?

I have no idea what you mean by vertical mobility.  I have only heard it described as horizontal mobility (from one specialty to another).  It's worked for me.  I went from ortho (awful job) to primary care and now back to ortho.  I have no plans to make a change in the near future, with zero plans to return to primary care.  Your autonomy and scope of practice will be directly correlated to your employer and CP.  For me that has meant a scope of practice that is equivalent to any physician I have worked with in primary care.  In ortho, not so much, but I knew that going in and I am absolutely ok with it.

Edited August 13, 2020 by mgriffiths

[EMEDPA]

I truly believe that lateral mobility is going away. I could switch into critical care or primary care right now pretty easily. Anything else and I would probably need a residency. You get privileges based on doing things before. I have never done endoscopic radial artery harvesting  or stripped saphenous veins, etc so there is no way I could transition seamlessly into something like CT surgery. 

Soon(next 10-20 years)  I believe new PAs will need to complete postgrad programs for everything except primary care and pass a specialty exam. 

[FriarMedic]

Current md student coming from PA of about 5 years. I read a little of your original post and a few things did stand out.
 

Yes - m1-m2 can very much be treated like a job 8-5 studying/classroom requirements. That’s what I did and also worked about 3 weekend shifts a month at a slower UC to reduce my loans. now in m3 and the unpredictable nature of when you’ll get out and just having longer days in general is a bit stressful having family at home relying on help to get dinner and kids to bed etc. 

 

you also mentioned doing all the go-to med school resources like pathoma, sketchy, bnb without actually going to med school- I don’t think anyone would have the motivation to ever do that.... however clearly you’ve researched what it entails, what the next steps are and how to get it done.

 

yes you’ll get down to the cellular /biochemical level for sure. Good example was on obgyn rotation postop after a d&c reviewing the path slides with a pathologist and really recognizing and understanding exactly what we were seeing at the cellular level. However don’t be surprised at how much buzz word and memorization goes on in med school too. Anki is essentially a learning/memorization tool loaded with buzz phrases (and its incredible I might add )  
 

I know I didn’t answer any of your questions really but feel free to pm me. 

 

[mgriffiths]

16 minutes ago, FriarMedic said:

However don’t be surprised at how much buzz word and memorization goes on in med school too.

I think this is something that many don't realize, and honestly many MD/DOs don't want to admit.  That is not meant to take away from their education...

[deltawave]

4 hours ago, FriarMedic said:

Current md student coming from PA of about 5 years. 

Are you doing a tradition MD path or the DO bridge? 

Edited August 13, 2020 by deltawave

[MediMike]

7 hours ago, SouthUStudent said:

Are you satisfied as being a PA? What are some things that Physicians do that you can't in your specialties? Give me concrete examples!

A lot of people say autonomy, wide scope of practice, vertical mobility, etc. But what exactly are those day-to-day job differences or limitations that you have noticed in your specialty as a PA? Or do you feel like you have full autonomy? 

I am interested in either Internal Medicine (Hospitalist) or Emergency Medicine. But if it's pretty much 90% of the same job as Physicians, then I am not sure if 7 years of medical school is worth it for me.

Satisfaction - To a certain degree. I've been practicing in critical care since graduation 5 years ago.  I feel as if through my own work and prior HCE I have developed a very strong grasp of the underlying pathophysiology of many of the disease states, procedural competency, communication skills with families, and the ability to perform a fantastic resuscitation, in many cases on par with the physicians I work with.  I work a nocturnist position where I only have to work 10 shifts a month, on some of those shifts I'm on home call, on others I'm in the office working on other projects just waiting for a fire to put out.  If I'm on days I only carry around 3-5 patients as opposed to the 12-15 the physician does.  In this job I make more than some physicians.

Limitations - I don't know that I will ever be able to simply glance at a patient and have the vast range of differentials go through my mind that I observe working with these folks.  The ability to know the best general and focused workups for the variety of zebras that may come through the door.  The exposure that they have achieved through their 9 years of schooling, residency and fellowship is something that will take me a career to achieve, if ever (I'm getting lazier as I get older). There is little to no vertical mobility, I'm familiar with a PA who is the lead for the entire inpatient team at a local hospital but that is a rarity.  I may work my way onto a committee or two but I will likely never sit in the C-suite. I will never have the same respect that my colleagues do, @EMEDPA said it very well earlier.  There have been times that I've called a consultant and they look at me like a talking dog who did a really neat trick when I asked a coherent question and they realized I was a PA.

I think coming on this forum and asking people to tell you what to do, to convince you of things etc is not the way to go about it.  If you have finished PA school go work as a PA for a bit and see what YOU think.  I've almost gone back twice now and made the decision not to for what I hope is the final time.  I don't want the remainder of my 30s and a chunk of my 40s to be taken up with school, away from my dogs, my running addiction and my family (in that order probably).  I don't want to have to specialize.  I don't want the additional administrative burden.  I don't want the additional patient burden.  I don't want to work twice as much as I currently do.

While the knowledge would be fantastic, and the respect appreciated...it's just not worth it.  And that worth is only something you'll be able to figure out on your own.  Go to work.

[ShakaHoo]

I find that as a physician assistant, I am used as the MD's workhorse.

While they sit in their office surfing the internet, or "work from home", or take a half day, or are in "meetings" all day long... I see 20-30 patients a day consistently.  Their take home pay is 2-3x what my take home pay is.

I would go to medical school to be compensated better for what I do, or have the option to slack off all day.  

Just my opinion...

 

[Joelseff]

I graduated PA School in my mid to late 30s...i thought about Med school/Bridge the first 3-5 years then pretty much squashed it. I don't want to take on more loans having just paid off my loans a couple of years ago and now in my mid to late 40s I am not willing to go back to school... (I even thought about a DMS but... Nahhh....I'm getting too old and don't want to spend 5 figures on anything unless it has an engine in it [emoji23])

 

I *like* being a PA, do I love it? Some times... I love medicine. But not sure if going back for 3-4 more post graduate school years and then 3-5 yrs of residency would be worth it. I make enough money, I get enough respect from my colleagues and my patients love me or at least they say they do [emoji53]. I like being a PA...

 

Just change our title and get rid of supervision and it would feel more like love... Maybe?... [emoji23]

 

Lateral mobility is not as certain as before. Pay is pretty good. COVID effed up jobs but that seems to be making a comeback.

 

I dunno... I guess you have to figure out how much YOU want to be a doctor or are YOU good with being a PA...

 

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