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Should I go to med school?


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This showed up in my inbox, and I'm going to answer it here. It's a good thing to review periodically:

"I'm 23 years old and starting PA program in January. I am getting second thoughts on whether I should pursue Medical school due to the compensation and being able to support my new family / kids. If I were you 23 year old son what would you advise me to do?"

So, my answer to this is going to be different than it was 12 years ago when I chose PA school, but fundamentally, "it depends"

- Being in residency when your kids need you sucks, but you can make it work. I made a conscious choice to not go to med school because my boys would be teens during my residency. Medicine will suck away portions of your life no matter what, both in training and in being a truly helping role--you get disturbed at dinner occasionally.

- The biggest problem in medicine is the business of medicine.  We've got lame, notionally effective medications being pushed through FDA approval that aren't shown to actually improve outcomes. More and more small practices with good service are selling out to larger conglomerates which have economy of scale, but impersonal "care." Venture capitalists are buying up medical practices. These issues affect both PAs and physicians, and each are in a way handicapped by their ability to respond.

- Both physicians and PAs are becoming increasingly pawns of this system, but physicians have a better ability to break free from it... I think. No matter what, you will be asked to do wrong things in your practice. It will start simple, like charting things you didn't do, or upcoding. If you can't say "no" when you're poor and powerless, you will be beaten into a cog in the system, no matter what theoretical independence you may or may not have.

I would still do PA school over again, knowing what I know now.  Having said that, going into PA school I had a false hope that I could be a competent subordinate to a physician who was smarter than me. Unfortunately, those docs are all retiring, and now all the smart physicians are employees or partners, and don't actually hire, train, or assume a personal responsibility for and relationship with their PAs.

If you are picking PA school because you get to spend more time with your patients than physicians do? Go to medical school, because that is a lie.

If you are picking PA school because it's easier to have kids and a career as a PA than as a physician? Go to medical school, because that is a lie.

You know who's been reading all those U.S. News and World Report rankings about how great a job PA is? Not your grandmother, who still will be asking when you're going to finish your training and become a real doctor until the day she dies. No, those venture capitalists I mentioned above... they get it. They see how PAs can be very profitable for them.

So, that may not have answered your question, but those are the key inputs and considerations I would take into account.

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4 hours ago, rev ronin said:

 

If you are picking PA school because you get to spend more time with your patients than physicians do? Go to medical school, because that is a lie.

If you are picking PA school because it's easier to have kids and a career as a PA than as a physician? Go to medical school, because that is a lie.

 

Great answer Rev.

 

Love that you hit these two points. These two are the most often I see as to why you should choose PA vs MD. 

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The one thing that keeps me from saying "definitely go to med school at 23" is that I am a much better PA in my 50's than I would have been a physician in my 30's. My years at Intel were wonderfully formative, and I would not be the same person today if I hadn't worked in that high performing environment where not only was I not the smartest person in the building... I wasn't even the smartest person in my row of cubicles. 🙂

We're never given "what ifs" or do-overs, so speculation is idle, but I believe my path was the best way for me when I came to the realization that I did not want to do technical risk assessments and would rather sit with hurting people. I lacked the compassion in my youth to be a good medical professional.

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For me starting PA school at 53 was the right choice.  It still was.  The better choice would have been to have started the path to medicine 10-15 years earlier and to have become a DO or an MD.

The choice really boils down to the size of the up front commitment to do medical school and residency vs the ~2.5x increase in financial return and full scope of practice vs the smaller up front commitment for PA school yielding ~ 40% of the financial return of being a physician and constantly hitting the ceiling of scope of practice.

I do believe that physicians are better trained that PA's.  Some are smarter, others are not.  Experience does narrow the gap but not eliminate it.  It's because of my respect for their greater training is why I wish I'd started on that path early enough in life that it would have make sense to choose it.

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  • 4 weeks later...
On 7/10/2022 at 9:47 AM, EMEDPA said:

If I had life to do over again I would do med school every day of the week and twice on sunday. PA over MD is the greatest regret of my life. 

You can still do it, E. Go for it!

I imagine the only thing you're missing is physics and MCAT. Online 1 semester physics, in person lab, and review Khan academy before taking MCAT. Go for it. (Full disclosure: I had recent conversation about this very thing with family and I'm still on the fence. go figure)

A 62-year old just recently matched and he went to Carb school. https://www.northjersey.com/story/news/health/2022/04/01/ridgewood-nj-michael-butler-62-year-old-medical-school-graduate/7206379001/

Return of investment, you say? The oldest practicing doctor is 100 y/o.

https://www.timesofisrael.com/at-100-a-jewish-doctor-in-cleveland-is-the-worlds-oldest-practicing-physician/

On 7/9/2022 at 11:05 PM, rev ronin said:

 

You know who's been reading all those U.S. News and World Report rankings about how great a job PA is? Not your grandmother, who still will be asking when you're going to finish your training and become a real doctor until the day she dies. No, those venture capitalists I mentioned above... they get it. They see how PAs can be very profitable for them.

So, that may not have answered your question, but those are the key inputs and considerations I would take into account.

 

This is so true and not just from grandmas, from patients too:)

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7 minutes ago, VentiMacchiato said:

You can still do it, E. Go for it!

I imagine the only thing you're missing is physics and MCAT. Online 1 semester physics, in person lab, and review Khan academy before taking MCAT. Go for it. (Full disclosure: I had recent conversation about this very thing with family and I'm still on the fence. go figure)

A 62-year old just recently matched and he went to Carb school. https://www.northjersey.com/story/news/health/2022/04/01/ridgewood-nj-michael-butler-62-year-old-medical-school-graduate/7206379001/

Return of investment, you say? The oldest practicing doctor is 100 y/o.

https://www.timesofisrael.com/at-100-a-jewish-doctor-in-cleveland-is-the-worlds-oldest-practicing-physician/

 

This is so true and not just from grandmas, from patients too:)

It would actually be easier than that. I took a full year of physics a few years ago and got As all 3 terms. I could get into the LECOM APAP program by taking one 3 unit online ochem course with labs done at home and no MCAT. The program director confirmed this for me a few years ago.  If I was single I would still do it in my mid 50s. I am married to an artist and have a child at an Ivy league school. I have a mortgage and 2 car payments. I just landed a new job with a significant raise based on years of experience (will be making more than many family medicine physicians) and the best schedule I have had in a long time. Hard for me to say it, but I think the med school ship has sailed for me unless they come up with a part time bridge I can do while working :)

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15 hours ago, EMEDPA said:

It would actually be easier than that. I took a full year of physics a few years ago and got As all 3 terms. I could get into the LECOM APAP program by taking one 3 unit online ochem course with labs done at home and no MCAT. The program director confirmed this for me a few years ago.  If I was single I would still do it in my mid 50s. I am married to an artist and have a child at an Ivy league school. I have a mortgage and 2 car payments. I just landed a new job with a significant raise based on years of experience (will be making more than many family medicine physicians) and the best schedule I have had in a long time. Hard for me to say it, but I think the med school ship has sailed for me unless they come up with a part time bridge I can do while working 🙂

I certainly understand your situation and can agree on the reservations you have but this is a perfect time for an office quote

 

 

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Edited by PAtoMD
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16 hours ago, VentiMacchiato said:

You can still do it, E. Go for it!

I imagine the only thing you're missing is physics and MCAT. Online 1 semester physics, in person lab, and review Khan academy before taking MCAT. Go for it. (Full disclosure: I had recent conversation about this very thing with family and I'm still on the fence. go figure)

A 62-year old just recently matched and he went to Carb school. https://www.northjersey.com/story/news/health/2022/04/01/ridgewood-nj-michael-butler-62-year-old-medical-school-graduate/7206379001/

Return of investment, you say? The oldest practicing doctor is 100 y/o.

https://www.timesofisrael.com/at-100-a-jewish-doctor-in-cleveland-is-the-worlds-oldest-practicing-physician/

 

This is so true and not just from grandmas, from patients too:)

Best of luck in your journey. Always feel free to reach out. 

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