PA vs. DO Route

[PAvsMDWife]

My husband is finishing up his pre-reqs for PA and DO school. We have researched both routes about a thousand times it seems.

 

Everyone will have an opinion, but I am a true believer that research is key, so if any of you would be so obliged to answer any of my questions with your personal experiences, it would be greatly appreciated!

 

FOR THOSE OF YOU WHO CONSIDERED PA vs. DO school:

• Now that you have graduated and are looking for jobs, working- are you glad you went the PA route? Why?
  
• Do any of you wish you had gone the "DO" route?
  
• Are you finding you have the opportunities available that you thought you would as a PA?
  
• Do you feel you have satisfactory autonomy when it comes to practicing medicine?
  
• For those of you with families- are you able to maintain a work schedule that includes some quality family time?
  
• Or any of you taking on more shifts just to make more money? If so, do you wish you had gone a different route?
  

 

Thank you so much for your time!

[Febrifuge]

I decided I wanted to be a PA, so after a certain point, questions about DO (or MD) really don't make a ton of sense to me. I had considered DO when I was on a track toward MD, sure, but making the decision to go PA was the right one for me, and I haven't looked back.

 

I'm a little confused about your situation. Has your husband found some programs where the pre-reqs for PA or DO programs are the same? I found them to be quite different, when I was planning and preparing. Or is he doing pre-reqs for both?

 

Please don't take offense, but lumping PA and DO together in this way can have connotations of "I don't think I can get accepted to MD school but I want to get involved in medicine and make money." This is very unlikely what you intended, but that's the way the question tends to get posed when it comes from innocently clueless young pre-meds.

 

If your husband is really still this flummoxed about two very different types of programs, with extremely different plans over the next, say, three to ten years of his life, then I'm afraid the question is still rather basic. It's also very personal, so other people's experiences can only be so helpful.

 

The best advice I can offer is for him to do some serious shadowing of people doing both those jobs, and think carefully about how you and he want life to be, three years from now, five years from now, ten years from now, etc.

[rcdavis]

Research? Great! There are a plethora of threads here going back over 10 years with " how happy are you as a PA" theme, along with "pa versus md" threads...

 

Personally I have had a great career .. Now winding down into semi retirement.

 

Became a PA with over 10 years heavy preeducation health care experience ( combat medic, independent duty corpsman, submarine corpsman) went to a great program, and was mentored carefully. Ended up being considered interchangeable with general medical officers/ family practitioners/ and fully credentialled to Work independently in level II EDs.

 

Absolutely no restrictions as to practice... Was able to get taught new skills and grow in my professional capacity as I became more experienced.

 

Made more money than I ever dreamed of... Starting with 32k year in 1988 ( when I retired from The military) to averaging 240k/ year the since 2000.

 

The down sides?

 

-- Every new job I have I have to "re-prove " my capacity, my capabilities... Much more so than the docs. Doesn't take long, but it is there, and needs to be done

 

-- am never considered "ultimately responsible", and many times my bosses are asked to answer for my actions without the persons asking even considering talking to me...

 

-- being subjected to "second class" medical citizenry in certain states ( south Carolina being one of them) ( north Carolina definitely the opposite of south Carolina)

 

I love being a PA. I have achieved a modicum of sucess and am pretty sure of who and what I am.

 

However, if given the chance, and we're I to do it again (Without a family , I would Definetly become a doc .. ( and virtually no one here will differentiate between MD and DO).. Simply because it decreases the grief factor involved in doing what I like best: taking care of patients.

 

Look up forum moderator EMEDPA comments / threads on his thoughts md vs pa for the most cogent answers..

 

My best advise is, if you do not mind being "second seat" during your career, sorta like being a co-pilot compared to a pilot.. Understanding that you will get to fly the plane often, and will learn most of what it takes to fly the plane, but never be ultimately responsible, then PA can be for you..

If that scenario is untenable to your (husband's) personality, then go to DO school.

 

I'll let the other's discuss the financial calculus between the education costs and returns..

 

And wish you both good luck in your decision making process.

[EMEDPA]

starting over I would do the physician route (md/do) over pa every time.

I am finally, after years of practice, starting to find places that will use my skills appropriately and treat me with respect. for the first 10 years of my career I was only allowed to practice to about 50% of my ability.

the lack of respect some places pour on pa's is unacceptable. having a new crop of docs younger every year feeling the need to assert their dominance over the pa group just sucks. I am happy to give the docs all the respect they deserve. they have gone a long and hard path but it should be a 2 way street. An fp doc day 1 out of residency with a total of 6 months of time in the er between medschool and residency gets more respect and is granted more authority at most places than an em pa with 25 + years of experience. it gets really old having to walk 30 yr old docs through cases, show them how to do procedures they have never done and point out differentials that they didn't consider while they make twice your salary and get all the perks that go along with being a "doctor".

[Febrifuge]

I should add that I'm very lucky, in that I have minimal supervision, but at the same time don't deal with anywhere near the complexity of most here. I'm in Urgent Care, and for various reasons this job happens to be perfect for me and my situation right now, and for the forseeable future. I'm hardly working at the upper reaches of my knowledge or ability, but then again MDs do this exact same job and we're all in the same boat.

 

If I had it all to do again, I would be a lot more likely to go the MD/DO route. EMED has some very important points... but I wouldn't do it at age 35, wanting to start a family, which is where I was when I got serious about PA school. And I have had pretty lousy experiences (ugh, first job out of schol) and pretty excellent ones. A lot depends on where and with whom one practices; in the general sense, the negatives that EMED and RC point out are very real and very much a part of daily life. The question becomes how well a person's temperament and personality allow for rolling with them.

[PAvsMDWife]

Thank you @Febrifuge for your reply! To answer your question with more background information (who knows if our logistics actually made sense, BUT our logic was)...my husband finished up all his pre-req and clinical hours to apply to PA school, but come late fall/winter we realized that with the deadlines he really wasn't the strongest candidate. He was also considering the DO route, but needed more pre-req. This is where the "overlap" was made because: if he took those DO pre-req. he was completing his requirements to apply for DO school but also increasing his knowledge if he decided to go the PA route and apply in fall 2013 as well as we knew taking more classes that could only help boost his GPA if he did well.

 

He has shadowed a few DO's, general practitioner, oncologist, a PA, a GP who had a PA in office, an Ortho, etc. so he hasn't gotten a broad base of what a PA does by shadowing a PA, what a PA does by shadowing the Dr., what a DO does, etc. etc.

 

I guess his main concern is- will he still want more after he is through the PA process and working? No one can answer that but him. But a few of the PA's he shadowed that worked in hospitals, were taking on more shifts to make more money. That was a little discouraging I think. I think he is also considered the PA route, because of our family situation (less time in school than DO and the POSSIBILITY of a more "normal schedule" as a PA to ensure more time with his family in the future, vs. crazy shifts and time away from the family during med school and after).

 

Thank you so much!

[KMD16]

Given what I know now. I would have gone the MD/DO track. By the way, I have my eyes at the PA-DO bridge.

[discogenic]

Given what I know now. I would have gone the MD/DO track. By the way, I have my eyes at the PA-DO bridge.

 

Can you give more detail here?

[PAvsMDWife]

Thank you so much for you well thought our response @rcdavis!

[Febrifuge]

I guess his main concern is- will he still want more after he is through the PA process and working? No one can answer that but him. But a few of the PA's he shadowed that worked in hospitals, were taking on more shifts to make more money. That was a little discouraging I think. I think he is also considered the PA route, because of our family situation (less time in school than DO and the POSSIBILITY of a more "normal schedule" as a PA to ensure more time with his family in the future, vs. crazy shifts and time away from the family during med school and after).

 

Thank you so much!

Thank you, for the clarification. Yeah, it's frustrating once you're on the track to prepare for something, and then not know if you're really ready to go to the next step. I think it's smart to do the worrying and thinking now, and then once you commit, commit, y'know?

 

It's certainly true that a lot of PAs are under-paid, or over-worked, or some combination. So are a lot of doctors, for that matter, but of course there's significant difference between an MD who's working 72 hours a week and should be making 440k, but who's "only" making 360k and a PA who can't make loan payments without bumping from 24 to 36 hours a week. And don't forget, that PA starts making those middle-sized PA dollars a lot sooner than the MD who gets paid McDonald's wages during residency, and then starts making serious bank later on.

 

I think talking with, and preferably following, a handful of PAs in very different settings would be the ideal. Even if all he can do is meet someone in a hospital cafeteria for coffee and 20 minutes of chat, that's useful. Get a sense of what it's like for a surgical PA in a hospital -- do they get to the OR, or are they only doing wound checks and after-clinic? Are they happy with their workload? Talk to a Derm PA who works in an outpatient office -- do they feel like they get to diagnose, or is it all about procedures? Is that boring, or the way they like it? Talk to an Urgent Care PA who solos in the evenings and weekends -- do they feel supported well enough if something goes horribly wrong? Do they have stories about interesting cases where they caught something the docs missed? Horror stories about cranky patients?

 

Hopefully somewhere in there, your husband will get an idea of whether the advantages of being a PA are actually advantages, for him. An MD or DO who does residency in Family Medicine for 3 years can go work in Family Medicine... but if they want to go into Interventional Radiology for some reason, they go back to residency again and start over. PAs have at least some degree of pretty serious lateral mobility, which can be huge for someone who's interested in a lot of areas, and likes the idea of shaking up where they work, who they work with, and what they do.

 

Finally, in terms of 'still wanting more,' consider that MD or DO isn't exactly the free-roaming top-of-the-pyramid type of career it used to be. Everyone has a boss; if you're the head of a department then you report to some Vice President or Executive Board, whether it's a hospital or an HMO. If you run your own private practice, you need to worry about maintaining contracts with health plans and managing the people who keep the bills paid every month.

 

For me, I decided that what I care about is the medicine, one patient at a time. I don't need or want responsibility for supervising people other than myself, I don't want to have to be concerned with the costs of the care I provide (or at least, I don't want thinking about that to be anywhere near as important as thinking about what's the best and most appropriate care), and I didn't feel that the perks involved with hearing "oooh, you're a doctor?" were worth it, to me personally.

 

Partly this was because I knew many really good PAs from my time working as an ER tech; I had originally thought they were staff docs, except then I noticed they tended not to work the suckiest hours. Partly it's because I shadowed a fair amount of docs, and all of them had similar complaints about all the stuff that they do in a day that isn't medicine.

 

And if I had gone to 4-year med school instead, I would today be a 42-year-old 2nd-year resident, probably in Emergency Medicine. I would not have been able to stay home with my now 3-year-old daughter during the day, working evenings and weekends. So there would be the expense of full-time daycare, the loss of all this bonding and development time, the stress of the long hours... nope. Clearly not for me.

[KMD16]

Can you give more detail here?

 

I shared what EMEDPA had echoed above.

[lang]

Thank you, for the clarification. Yeah, it's frustrating once you're on the track to prepare for something, and then not know if you're really ready to go to the next step. I think it's smart to do the worrying and thinking now, and then once you commit, commit, y'know?

 

It's certainly true that a lot of PAs are under-paid, or over-worked, or some combination. So are a lot of doctors, for that matter, but of course there's significant difference between an MD who's working 72 hours a week and should be making 440k, but who's "only" making 360k and a PA who can't make loan payments without bumping from 24 to 36 hours a week. And don't forget, that PA starts making those middle-sized PA dollars a lot sooner than the MD who gets paid McDonald's wages during residency, and then starts making serious bank later on.

 

I think talking with, and preferably following, a handful of PAs in very different settings would be the ideal. Even if all he can do is meet someone in a hospital cafeteria for coffee and 20 minutes of chat, that's useful. Get a sense of what it's like for a surgical PA in a hospital -- do they get to the OR, or are they only doing wound checks and after-clinic? Are they happy with their workload? Talk to a Derm PA who works in an outpatient office -- do they feel like they get to diagnose, or is it all about procedures? Is that boring, or the way they like it? Talk to an Urgent Care PA who solos in the evenings and weekends -- do they feel supported well enough if something goes horribly wrong? Do they have stories about interesting cases where they caught something the docs missed? Horror stories about cranky patients?

 

Hopefully somewhere in there, your husband will get an idea of whether the advantages of being a PA are actually advantages, for him. An MD or DO who does residency in Family Medicine for 3 years can go work in Family Medicine... but if they want to go into Interventional Radiology for some reason, they go back to residency again and start over. PAs have at least some degree of pretty serious lateral mobility, which can be huge for someone who's interested in a lot of areas, and likes the idea of shaking up where they work, who they work with, and what they do.

 

Finally, in terms of 'still wanting more,' consider that MD or DO isn't exactly the free-roaming top-of-the-pyramid type of career it used to be. Everyone has a boss; if you're the head of a department then you report to some Vice President or Executive Board, whether it's a hospital or an HMO. If you run your own private practice, you need to worry about maintaining contracts with health plans and managing the people who keep the bills paid every month.

 

For me, I decided that what I care about is the medicine, one patient at a time. I don't need or want responsibility for supervising people other than myself, I don't want to have to be concerned with the costs of the care I provide (or at least, I don't want thinking about that to be anywhere near as important as thinking about what's the best and most appropriate care), and I didn't feel that the perks involved with hearing "oooh, you're a doctor?" were worth it, to me personally.

 

Partly this was because I knew many really good PAs from my time working as an ER tech; I had originally thought they were staff docs, except then I noticed they tended not to work the suckiest hours. Partly it's because I shadowed a fair amount of docs, and all of them had similar complaints about all the stuff that they do in a day that isn't medicine.

 

And if I had gone to 4-year med school instead, I would today be a 42-year-old 2nd-year resident, probably in Emergency Medicine. I would not have been able to stay home with my now 3-year-old daughter during the day, working evenings and weekends. So there would be the expense of full-time daycare, the loss of all this bonding and development time, the stress of the long hours... nope. Clearly not for me.

 

This is a great reply. You stated every reason why I chose PA over Doc after many years of debating. I can certainly understand the drawbacks stated by others and its not that they don't bother me. It's just that these reasons here to chose PA are more important to me. To the OP, I will say that I feel you're doing the right thing by asking these questions. The people on here tell some hard to hear truths and when I first started reading them, I began questioning my decision again. I took some time and really asked myself to be honest (with myself) about the most important aspects of my future career. PA won but your husband will have to decide for himself. I'm sure he will make the right choice. :)

[BeatlesLVR]

I am so happy to have come across this thread. I too am at a conundrum. I have always wanted to be a DO (specializing in Ortho Surgery), but then I learned that PAs can ALSO specialize in this particular field (PAOS has provided me with quite a bit of info on this career). I'm currently in my mid-30's, wanting to make this career change, and have a great support system in my husband- both financially and emotionally- with whichever choice I make. I'm just hesitant to go the DO route bc I won't be done with school until I'm in my late 40's, but I like the autonomy and the AMPLE job opportunities a doctor would be able to get over a PA. Though the salary of a DO would be astronomically higher (540K+), a PA's salary in this specialty isn't so bad either (230K+)-- after all the taxes and liability the DO would be responsible to pay for, it SORTA balances out so I'm not too concerned about the eventual financial outcome.

 

The big thing I am curious about, which would make me lean towards DO school if it is true, is that I've been reading again and again that DO school (NOT MD schools!) is easier to get into vs PA school due to "grade forgiveness". Rather than averaging in past negative marks/grades, DO schools look at your latest attempts/best grade. Since I have a few mistakes that need to be forgiven, this would be much more appealing than CASPA's system of averaging all grades. If anyone has any further clarification on this issue I would appreciate it!

 

 

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[wjm7]

I'm not so sure where you're getting the 230K+ figure.  I wish we had that sort of earning potential!  I know that a few extremely experienced PAs in specialties (most surgery, I believe) make in the ~200K range, but from what I understand it's pretty rare.  When I graduate I'm hoping to find a job in the 85 to 90K range.

[Maverick87]

I am so happy to have come across this thread. I too am at a conundrum. I have always wanted to be a DO (specializing in Ortho Surgery), but then I learned that PAs can ALSO specialize in this particular field (PAOS has provided me with quite a bit of info on this career). I'm currently in my mid-30's, wanting to make this career change, and have a great support system in my husband- both financially and emotionally- with whichever choice I make. I'm just hesitant to go the DO route bc I won't be done with school until I'm in my late 40's, but I like the autonomy and the AMPLE job opportunities a doctor would be able to get over a PA. Though the salary of a DO would be astronomically higher (540K+), a PA's salary in this specialty isn't so bad either (230K+)-- after all the taxes and liability the DO would be responsible to pay for, it SORTA balances out so I'm not too concerned about the eventual financial outcome.

 

The big thing I am curious about, which would make me lean towards DO school if it is true, is that I've been reading again and again that DO school (NOT MD schools!) is easier to get into vs PA school due to "grade forgiveness". Rather than averaging in past negative marks/grades, DO schools look at your latest attempts/best grade. Since I have a few mistakes that need to be forgiven, this would be much more appealing than CASPA's system of averaging all grades. If anyone has any further clarification on this issue I would appreciate it!

 

 

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Your averages are pretty far off.

 

According to the most recent salary reports, the average orthopedic specialist makes $400k and the average orthopedic PA makes $105k. Big difference.

 

But you also have to take into account the amount of money you spend for school. I (would have) spent $70k for my PA school (in just tuition), whereas average tuition for medical school is $200k (you also have to factor in interest here, as you would be able to pay off the $70k after 2 years, while you will have to wait at least 4 years to start paying off the $200k).

 

Also, orthopedic surgery is a 5 year residency. So that's 9 years total, while an orthopedic PA can start practicing right out of school. 

 

Also, you have to consider residency. In a 2012 article, 6% (about 1,000) medical students didn't get ANY residency spot and were unable to practice at all. I'm not sure of the exact year, but they are planning to increase medical school slots by 5,000 students, but they are not increasing residency slots.

 

Even if you do get a residency, it may not be the one of your choosing. A LOT of people want orthopedic residencies. I'm sure it's quite competitive (though, not as competitive as ROAD). You may not do as well in medical school as you think and end up in family medicine. Would you be okay with that?

 

It's really up to you and what you can handle.

 

PS: I've been looking into going back to be a DO as well. Can you tell? :P

[primadonna22274]

Ortho is the new O in ROAD (and R is fading fast with many radiology slots unfilled this year due to falling reimbursement). Ortho is incredibly competitive for DO and MD. It's much easier for a PA to get a job in Ortho than it is for a less-than-stellar med student to match to Ortho.

And yeah, the salaries projected are ridiculously high.

[BeatlesLVR]

Hi Primadonna and aiviphung, thanks for responding! I was just being a little flippant about numbers as far as salaries go but u are correct, big difference , but higher than the average for PAs in general. I'm actually very interested in the field of Ortho, I'd like to make SURE I have a fighting chance to get into that field. Do you have any suggestions or ideas on how I might go about getting some pre-DO/PA school experience to learn more and make myself a better candidate?

 

I'm in the military so I don't have to worry about tuition as I will be utilizing my GI Bill and applying to schools that participate in the yellow ribbon pgm (= ZERO debt, rent, books, and general living expenses taken care of-- can u tell I might be trying to sell the military *wink*wink*!) I'm more worried about WHICH PA schools I should apply to that will afford me the opportunity to concentrate on Ortho Surgery... I also plan on taking the MCATS and applying to DO schools as well, but I'm leaning heavier towards PA school bc of the length of time in school is much less. I'm currently 35, married, wanting to start a fam in the next yr or two, and I know I won't be that STELLAR student who might match into Ortho Surgery.

 

 

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[Guest Paula]

If you really think you want to be in ortho surgery then PA school plus an ortho residency.  Doesn't Baylor offer a DHSc in ortho for PAs?  It is for military PAs only.   This is your best route, especially since you want to start a family.  PA career more flexible for women with families.  I'd steer clear of MD/DO for that reason. 

[KMD16]

^ DScPAS-EM residency @ Baylor for US Army only.

 

PA career being flexible for women? Very specialty dependent. Same applies being an MD and female. Both has it +/-

 

As an MD, you would have better control of your hours and can say no to working crapy hours/holiday/weekends w/o repercussion.

[EMEDPA]

I know several female fp docs who work 2 days/week with full benefits and make > 100k/yr. try to do that as a pa.

[Guest Paula]

^ DScPAS-EM residency @ Baylor for US Army only. PA career being flexible for women? Very specialty dependent. Same applies being an MD and female. Both has it +/- As an MD, you would have better control of your hours and can say no to working crapy hours/holiday/weekends w/o repercussion.

 

And can hire a PA to do the weekend work, holiday work  and call. 

[EMEDPA]

And can hire a PA to do the weekend work, holiday work  and call. 

and nights and anytime you(the doc) doesn't want to work...

[KMD16]

^ True.

 

You work smart NOT hard

[UGoLong]

We see a fair amount of entry level ortho jobs for PAs in our area.

 

 

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[Guest JMPA]

one does not need a residency to become an ortho PA. many employers want to feel as if they can hire fresh and teach into the specialty. there are always a ton of ortho openings. I find ortho rather boring but to each their own