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How to start my career & loan repayment

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I'm about to graduate this summer, and I am looking for advice on the best way to start my career. One of the things I like about the PA profession is the flexibility and the lateral mobility, but in reality how easy is it to make transitions between specialties? I'm afraid of getting pigeonholed into a specialty early on, but I would like the ability to move into a specialty later in my career.


Some PA's have told me to start out by getting a few years of primary care under your belt. I enjoy the complex problem solving in IM, and I've been told by other PA's that getting a broad and solid base of experience in hospital IM will open doors to IM subspecialties later in my career. I would also like to teach medicine one day, and I am great at pharmacology and pathophysiology so I think IM would give me opportunities to expand my knowledge in these areas.


On the other hand, I do enjoy working in the OR. I've heard a lot of PA's tell me that starting in surgery at a big teaching hospital you rarely get to scrub in. If I'm working in surgery, I want to be in the OR, not just doing scut. Also, how easy is it to move from a surgical specialty to medical and vice versa?


One more thing: I am also considering NHSC loan repayment jobs, but I've heard the downside to this is you are pretty much limited to family practice. You also typically start at a lower salary at these jobs, and I've been told that your starting salary is the base from which you can negotiate your future salaries. Start lower and you will get lowballed when negotiating future contracts. Not sure if this applies to PA's, but it is something I am concerned about.


I like family practice, especially seeing peds patients, and I believe primary care will soon have more abundant and lucrative opportunities with the changes coming with Obamacare, but I am concerned about losing the opportunity to gain hospital experience and managing complex patients. I did a rural FM rotation where the doc saw all his patients in the hospital (many were very sick) and did deliveries and assisted in C-sections. But I am planning on initially working in a urban location where most FM docs use hospitalists. Also, I've noticed that a lot of the midlevel family practice is dominated by NP's. Should I choose a specialty where PA's have a greater niche?


Sorry for the long post, but I a have to start looking for jobs and I'm so confused about what to look for starting out as a new grad. So any pearls of wisdom from seasoned PA's or things you would do differently if you had the chance would be GREATLY appreciated.


Thank You!

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Congrats on graduating, IMO I really think that you should go into which ever field you feel the most compelled to do. There may be some teaching institutions which will have fewer opportunities to scrub in but there are plenty of surgical jobs in hospitals and in private groups which you will scrub in on a very regular basis. When I started I took a surgical position as well as a moonlight job in the ER. There is not a "correct" formula. There are some jobs which will be better for a "seasoned" provider but if you really want a specific specialty and are willing to move to it, I am confident that you can find it and do perfectly well.

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