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Got into PA school and MD school. HELP?!

Discussion in 'Pre-Medical Allopathic [ MD ]' started by docjay26, 12.03.12.

  1. docjay26

    docjay26

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    So the short version is. I will be 27 soon. Have one 3y/o and another on the way. Am married with a wife who is willing to follow me anywhere I decide to go. Got into Med school and PA school this year. I will be paying for both on my own. MD school = 200k (estimate) PA = 100K.

    What should I do? Medicine is a passion, but so is family. After shadowing MDs for over 3 months (7 diff docs, men and women, dif spec.), none seemed happy. Only one said go into medicine. The others said I was nuts and they wouldn't do it again.

    The two PAs I shadowed are very happy and recommended PA school and a PA career to follow.

    I want to work with patients but I have other interests. (My kids, music, fishing...the list goes on.)

    I know the answer to lifestyle and balance is all about the individual and how they handle their career but I wanted to know what any of you would do if you were in my situation?

    Thanks for the advice!!!
  2. Smokemont

    Smokemont

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    The fact that you are even considering this means you should do PA.
  3. docjay26

    docjay26

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    I would agree with you to some extent. I mean the irony of that is I never considered PA until a year ago when an IM doc who had recently sold her practice told me she told her kids to go PA instead of MD. The confusion for me came with all the shadowing I did. The physiatrist wished he'd gone into radiology, the radiologist wanted to be an orthosurg, the peds doc should have been a derm...Really a better lesson in,"the grass is always greener" but taken as a whole it made me start to question the years of schooling and debt. I guess I was looking for the, "you won't regret it" and the PA's were the only ones who told me that - and their only regrets were salary based.

    The fact that healthcare is in flux I believe contributes to the uncertain attitudes so I can chalk them up to that... but to not consider the debt and family impact of a future in medicine as an MD seems irresponsible to some extent.
  4. tco

    tco

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    It sounds like you've made your decision. Go PA.
  5. Stixman28

    Stixman28 Medical Scientician

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    This really depends on what your ultimate goals are. I have always felt strongly that the MD is appropriate for those with an intellectual pursuit. If you want to help shape the field, whether it be through the development of clinical protocols, basic research or teaching, you need the MD.

    If carrying out the daily activity, seeing patients and managing basic problems in whichever field you end up practicing in is more of what you're into, the PA route may satisfy you intellectually, get you there quicker, and give some more time to your kids and wife during training. Another way to think about it would be the difference between a career and a job.

    Seeing some of my fellow MS4's hate their decision and say I shoulda been an NP or PA really put the decision into perspective. Not everyone needs the MD to accomplish their ultimate goal.
  6. brofessor

    brofessor

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    I'm in medical school, and while I like it, I would say go with PA. With a wife and kids you will want the time that going PA will afford you and medicine will not
  7. flodhi1

    flodhi1

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    Medical school is not easy, academically it's alright sometimes but it can be a burden on your loved ones. I'm living a pretty tense life right now my relationship with my gf is rapidly deteriorating simply because I'm dedicating my whole life to medical school (not the right thing to do but I have to do it). If you want to have a happy life with fulfillment but also spending tons of time with your family you know what route is best for you. 3rd year medical school, internship and residency just gets worse this is a 7-10 year long marathon and at times it's going to wear you out and most importantly wear out your family.

    I would say however don't listen to some random strangers online. You need to talk this out thoroughly with your family and best of friends. Good luck :thumbup:
  8. Acoustic

    Acoustic

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    I'll go ahead and throw out a "go MD" vote since there is a bit of "go PA" opinions already. I'm not 100% familiar with the inner workings of a PA, so take this all within that light.

    You've said that you want to have a life outside of your career. While it may not be entirely possible during training, that is certainly a possibility once you are out of residency. You can basically form your practice (or your role within another practice) however you want. Which can include working less than 5 days a week. While you MAY be able to do this as a PA, I would think you would have less "persuasive influence" over your availability because you are more often working for someone else. As the MD you can dictate whatever you desire. Of course this means less pay, but you're going to be making more per time than a PA anyway. So this might make it more financially feasible to work part time.

    I know there is an increasing trend towards part time physicians, and I've been told this is especially true of those who have children. I personally know several MDs who work 4 or even 3 days a week, granted they often work intense hours during those days.

    I'd be curious if you've only shadowed physicians at academic or large institutions who have much less control over their careers and lives. Even if they do have control, they tend to be in a "rat race" environment, where many of the people are always chasing something new, be it another research grant or moving up the academic chain. Even the most ambitious people can get jaded after living in a constant state of "everything will be better when I get to that next step". You might want to seek out input from smaller and private groups, as not having this input could easily skew your perception.

    Also, what you mentioned about physicians having a "grass is always greener" mentality - you're going to find that wherever you go. The difference between PA and MD, though, is that the MD has much more ability to actually switch into something new (financially, logistically and job description wise), at least with my understanding of a PA.

    It sounds like you're being heavily influenced by anecdotal encounters with emotional MDs. I'll counter that with other anecdotes for you. Almost every physician I have spoken to as a medical student has basically said "this is really hard and it can consume a lot for awhile, but you should be very excited because this is the best job you could ever have". Again, this could be because I go to a school that tends to associate more with private physicians than with academic ones (i.e. many of the group preceptors are volunteers from the community, and don't have practices that are based in university owned hospitals). Like in everything, volunteers tend to be more enthusiastic than employees.

    If you want to look at things objectively, without all the "would you do it again" stuff (because in reality this is a position that is the result of many, many different personal factors), as a physician you will have more financial and persuasive power to dictate how much free time you have for everything else. You will have a broader choice of field. You will have more say and a stronger role in the healthcare of your patients, especially if it turns out you like research or public policy. It's harder initially, but doesn't have to be in the long run (might not matter for you if you already have kids).

    Edit: As a side note, when we first started as medical students we were shown a series of slides about what past graduates from my school thought about their careers and their education. For happiness and job satisfaction, in every cohort the top contributor was ALWAYS ability to control their work and influence over their careers, even over satisfaction with the field of choice or the job itself. This is something you will have less of as a PA and less of if you work for large institutions.
    Last edited: 12.03.12
  9. doxycycline

    doxycycline

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    Idk if this is my burn out talking or not but if ur ok with not being the head honcho EVER then go pa because medical school sucks in ways u can't imagine. I was unfortunalty not ok with that and now I'm 175K in the hole with nothing but more years and slave labor ahead. Don't do it if you are even doubting it because I think most ppl who go to med school had 0 doubts starting.
  10. Hemorrage

    Hemorrage 117

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    go MD. Regardless of how your feelings/family will be for the next 4-8 years, after that it will be way smoother sailing than if you went PA. MDs universally make more money and this is very important if you want to send your kids to college, etc. If you are OK having to work under someone else for the rest of your life then go PA, but i am almost certain you will regret it.
  11. YH5

    YH5

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    You haven't even taken the MCAT yet!
  12. emedpa

    emedpa GlobalDoc2B2015

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    as a longtime pa let me join those saying, go md.
    the glass ceiling as a pa is very real and the lack of respect you often get even when you do a great job is intolerable. your options for scope of practice and geographical area of practice as well as international options are far greater as an md.
  13. docjay26

    docjay26

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    Thank you very much for the informed replies and the advice. The MDs who I shadowed did actually range in place of work from a small rural clinic to a busy east coast city Hospital. The question of autonomy is a valid one...I actually brought this up to a hospitalist and again, everyone has their own opinions, but she spoke about the fact that private practice in the future is going to be harder and harder to maintain and how everyone is working for someone, whether it is the insurance companies or the hospital admin bean counters. So I guess that frustration can be found no matter where you look.

    That being said. She said she would never be a PA. Enlightening and confusing at the same time.

    One other aspect of PA that I find interesting is the ability to jump specialties. Whether or not this can actually be utilized and whether or not you would want to do this after settling down and finding a position is another question. That option is there though.

    But I do want the knowledge and depth of education as well so I guess I still have some soul searching to do in a short period of time.

    I really appreciate the replies though, so keep them coming if you can..

    Acoustic, thank you for taking the time for that reply!
  14. MCAT guy

    MCAT guy ...

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    Tough. The pessimist inside of me says go PA... but I think MD is fine if you are willing to go through the 7 years or so of training. Certainly sacrificew in that time period.

    Honestly, I would rather be an MD especially if I'm training for a new position. If I had a solid job in anothrr field with current income, that's harder to walk away from... in other words, medicine is a guaranteed job but not the end all be all.

    One quick point. Being a doctor or not isnt what determines your happiness. They are completely independent. Lots of unhappy doctors just means their expectations exceed their reality. Any doctor can learn to be happy of they adjust their psychology and expectations, and maybe even adjust their schedule/responsibity.
  15. shinbeats

    shinbeats

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    lol!
  16. pencilcase

    pencilcase

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    Go MD. The next four years will suck: but after that life can get better if you pick a lifestyle-friendly specialty.
  17. Bancrofti

    Bancrofti

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    I think it really depends on your personality for the overall question of whether someone should do PA or MD. I remember a PA that was working with an Ortho doctor asked me if I considered PA school. I had a difficult time eloquently putting that I had no desire to work under somebody else for the rest of my life. In this day and age autonomy isn't what it used to be anyways, but that's a different story. I would probably actually go into nursing before I did PA school (both are good options if you haven't considered nursing).

    But like everyone said already, it seems like you've already made your decision. I think you have your mind set that you need time for all the important things in your life. If you do PA school, your only regret will probably be not becoming a physician. If you become a physician, your regrets will certainly increase as you factor in that (depending on your specialty) it is unlikely that you will still have time for all those things you hold to be important. Not trying to convince you either or. I think you should weigh what the worst result potential outlooks are for each choice... and see which one it would be easier for you to live with. That or flip a coin :D
  18. dichloromethane

    dichloromethane

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    I'd say go PA. 2-3 years>6+ years

    You won half the battle. You "got in" :laugh:

    You should do what's best for you. Seeing as you have kids and you want that balanced lifestyle PA seems to be the better route.
  19. BabyDoc86

    BabyDoc86 MS2, pediatrics hopeful

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    From what I've read, it seems that PA is where your heart is. Totally understandable when you have spouse + kids and still want a life.
  20. shinbeats

    shinbeats

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    Someone's on a power tripp. You know you could have just joined the Police and made it easier on yourself.
  21. emedpa

    emedpa GlobalDoc2B2015

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    they already have a lead singer.....:)
  22. IslandStyle808

    IslandStyle808 Akuma med school or bust!

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    This is not completely true. MDs cannot switch from one speciality to another unlike PAs. For example, a dermatologist can only practice dermatology. However, a PA can be in the dermatology field and then can decide to switch to pediatrics (no extra education necessary). This is one of the advantages to being a PA.

    However, in terms of progressing the field of medicine and making the large decisions in a person's care, it would be better to have the MD.

    OP try to look into the fields even more and decide what type of life style you are most comfortable with. Congrats to you on getting to both MD and PA school and good luck with whatever you decide!
  23. jackets5

    jackets5 Senior Member

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    PA is an option is ok if your ok with not making the decisions for "your" patients for the rest of your life. Realize you will much more superficial understanding of what is going on with patients and rarely get do anything complex.

    Also, who knows how the mid-level landscape will change in 5,10 or 20 years. If MD's ever grow some balls and stop letting NP's and PA's encroach on their turf there could be an issue especially with more and more US MD and DO schools opening and the current ones increasing enrollment. Mid levels will always lesser trained and less qualified than a MD or a DO when it comes to patient care.
  24. emedpa

    emedpa GlobalDoc2B2015

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    some fields certainly allow for a wider choice of practice style. an fp md can do minor and/or cosmetic derm, urgent care, em anywhere except in a major metro area, ob, treadmills, vasectomies, colonoscopy, hospitalist, occ. med, etc, etc
  25. emedpa

    emedpa GlobalDoc2B2015

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    this is really dependent on setting. I staff a facility by myself with no md on site and my charts are reviewed after the fact(sometimes as much as 30 days later) so all choices were mine as to tx and dispo. certainly the doc can say "next time, think about this option" but they have no real time input into my decisions.
    I agree that docs have a greateer understanding of the basic science behind disease.
    if anything, the future for pa's is bright. they are the #1 ms degree in terms of emplyment outlook in several studies. there are 4-5 jobs for each new pa grad and with the u.s. leaning towards a more socialized style of medical practice, we will be in constant demand as a low cost option to work alongside docs. a clinic can be run with 2 docs or 1 doc and 3 pa's for the same price for example.
  26. jackets5

    jackets5 Senior Member

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    For the most part PA's are by far the best trained, prepared mid-levels and realistic about their level of training. Whereas NP's are delusional. It's just that us as MD's are so heavily regulated and mid levels are not really
  27. Acoustic

    Acoustic

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    As I said, I'm not super familiar with the career patterns of PAs. However, it certainly is true that MDs can switch specialties and often do. Yes, it entails more education, but I seriously question how much "switching of specialties" you do as a PA if you don't need further specialty specific training. This says to me that PAs aren't really that much different between "specialties", so the notion that you can switch isn't as prominent as it is for a physician.

    Many MDs further direct their careers after residency or can switch altogether. This doesn't always mean another residency, but it does mean that as an MD you can make your career however you want. That level of freedom doesn't exist for PAs.
  28. sonofva

    sonofva

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    what? since when is it a bad idea to consider all your options and make an informed decision?
  29. emedpa

    emedpa GlobalDoc2B2015

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    pa's who switch specialties get much of their training on the job with a progressive increase in responsibilities and scope of practice. it is becoming more difficult every yr for pa's to switch specialties as hospitals are getting tougher with regards to credentialing standards. they want to see procedures logs, etc and while these can be done on the job it takes time. pa residencies are becoming more common. see www.appap.org for a list with links. there are also now national (caq) certificate of added qualification exams(basically specialty certs) for pa's in a number of specialties requiring proof of procedures performed, years in practice, attestations of competance from physicians, etc
    20 years from now all pa's will probably have to do a 1 yr postgrad program and pass a caq exam.
  30. Acoustic

    Acoustic

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    It sounds like you're describing an unofficial residency then. So switching is basically the same, with intensity according to scope of practice. Thanks for the info. It's always helpful to know how everyone else on the healthcare team actually got to where they are and what their background is.
  31. Mass Effect

    Mass Effect

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    Switching specialties isn't exactly cake for doctors and I'd argue that don't "often" do it. If an OB/GYN wanted to practice psych, he/she would have do a psych residency to be board certified and doing two residencies isn't very easy due to funding concerns. There is some overlap in some specialties -- a FM doctor can do skin exams, but it's not like they'll be practicing dermatology. An IM doctor can continue seeing patients who get pregnant, but it's not like they'll be catching babies in the delivery room. If he/she wanted to do that, they'd have to complete another residency.
  32. Acoustic

    Acoustic

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    "Often" is a relative term man.
  33. D elegans

    D elegans 2 1 5

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    I'm another vote for the "PA unless you can't stand working for someone" camp.

    I couldn't be a PA because I couldn't stand the feeling of being a subordinate. I want to be the person with the ultimate responsibility of making decisions.
  34. Mass Effect

    Mass Effect

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    Relative to PAs switching specialties, I think it's inaccurate. I'm only pointing it out so the OP isn't thinking that's one of the pros of going to med school over PA school.
  35. Acoustic

    Acoustic

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    Ease of switch doesn't equal rate of switch. Also, switching specialties can be done as an MD by simply further specializing. This IS done often, especially as physicians advance in their careers (i.e. anesthesia > pain, rads > specific organ system etc.). You can't really further specialize as a PA to the same degree.
  36. Bancrofti

    Bancrofti

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    Ehhh, I don't see it that way. I've seen/heard others say the same thing. I just know for my personality, I would personally get the most satisfaction from my job knowing that for the most part it is my decision-making that is the final call and what leads to outcomes.

    But then again, my perspective may be short-sighted. I remember I had a cyst removed when I was younger and from what I can remember, the PA in the ER was the one who diagnosed it, explained everything to me, cut it out, packed the wound and prescribed my meds.
  37. emedpa

    emedpa GlobalDoc2B2015

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    it varies by location, experience of the pa and preference of the physician group.. in my practice I typically only involve a physician for pts who will require admission. the rest I eval, tx and dispo myself.
  38. lykyamy00

    lykyamy00

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    i'm not sure if someone said this already, i didnt feel like reading through everything, but i wouldnt have thought to comment on this if i hadnt just seen the fb status of a girl i went to college with who is just about done with pa school. its something like

    going from seeing my own pts on my rotation in belize to having the doctor see the patient and i dont get to ask the pt a single question... disappointed

    obviously shes a student, and i guess it really depends on where you go, but in the ed's i've volunteered in and been to as a patient, the pas see the fast track patients (minor lacs, cysts, 'minor' broken bones sprains muscle pain etc) and the doctors do the critical cases, admits, traumas, anything that comes in via ambulance. a recent experience, my roommate cut her finger on a knife and needed stitches, an M4 was with the PA on the 'super fast track' the PA talked a little, the M4 did the suturing, the MD checked to see that everything was OK. on the wards (especially in surgical areas as far as i've seen) the pa's monitor the pts while the docs are in the office or operating. at past shadowing experiences (at small community hospitals) the pa was the second 'surgeon', but at a larger academic facility with any number of students and residents need to be trained, i have not seen a single pa in the or. so it really depends on where you go, how much control you want to have over a patient, and how critical you want your patients to be.

    sure 4 years of med school followed by residency is hard on your family. but it would also be hard on your family if you went to work every day at a job you hated (this goes both ways!)

    so pick the one that you think fits with the way you see yourself practicing medicine! :) good luck!
  39. medwidget

    medwidget

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    I was in a similar situation. I started med school with a 3-year old, and my husband was really supportive and excited. I ended up getting divorced while studying for Step 1 (still pulled off a score over 240, btw). It's impossible to explain how much med school takes out of you and how tough it will be on your family. Even the first two years will change you in ways you can't imagine.

    I'm currently in the middle of third year rotations, desperately trying to see my son whenever I can. It's incredibly hard, but I still love medicine. I would have been miserable and resentful as a PA. Being an MD will allow me to research and publish and possibly shape the future of healthcare.

    My advice is this: go MD if you cannot possibly do anything else with your life. It is so very hard to do with a family; you need to be absolutely sure. You also need to sort out your priorities, be 100% realistic with your wife, and become amazing at time management. If you can tolerate the prospect of being a PA, it's probably the better choice.
  40. MCAT guy

    MCAT guy ...

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    I feel for you. Its sobering to hear a real story. Most of the time we hear premeds saying anything is possible and MD at all costs... thx for sharing.
    Last edited: 12.03.12
  41. Mass Effect

    Mass Effect

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    I'm not following. If you're in anesthesia and you do a fellowship in pain medicine (which is pretty competitive, from what I'm told), then you'll be a pain doctor. I don't really consider that a change in specialty though. It's like going from IM to do a fellowship in cardiology and being a cardiologist. I'd consider going from anesthesiology to OB/GYN to be a true change of specialty and that's something that most people can't do.

    I disagree that ease of switch doesn't equal the rate of switch. If it was easy for everyone to switch specialties, then many would. The reason so many don't, even though some want to, is because it's hard to do it.

    Based on the PAs I know, I think it would be much easier to switch specialties as a PA than as a doctor. But I'll agree to disagree at this point.
  42. Acoustic

    Acoustic

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    I would, as would almost every cardiologist, consider going from IM to cardiology a change in specialty. That's a pretty huge difference. I also never said it was easy to switch specialties, just that it isn't infrequent and is totally within the realm of possibilities.
  43. rocketbooster

    rocketbooster Removed

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    Based on your concerns, I would recommend PA, unless you can land a lifestyle specialty with great hours and good pay. Dermatology, ophthalmology, urology, etc. Even though radiology is a lifestyle specialty, I can still see ppl hating it because it seems incredibly boring to me. I've never met any dermatologists or ophthalmologists complaining about their careers, though. Unfortunately, you can't guarantee getting into one of these very competitive fields before you start med school. Just a risk you have to take. I will say that intellectually you'll like MD way more no matter what residency you do. PAs lack a huge portion of basic medical knowledge that even me as a lowly med student picks up on haha.
  44. Smokemont

    Smokemont

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    You apparently missed the point. With medicine where it's at today, you need to know it's what you want. If you can find happiness outside of the MD then you should do it.
  45. mjl1717

    mjl1717 Senior Member

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  46. emedpa

    emedpa GlobalDoc2B2015

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    .[/QUOTE

    6)Id say a good PA can earn respect. (This entails being a good clinician, good detective, excellent beside manners, great rapport, understanding humour and of course being Osler like..

    :thumbup::sleep:[/QUOTE]

    DEPENDS...you have to be able to at least present the pt....there are some docs out there who say " I don't ever talk to pa's , have your attending examine the pt and have them call me"(click, as they hang up on you)
  47. VenusinFurs

    VenusinFurs I am tired, I am weary

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    FMGs who were doctors for a while switch specialties all the time. Like you'll have the dude who was a general surgeon in China who then goes to the US and does an IM residency. But that's out of necessity and takes years of pain.
  48. PrideNeverDie

    PrideNeverDie We're all gonna make it brah

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    go MD, but be prepared to lose your family

    i'm one of those people who couldn't handle not being a MD, but if i had a wife and kids whom i loved i would go PA.
  49. MCAT guy

    MCAT guy ...

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    In medicine "changing specialties" is not equal to sub specializing. If what you're saying is true then every cardiologist has changed specialties because they all train via IM.

    Sub specializing : general ortho to spine.... switching? Ortho to ent.

    Sub: IM to IM subspecialty... anesthesia to anesthesia sub specialty. Switching? Surgery to ER
  50. MCAT guy

    MCAT guy ...

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    Yeah. I bet very few doctors do this. I'm sure there are stats somewhere. I'd guess under 5 or 10%.

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