Another MD vs PA post

[TheDude_]

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Hey guys,

I am simply looking for wise advice based on the scenario below.

I am an O-3 and a Non-Trad Pre-Health Professions. I will be entering CIP (Career Intermission, for those who don’t know) next year to both finish my prerequisites and PCS to be with my military husband sooner.

At the end of my new commitment, I intend on either going to Medical School or PA school by using both my GI Bill and HPSP (I would have zero debt and maintain that cush O-3 life throughout training).

Now, I am female. If I did medical school, I would (today) want to practice in Family Med, Peds, Psych, or Anesthesiology (all for different reasons). Because my schooling would be free, and because my husband and I could do things like hire an au pair, I would be crazy to NOT do Medical school, right? And if I do not match into the residency that I desire, I become a GMO and be a pilot-physician (yes lol).

My biggest fear is that I would be asking for a job I would regret (due to all of the increased Admin/paperwork/businesses)... I don’t want to climb the feaux ladder of success; I simply want to practice (and financially, Med School makes sense). But is PA really that much “better” life wise?

If you were a 34yo mother of two (the plan), what would you choose? If you were to make the best decision for your family (and finances are of no concern), what would you choose?

 

[HighPriest]

In some cases a PA might have more administrative work to do. Although perhaps not as much of a difference in the military.

The issue is, in part, that the military uses PAs very differently than a lot of civilian practices. So part of the answer depends upon where you think you'll spend most of your career, and how much of a career outside of the military you think you'll eventually have. In the civilian world, PAs have a lot more supervision, generally (there are exceptions). They do a lot more of the scut and administrative work. They're usually not as independent as they are in the military, where they are essentially autonomous providers.

Part of it depends upon what your interests are as well. PAs do not have the medical knowledge or expertise that a physician has. Period. Now there are good PAs and bad PAs, and there are good doctors and bad doctors, but what I'm talking about here is the general experience. PAs have nowhere near the training, and they're expected to learn a lot on the job from the physicians that they work with. A good PA will do that. A bad PA will come out of training assuming that they know everything, which they do not. I've seen a lot more bad PAs in the military than I have since I left. That doesn't mean they were dumb, it just means that I met a lot more PAs who felt like they were just as good as a doctor right out of training. I think the good PAs in the military are actually better than the good PAs outside of the military. I actually think the military PA training is pretty good.

If you want to be the place where the buck stops for patient care, do medical school. If you want to treat patients, but you also don't want to be the end of the line, and you like the idea that there's always going to be someone to whom you can defer when things don't add up for you, then PA may be a better route.

34 is not that big of a deal, frankly. Med school and residency will be a bigger commitment, but it's not insurmountable at 34.

PA lifestyle really depends where you're working as well. I think a lot of military PAs share more or less the same lifestyle that their MD/DO counterparts do, because they're seeing clinic on the same days and at the same time. I had PAs that worked for me in a surgical clinic in the Army who definitely saw fewer patients (like, half) and never took call. I know PAs in the civilian sector who work 12 hours shifts 5 days/week. So you kind of have to focus on where you're going to practice, and what kind of practice you're going to have.

FWIW, one of the benefits of medical school is that once you match into a specialty, the military is probably going to let you practice in that specialty....probably.....unless you end up in a brigade surgeon billet or some such nonsense. If you're a PA? Well, they can stick you wherever they need someone stuck. Statistically it would probably be primary care, but there's no way to know for sure.

I think most of us are going to say that we would choose med school, as almost everyone who posts on this forum chose med school.

In your case, I would go to med school.

 

[notdeadyet]

If you were a 34yo mother of two (the plan), what would you choose? If you were to make the best decision for your family (and finances are of no concern), what would you choose?

Can’t answer this because I don’t know you, your husband, or your kids.

That said, I went back to medical school at 35 and thought long and hard about PA vs. NP vs. MD. What sold it for me was that the kind of drive that was making me leave a pretty good career at prime earnings/growth time and start over was the same kind of drive that made me think I’d be less satisfied as a PA or NP.

I have much more freedom as an MD in terms of jobs and prospects (at least in my field). If and when my opinions or actions are questioned, it’s only by folks with more training and experience. When I’m working with a patient, I’m in charge of the team. These are pluses for me. If they’re minuses for you, that puts ticks in the not-MD boxes. The training for MD is much longer than PA but your skills will be proportionally better and you have much more choice.

 

[TheDude_]

Thank you all so much for your inputs. I know that I would much rather become an MD/DO; I am competitive and driven. My biggest concern is definitely my family and making sure that they don’t suffer. I grew up with a mom who stayed home until we were in school, and then she went back to teaching. I think we turned out alright, haha.

But what about when your mom is a Military Officer and Physician who works long hours— but still tries to invest and give her children the best. Did you all turn out alright? Lol

The more I look into it, the more I don’t think I could do anything else In healthcare. But that’s just me; my family is involved as well. Again, thank you all for your input and insight!

 

[star1]

I would choose the PA route. I’m a mom also and I as a mother you want the best for your kids. Being a PA will allow you to spend more time with your family.

 

[LTMCUSN]

OP, just out of curiosity, why use the GI bill along with HPSP? It seems like a waste of the tuition (hundreds of thousands of dollars potentially that you could transfer to your kids), just for the BAH. Also, how are you going to maintain an 03 lifestyle with the HPSP stipend?

 

[scoopdaboop]

If you were a 34yo mother of two (the plan), what would you choose? If you were to make the best decision for your family (and finances are of no concern), what would you choose?

Ok disregard first 2 years of pre-clinical, I do not think the sacrifice there is that much. But third year rotations, and most of 4th year, and then residency (3-7) years is a big sacrifice. So 5-9 years of working hard to be able to call yourself a doctor, is that something you can manage? The good thing about being a physician is that your work life balance is anything you want it to be. Idk any PA's that work 4 days a week making 250K+ as a family med PA, but that's pretty much standard for any FM doc. The lifestyle in medicine can be any NP/PA lifestyle if you wanted it to be, and make probably 1.5-2x as much as any other PA/NP with a similar lifestyle... Hell, even in things like neurology, or cardiology, 4 day work weeks + 4-6 weeks vacation is like 350K+. But, most people come out with debt, so they work a bit hard to pay off debt first... You're in a position where that is not even a problem. So the question becomes, are you okay with less responsibility over patient care, more of a "monkey see monkey do" type of role in PA? Unless of course you work in a rural setting where you might not be managed or looked over by a physician nearly as much, but that means your lifestyle would take a sacrifice...

 

[DrMetal]

PA's that work 4 days a week making 250K+ as a family med PA, but that's pretty much standard for any FM doc.

In time, you won't know any family med docs working primary care.

The job market for physicians is becoming very tenuous.

I have a friend who's in her early 50s. She went to medical school, completed a residency in FM, got her initial BC, practiced a few years but then came home to raise her 3 children. This was all 20 years ago. Now that her children have grown, she's trying to get back into clinical medicine, but she can't get hired b/c she's no longer BC'd, nor board eligible. She would have to complete another year of residency (good luck finding that avenue) to sit for the test again.

So a U.S. medical school graduate, who completed an ACGME-accredited residency, can't find work because she's no longer BC'd. And yet, the same clinics in her neighborhood are hiring PAs/NPs by the droves. She even offered to take one of the PA spots, and work for PA pay!

@TheDude_

Go to PA school. It's clearly the better deal. I may join you!

 

[scoopdaboop]

In time, you won't know any family med docs working primary care.

The job market for physicians is becoming very tenuous.

I have a friend who's in her early 50s. She went to medical school, completed a residency in FM, got her initial BC, practiced a few years but then came home to raise her 3 children. This was all 20 years ago. Now that her children have grown, she's trying to get back into clinical medicine, but she can't get hired b/c she's no longer BC'd, nor board eligible. She would have to complete another year of residency (good luck finding that avenue) to sit for the test again.

So a U.S. medical school graduate, who completed an ACGME-accredited residency, can't find work because she's no longer BC'd. And yet, the same clinics in her neighborhood are hiring PAs/NPs by the droves. She even offered to take one of the PA spots, and work for PA pay!

@TheDude_

Go to PA school. It's clearly the better deal. I may join you!

BC'd? what is that?

Also, FM is the most recruited specialty, so if she wasn't 20 years out, she would find a job in a heart beat.

 

[Apollyon]

BC'd? what is that?

Also, FM is the most recruited specialty, so if she wasn't 20 years out, she would find a job in a heart beat.

Board Certified.

 

[scoopdaboop]

I wonder if in the future, there can be like a 4 year residency where you can rotate through several specialties, and be able to be take board exams for one you want to practice....Almost like a transitional year on crack or something. Then, if you change your mind, sit for another board exam and practice something else... Obviously, not for surgical specialties, though. I don't see why not if NP/PA can basically do this without even needing to take board exams for whatever they want to practice in.

I don't see why physicians don't advocate for less stringent laws on being able to switch from one specialty to another without needing more residency. Hell, even if they want to have a role similar to that of a PA. For example, a PA can practice in dermatology with a specific role, and then switch to EM if they really wanted... Why the hell can't an EM doc switch to derm if he wants, and take the same responsibility of the PA + lil more.

 

[DrMetal]

BC'd? what is that?

It should be 'Before Christ', but unfortunately it's board certified in this context.

I wonder if in the future, there can be like a 4 year residency where you can rotate through several specialties, and be able to be take board exams for one you want to practice....Almost like a transitional year on crack or something. Then, if you change your mind, sit for another board exam and practice something else...

No. The correct thing to do would be to eliminate BC/MOC as a requirement for employment. Having gone through a pre-med curriculum, then medical school, then residency, and having independent clinical experience....all of that should be enough! Sure some re-training, some work under supervision may be appropriate for any one who hasn't done something in a long time. But to keep physicians out of work b/c they're not BC/MOC, and to hire NPs/PAs instead in their place . . .does that make sense to anyone?!

 

[HighPriest]

Hard to argue that requiring different standards for people doing the same job makes sense. I don’t have an issue with board certification if it helps to normalize variations in training from institution to institution. Considering some of the pass rates year to year, it actually makes sense to verify that there is at least some baseline fund of knowledge. But NPs and (especially) PAs should have to do this too. MOC: I don’t have and issue with CME, but I get real irritated that I have MOC, CME, and everyone and their mother wants different amounts of each. Just make MOC a monthly online test (we do it quarterly now) and include a list of good, useful journal articles that you expect your board certified diplomats to read and understand. And count all of that as the CME. WTF else do I pay my board for? They’re supposed to guarantee that I am up to date and competent, but then I have to pay thousands of dollars to arbitrary CME providers every year, hoping that it’s a good coarse, because the testing and verification process the board does isn’t sufficient. Consolidate it.

 

[jurassicpark]

Hard to argue that requiring different standards for people doing the same job makes sense. I don’t have an issue with board certification if it helps to normalize variations in training from institution to institution. Considering some of the pass rates year to year, it actually makes sense to verify that there is at least some baseline fund of knowledge. But NPs and (especially) PAs should have to do this too. MOC: I don’t have and issue with CME, but I get real irritated that I have MOC, CME, and everyone and their mother wants different amounts of each. Just make MOC a monthly online test (we do it quarterly now) and include a list of good, useful journal articles that you expect your board certified diplomats to read and understand. And count all of that as the CME. WTF else do I pay my board for? They’re supposed to guarantee that I am up to date and competent, but then I have to pay thousands of dollars to arbitrary CME providers every year, hoping that it’s a good coarse, because the testing and verification process the board does isn’t sufficient. Consolidate it.

This has been the huge debate for a while. Everyone was BE forever and ever in IM until 2012. Then they changed it, which resulted in a lot of people who either didn't take their boards or let things lapse in a lurch. People lost jobs, insurance contracts, etc. Almost a decade out, at least the ABIM is constantly changing their qualifications. Okay, people are failing their 10 year board re-cert and losing everything, let's make a 2 year less stressful exam. People are still angry, hmmmm.. fine, one question a week! They're going to keep changing it around in some form to make sure everyone passes, but the fees will always be the same if not more. It's a cash cow. CMEs are extremely small irritants to pay for compared to losing BC/BE, especially when I can write it off on my taxes (and pre-COVID at least go to nice places at drink and nice bars).

 

[HighPriest]

This has been the huge debate for a while. Everyone was BE forever and ever in IM until 2012. Then they changed it, which resulted in a lot of people who either didn't take their boards or let things lapse in a lurch. People lost jobs, insurance contracts, etc. Almost a decade out, at least the ABIM is constantly changing their qualifications. Okay, people are failing their 10 year board re-cert and losing everything, let's make a 2 year less stressful exam. People are still angry, hmmmm.. fine, one question a week! They're going to keep changing it around in some form to make sure everyone passes, but the fees will always be the same if not more. It's a cash cow. CMEs are extremely small irritants to pay for compared to losing BC/BE, especially when I can write it off on my taxes (and pre-COVID at least go to nice places at drink and nice bars).

Yeah, I was in training when they made the call to go to 10 year certification for us. But not for the really old guys. You know, the ones who probably need updated training the most?

It is a cash cow for sure. That’s the most frustrating thing about it. It’s an extortion racket.

 

[Gastrapathy]

This thread has taken an odd turn. There are plenty of physician jobs, particularly in primary care. The mafia-like behavior of the ABIM is incredibly frustrating.

But...are we really saying that a physician with a 20! year employment gap should be able to be immediately credentialed to see patients without any further training? A supervised year seems pretty reasonable to me after an extreme gap like that. Would you really just sign that doctor’s privileges application without some remediation and assessment?

 

[HighPriest]

This thread has taken an odd turn. There are plenty of physician jobs, particularly in primary care. The mafia-like behavior of the ABIM is incredibly frustrating.

But...are we really saying that a physician with a 20! year employment gap should be able to be immediately credentialed to see patients without any further training? A supervised year seems pretty reasonable to me after an extreme gap like that. Would you really just sign that doctor’s privileges application without some remediation and assessment?

Yeah. 20 years is a long time. Unless you’re frozen and fed updated information like in Demolition Man. But even then he was frozen for 36 years and when he got out, guys in their 70s still acted like he came from the Stone Age. And they really just taught him to knit - not anything that would make his transition back to the real world easier. Which seems counter productive if you’re trying to re-assimilate an ex-con back in to society. So yeah, even that wouldn’t work.

No weird turns here.

 

[DeadCactus]

Go to medical school because you really want to be a physician. There are more sacrifices than just the financial ones. Many of the unhappy physicians pursued medicine because internal or external pressures related to medicine’s positions on the medical and socioeconomic totem poll rather than the unique aspects of being a physician that make it worth it to others.

If you just want to take provide medical care to people and make good money, being a PA seems like a very fulfilling career with fewer sacrifices.

As a tangent, becoming a physician involves a sacrifice of free time particularly during training that means taking away from time to travel, pursue hobbies, and spend time with family. Plenty of physicians still find time to be excellent parents, extensive travel, and not only pursue hobbies but excel in them. Because you’re a woman, you’ll get unfair and sexist pressure to avoid being a physician “because of kids” that men never get. You can still be a great and involved mom and a physician just like men can be great and involved fathers and physicians. Avoid becoming a physician because it’s not what you want, don’t do it because of this nonsense idea that you’re sacrificing your motherhood.

 

[DrMetal]

This thread has taken an odd turn. There are plenty of physician jobs, particularly in primary care. The mafia-like behavior of the ABIM is incredibly frustrating.

But...are we really saying that a physician with a 20! year employment gap should be able to be immediately credentialed to see patients without any further training? A supervised year seems pretty reasonable to me after an extreme gap like that. Would you really just sign that doctor’s privileges application without some remediation and assessment?

So consider this: you're the director of a clinic, and you have to hire more clinicians.

Candidate A: my friend, a 50-yo mother of 3, who completed a ACGME-accredited FM residency program but hasn't practiced in some time, and is no longer BC/BE. She's certainly willing to practice under a supervision or remediation plan, for as long as it takes, and she's even willing to take less pay.

Candidate B: a NP/PA who just finished school.

The problem is: Candidate A isn't even an option, b/c your clinic requires BC/BE. She has to find a residency program that'll take her for a year of extra training (hard to find, and she's not willing to relocate---good for her, she shouldn't have to). And even if they did find this avenue, it may be another good 2-3 years before she becomes BC'd again (has to complete the residency, has to wait for the test administration, maybe doesn't pass on the first shot, etc etc).

Candidate A doesn't get hired, isn't employable.

Candidate B starts tomorrow in your clinic.

It's no wonder NP/PAs are able to encroach in almost every specialty of medicine (primary care, surgical, procedures, etc).
We physicians have boxed ourselves out of our own profession. This thread never left topic. @OP: go to PA school.

 

[Gastrapathy]

I choose C. A physician who is ready to practice. A practice isn’t running a residency program. There’s no meaningful mechanism for training or assessment. Letting someone go is incredibly disruptive and legally risky. In addition, I’d worry about hiring someone who felt entitled to just resume practice after 20 years. Pass.

 

[Gastrapathy]

As for MD vs PA, I’d choose MD. Just not primary care.

 

[DeadCactus]

So a U.S. medical school graduate, who completed an ACGME-accredited residency, can't find work because she's no longer BC'd. And yet, the same clinics in her neighborhood are hiring PAs/NPs by the droves. She even offered to take one of the PA spots, and work for PA pay!

I really doubt a PA/NP who is years (decades?) out of clinical practice would have an easier time finding a job and additionally they would have fewer non-clinical options. I wouldn’t want a subspecialist providing my primary care let alone someone who hasn’t seen any sort of patient for years and didn’t keep up with the minimal requirements for board certification.

 

[DrMetal]

I choose C. A physician who is ready to practice. A practice isn’t running a residency program. There’s no meaningful mechanism for training or assessment. Letting someone go is incredibly disruptive and legally risky. In addition, I’d worry about hiring someone who felt entitled to just resume practice after 20 years. Pass.

That's not fair, I didn't give you a choice C. Ok: suppose it was a physician who'd been practicing all of this time, had great clinical experience, never any issues, but decided to let her BC expire (said 'F it! I've taken that test twice already, I don't need to prove myself again!'). Still can't get hired because she's no longer BC'd/BE.

What do you think about NPs/PAs scoping (doing routine EGDs/Colonoscopies)? I think it started in Europe, trend coming to the US?

 

[HighPriest]

I think the problem is that it’s two separate hypotheticals. One is someone who isn’t B.C., the other is someone who has been out of practice for 20 years. Also not B.C., but that’s not the hangup in that scenario.
To be honest, I’m not sure who I would hire in the 20 year gap vs newly trained PA choice. I don’t think it’s that easy of a choice. I have to train either one. And I understand the “choice C”, because my first instinct would be to just wait longer to hire someone and hope I could get someone who has an MD and had been regularly practicing. It would depend upon the scenario too. If I was a private practice doc and I was looking for someone to share overhead - definitely the MD. If I’m not either one of those things, maybe the PA. I can train them to do 30% of what I do and just shift my patient load to accommodate. And it’s cheaper. I mean, I went to graduate school 20 years ago and I I tried to get back in a lab today it would be a total CF.

If it’s a physician who just said “eff it” and let their BC lapse, yeah I agree, it’s silly to require B.C. under all circumstances - especially if they passed BC at one point (a lot of people actually can’t pass their exams, and I would t hire them). But in that last scenario I would really question the judgement of someone who knew BC was almost universally required but just said “eff it.” That demonstrates poor decision making or poor anxiety management skills.

 

[scoopdaboop]

What do you think about NPs/PAs scoping (doing routine EGDs/Colonoscopies)? I think it started in Europe, trend coming to the US?

Anybody can train someone to do 1-2 procedures to bill more. IMO, that is what is happening in cases like this. It will happen in the future also. There's already been research showing that there are a lot of problems with this too; insurance not reimbursing, or the time it takes for a physician to train someone to do this... But, in the end, a hospital will need a GI doc to decide who can be scoped, who cannot, and obviously GI has more procedures than those 2 also.

 

[smq123]

The OP started this thread a year ago. I wonder what she decided.

 

[Gastrapathy]

I despise the ABIM and all of their shenanigans. One of their most effective tactics has been to tie eligibility for insurance plans and privileges to board status. That puts the practice in a difficult position. I’d certainly be willing to hire someone whose boards have lapsed if there was a way for them to get paid (this is state and even locality specific). I’d love to let my own lapse but, for now, it is a prerequisite for my job.

 

[Gastrapathy]

The “midlevel threat” in GI is very small. There are effective ways to use midlevels in subspecialty practice (versus primary care/urgent care/EM). Seeing a subset of a subset of already differentiated patients is the best place to employ them IMO. That said, there are very few opportunities for them to train in endoscopy. We’re good.

 

[DrMetal]

The “midlevel threat” in GI is very small. very few opportunities for them to train in endoscopy. We’re good.

Said the Anesthesiology community 20 years ago . . . but I hope you're right.

One of their most effective tactics has been to tie eligibility for insurance plans and privileges to board status. That puts the practice in a difficult position.

How do you suppose this can be reversed? Can a state make legislation forbidding insurance companies from tying eligibility to payment, forbidding hospitals from requiring it for privileges or even for employment? A Proposition maybe? (bare with me, I'm in CA, we love to make propositions over everything).

 

[Gastrapathy]

There are several states where laws have been passed to protect physicians from MOC requirements. CA is not one of them. But yes, state medical societies lobbying to stop this would be the best path.

A little google-fu says for Ca there is a bill that was written but never went anywhere:

Anti-MOC Laws Picking Up Steam Across the United States

Lawmakers across America have started to take a variety of matters into their own hands, the most recent of which is Maintenance of Certification (MOC) licensure requirements. This trend started late last year when Oklahoma became the first state to

www.google.com

Bill Text - SB-487 Practice of medicine: hospitals.

 

[Apollyon]

I despise the ABIM and all of their shenanigans. One of their most effective tactics has been to tie eligibility for insurance plans and privileges to board status. That puts the practice in a difficult position. I’d certainly be willing to hire someone whose boards have lapsed if there was a way for them to get paid (this is state and even locality specific). I’d love to let my own lapse but, for now, it is a prerequisite for my job.

Didn't the ACC make a decision that diplomates in cards could let their primary boards lapse? I take it that your college hasn't done that?

Or, I don't even know, does ABIM administer/adjudicate sub board exams?

 

[armytrainingsir]

Get boarded by another org?

Certification Criteria | National Board of Physicians and Surgeons (NBPAS)

Learn about NBPAS certification criteria. Understand requirements for physician and surgeon certification.

nbpas.org

 

[Gastrapathy]

Yes my primary certification has lapsed but I still have to do MOC and recert for GI which is a massive PITA. The primary barrier to NBPAS is getting hospitals to accept it as equivalent.

 

[DrMetal]

Get boarded by another org?

Certification Criteria | National Board of Physicians and Surgeons (NBPAS)

Learn about NBPAS certification criteria. Understand requirements for physician and surgeon certification.

nbpas.org

Also:

Board Certifications | American Board of Physician Specialties®

ABPS offers board certification and recertification exams for qualifying allopathic and osteopathic physicians. Click to see the certifications we offer.

www.abpsus.org

So there's 3 organizations: the ABPS, ABMS, and NBPS. It's like picking a religion; you gotta choose one and go with it. Now, if you're a free-thinking athiest who doesn't believe any of that crap is necessary, then you're screwed!