Good afternoon everyone. After coming out of the military as a rescue swimmer, I decided that I wanted to pursue a career in healthcare mainly because I highly enjoyed my exposure to patient care. I imagine that paramedics recieve very similar training and operate in a similar environment, minus the swimming. That being said, I initially was thinking about becoming a paramedic, but as time goes on I find myself wanting to reach higher. For a while I considered PA. Now I'm very seriously considering the pursiut of becoming a doctor. So far I've spoken to two doctors about this and their opinions were surprisingly different. One is a trauma surgeon and the other is a hematologist. In short, the surgeon told me to pursue medical school, and the hematologist strongly recommended PA. The hematologist made it sound like being a doctor wasnt worth it unless I wanted to go into surgery. He explained that doctors are progressively becoming paper pushers while the mid-level providers handle most of the patient care. To illustrate, he told me that if he has a patient in the hospital for a week the PA with see them everyday, while the doctor will on visit the patient once to review what the mid-level provider has done. The majority of the time he's in his office doing paper-work. Additionally, he said that he knows a lot of doctors who tell there kids not to pursue medical school anymore because the increasingly changing environment. Hearing all this was pretty discouraging to say the least. I don't like the idea of going through over a decade of higher education just to not really be doing what you pursued the career for in the first place. What do you guys think? Do you think there is a lot of truth in this? Do you think its overexaggerated? How do you think the dynamic of a doctors work will change in the next ten years?
Becoming a doctor worth it?
- Thread starter DavidP
- Start date
- Joined
- Nov 6, 2015
- Messages
- 3,086
- Reaction score
- 6,300
Can we get a TLDR?
- Joined
- Nov 6, 2015
- Messages
- 3,086
- Reaction score
- 6,300
Lol jk...
I think both have good points. I will be totally honest if direct patient care is what you value more than anything else, yes PA aid a better fit.
However, there are many benefits to being a doctor. Namely you are the one in charge of coordinating care rather than the one delivering it. If the idea of being the one running the show is what you like then MD > PA every time.
Also I think this gets at a larger point that we often don't think about. The MD degree is a doctorate degree, as opposed to PA which is a professional degree. A doctorate will have a much more robust science component - hence why MDs spend 2 years doing basic science classes and most do very well in the undergrad sciences and on the MCAT. With this science background you have many more options open to you in terms of research, and more leeway in terms of treatment decision making...because you understand the physiology.
PA is a professional degree, hence it is much more focused on practice. PAs have a rigorous training, but it is much shorter and more geared towards practical care (rather than understanding physiology). The result is that they are limited to patient centered settings, and do not get the same autonomy an MD gets.
I think both have good points. I will be totally honest if direct patient care is what you value more than anything else, yes PA aid a better fit.
However, there are many benefits to being a doctor. Namely you are the one in charge of coordinating care rather than the one delivering it. If the idea of being the one running the show is what you like then MD > PA every time.
Also I think this gets at a larger point that we often don't think about. The MD degree is a doctorate degree, as opposed to PA which is a professional degree. A doctorate will have a much more robust science component - hence why MDs spend 2 years doing basic science classes and most do very well in the undergrad sciences and on the MCAT. With this science background you have many more options open to you in terms of research, and more leeway in terms of treatment decision making...because you understand the physiology.
PA is a professional degree, hence it is much more focused on practice. PAs have a rigorous training, but it is much shorter and more geared towards practical care (rather than understanding physiology). The result is that they are limited to patient centered settings, and do not get the same autonomy an MD gets.
- Joined
- Mar 12, 2017
- Messages
- 1,587
- Reaction score
- 1,424
"Worth" would highly depend on what you gain from becoming a physician which may be different for everyone. Not just in salary but job satisfaction/self fulfillment as well as the sacrifices made such as length of education and time commitment away from home.
Also you mention how you are considering PA while strongly considering medical school. I'm curious if you have shadowing experience which would give you a superficial capacity for what PAs and MDs/DOs do daily and which you may actually prefer.
I hope you can decide on what makes you happy.
Also you mention how you are considering PA while strongly considering medical school. I'm curious if you have shadowing experience which would give you a superficial capacity for what PAs and MDs/DOs do daily and which you may actually prefer.
I hope you can decide on what makes you happy.
I've asked a couple of doctors about shadowing, but apparently it's not really allowed where I live anymore due to the risk of violating patient confidentiality. I'm looking into becoming a scribe as a way around this.
- Joined
- Nov 4, 2014
- Messages
- 2,107
- Reaction score
- 3,660
You've spoken with one surgical sub-specialist and one internal sub-specialist, not really a breadth of opinions. Without knowing why you want to go into healthcare or what your career goals are, no one can say whether it's worth it.
TL;DR-- IMO, 1. This is largely specialty dependent. 2 (to a lesser degree). This is regionally and healthcare setting dependent.
It's unfortunate that you got 2 vastly different opinions on this from physicians, but it doesn't surprise me in the least, and it ESPECIALLY doesn't surprise me that the surgical doc encouraged you to go the physician route > PA route. I've worked as a scribe in both an orthopedic clinic and ER setting. The best way to explain my observations is thinking in terms of duties performed by each professional in each specialty. If you charted these on a venn diagram, there would be vastly more overlap between ER physician and PA vs Orthopedic physician and PA. So if your "worth it" is to have more responsibility then it would be specialty/regional/setting dependent. If your "worth it" is income based, this is also speciality dependent-- In the ER doc vs ER physician example (keep in mind this is a small critical access hospital), our PA performs the exact same duties and manages the exact same patients that the ER physician does. He/she runs all level 3 triages past the physician with input here and there, but their job description is very similar. However, there's at least a $150k difference in salary.
It's unfortunate that you got 2 vastly different opinions on this from physicians, but it doesn't surprise me in the least, and it ESPECIALLY doesn't surprise me that the surgical doc encouraged you to go the physician route > PA route. I've worked as a scribe in both an orthopedic clinic and ER setting. The best way to explain my observations is thinking in terms of duties performed by each professional in each specialty. If you charted these on a venn diagram, there would be vastly more overlap between ER physician and PA vs Orthopedic physician and PA. So if your "worth it" is to have more responsibility then it would be specialty/regional/setting dependent. If your "worth it" is income based, this is also speciality dependent-- In the ER doc vs ER physician example (keep in mind this is a small critical access hospital), our PA performs the exact same duties and manages the exact same patients that the ER physician does. He/she runs all level 3 triages past the physician with input here and there, but their job description is very similar. However, there's at least a $150k difference in salary.
Last edited:
Our PA handles everything that comes in via ambulance. CVA's are bread and butter for him/her. I've seen him/her run 3-4 found-down Code Blues basically alone. All of the STEMI's I've seen have been quick in-and-out of the ER though. Call cardiology, and they're in cath lab in less than 30 minutes. You're very correct in saying this is far from the norm though. We are in the rural midwest. Hence my 2nd point up top.
- Joined
- Nov 4, 2014
- Messages
- 2,107
- Reaction score
- 3,660
Just to reemphasize Coltuna's point. If you are in rural, suburban or limited access areas, mid-levels in primary care services - family med, EM, OB, etc - have much broader responsibilities due to limited resources, in particular budget. There are many mid-levels I know who make a good living and have very fulfilling and patient centered careers. But I also see the same from most MDs.
- Joined
- Aug 2, 2013
- Messages
- 791
- Reaction score
- 703
All those old people hate their jobs because they are slow typists and suck at using computers. It’s all we’ll ever know. Love medical school so far. Things could change. I’ll post a follow up on this thread in 6 years to let everyone know how my career turned out and if I’m enjoying it.
Hey, so its been about 4 years. How's it going so far?
- Joined
- Nov 6, 2015
- Messages
- 3,086
- Reaction score
- 6,300
Not QP but now a resident - I still really enjoy my work. The job market has collapsed for my field (EM) and things are much gloomier in the house of medicine vs 4 years ago.
That said I have friends who are lawyers, bankers, dentists, and everything else, and I’d take my line of work any day of the week.
The potential to have your degree/training become obsolete and be replaced by a mid level are certainly real and valid concerns though. About half our grads are facing unemployment or serious underemployment.
Well, I have to be honest, the last portion of your post is highly discouraging. But, I'm glad to hear that you find the work fulfilling. I'm hoping to go into emergency medicine myself, but I'm not sure that it would be a wise choice from what your saying about mid-level encroachment Do you think doctors are having a hard time finding a job because of the location or do you think its mostly due to PAs and NPs takin' your jobs?
- Joined
- Nov 30, 2020
- Messages
- 937
- Reaction score
- 1,124
Honestly it heavily depends on what you do with your degree. From what I've seen from virtual shadowing so far if you do something like family medicine or pediatric you're seeing your patients face to face regularly. One physician I saw on there tries to not deal with insurance for seeing her patients if it can save them money and save her time and stress. It's honestly what you do with it that determines the degree of patient interaction.
- Joined
- Nov 6, 2015
- Messages
- 3,086
- Reaction score
- 6,300
So it’s a combination of things - not just NPs taking physician jobs. A large part of the problem is for profit companies, owned by Wall Street/private equity, have bought up a large portion of the contracts, giving them a lot of control over the employment landscape.
These private non-physician business control and fund our professional organization, ACEP, and used that control to open up a ton of crap quality residencies, more than doubling the number of graduating docs in the last decade.
If you don’t generate enough money for their investors in your billing, they’ll throw you overboard. And when there’s more docs than jobs, they’ll have physicians bid each other to the bottom, accepting lower and lower pay just to have employment...since lower pay for the doc means more profit that the Wall Street investors can pocket.
Couple that with an aggressive push for “Physician free EDs” where these private companies can bill Doctor rates but have all patients seen by cheaper less skilled np/Pa providers, and again pocket the difference for their shareholders, and it’s a recipe for disaster. They’ve also figured out you can run an ER bare bones, with insufficient staff to operate an ED safely, but that doesn’t matter because it’s cheaper for them and if there’s a bad outcome the doc gets sued, not the company.
Suffice to say private equity/Wall Street saw a profit opportunity and eviscerated the specialty over the course of a couple decades. I would strongly recommend against anyone pursuing a career in EM, as the career no longer offers the stability to pay back Med school debt or safely start a family (since your job can disappear overnight and there’s no guarantee you’ll be able to find another on).
- Joined
- Aug 2, 2013
- Messages
- 791
- Reaction score
- 703
Psychiatry resident now. Very happy with my career choice (so far).
- Joined
- Aug 2, 2013
- Messages
- 791
- Reaction score
- 703
I've been hearing a lot about the EM job market recently. Insufficient job opportunities everywhere or just in select and/or desirable areas?
- Joined
- Nov 6, 2015
- Messages
- 3,086
- Reaction score
- 6,300
Catastrophic job market collapse in every market in the United States. Like I said, I love my work. I go to my hospital each day with a smile on my face and think the world of my doctor, nurse, and tech colleagues.
In practice the field of Emergency Medicine is dead though. Emergency medicine is a valueless board cert, as it does not confer any job security or improve your chance of meaningful employment. A huge chunk of people who are board certified are/will soon be unemployed as the mid levels and new grads (myself included sadly) rush to the bottom of the barrel fighting each other for every last ultra-underpaid job in Bumblef*ck, Kentucky.
Here’s my off the top list of places you will not be able to find work in EM currently or in the immediate future:
San Diego
Los Angles Metro
Coastal CA
San Francisco Metro
Portland
Seattle
Tucson
Phoenix
Flagstaff
Salt lake city
Jackson Hole
Denver
Albuquerque
El Paso
Austin
Houston
Dallas
Brownsville
Lubbock
San Antonio
Kansas city
St Louis
Chicago
Madison
Milwaukee
Indianapolis
Birmingham
New Orleans
Atlanta
Savannah
Charleston
Columbia SC
Greenville SC
Charlotte
Asheville
Raleigh/Durham/Chapel Hill
Richmond
Charlottlesville
Roanoke VA
Pittsburgh
Philadelphia
New Jersey (entire state)
DC metro
NYC metro
Boston Metro
Entire state of Florida, from end to end
Portland
if you’re not interested in any of these places let me know - you may still find a job.
- Joined
- Aug 2, 2013
- Messages
- 791
- Reaction score
- 703
That's rough. Seems like just a few years ago when I was in med school EM was very optimistic overall, at least where I trained. Then again, maybe no one was talking about what they knew was coming. I have a couple friends in the EM program where I am...I'll ask them about it. Never knew it was that bad until seeing your post.
That is rough... In your opinion do you think the field of trauma surgery is seeing a similar change in their job outlook. I'm just a premed in my senior year, but if I couldn't go into emergency medicine or trauma surgery, I'm not sure I would still want to become a doctor anymore.
On a similar note, I wonder if other specialties are going to experience the same decrease in job availability. It seems as if there are more and more med school applicants each year. Thoughts?
Finally, some good news. I've heard that the field of psychiatry is actually experiencing some job growth, in contrast to emergency medicine.
- Joined
- Aug 2, 2013
- Messages
- 791
- Reaction score
- 703
Increase in competitiveness this year at least from people I know. And very good job market. People I know landing first jobs out of residency 45ish min from Manhattan in suburbs making 300K starting semi-academics for 40hrs/wk.
- Joined
- Nov 4, 2011
- Messages
- 28,811
- Reaction score
- 55,080
Medicine is not a good choice for anyone who would only do it if they could practice in a small slice of potentially competitive specialties.
By the time you discover that your only preferred field is not open to you, there will be a sunk cost of many years.
