Big Decision and in need of some advice

[ChandutheMagici]

Hello everyone. I am posting on here because I have a big decision to make and I am in need of advice. Unfortunately, I have not been able to ask this to practitioners in real life because I honestly have not had the time to shadow. This may seem like an inadequate excuse, but there are several good reasons (full time school, full time military, full time family) why I have not had the time to shadow practitioners and ask questions of them in person. However, I'm hoping the users of these forums may be able to clear up some answers before approaching some practitioners in person.

That being said, allow me to explain a little about myself and how my standing would be as far as applying to programs. My standardized test scores (both MCAT and GRE) are well above average as are both my science and cumulative grade point averages. I feel I'm a fairly competitive student. I don't feel the need to share these with people as this really pertains little to my question (which I promise I'm getting to) at hand. The point in explaining that is just to let someone know that grades/scores allow me the latitude to choose either program I'm interested in. God, I hope that doesn't sound pompous. If it does I'm sorry. It's really not meant to be. Also, I could really care less about letters behind my name. I could care even less about salary. Surely I understand it though. And I'm certainly not here to judge anyone for wanting to make a lot of money. Everyone has their own personal reasons for what they do. My personal reason for wanting to pursue a career in medicine is out of a strong desire to help others. That may sound pretty naïve from someone not in medicine, but for me it's the truth. Regardless, sorry about the rambling.

And now, the question. My question really boils down to this, DO or PA? I know there are pros and cons to each. And, I'm looking for objective explanations of those pros and cons. As for an MD, I really have no interest in pursuing an allopathic program. It's just not the right fit for me.

Anyway, from what I've read here most threads start off by saying….."MD or PA" and then long discussions pursue about the differences between the two. Then they get into some kind of flame war and eventually get shut down. While amusing, that's not really what I'm looking for. I have a decent understanding of the scope of practice of both a DO and PA. I think they're both excellent careers. And, I have no illusions that one is better than the other. I think they are both fantastic professions that are absolutely essential to any health care team.

What I'm looking for basically in the pros in cons is more so related to personal experience. I hope that makes sense.

Regards,

Chandu the Magician ?

P.S. – as a for instance, my wife who is a practicing occupational therapist says I would hate being a physician because of fighting with managed care and insurance companies over billing and the like. I don't really know if that cleared anything up, but I hope it does. Basically, why do you hate being a DO, why do you love being a DO? Or, why do you hate being a PA, why do you love being a PA?

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[lrobin15]

Hello everyone. I am posting on here because I have a big decision to make and I am in need of advice. Unfortunately, I have not been able to ask this to practitioners in real life because I honestly have not had the time to shadow. This may seem like an inadequate excuse, but there are several good reasons (full time school, full time military, full time family) why I have not had the time to shadow practitioners and ask questions of them in person. However, I’m hoping the users of these forums may be able to clear up some answers before approaching some practitioners in person.

That being said, allow me to explain a little about myself and how my standing would be as far as applying to programs. My standardized test scores (both MCAT and GRE) are well above average as are both my science and cumulative grade point averages. I feel I’m a fairly competitive student. I don’t feel the need to share these with people as this really pertains little to my question (which I promise I’m getting to) at hand. The point in explaining that is just to let someone know that grades/scores allow me the latitude to choose either program I’m interested in. God, I hope that doesn’t sound pompous. If it does I’m sorry. It’s really not meant to be. Also, I could really care less about letters behind my name. I could care even less about salary. Surely I understand it though. And I’m certainly not here to judge anyone for wanting to make a lot of money. Everyone has their own personal reasons for what they do. My personal reason for wanting to pursue a career in medicine is out of a strong desire to help others. That may sound pretty naïve from someone not in medicine, but for me it’s the truth. Regardless, sorry about the rambling.

And now, the question. My question really boils down to this, DO or PA? I know there are pros and cons to each. And, I’m looking for objective explanations of those pros and cons. As for an MD, I really have no interest in pursuing an allopathic program. It’s just not the right fit for me.

Anyway, from what I’ve read here most threads start off by saying…..”MD or PA” and then long discussions pursue about the differences between the two. Then they get into some kind of flame war and eventually get shut down. While amusing, that’s not really what I’m looking for. I have a decent understanding of the scope of practice of both a DO and PA. I think they’re both excellent careers. And, I have no illusions that one is better than the other. I think they are both fantastic professions that are absolutely essential to any health care team.

What I’m looking for basically in the pros in cons is more so related to personal experience. I hope that makes sense.

Regards,

Chandu the Magician ?

P.S. – as a for instance, my wife who is a practicing occupational therapist says I would hate being a physician because of fighting with managed care and insurance companies over billing and the like. I don’t really know if that cleared anything up, but I hope it does. Basically, why do you hate being a DO, why do you love being a DO? Or, why do you hate being a PA, why do you love being a PA?

I can't tell you why I love or hate one route or another because I am just entering DO school in the fall. But I can shed light on what I found out when I was researching these routes.

I have a friend who is a PA in orthopedics who makes $102,000 a yr. So he doesn't complain about salary, what he complains about is control. He really is limited in what he can do. He has no real control over what direction the patient takes, it is all dictated to him. He is now considering med school.

I was shadowing a physician in a local hospital ER and ran into a PA who sees the "clinic" pts that come into the ER. He says that he sees the patient, then has to go out and talk it over with a physician and then write a prescription. UGGhhh. He said it was better than nursing, but he should of taken the med school route. Plus he said that many physicians assume that he is a PA because he didn't have what it takes to get into med school. He never tried to go to med school, so that really ticked him off.

Like I said, I can only tell you what I have observed. Also, in no way do I think that two PAs represent the entire PA population.

 

[ShyRem]

We have a PA in our med school class. I also know of four other PAs who wish they had gone to med school, but I have spoken with 6 PAs who are so outrageously happy they never went to med school (too much debt, too long a program, too much responsibility).

So I suppose it comes down to what you want to do. If you don't want to handle the paperwork, etc., then choose a specialty where you either work in a hospital or have a staff to handle that stuff (a group is nice that way - you split the costs of specialized support staff - and believe me, medical billing is specialized if you want to get paid in a timely fashion).

PA programs vary WIDELY state to state. I heard of one program that doesn't need a bachelor's degree and is only two years long. Then there are others that are four years long AFTER a bachelor's degree where the pre-reqs are more stringent and more work than for medical school.

I'm not a great person to ask about your MSI year in med school right now -- I have one week of classes left and then a week of finals. I'm still in the "kill me now" stage of drowning and contemplating how many boxes of Kleenex and how many bottles of wine/beer/scotch I'll need when I'm done. (really I'm enjoying the h3ll out of it, I'm just totally overwhelmed right now.)

 

[ChandutheMagici]

Many thanks for your replies. After going over to the PA website and reading many of their threads, I think I'm leaning towards DO. However, I shadow next week, so we'll see. Thanks again.

Chandu

 

[Skialta]

I would like to know why you would consider being a PA but not an MD, that seems to make little sense. As far as becomingt a DO vs MD, if it is the OMM addition you want, you will not be trained in that as a PA. If it is the "DO looks at the whole patient" theme that gets thrown around on these boards then you would be misinformed as MDs are also taught to look at the whole patient. You really don't have to tell me your motivation, it just seemed like it was an odd choice. Good luck.

 

[ChandutheMagici]

I would like to know why you would consider being a PA but not an MD, that seems to make little sense. As far as becomingt a DO vs MD, if it is the OMM addition you want, you will not be trained in that as a PA. If it is the "DO looks at the whole patient" theme that gets thrown around on these boards then you would be misinformed as MDs are also taught to look at the whole patient. You really don't have to tell me your motivation, it just seemed like it was an odd choice. Good luck.

I have no problem at all with telling you my motivations. And, thanks for the wellwishes. Anyway....

DO vs. MD

1. I appreciate the differences in the philosophy however subtle they might be. And, in my readings I've found that several allopathic schools are beginning to look at a more osteopathic approach to medicine. However, I'd rather have a school that's been doing it for a while and has it down. This isn't to say that the allopathic schools are bad, there just a little behind in the game when it comes to the osteopathic approach. Or, so I'm guessing.

2. OMM - This seems like the hands on medicine I want to practice. Procedural stuff really interests me.

3. I have currently talked with 3 MD schools (their staff and what not) and 3 DO schools. In each case the DO school's staff seemed nicer, more attentive, and just all around more consumer friendly. Now I don't know if only talking to six schools really provides me with an accurate portrayal of how all DO and MD schools are, but I feel it was a pretty good indication. Please feel free to correct me if I'm wrong.

4. With medicine being driven more and more into specialties I must say, primary care is what interests me most (with a possible interest in emergency medicine). Roughly 60% of DO's go into primary care. Of course there are a lot of MD's that do primary care too, but it seems as if that's more of a focus for DO's. Again, I could be completely wrong, but this is just my opinion from what I've read.

5. DO's have a good reputation in treating the poor and under served communities.

PA vs. DO (or MD for that matter)

1. It seems as if you get to spend more time doing patient care as opposed to dealing with the bureaucracy of managed care and insurance companies. Again, please feel free to correct me if I'm wrong.

2. Procedural stuff (which it seems that PA's do a lot of) is my cup of tea. Or at least it seems to be.

3. My main interest is primary care. With more and more primary care moving into the hands of midlevel practitioners, I'm wondering if I would be wasting 7 years as opposed to 2 and 1/2.

4. Less responsibility is not necessarily a bad thing

5. Time and family. I can't really seem to get a grip on whether or not this is true. Some PA's say it isn't, some say it is. And even though I've looked for national statistics I just can't seem to find a good PA vs. Physician hourly work week. I know residency is no time for home life, but what about after that? Anyway, the prevailing attitude that I've seen is that PA's work less hours.


As for the cons...

1. I'm a bit of a control freak. While less responsibility may be good I'm not sure I really like the idea of not being able to guide the direction a patient takes. Of course, this could be said of Physicians as well, as they have bosses. And from my understanding Physicians aren't what they used to be in this category either. They get a lot of treatments, tests, and whatever else declined because of bottom line bullcrap. Regardless, I see myself more as the head of an interdisciplinary team (this is pretty huge for me).

2. Explaining to people all the time what you do. PA's don't have a widely understood role in medicine. Of course, there an essential part of the team, but having to explain this to people time and time again would be a little cumbersome I think.

3. No OMM. OMM interests me very much. I just like the idea of it. Of course there are seminars on this and books etc, but it never hurts to be formally trained.

4. Having to deal with ******ed med students and others who think you're somehow a second class citizen. Now, I don't know if this is true everywhere you go, but I've read several different places that if you work in a teaching hospital (which I hope to someday) that this happens sometimes. And, while stuff like this should be water off a duck's back I think it might get to me.

As an aside I feel that respect is earned, not given. I don't buy into this whole ego trip that some people get on that a physician is more well respected. It may be true that physicians and their role in medicine are more widely understood by the public however, the public (also called the mob in Roman times) is rarely well informed. Basically, I feel if you keep a level head as a PA, care about your patients, and do everything in your power to try to get them the best possible treatment, respect will be yours.

5. Doctors without borders does not actively recruit PA's nor use them to a wide extent. Doctors without borders is something that both interests my and I.

^ Of course 2 and 4 could be said about DO's. So that's really why I'm up in the air. And I have several questions that I haven't asked because I was hopefully thinking that they would be answered in some personal pros and cons.

Questions like...

1. Who does more paperwork?
2. Who does more procedures?
3. Who gets to spend more time with patients?
4. Which has greater latitude in choice of field (I'm assuming physician for that one)?
5. Who has to deal less with managed care and insurance companies (I'm assuming PA for this one)?

I think frustrations and headaches come with both careers. I'm just trying to find which one comes with the least.

Chandu The Magician

 

[Crookshanks]

Hi,

Here are my 2 cents. Please don't flame me!

1.) When deciding between DO and PA take into consideration (I think it's the biggest factor) responsibily and knowledge. From what I understand, some PA's feel as if though they're missing something, in terms of what they learned, because they simply just didn't have as much schooling as DO/MD's. Do you feel the need to "know more" or do you think you will feel that need? If not, then PA should be fine. Also, how much responsibility do you want? Do you care for more or for less? If you scrool down on the forum's main page, towards the bottom you'll find a forum for Clinicians (PA, NP, etc) that might be helpful. One of the things I was trying to consider was "time"...do PA's have more free time than doctors? But according to some on the forum, it's a myth, yet others disagree...so I still don't know.

2.) I think the DO's I've met have nicer bed-side manners, they're easier to approach. Not that MD's aren't, but the DO's that I've met have been better at this than the good MD's I've known. I also think DO adcoms are nicer human beings (because they emphasize the whole applicant). lol (In general, ofcourse, by no means all of them)

 

[ChandutheMagici]

Crookshanks,

Thank you for your insightful questions. They give me even more to think about. As for flaming, that's not really my style.

And yeah, I've been browsing the clinicians forum as well as www.physicianassistantforum.com (which actually has a thread on DO vs. PA). I just didn't know if it was appropriate to post both here and that forum (clinicians). I thought it might be a little overkill.

Thanks for your reply.

Chandu The Magician

 

[medtechv79]

I have no problem at all with telling you my motivations. And, thanks for the wellwishes. Anyway....

DO vs. MD

1. I appreciate the differences in the philosophy however subtle they might be. And, in my readings I've found that several allopathic schools are beginning to look at a more osteopathic approach to medicine. However, I'd rather have a school that's been doing it for a while and has it down. This isn't to say that the allopathic schools are bad, there just a little behind in the game when it comes to the osteopathic approach. Or, so I'm guessing.

2. OMM - This seems like the hands on medicine I want to practice. Procedural stuff really interests me.

3. I have currently talked with 3 MD schools (their staff and what not) and 3 DO schools. In each case the DO school's staff seemed nicer, more attentive, and just all around more consumer friendly. Now I don't know if only talking to six schools really provides me with an accurate portrayal of how all DO and MD schools are, but I feel it was a pretty good indication. Please feel free to correct me if I'm wrong.

4. With medicine being driven more and more into specialties I must say, primary care is what interests me most (with a possible interest in emergency medicine). Roughly 60% of DO's go into primary care. Of course there are a lot of MD's that do primary care too, but it seems as if that's more of a focus for DO's. Again, I could be completely wrong, but this is just my opinion from what I've read.

5. DO's have a good reputation in treating the poor and under served communities.

PA vs. DO (or MD for that matter)

1. It seems as if you get to spend more time doing patient care as opposed to dealing with the bureaucracy of managed care and insurance companies. Again, please feel free to correct me if I'm wrong.

2. Procedural stuff (which it seems that PA's do a lot of) is my cup of tea. Or at least it seems to be.

3. My main interest is primary care. With more and more primary care moving into the hands of midlevel practitioners, I'm wondering if I would be wasting 7 years as opposed to 2 and 1/2.

4. Less responsibility is not necessarily a bad thing

5. Time and family. I can't really seem to get a grip on whether or not this is true. Some PA's say it isn't, some say it is. And even though I've looked for national statistics I just can't seem to find a good PA vs. Physician hourly work week. I know residency is no time for home life, but what about after that? Anyway, the prevailing attitude that I've seen is that PA's work less hours.


As for the cons...

1. I'm a bit of a control freak. While less responsibility may be good I'm not sure I really like the idea of not being able to guide the direction a patient takes. Of course, this could be said of Physicians as well, as they have bosses. And from my understanding Physicians aren't what they used to be in this category either. They get a lot of treatments, tests, and whatever else declined because of bottom line bullcrap. Regardless, I see myself more as the head of an interdisciplinary team (this is pretty huge for me).

2. Explaining to people all the time what you do. PA's don't have a widely understood role in medicine. Of course, there an essential part of the team, but having to explain this to people time and time again would be a little cumbersome I think.

3. No OMM. OMM interests me very much. I just like the idea of it. Of course there are seminars on this and books etc, but it never hurts to be formally trained.

4. Having to deal with ******ed med students and others who think you're somehow a second class citizen. Now, I don't know if this is true everywhere you go, but I've read several different places that if you work in a teaching hospital (which I hope to someday) that this happens sometimes. And, while stuff like this should be water off a duck's back I think it might get to me.

As an aside I feel that respect is earned, not given. I don't buy into this whole ego trip that some people get on that a physician is more well respected. It may be true that physicians and their role in medicine are more widely understood by the public however, the public (also called the mob in Roman times) is rarely well informed. Basically, I feel if you keep a level head as a PA, care about your patients, and do everything in your power to try to get them the best possible treatment, respect will be yours.

5. Doctors without borders does not actively recruit PA's nor use them to a wide extent. Doctors without borders is something that both interests my and I.

^ Of course 2 and 4 could be said about DO's. So that's really why I'm up in the air. And I have several questions that I haven't asked because I was hopefully thinking that they would be answered in some personal pros and cons.

Questions like...

1. Who does more paperwork?
2. Who does more procedures?
3. Who gets to spend more time with patients?
4. Which has greater latitude in choice of field (I'm assuming physician for that one)?
5. Who has to deal less with managed care and insurance companies (I'm assuming PA for this one)?

I think frustrations and headaches come with both careers. I'm just trying to find which one comes with the least.

Chandu The Magician

in my opinion, the doctor does more of the paperwork. my aunt owns her own practice and has to take a day off just to handle all the paperwork, bills etc needed to run her practice. as a PA you would probably have more hands on and deal less with bureacratic matters. but that is just my opinion.
As for patients, I would think PA's would handle the more routine cases and let the doctors handle the more difficult cases and allow them to spend more time with those patients that need it most.

but u should choose what's best for you. I have a cousin whose a PA and shes very happy...she works in surgery. 9-5 no weekends, has holidays and gets paid very well. I have a cousin in med school in residency now and hates it...but then she is doing residency so no wonder.....

Good Luck! Being a PA isn't subject to a lesser standard in the public eye...at least just my opinion....yer still involved in the healthcare field..very respectable!

 

[chopstick1]

I have no problem at all with telling you my motivations. And, thanks for the wellwishes. Anyway....

DO vs. MD

1. I appreciate the differences in the philosophy however subtle they might be. And, in my readings I've found that several allopathic schools are beginning to look at a more osteopathic approach to medicine. However, I'd rather have a school that's been doing it for a while and has it down. This isn't to say that the allopathic schools are bad, there just a little behind in the game when it comes to the osteopathic approach. Or, so I'm guessing.

2. OMM - This seems like the hands on medicine I want to practice. Procedural stuff really interests me.

and it works!! we use it all the time to help fix back and neck pain from studying and carrying med school books

3. I have currently talked with 3 MD schools (their staff and what not) and 3 DO schools. In each case the DO school's staff seemed nicer, more attentive, and just all around more consumer friendly. Now I don't know if only talking to six schools really provides me with an accurate portrayal of how all DO and MD schools are, but I feel it was a pretty good indication. Please feel free to correct me if I'm wrong.

my DO interviews did seem a little nicer

4. With medicine being driven more and more into specialties I must say, primary care is what interests me most (with a possible interest in emergency medicine). Roughly 60% of DO's go into primary care. Of course there are a lot of MD's that do primary care too, but it seems as if that's more of a focus for DO's. Again, I could be completely wrong, but this is just my opinion from what I've read.

I am planning on going into emer med with sports med emphasis and OMM
possibilities are endless once you graduate and choose a residency, although many do choose family prac.

5. DO's have a good reputation in treating the poor and under served communities.

I can only guess both serve the community well

PA vs. DO (or MD for that matter)

1. It seems as if you get to spend more time doing patient care as opposed to dealing with the bureaucracy of managed care and insurance companies. Again, please feel free to correct me if I'm wrong.

2. Procedural stuff (which it seems that PA's do a lot of) is my cup of tea. Or at least it seems to be.

if you don't have a PA working with you, you're doing it all!!

3. My main interest is primary care. With more and more primary care moving into the hands of midlevel practitioners, I'm wondering if I would be wasting 7 years as opposed to 2 and 1/2.

4. Less responsibility is not necessarily a bad thing

5. Time and family. I can't really seem to get a grip on whether or not this is true. Some PA's say it isn't, some say it is. And even though I've looked for national statistics I just can't seem to find a good PA vs. Physician hourly work week. I know residency is no time for home life, but what about after that? Anyway, the prevailing attitude that I've seen is that PA's work less hours.

my family PA works the same hours as the other MD/DO in the practice....7-4.I can only assume it all depends on your spec if you work more/less. any PA's out there?

As for the cons...

1. I'm a bit of a control freak. While less responsibility may be good I'm not sure I really like the idea of not being able to guide the direction a patient takes. Of course, this could be said of Physicians as well, as they have bosses. And from my understanding Physicians aren't what they used to be in this category either. They get a lot of treatments, tests, and whatever else declined because of bottom line bullcrap. Regardless, I see myself more as the head of an interdisciplinary team (this is pretty huge for me).

2. Explaining to people all the time what you do. PA's don't have a widely understood role in medicine. Of course, there an essential part of the team, but having to explain this to people time and time again would be a little cumbersome I think.

3. No OMM. OMM interests me very much. I just like the idea of it. Of course there are seminars on this and books etc, but it never hurts to be formally trained.

4. Having to deal with ******ed med students and others who think you're somehow a second class citizen. Now, I don't know if this is true everywhere you go, but I've read several different places that if you work in a teaching hospital (which I hope to someday) that this happens sometimes. And, while stuff like this should be water off a duck's back I think it might get to me.

As an aside I feel that respect is earned, not given. I don't buy into this whole ego trip that some people get on that a physician is more well respected. It may be true that physicians and their role in medicine are more widely understood by the public however, the public (also called the mob in Roman times) is rarely well informed. Basically, I feel if you keep a level head as a PA, care about your patients, and do everything in your power to try to get them the best possible treatment, respect will be yours.

5. Doctors without borders does not actively recruit PA's nor use them to a wide extent. Doctors without borders is something that both interests my and I.

^ Of course 2 and 4 could be said about DO's. So that's really why I'm up in the air. And I have several questions that I haven't asked because I was hopefully thinking that they would be answered in some personal pros and cons.

Questions like...

1. Who does more paperwork?
2. Who does more procedures?
3. Who gets to spend more time with patients?
4. Which has greater latitude in choice of field (I'm assuming physician for that one)?
5. Who has to deal less with managed care and insurance companies (I'm assuming PA for this one)?

I think frustrations and headaches come with both careers. I'm just trying to find which one comes with the least.

Chandu The Magician

one last thing about the managed care/insurance bit.....work on post as a doctor. no problems now!! if you like OMM, get the formal education. a book just won't do. the background and how it ties in with medicine will surprise you. good luck on whatever you choose!

 

[Skialta]

Thanks for detailing your reasons for choices.

I will tell you my perspective as a 4th year MD student and as a former physical therapist. Manual therapy is a great skill to have and in certain practices (mostly FP or PM&R) I think it would be useful. The fact is that if you are an IM or FP doing 45 minutes of manual therapy may not be that financially rewarding. You can say you don't care about money, but at some point you have to look at overhead, repaying student loans, and how busy your scedule is. Manual therapy is definitely a skill that you must constantly perform or you really lose proficiency. My point is it is a good skill to know but you really have to be in the right practice setting to really use it. I have worked with several DOs and they have all been great, but most of them really don't use it all that often with the exception of the ER doc who relocates dislocations (which MDs do as well).

I really don't think there is a difference in how MD students and DO students are taught to approach patient care. There are far more things that MD and DO students share in common than are there differences, both practice medicine or surgery pretty much the same way using the same standards. It really bugs me to read how someone likes the DO or MD perspective because the truth is if you go to residents DO or MD you can't tell them apart.

It sounds to me like you need to be the physician and not the PA by some of your statements. You will never head an interdisciplinary team as a PA. I have tremendous respect for PAs and NPs as I have worked with some great ones and have had some excellent teaching from some of them. That said, if you are in an academic environment you will find that you pretty much function as the intern (for the most part, depends on specialty). I think if I was a PA I would feel cheated that I was stopped at that level of responsibility. As the mid level you really don't get to call many of the shots with the challenging patients.

As far as paperwork, on a day to day basis you will do as much as a physician minus the administrative work. You still have to do admits, progress notes and discharges, and if you are in an academic center I would almost guarrantee that you will do more paperwork than the attending.

It is a tough choice to decide physician or PA, I toyed with the idea as well but knew I needed to be the one calling the shots or I would always be kicking myself for not going the extra mile to become a physician. As I said before good luck to you...

Skialta

 

[ChandutheMagici]

Many thanks for everyone who replied. I really appreciate everyone's answers. I'm actually off right now to shadow my first PA.

Skialta,

I just wanted to give a personal thank you for clearing up some misconceptions I had. As a 4th year med student I know you must be pretty busy so thanks for taking the time to write such a long post. And, it looks like I'll be applying to some MD schools too

Chandu