Career path advice.. Primary Care MD/DO vs. PA

[bonnski]

Hey everybody,
Appreciate all the info here, looking for some opinions. I myself am debating between the PA vs MD/DO route.. I just graduated with a BS in Biology, 3.84 gpa, lots of research experience, volunteering, shadowing, etc, but am very hesitant toward pursuing medical school for financial and (most importantly) lifestyle reasons. I know for sure I do not want to become a surgeon. Although I really don't know which particular specialty I would like to go into, primary care does seem very attractive to me due to sheer breadth of knowledge, however I'm struggling to see how becoming a PCP would have any major advantage to becoming a PA (except for status/respect issues obviously, not to underestimate this, but in the grand scheme of things, setting aside one's ego and being humble for the sake of life balance and sanity seems more in line with my values in life (family, relationships)). Either way, my entire education and living expenses, everything, will be paid for through loans. With the MD/DO route, I'd be looking at at least 250k-300k in debt. With Federal loan interests rates now at 6.8%, the interest on these loans will be tremendous by the time med school and residency are over. By this time I will be in my early 30's with no money saved or invested, no assets, etc. Even more, the opportunity cost of these 7+ years of lost income would put me at an even greater disadvantage. With the PA route, I'd be looking at 80-95k of debt, and be done in 2-2.5 years, start out making ~75-80k and gradually work my way up to ~90-95k (more if I get into specialties like derm, or as a surgical PA, (I would consider being a surgical PA over an MD surgeon because of the no need to go through a grueling 7+ year residency and could have the flexibility to switch out of that whenever I wanted after making that extra $, just an option). Anyway, by starting making PA money at least 5 years earlier, plus the ~200k less in student loans, I feel like that may put me at a better advantage financially than becoming a primary care MD, where I may only earn ~130-150k/yr, and be able to do virtually everything the PCP can do. Because of this debt +interest and years of lost income, does anyone see the real advantage of going through med school to become a PCP? (the time saved by becoming a PA I could be saving, contributing to my retirement, 401k, saving for kids college, starting my life financially, and still basically practicing full-fledged primary care). What do you guys think about this? Appreciate all the advice folks.

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[ghost dog]

Hey everybody,
Appreciate all the info here, looking for some opinions. I myself am debating between the PA vs MD/DO route.. I just graduated with a BS in Biology, 3.84 gpa, lots of research experience, volunteering, shadowing, etc, but am very hesitant toward pursuing medical school for financial and (most importantly) lifestyle reasons. I know for sure I do not want to become a surgeon. Although I really don't know which particular specialty I would like to go into, primary care does seem very attractive to me due to sheer breadth of knowledge, however I'm struggling to see how becoming a PCP would have any major advantage to becoming a PA (except for status/respect issues obviously, not to underestimate this, but in the grand scheme of things, setting aside one's ego and being humble for the sake of life balance and sanity seems more in line with my values in life (family, relationships)). Either way, my entire education and living expenses, everything, will be paid for through loans. With the MD/DO route, I'd be looking at at least 250k-300k in debt. With Federal loan interests rates now at 6.8%, the interest on these loans will be tremendous by the time med school and residency are over. By this time I will be in my early 30's with no money saved or invested, no assets, etc. Even more, the opportunity cost of these 7+ years of lost income would put me at an even greater disadvantage. With the PA route, I'd be looking at 80-95k of debt, and be done in 2-2.5 years, start out making ~75-80k and gradually work my way up to ~90-95k (more if I get into specialties like derm, or as a surgical PA, (I would consider being a surgical PA over an MD surgeon because of the no need to go through a grueling 7+ year residency and could have the flexibility to switch out of that whenever I wanted after making that extra $, just an option). Anyway, by starting making PA money at least 5 years earlier, plus the ~200k less in student loans, I feel like that may put me at a better advantage financially than becoming a primary care MD, where I may only earn ~130-150k/yr, and be able to do virtually everything the PCP can do. Because of this debt +interest and years of lost income, does anyone see the real advantage of going through med school to become a PCP? (the time saved by becoming a PA I could be saving, contributing to my retirement, 401k, saving for kids college, starting my life financially, and still basically practicing full-fledged primary care). What do you guys think about this? Appreciate all the advice folks.

There is no real comparison between a mid level provider and a medical doctor, at least from my perspective (as a Canadian family physician).

It seems that a P.A. is limited to what they can do; a family doctor is not.

Family physicians can work in the ER, can do outpatient work, nursing home, peform as a hospitalist, palliative care, etc. However, this does require significantly more sacrifice (academically and financially compared to a P.A.). On the other hand, you will be compensated more in the end.

I have noticed a trend recently: American MDs moving to Canada. In fact my own family MD is American trained. Although not necessarily an easy thing to do, it is doable.

There are numerous benefits to practicing in Canada:

1. Less litigous environment, with much less malpractice insurance.

2. For some reason, it seem that Canadian family MDs are making better incomes (if the quoted American figures are to be believed). This may have something to do with the significant overhead involved in running a US practice (i.e. devoted personnel for billing multiple sources, chasing down non-payers , etc. Whereas in Canada payment is via one source and performed by the administrator, and not typically another worker. )

This may change with Obamacare ?

 

[deleted87716]

I've never met a doctor who wished they were a PA.

However, I've met lots of PAs who wanted to be doctors.

Your call.

 

[bonnski]

in your opinion do you think that is because of a fundamental scope of practice/authority issue or ego issue? not that those can really be distinguished...

 

[deleted87716]

in your opinion do you think that is because of a fundamental scope of practice/authority issue or ego issue? not that those can really be distinguished...

"Ego issues" aren't confined to physicians.

Doing something less than what you want or what you are capable of is usually regrettable.

Again, your call.

 

[bonnski]

right, i didnt mean say that "ego" was confined to doctors, we all have one to some extent (not that it's bad at all, definitely healthy up to a certain degree)... it is a tough call trying to predict whether i will feel limited/not living up to my full potential vs. the benefits of not having to deal with as much hassle, be it managerial, litigation, worrying about overhead, debt... hmmmm

 

[deleted87716]

right, i didnt mean say that "ego" was confined to doctors, we all have one to some extent (not that it's bad at all, definitely healthy up to a certain degree)... it is a tough call trying to predict whether i will feel limited/not living up to my full potential vs. the benefits of not having to deal with as much hassle, be it managerial, litigation, worrying about overhead, debt... hmmmm

Yes, becoming a doctor and being a doctor is hard.

To paraphrase Tom Hanks in "A League of Their Own":

"It's supposed to be hard. If it wasn't hard, everyone would do it. The hard... is what makes it great."

 

[deleted6669]

"Family physicians can work in the ER, can do outpatient work, nursing home, perform as a hospitalist, palliative care, etc. "

pa's can do all of these things as well. there are lots of reasons to go md/do over pa. this isn't one of them.

 

[deleted6669]

. it is a tough call trying to predict whether i will feel limited/not living up to my full potential vs. the benefits of not having to deal with as much hassle, be it managerial, litigation, worrying about overhead, debt... hmmmm

being a pa has its own specific hassles. trust me on this.
do some significant shadowing of pa's and docs in a variety of settings. this may help you decide on a path.

 

[deleted87716]

it is a tough call trying to predict whether i will feel limited/not living up to my full potential vs. the benefits of not having to deal with as much hassle, be it managerial, litigation, worrying about overhead, debt... hmmmm

You will definitely be more limited as a PA, there's no question about that.

By your own estimate, your debt load as a PA would be roughly half of what it would've been had you gone to medical school, but...so would your income. Advantage...?

PAs can be sued for malpractice just like physicians. The lower incidence of lawsuits amongst PAs is mainly reflective of their smaller numbers and the fact that most practice in low-acuity settings.

As for managerial "hassle" and "worrying" about overhead, nearly all PAs and more than half of all physicians are working in employed settings, so that's something you can do either way, should you be so inclined. Keep in mind that giving up "worry" and "hassle" means giving up control. Control (a.k.a. "autonomy") is a major factor in job satisfaction. Be careful what you ask for.

http://www.kevinmd.com/blog/2011/02/job-satisfaction-physicians.html

Of the physician compensation, financial incentive, and care management variables that we examined, only being a salaried employee was associated with physician job dissatisfaction.

 

[ghost dog]

"Family physicians can work in the ER, can do outpatient work, nursing home, perform as a hospitalist, palliative care, etc. "

pa's can do all of these things as well. there are lots of reasons to go md/do over pa. this isn't one of them.

Ok, but P.A.'s are not practicing medicine in these spheres; they are midlevel providers / middlemen.

If you want to be a doc, go to medical school.

 

[deleted6669]

Ok, but P.A.'s are not practicing medicine in these spheres; they are midlevel providers / middlemen.
.

PA'S by definition practice medicine with autonomy and some degree of oversight. I would argue a pa covering a solo rural er or family practice at which a doc is never on site but reviews a few charts/mo is practicing medicine. the only time I ever see my sponsoring physician is if he relieves me after a night shift. we almost never work together unless I pick up an extra day shift. we staff pa's 24/7 and have a doc on day shift only.
pa's do a lot more than you think they do. it's very different here in the states than in canada.
A BIT OF REVIEW FOR YOU:
http://en.wikipedia.org/wiki/Physician_Assistant

 

[michaelrack]

I've never met a doctor who wished they were a PA.

.

I have, although this was a doctor who was terminated from residency.

 

[MJB]

Hey everybody,
Appreciate all the info here, looking for some opinions. I myself am debating between the PA vs MD/DO route.. I just graduated with a BS in Biology, 3.84 gpa, lots of research experience, volunteering, shadowing, etc, but am very hesitant toward pursuing medical school for financial and (most importantly) lifestyle reasons. I know for sure I do not want to become a surgeon. Although I really don't know which particular specialty I would like to go into, primary care does seem very attractive to me due to sheer breadth of knowledge, however I'm struggling to see how becoming a PCP would have any major advantage to becoming a PA (except for status/respect issues obviously, not to underestimate this, but in the grand scheme of things, setting aside one's ego and being humble for the sake of life balance and sanity seems more in line with my values in life (family, relationships)). Either way, my entire education and living expenses, everything, will be paid for through loans. With the MD/DO route, I'd be looking at at least 250k-300k in debt. With Federal loan interests rates now at 6.8%, the interest on these loans will be tremendous by the time med school and residency are over. By this time I will be in my early 30's with no money saved or invested, no assets, etc. Even more, the opportunity cost of these 7+ years of lost income would put me at an even greater disadvantage. With the PA route, I'd be looking at 80-95k of debt, and be done in 2-2.5 years, start out making ~75-80k and gradually work my way up to ~90-95k (more if I get into specialties like derm, or as a surgical PA, (I would consider being a surgical PA over an MD surgeon because of the no need to go through a grueling 7+ year residency and could have the flexibility to switch out of that whenever I wanted after making that extra $, just an option). Anyway, by starting making PA money at least 5 years earlier, plus the ~200k less in student loans, I feel like that may put me at a better advantage financially than becoming a primary care MD, where I may only earn ~130-150k/yr, and be able to do virtually everything the PCP can do. Because of this debt +interest and years of lost income, does anyone see the real advantage of going through med school to become a PCP? (the time saved by becoming a PA I could be saving, contributing to my retirement, 401k, saving for kids college, starting my life financially, and still basically practicing full-fledged primary care). What do you guys think about this? Appreciate all the advice folks.

You seem to be looking at this only from a money standpoint.

Personally, I'd explore why you're even interested in medicine, then work on whether which role you want.

When i was going back to school, I didn't wanna aim below the absolute best and end up regretting it (and wasting time), so I went to med school. I don't regret my decision. Yep, I'm mid-thirties, ruined financially, and working harder than I ever have but you know what? I'm not sitting at a desk rotting my brain any longer, I have an AWESOME job, and I will not have to have anyone supervise my work when i finish residency. If I wish, I may have complete autonomy.

 

[ghost dog]

it's very different here in the states than in canada.
👍

 

[senseiturtle]

PA'S by definition practice medicine with autonomy and some degree of oversight. I would argue a pa covering a solo rural er or family practice at which a doc is never on site but reviews a few charts/mo is practicing medicine. the only time I ever see my sponsoring physician is if he relieves me after a night shift. we almost never work together unless I pick up an extra day shift. we staff pa's 24/7 and have a doc on day shift only.
pa's do a lot more than you think they do.

I'm EXTREMELY pro-PA, but....

1) A physician's assistant MUST have oversight. Spot-checking does not equal oversight.

2) If a PA is doing 100% of the work with only occasional oversight... that's an unethical malpractice nightmare and needs to be addressed. You're attempting to replace a physician with 7 or 8 years of full-time training with someone with 26-28 months. Yes, "stuff" happens and patients have adverse outcomes. No, PA's are not equipped with the depth of experience and guidance to deal with everything that is medicine.

3) Yes, I know exactly what a PA's is capable of. I'm marrying one. I've lived with 2. I've trained with dozens, and worked with dozens more. They can be both amazing life-savers, as well as complete newbies. There is absolutely no comparison that can be made to the training a physician receives.... but, I'd still value a PA's style of training over any ubernurse usurpers.

 

[deleted6669]

I'm EXTREMELY pro-PA, but....

1) A physician's assistant 3) Yes, I know exactly what a PA's is capable of. I'm marrying one. .

before the wedding you might want to figure out that there is no 's in PHYSICIAN ASSISTANT.

 

[ghost dog]

before the wedding you might want to figure out that there is no 's in PHYSICIAN ASSISTANT.

Pretty much a non-answer.

 

[deleted6669]

Pretty much a non-answer.

That's because he realized he had been caught in a lie to advance his misguided sentiments.
do people marrying a physician who specializes in the cardiovascular system say " I am marrying a heart doctor" or do they say " I am marrying a cardiologist".
same deal. dude should know what PA stands for if he is marrying one....
if you were referring to my response and his lack of response I can only say that he is being unrealistic. pa's should not be expected to present each and every pt in real time before they go home. there is no efficiency in that.
a specialty pa knows much more about their specialty than most physicians outside of their specialty. I train fp residents to do emergency medicine at 2 well known fp residencies and have for almost 15 years. I know more em than they do. when a resident is working with me and a pt crashes it's me the nurses grab, not the fp resident. when we hire residency trained, board certified fp docs to work part time in the ed they ask me 10 questions for every one I ask them. I respect fp docs(see my other current thread in the fp forum:
http://forums.studentdoctor.net/showthread.php?t=839887) but expect some respect in return. I have been doing this for almost 25 years and seen the full range of em pts with well over 120,000 em pt encounters. isn't it possible I have learned a bit along the way....

 

[ghost dog]

Pretty much a non-answer.

On a somewhat related note, it appears that there is about to be a large PA training program established in Toronto / Canada. The program director is a real *******, as I have some direct knowledge of her.

She seemed to think that scripting ridonculous doses of narcotics to a FM patient with a tumultous psychosocial hx AND cocaine abuse was a reasonable idea.

Unfriggin unbelievable.

This does not bode well for this program.

 

[ghost dog]

That's because he realized he had been caught in a lie to advance his misguided sentiments.
do people marrying a physician who specializes in the cardiovascular system say " I am marrying a heart doctor" or do they say " I am marrying a cardiologist".
same deal. dude should know what PA stands for if he is marrying one....

That is your rebuttal?

Dude.

 

[deleted6669]

look again

 

[deleted6669]

On a somewhat related note, it appears that there is about to be a large PA training program established in Toronto / Canada. The program director is a real *******, as I have some direct knowledge of her.

She seemed to think that scripting ridonculous doses of narcotics to a FM patient with a tumultous psychosocial hx AND cocaine abuse was a reasonable idea.

Unfriggin unbelievable.

This does not bode well for this program.

there are already 3 established pa programs in canada and jobs there for any U.S. pa who wants one.
Education programs are now offered at the University of Manitoba in Winnipeg, McMaster University in Hamilton, Ontario, and the University of Toronto.
I get an email from healthforceontario every month with a list of em pa openings.
any guess where the 40th annual pa national convention is next year? it's in a place we expect a lot of growth in the next few years: TORONTO:http://www.aapa.org/upcoming-events/annual-conference
Want to improve the quality of future pa's in your country? give a lecture at the conference. I'm sure you have something valuable to teach.

 

[deleted6669]

double post .delete.

 

[ghost dog]

there are already 3 established pa programs in canada and jobs there for any U.S. pa who wants one.
Education programs are now offered at the University of Manitoba in Winnipeg, McMaster University in Hamilton, Ontario, and the University of Toronto.
I get an email from healthforceontario every month with a list of em pa openings.
any guess where the 40th annual pa national convention is next year? it's in a place we expect a lot of growth in the next few years: TORONTO:http://www.aapa.org/upcoming-events/annual-conference
Want to improve the quality of future pa's in your country? give a lecture at the conference. I'm sure you have something valuable to teach.

Never taught P.A.'s ; though I have taught RNs, med students, residents and international medical graduates (IMGs). I hold a faculty position at UofT.

I have not seen PA's in the civilian canadian medical setting as yet, although it appears this is coming (if not already here). I believe their scope of practice is primarily in the Canadian military at present.

I find it very ironic that the government sees fit to grant these mid level providers new medical privileges, while at the same time being somewhat draconian in regards to it's current physician population.

Specifically, their new out of hospital premises inspection program in Ontario, which has led to closure of approximately 40 % of chronic pain clinics as a result.

Also the ironic fact: Ontario already has thousands of trained DOCTORS in the form of IMGs, yet only a small fraction of these are accepted into retraining residencies. A tremendous waste of existing resources.

But hey, why not use lesser trained P.A's? Makes sense to me.

Oh, and let's not forget the fact that one province has seen fit to grant naturopaths ( yes - naturopaths ) the ability to PRESCRIBE MEDICATIONS.

WTF?

 

[deleted6669]

the health force ontario project is about pa's working in the civilian sector, mostly in em and surgery at this point. if you can lecture med students and residents you can lecture pa's. just give the same lecture. you don't need to water it down.
this is where civilian pa's are working in ontario at present:
http://www.healthforceontario.ca/upload/en/work/pa_map_11_22_2010_eng.pdf

 

[senseiturtle]

That's because he realized he had been caught in a lie to advance his misguided sentiments.

... No... Quite frankly, your angry retort of an added apostrophe and a letter did not qualify a response. I laughed.


Argue the points directly if you want a dignified response. I'll repeat them for you.


1) Spot checking does not equal oversight.

2) 26-28 months of training as a PHYSICIAN ASSISTANT (there, got it right for you) does not equal 4 years of medical school +3 or more years residency.

3) Lack of oversight of PA's is an unethical, malpractice nightmare.

 

[VA Hopeful Dr]

On a somewhat related note, it appears that there is about to be a large PA training program established in Toronto / Canada. The program director is a real *******, as I have some direct knowledge of her.

She seemed to think that scripting ridonculous doses of narcotics to a FM patient with a tumultous psychosocial hx AND cocaine abuse was a reasonable idea.

Unfriggin unbelievable.

This does not bode well for this program.

Right, because I've never seen an MD do that before.

 

[ghost dog]

Right, because I've never seen an MD do that before.

I was referring to an MD, professor.

 

[VA Hopeful Dr]

I was referring to an MD, professor.

An MD is head of a PA program? Is that how it usually works?

I'd assumed that PA programs were lead by PAs much like MD programs are heading by MDs.

 

[ghost dog]

An MD is head of a PA program? Is that how it usually works?

I'd assumed that PA programs were lead by PAs much like MD programs are heading by MDs.

Nope, Medical director is an MD :


http://www.facmed.utoronto.ca/programs/healthscience/PAEducation/Faculty_and_Staff.htm

 

[apricotattack]

Back to the original question...

PAs cannot deliver babies, do C-sections, or primary any surgery whereas family docs can in a lot of places.

 

[deleted6669]

Back to the original question...

PAs cannot deliver babies, do C-sections, or primary any surgery whereas family docs can in a lot of places.

you are partially right.
there are pa's who do uncomplicated vag. deliveries solo.
you are correct that pa's do not do c-sections as primary surgeon(they 1st assist). there are not too many family medicine docs who work as primary surgeons aside from c-sections. I know of 1 program that teaches fp residents to do open appys but there are not many places that would actually credential them to do this.
although not required there are a few postgrad obgyn pa residencies out there. this is from one of them:

The mission of the Riverside-Arrowhead Physician Assistant Residency program is to expand the knowledge of Physician Assistants in the field of Obstetrics and Gynecology. We believe that with intensive training our Physician Assistant Residents will be exceptional providers in the inpatient, outpatient and labor and delivery settings.
Residents typically graduate with having performed over 200 vaginal deliveries and first assisted in over 50 cesarean sections. This program teaches Physician Assistant Residents to manage complicated and non-complicated antepartum, intrapartum, postpartum, postoperative, and acutely ill OB and GYN patients. The curriculum also includes L&D triage management, ER consultations, experience with evaluating and treating common GYN complaints, and routine OB and GYN outpatient care.

and from another:
The Montefiore Post-Graduate Residency is a 52 week, full-time postgraduate residency program offering intensive training in obstetrics and gynecology. PA residents are trained alongside the OB/GYN physician residents and are exposed to the management of OB/GYN patients in a variety of settings and circumstances. The PA-Resident will have rotations focused on Antepartum, Labor and Delivery, and Postpartum services, along with rotations on the GYN and GYN oncology services, including ultrasound and surgical instruction. Upon completion of this residency, the PA should be competent in performing vaginal deliveries, 1st assisting in Cesarean deliveries and gynecological surgeries, and performing office-based gynecological procedures.

last but not least a partial list of hospitals credentialing pa's to do solo uncomplicated vag. deliveries:

1. East Georgia Regional Medical Center, Statesboro, GA
2. Hurley Hospital, Flint, MI
3. St. John's Hospital, Detroit, MI
4. Sinai-Grace Hospital, Detroit, MI
5. Oakwood Hospital , Dearborn, MI
6. Cambridge Health Alliance, Cambridge MA
7. Brooklyn Hospital, NY
8. Coney Island Hospital, NY
9. Lennox Hill Hospital, NY
10. New York Methodist, NY
11. New York Hospital Medical Center of Queens, NY
12. Harlem Hospital, NY
13. Staten Island Hospital, NY
14. Weiler Hospital, Bronx, NY
15. Park Ridge Hospital, Rochester, NY
16. Christiana Hospital, Newark, Delaware
17. Abington Memorial Hospital, Abington, Pennsylvania
18. Arrowhead Regional Medical Center, Colton, CA
19. Riverside County Medical Center Riverside, CA
20. Albert Einstein Medical Center, Philadelphia, PA

 

[smq123]

"Family physicians can work in the ER, can do outpatient work, nursing home, perform as a hospitalist, palliative care, etc. "

pa's can do all of these things as well. there are lots of reasons to go md/do over pa. this isn't one of them.

emedpa - I appreciate your input as to the benefits of being a PA and what PAs can do.

But, seeing as this is a forum for MDs/DOs, what do YOU see as the ADVANTAGES of being an MD/DO over a PA? I ask this particularly because I remember that, a few years ago, you considered going back to med school to become a DO. What was going on that made you consider going DO over PA?

Thanks. 🙂

 

[deleted6669]

what do YOU see as the ADVANTAGES of being an MD/DO over a PA? I ask this particularly because I remember that, a few years ago, you considered going back to med school to become a DO. What was going on that made you consider going DO over PA?

Thanks. 🙂

md/do advantages over pa:
1.scope of practice based on your training, not what others think you can do. my current scope at most places is limited to probably 70% of what I am actually capable of doing.
2.more international/volunteer opportunities
3.easier credentialing to work anywhere/anytime without the hassles involved with getting delegation of services plans approved(can take MONTHS at a new job).
4.em md/do's have better work schedules than pa's. most em docs I know work around 12-14 eight hr shifts/mo while most em pa's work 18 tens or 16 twelves.
5. much more respect from pts and other medical professionals. a lot of folks still confuse pa's with medical assistants. when the name changes to physician associate that will be a step in the right direction.

 

[EMDream]

I've never met a doctor who wished they were a PA.

However, I've met lots of PAs who wanted to be doctors.

Your call.

I have. I thought they were crazy. They said they just wished they didn't have the responsibility and regretted spending so much time in school/residency/fellowship. I'm sure if I could wave a magic wand to switch their degree they'd probably decline though 😛