Comparing Orthro MD Vs. PM&R MD Vs. Orthro PA

[adamrose]

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Hey everyone, Junior undergrad here.. been doing lots of research. So far Here is my thought process deciding between the two.
My Main considerations:
Love for my area of work
Lifestyle (No more than 60 Hours a week)
Pay (realistically would be fine with 150k-200k take home money)
Prestige

MD/DO route: Orthro , PM&R
PA route: Specialize in Orthro/Cardiac surgery


The PA route interests me for the so called "easy lifestyle". The salary (so I've heard) could be 100k starting up to around 130k-140k if you're in a surgical specialty. this seems favorable in your 20's and 30's while life is still nice but I cant imagine being happy as a PA when I am in my 40's and 50's and have to answer to fresh MDs in their early 30's straight out of med school. Is this a fair judgement to make?

The MD route:
My internal struggles resides in comparing the lifestyle/job satisfaction trade off between the Surgical PA route and the long hauled orthro route. Is it possible and realistic to work under 60 hours a week as an orthro surgeon? if so, how come I have not heard of this trend?

What I have been thinking about is a middle ground solution: pursuing med school to obtain a residency in PM&R and becoming a Physiatrist.
My interests in medicine are definitely focused on the musculoskeletal system and helping people with trauma induced injuries. But at the same time, I would not like to be the last physician someone sees after all problems are ruled out. Also the idea of dealing with mysterious Fibromyalgia and inherently unfixable lower back problems seems to be unsettling to me. After reading tons on this specialty I still don't quite understand their area of work since it is so broad.

Does anyone have any advice/information I have bias-ly represented?

 

[Ace-Co-A]

MD/DO route: Orthro , PM&R
PA route: Specialize in Orthro/Cardiac surgery

The PA route interests me for the so called "easy lifestyle". The salary (so I've heard) could be 100k starting up to around 130k-140k if you're in a surgical specialty. this seems favorable in your 20's and 30's while life is still nice but I cant imagine being happy as a PA when I am in my 40's and 50's and have to answer to fresh MDs in their early 30's straight out of med school. Is this a fair judgement to make?

Is it fair? Maybe. It depends on what is important to you. Do you care that you'll have to answer to your peers or would you prefer to be in a position of leadership? How have you felt in these two roles in your work experiences to this point? By the way, I've heard that the "life is still nice", gasp, even after your 20s and 30s.

The MD route:
My internal struggles resides in comparing the lifestyle/job satisfaction trade off between the Surgical PA route and the long hauled orthro route. Is it possible and realistic to work under 60 hours a week as an orthro surgeon? if so, how come I have not heard of this trend?

Almost certainly not realistic to do so throughout your career. During your residency and probably in medical school, you will be working a lot more than 60 hours per week. I don't know about the typical schedule of attending orthopedic surgeons (see the resource I've posted below), but I imagine 60 hours is slightly above average for attendings (I think this paper and another one speak to your concern).

What I have been thinking about is a middle ground solution: pursuing med school to obtain a residency in PM&R and becoming a Physiatrist.
My interests in medicine are definitely focused on the musculoskeletal system and helping people with trauma induced injuries. But at the same time, I would not like to be the last physician someone sees after all problems are ruled out. Also the idea of dealing with mysterious Fibromyalgia and inherently unfixable lower back problems seems to be unsettling to me. After reading tons on this specialty I still don't quite understand their area of work since it is so broad.

Does anyone have any advice/information I have bias-ly represented?

I think your best bet is to listen to the wisdom of those that have gone before you. In your case, fortunately a few days ago, an orthopedic spine surgeon offered to answer our questions. I recommend that you thoroughly read through the entire thread before asking your own questions.

 

[adamrose]

Thank you! Will read the thread

 

[adamrose]

Still looking for more view points if possible

 

[Lya]

If I were you, what I would do is to shadow PAs and other specialists, considering whether you see yourself in their shoes. They will probably offer you more firsthand, comprehensive answers.

In my opinion, choosing MD over PA just because you might feel less prestige when you become 40s and 50s as a PA is not a good perspective to have when you go into medical school--regardless of whether you go into ortho or PM&R. (Maybe if you rather see yourself as part of a healthcare team, you might ultimately feel happier as a PA while having great lifestyle and decent pay?) It is perfectly understandable, though. I am sure there are successful doctors and students with similar mindsets like yours.

However, it might be very difficult to find an ideal job position that satisfies all of your criteria, so if you decide to go with a MD route, I would at least be prepared realistically for a situation where one or some of your criteria need to be compromised.

 

[The Buff OP]

 

[AlbinoHawk DO]

If I were you, what I would do is to shadow PAs and other specialists, considering whether you see yourself in their shoes. They will probably offer you more firsthand, comprehensive answers.

In my opinion, choosing MD over PA just because you might feel less prestige when you become 40s and 50s as a PA is not a good perspective to have when you go into medical school--regardless of whether you go into ortho or PM&R. (Maybe if you rather see yourself as part of a healthcare team, you might ultimately feel happier as a PA while having great lifestyle and decent pay?) It is perfectly understandable, though. I am sure there are successful doctors and students with similar mindsets like yours.

However, it might be very difficult to find an ideal job position that satisfies all of your criteria, so if you decide to go with a MD route, I would at least be prepared realistically for a situation where one or some of your criteria need to be compromised.

Lets keep it real, answering to younger people is tough to swallow especially when they chew you up. Not saying a good reason to pick med, but it's a valid concern.

 

[adamrose]

Lets keep it real, answering to younger people is tough to swallow especially when they chew you up. Not saying a good reason to pick med, but it's a valid concern.

Why would this not be a good reason to pick med over PA?
Inherently, both positions do the same thing patient care wise, my core reason for considering med school would be for job satisfaction. to me that would be being an expert in what I am doing and having full autonomy.

I don't mean to sound feisty, is this a bad way to thing about it?

 

[Lya]

Why would this not be a good reason to pick med over PA?
Inherently, both positions do the same thing patient care wise, my core reason for considering med school would be for job satisfaction. to me that would be being an expert in what I am doing and having full autonomy.

I don't mean to sound feisty, is this a bad way to thing about it?

Depending on where you end up working in, you might not have that full autonomy even as a physician. If you are willing to keep that prestige and expertise, while compromising pay/lifestyle/autonomy inevitably because of some circumstances you might face in the future beyond your control, then maybe MD is worthwhile.

 

[SN12357]

Prestige and lifestyle are generally competing interests. You're going to have to decide which is more important.

In my opinion PA makes sense if your interest in medicine is treating patients and that's it. If you want to be a provider AND [administrative leader, researcher, etc] then a PA degree doesn't get you that. If you want to do something more than treating patients you're better off with an MD degree or, actually, pursuing some of the nursing degrees and routes.

 

[RueTay]

More importantly, do you want to operate? If so take PMR off the table.

If you do want to operate the the question is... do you want to be THE surgeon?

As a PA you will open, close, and hold a lot of hook for the surgeon... who is your boss. In some private practice settings you may get a little more autonomy, but only for the most basic cases. If you want really know what you are doing and be licensed to practice, you will have to go to med school and Ortho residency. Trust me, this is a loooooong and competitive road. At the end you will make plenty and be able to structure your lifestyle at <60 hrs/ wk.

First shadow, read and figure out what you want out of life. Then decide what sacrifices you are willing to make to get there..

 

[RueTay]

Why would this not be a good reason to pick med over PA?
Inherently, both positions do the same thing patient care wise, my core reason for considering med school would be for job satisfaction. to me that would be being an expert in what I am doing and having full autonomy.

I don't mean to sound feisty, is this a bad way to thing about it?

This is far from the truth.

 

[adamrose]

This is far from the truth.

My understanding is that, with how things are going politically, there would be not so much sense (for me) in becoming a primary care physician over a PA. Especially with new local laws granting PAs more autonomy. I am still up in the air of specialties as I'm sure everyone is before they choose. But I would like some sort of closure with certainty with what I want from my career before I make the tremendous sacrifices getting there.

DO School is my realistic option due to my freshmen mistakes. However, I am uncomfortable with the fact that they are not open to the same residency outlook as MDs are. Im not sure if it is because DOs are less competitive into these fields by nature, or because the system is biased towards the hypothetical "equal DO vs MD and would rather choose someone with an MD title" situation.

I am also uncomfortable with how DO schools - for lack of a better word, "funnel" students into primary care since I previously stated how being a PA would be better for me. and I would hate to see myself going through all of this to become just an IM

I am interested in operating yes, but as technology is on the rise, I could see myself interested doing non invasive procedures/injections/prolotherapy as well
Wouldn't this encompass the fields such as PM&R and Interventional Radiology?

My understanding that with PM&R, Going to DO school would not be an issue for residency spots. However, it would be an issue in regards to IR.

Would love to hear what you think

 

[AlbinoHawk DO]

Why would this not be a good reason to pick med over PA?
Inherently, both positions do the same thing patient care wise, my core reason for considering med school would be for job satisfaction. to me that would be being an expert in what I am doing and having full autonomy.

I don't mean to sound feisty, is this a bad way to thing about it?

4 years training plus 6 year residency and incredible debt is not something to pick just because you may be bothered once in a while to respond to a 35 year old in your 50's.

 

[RueTay]

My understanding is that, with how things are going politically, there would be not so much sense (for me) in becoming a primary care physician over a PA. Especially with new local laws granting PAs more autonomy. I am still up in the air of specialties as I'm sure everyone is before they choose. But I would like some sort of closure with certainty with what I want from my career before I make the tremendous sacrifices getting there.

DO School is my realistic option due to my freshmen mistakes. However, I am uncomfortable with the fact that they are not open to the same residency outlook as MDs are. Im not sure if it is because DOs are less competitive into these fields by nature, or because the system is biased towards the hypothetical "equal DO vs MD and would rather choose someone with an MD title" situation.

I am also uncomfortable with how DO schools - for lack of a better word, "funnel" students into primary care since I previously stated how being a PA would be better for me. and I would hate to see myself going through all of this to become just an IM

I am interested in operating yes, but as technology is on the rise, I could see myself interested doing non invasive procedures/injections/prolotherapy as well
Wouldn't this encompass the fields such as PM&R and Interventional Radiology?

My understanding that with PM&R, Going to DO school would not be an issue for residency spots. However, it would be an issue in regards to IR.

Would love to hear what you think

Primary care is a whole different story, but mid-level providers are not gaining autonomy in surgical subspecialties. Thank goodness.

DO school is a fine way to get into orthopedics or PMR and it is a MUCH better than going to a Carib school. Right now the competitive level is about equal for DOs getting into AOA Ortho residencies compared to MDs getting into ACGME Ortho residencies. DOs VERY rarely get into MD Ortho residencies, but they do frequently get into PMR ACGME residencies. AOA and ACGME announced they are merging so the future is somewhat unknown for Ortho. Carib grads don't get into either by the way.

One could also argue that MD schools try to "funnel" students into primary care too, but the bottom line is you can do what you want. I agree with you that the primary care outlook for doctors is uncertain at best.

PMR does a lot of injections, so does Ortho. IR is a whole different story and a lot of your training would be focused on other systems beyond MSK.

At this point, Ortho is actually the specialty leading the way for less invasive treatment modalities with arthroscopy, minimally invasive spine surgery, anterior hip replacement etc.

If they cure arthritis with medicine, the orthopods are definitely in trouble. But I think they are going to have to cure obesity first. All the prolotherapy in the world isn't going to stop those fat joints from wearing out under all that weight. Between that and trauma (never going away), we should be in business for the foreseeable future.

 

[adamrose]

This has been by far the best response to any of my posts.

Thank you

Primary care is a whole different story, but mid-level providers are not gaining autonomy in surgical subspecialties. Thank goodness.

DO school is a fine way to get into orthopedics or PMR and it is a MUCH better than going to a Carib school. Right now the competitive level is about equal for DOs getting into AOA Ortho residencies compared to MDs getting into ACGME Ortho residencies. DOs VERY rarely get into MD Ortho residencies, but they do frequently get into PMR ACGME residencies. AOA and ACGME announced they are merging so the future is somewhat unknown for Ortho. Carib grads don't get into either by the way.

One could also argue that MD schools try to "funnel" students into primary care too, but the bottom line is you can do what you want. I agree with you that the primary care outlook for doctors is uncertain at best.

PMR does a lot of injections, so does Ortho. IR is a whole different story and a lot of your training would be focused on other systems beyond MSK.

At this point, Ortho is actually the specialty leading the way for less invasive treatment modalities with arthroscopy, minimally invasive spine surgery, anterior hip replacement etc.

If they cure arthritis with medicine, the orthopods are definitely in trouble. But I think they are going to have to cure obesity first. All the prolotherapy in the world isn't going to stop those fat joints from wearing out under all that weight. Between that and trauma (never going away), we should be in business for the foreseeable future.

Thank you for helping me understand. Best response to any post I have posted

 

[darksurg]

Since when PA perform surgery?

 

[adamrose]

Since when PA perform surgery?

Not sure what you mean, didn't mention that