DO vs. PA: Is DO worth it?

[theITcrowd]

So here's what I'm wondering...

It's no secret that DO school traditionally send a large number of applicants to primary care. It's also no secret that PA programs are geared toward filling the rather gaping primary care needs in the US. If that's the case, what are the advantages of going to DO school rather than PA school? I'd be especially interested in hearing from current DO applicants, DO students, and faculty at DO schools (what's up, @Goro ). I realize that a DO can apply to any medical residency he or she chooses, but it seems that most still end up in IM and FM, and I personally am aiming for a surgical specialty or at least something outside the bounds of primary care.

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[Chibucks15]

Well if you want surgery then don't do PA? Seems pretty well set in stone for you.

DO = possible chance (probably will match) in surgery
PA = listening to orders and always being under someone.

Do you have any specific questions because you're comparing entirely different careers and different people have different reasons for going into each

 

[potential_fut_doc]

Not sure about listening to orders since many of the PAs I know work pretty much independently but person above me is correct in saying that youll always be under someone. Not necessarily a bad thing but you have more independence as a DO.

 

[Chibucks15]

Not sure about listening to orders since many of the PAs I know work pretty much independently but person above me is correct in saying that youll always be under someone. Not necessarily a bad thing but you have more independence as a DO.

It all depends on the situation. They don't have independent practice rights in every state yet, ergo still have to listen to orders. Some docs are just more strict than others in terms of oversight

 

[theKingLT]

Socks and shoes both do the same general thing, but are very different. You can't wear socks without shoes (unless you want lots of holes), but you can wear shoes without socks. Nevertheless for many types of shoes, socks may make your life more comfortable. Make sense?

As far as specific responsibilities go shadow a bit of each and see for yourself

 

[Chibucks15]

Socks and shoes both do the same general thing, but are very different. You can't wear socks without shoes (unless you want lots of holes), but you can wear shoes without socks. Nevertheless for many types of shoes, socks may make your life more comfortable. Make sense?

As far as specific responsibilities go shadow a bit of each and see for yourself

that's honestly one of the best metaphors for this I've ever seen haha

 

[theITcrowd]

Socks and shoes both do the same general thing, but are very different. You can't wear socks without shoes (unless you want lots of holes), but you can wear shoes without socks. Nevertheless for many types of shoes, socks may make your life more comfortable. Make sense?

As far as specific responsibilities go shadow a bit of each and see for yourself

Thanks for the input. I’ve been fortunate enough to shadow both which is how I’ve realized how similar a PA is to a primary care doc.

 

[theITcrowd]

Well if you want surgery then don't do PA? Seems pretty well set in stone for you.

DO = possible chance (probably will match) in surgery
PA = listening to orders and always being under someone.

Do you have any specific questions because you're comparing entirely different careers and different people have different reasons for going into each

It probably helps if I share my thought process more. I’m planning to apply to med school when I’m about 31 so I’ll hopefully matriculate at 32. Based on the timeline my wife and I made for starting a family, I’m planning on making only one attempt at applying—essentially putting everything I have into the initial cycle. If I come up empty, it’ll be hard to justify going through it all again and pushing back our plans for children even further (I get this isn’t the way everyone looks at it, but it’s ours). So my “back-up” is PA, because then I’ll at least still be able to be a provider.

 

[Chibucks15]

Thanks for the input. I’ve been fortunate enough to shadow both which is how I’ve realized how similar a PA is to a primary care doc.

There are PAs in many specialties also, they just aren't as common. So it really is whether you wanna go all out or not. You'll never be fully autonomous as a PA, but you'll be much much less in debt and can get through the process faster

 

[Nurse2MD2018]

Thanks for the input. I’ve been fortunate enough to shadow both which is how I’ve realized how similar a PA is to a primary care doc.

You need to broaden your shadowing experience to include more specialities to see the difference between these fields. In my hospital system my surg PAs essentially serve as specialized residents(they do intakes, put in orders, respond to consults, assist in the OR) and because they don’t rotate to other teams tend to know more about the coordination of care for their pts than the residents. While the physicians both MDs/DOs operate, oversee the residents/mid-levels, coordinate care, etc.

 

[JSReed]

Is it that different to apply to both? Honestly this discussion is moot if you only get one or the other. And have friends who applied to both.

 

[Goro]

So here's what I'm wondering...

It's no secret that DO school traditionally send a large number of applicants to primary care. It's also no secret that PA programs are geared toward filling the rather gaping primary care needs in the US. If that's the case, what are the advantages of going to DO school rather than PA school? I'd be especially interested in hearing from current DO applicants, DO students, and faculty at DO schools (what's up, @Goro ). I realize that a DO can apply to any medical residency he or she chooses, but it seems that most still end up in IM and FM, and I personally am aiming for a surgical specialty or at least something outside the bounds of primary care.

Pro DO:
You get to be a doctor
You're the QB, not a tackle
Greater intellectual challenges/problem solving
Avg salary will be at least 2x to that of a PA

Pro PA:
Less schooling and debt
No residency
Less responsibility
Only one licensing exam, I believe, although certification might also be required
Avg salary is $104K

To be realistic, the odds of you being in Primary Care as a DO are about 50%. Surgical subspecialties are quite unlikely

 

[theITcrowd]

To be realistic, the odds of you being in Primary Care as a DO are about 50%. Surgical subspecialties are quite unlikely

Thanks Goro. That's definitely the concern I have. Not that I'm 100% sure I don't want to be in primary care or some other non-surgical specialty, but I'd like my options to be open.

You need to broaden your shadowing experience to include more specialities to see the difference between these fields. In my hospital system my surg PAs essentially serve as specialized residents(they do intakes, put in orders, respond to consults, assist in the OR) and because they don’t rotate to other teams tend to know more about the coordination of care for their pts than the residents. While the physicians both MDs/DOs operate, oversee the residents/mid-levels, coordinate care, etc.

I've spoken to two PAs about what they can do in surgery (the one I shadow and another who's a friend) and both are of the opinion that surgical PAs pretty much end up becoming eternally resident-level providers, kind of like what you're saying I think. Knowing myself, I'd probably get bored of that. I'm trying to find a surgical PA to shadow but they're unfortunately not super plentiful in my area.

 

[allantois]

If you want surgery, go MD

 

[JSReed]

I've spoken to two PAs about what they can do in surgery (the one I shadow and another who's a friend) and both are of the opinion that surgical PAs pretty much end up becoming eternally resident-level providers, kind of like what you're saying I think. Knowing myself, I'd probably get bored of that. I'm trying to find a surgical PA to shadow but they're unfortunately not super plentiful in my area.

You sure about that? Idk, kind of seems like you get to do all the patient care without all the bureaucracy, red tape, and paperwork. There could definitely be worse things. To each their own...

 

[Chibucks15]

You sure about that? Idk, kind of seems like you get to do all the patient care without all the bureaucracy, red tape, and paperwork. There could definitely be worse things. To each their own...

Eh you still get all that with PA. That’s healthcare. You don’t just get to walk around, treat patients, and have no record of it. It’s not as much BS, but it’s still there

Edit: plus being a resident forever sounds horrendous. Yeah you have better hours but still. Personally I’d be annoyed when a brand new doc comes in and is already higher on the food chain than me, hence why I went DO. To each their own still though

 

[JSReed]

Eh you still get all that with PA. That’s healthcare. You don’t just get to walk around, treat patients, and have no record of it. It’s not as much BS, but it’s still there

Edit: plus being a resident forever sounds horrendous. Yeah you have better hours but still. Personally I’d be annoyed when a brand new doc comes in and is already higher on the food chain than me, hence why I went DO. To each their own still though

Hah of course. Can you imagine?? How would insurance companies get paid??

 

[theITcrowd]

Personally I’d be annoyed when a brand new doc comes in and is already higher on the food chain than me, hence why I went DO.

Yeah, that would drive me insane. Good point.

 

[BC_89]

Think long-term:

If you didn’t make the cut for any specialty surgery, would you still like to be a physician in your early 40’s knowing you could’ve been a PA?

OR

Would you be happy as a 50 year old PA working under a young first year attending?

Autonomy and ceiling cap would also be major factors to consider along with hours and when to start a family.

 

[stickgirl390]

Have you considered Podiatry? You could get a fair amount of surgical exposure that route.

 

[Moose A Moose]

Socks and shoes both do the same general thing, but are very different. You can't wear socks without shoes (unless you want lots of holes), but you can wear shoes without socks. Nevertheless for many types of shoes, socks may make your life more comfortable. Make sense?

As far as specific responsibilities go shadow a bit of each and see for yourself

 

[theITcrowd]

Have you considered Podiatry? You could get a fair amount of surgical exposure that route.

I considered podiatry for a hot minute in college but decided against it for the same reason I don't want to be a dentist: I want to study the entire body, not just a certain part of it. I get that specialty training can be very specific but at least during med school I'd like to learn about the body from top to bottom.

 

[BC_89]

I considered podiatry for a hot minute in college but decided against it for the same reason I don't want to be a dentist: I want to study the entire body, not just a certain part of it. I get that specialty training can be very specific but at least during med school I'd like to learn about the body from top to bottom.

I can’t speak of my own experience (not a med student), but the concept of specializing is the same throughout any subject:

Until you go to med school, your mind will constantly change as to what you wish to specialize in. That’s just due to exposure and the learning curve.

That being said, once your an attending you have one title (FM, IM, primary care, so on so forth). As a PA, you can cross train if your willing and interested.

Sounds like you made up your mind for med school. Yet your only interested in giving it one shot and be done....if it’s a family concern I’ll say this: I brought my newborn to physics class a few times in undergrad...No regrets (wife and I both students at the time).

 

[de Ribas]

I considered podiatry for a hot minute in college but decided against it for the same reason I don't want to be a dentist: I want to study the entire body, not just a certain part of it. I get that specialty training can be very specific but at least during med school I'd like to learn about the body from top to bottom.

DPMs cover the same material as other medical students. At my school, 2 years are pretty much the same. First year we are in the same classes working together. We are in the same Gross anatomy lab working with DOs at the same cadaver table for the whole year. We are in the same Clinical Med courses and labs doing same procedures over the whole body and are tested in Sim Labs Exams over the whole body. We cover all sciences that DOs do and attend the same case studies sessions, advanced dissections, and grand rounds. We rotate through most of the same specialties in our last 2 years. Most DPM schools are associated with DO schools and 2 are with MD schools.

Since podiatry is lower limb specialty, does not mean we dont learn the whole body in med school.

 

[pericardium]

Current 3rd year DO student, I actually applied to (and was rejected) from PA school prior to my application to DO school. Now that I'm here, I can confidently say that I made the right choice. I say this because at some point as a PA, you might run into a physician/surgeon, who might be younger, who you might perceive to be less intelligent, and less capable than you, when you were in the "pre-med/pre-PA" phase. At that point, you will think to yourself, "I could've done that, I was more capable than them".

If the thought "I could have done that" comes to mind and makes you uncomfortable, go to MD/DO school. If you are comfortable with it, then go to PA school. Now that I'm here, I can say that I would not have been comfortable thinking "I could have done that" if I was PA.

 

[NontradICUdoc]

It probably helps if I share my thought process more. I’m planning to apply to med school when I’m about 31 so I’ll hopefully matriculate at 32. Based on the timeline my wife and I made for starting a family, I’m planning on making only one attempt at applying—essentially putting everything I have into the initial cycle. If I come up empty, it’ll be hard to justify going through it all again and pushing back our plans for children even further (I get this isn’t the way everyone looks at it, but it’s ours). So my “back-up” is PA, because then I’ll at least still be able to be a provider.

Be very careful using PA as a “back up“. Because if you do go the PA route, because you did not get into medical school and this is not exactly what you wanted to do, you will always have regret and that may impact your career for years to come. It is very doable to have children in medical school, hard but doable.

 

[theITcrowd]

Be very careful using PA as a “back up“. Because if you do go the PA route, because you did not get into medical school and this is not exactly what you wanted to do, you will always have regret and that may impact your career for years to come. It is very doable to have children in medical school, hard but doable.

Thanks to EMT2ER-DOC and others for the frank answers and insights.
I’m pretty certain now that I won’t go the PA route unless I end up actually wanting to do it rather than feeling like I need to. As for the family stuff...in the end, while I would be willing to start a family during school I feel the decision is largely my wife’s, since she has to actually carry the kiddo and spend a good deal of time taking care of him/her while I’m slogging through school, studying, training, etc. But I think that’s just something we need to work out on our own.
Also, we have a very cute dog, so at least I have a fur child.

 

[GypsyHummus]

split the difference. Do dentistry or optometry. only 4 years with "doctor" autonomy.

 

[Robin-jay]

I considered podiatry for a hot minute in college but decided against it for the same reason I don't want to be a dentist: I want to study the entire body, not just a certain part of it. I get that specialty training can be very specific but at least during med school I'd like to learn about the body from top to bottom.

Don't worry, as a DPM you would get to experience the same medical school curriculum as an MD/DO.

The "amazing, fun-filled, exciting" experience of gross anatomy for everyone!

 

[PAfuture]

So here's what I'm wondering...

It's no secret that DO school traditionally send a large number of applicants to primary care. It's also no secret that PA programs are geared toward filling the rather gaping primary care needs in the US. If that's the case, what are the advantages of going to DO school rather than PA school? I'd be especially interested in hearing from current DO applicants, DO students, and faculty at DO schools (what's up, @Goro ). I realize that a DO can apply to any medical residency he or she chooses, but it seems that most still end up in IM and FM, and I personally am aiming for a surgical specialty or at least something outside the bounds of primary care.

I am facing this same struggle although I was accepted into a DO program this year! I am flattered to have been accepted but I want to work in Radiology and I am nervous about earning high enough STEP scores.
My other apprehensions:
Giving up vacation time
No weekends no call no holidays
My good salary

I applied last year and did not get my acceptance so after a lot of reluctance I applied again this year. I will be 29 years old when I start, radiology is 9 years long.

I love my job as a PA, I have next to no stress at work and I actually look forward waking up to work after 2 years still! What I don’t like is my second job in clinic at an urgent care, this makes me nervous about pursuing medicine further let alone DO school due to most DOs going into primary care.
I am a little nervous about the influx of PAs still coming into the workforce but the job outlook is still fantastic.
If I turn against DO I definitely plan on pursuing a healthcare administration masters in hopes of broadening my scope of employement opportunities away from clinic.

I am not excited about the work to become a physician not just in med school but in lecture during residency, doing research in residency, accepting call, becoming in debt again. But there is part of me that feels like I will always regret it if I walk away.

Has anyone else had a similar experience?

 

[theITcrowd]

I am a little nervous about the influx of PAs still coming into the workforce but the job outlook is still fantastic.

I appreciate the input! I’m wondering, why do you think the influx of PAs is an issue? Isn’t the idea that PAs can improve access to care in underserved areas, not to mention decrease the primary care shortage in general?

 

[NicMouse64]

I appreciate the input! I’m wondering, why do you think the influx of PAs is an issue? Isn’t the idea that PAs can improve access to care in underserved areas, not to mention decrease the primary care shortage in general?

The problem is exactly that. They don't.

 

[precisiongraphic]

I appreciate the input! I’m wondering, why do you think the influx of PAs is an issue? Isn’t the idea that PAs can improve access to care in underserved areas, not to mention decrease the primary care shortage in general?

There is projected growth and need for Physicians MD/DO and physician replacers. However whether it's NP, PA, DO, MD or CRNA the trouble is getting people who want to work primary care and/or in underserved areas. That is the hard part. Economic laws don't change and many people don't want to work for less money or in a rural area or in a low-income clinic no matter what their degree/education they have. There can be a surplus of providers in areas high in demand and still a shortage in others.

 

[NicMouse64]

There is projected growth and need for Physicians MD/DO and physician replacers. However whether it's NP, PA, DO, MD or CRNA the trouble is getting people who want to work primary care and/or in underserved areas. That is the hard part. Economic laws don't change and many people don't want to work for less money or in a rural area or in a low-income clinic no matter what their degree/education they have. There can be a surplus of providers in areas high in demand and still a shortage in others.

Freudian slip???? lol

 

[precisiongraphic]

Freudian slip???? lol

No not a slip. NPs and CRNAs and PAs serve to replace a doctor. Some people think replacer is a perjorative. You could say “alternative “ or something but these providers substitute for physicans in some cases.

 

[NicMouse64]

No not a slip. NPs and CRNAs and PAs serve to replace a doctor. Some people think replacer is a perjorative. You could say “alternative “ or something but these providers substitute for physicans in some cases.

Poorly trained substitutes, but sure.

 

[Black Coffee 24/7]

DO physician is a real physician.

A PA is a third or fourth yr medical student for life.

Yes, I say that as a soon to be fourth yr medical student. That's the truth. A physician salary is almost at least twice that of a PA through all specialties.

 

[PTPuser]

What's your goal for yourself? Where do you see yourself? What do you expect to accomplish? How do you feel about having the bucks stops with you? Which role do you see yourself on the team? Do you want to make big decisions or do you want to make them to an extent but like the back-up when needed?

Putting all the, "Do pushes for PCP specialties etc" aside and just think about what YOU want. What kind of career do you pray for? Yes, certain field are harder to obtain as a DO but that doesn't mean you're out of the running automatically cause you're a DO.

You're jumping into worry about specialties etc when you're not sure what position on the team you want to play on. Until you know to the best of your ability what position you want to be in, then it makes no sense to decide between MD / DO or PA etc. My best friend will be 45 YO finishing general surgery.

 

[theITcrowd]

DO physician is a real physician.

A PA is a third or fourth yr medical student for life.

Yes, I say that as a soon to be fourth yr medical student. That's the truth. A physician salary is almost at least twice that of a PA through all specialties.

I’ve heard they’re more like eternal interns/residents

 

[Black Coffee 24/7]

I’ve heard they’re more like eternal interns/residents

That's what the PAs tell you. But, late third year and fourth year medical students can def do everything that they do if those students spend a few months of initial training with their preceptors.

 

[borntowin]

That's what the PAs tell you. But, late third year and fourth year medical students can def do everything that they do if those students spend a few months of initial training with their preceptors.

This is so ignorant. Third and fourth year medical school students don't order labs, imaging, and prescribe medications! They also don't sign notes as a provider!

 

[Black Coffee 24/7]

This is so ignorant. Third and fourth year medical school students don't order labs, imaging, and prescribe medications! They also don't sign notes as a provider!

I did under the authority of my doc. PAs don't know anything more than a senior 4th yr medical student. That's where the knowledge difference ends. Sorry for hurting your ego.​

 

[HaveAnOsteoblast]

A PA is a third or fourth yr medical student for life.

You probably shouldn't talk **** about your future colleagues. PAs are healthcare professionals, not "students for life."

PAs don't know anything more than a senior 4th yr medical student. That's where the knowledge difference ends. Sorry for hurting your ego.

You think that a PA with 10+ years of experience working as a healthcare provider, working directly with patients and physicians, hasn't gained any clinical knowledge that a fourth-yr med student doesn't possess? You're not hurting anybody's ego. You're insulting people's intelligence with your inflammatory garbage posts.

 

[Black Coffee 24/7]

You think that a PA with 10+ years of experience working as a healthcare provider, working directly with patients and physicians, hasn't gained any clinical knowledge that a fourth-yr med student doesn't possess? You're not hurting anybody's ego. You're insulting people's intelligence with your inflammatory garbage posts.

Yes, I believe that especially for a sincerely hardworking 4th yr medial student who has spent at least 1 month on that service. There's minimal or no knowledge gap between the two people.

That's my honest opinion after working with a lot of PAs.

 

[borntowin]

I did under the authority of my doc. PAs don't know anything more than a senior 4th yr medical student. That's where the knowledge difference ends. Sorry for hurting your ego.​

You're not hurting my ego. I'm going to be a doctor just like you. You are speaking completely ignorantly because you did not sign orders for those patients as their provider like a PA would because that would be AGAINST THE LAW. Also, a PAs knowledge base does not end the minute they graduate school. Some PAs chose to do a residency or work in the same field for 30+ years. They acquire knowledge over their career. Don't you think this also happens as a physician? You don't think that a doctor who has worked in their field for 30+ years is different then someone right out of residency? I don't really care for your responses.

 

[Black Coffee 24/7]

You're not hurting my ego. I'm going to be a doctor just like you. You are speaking completely ignorantly because you did not sign orders for those patients as their provider like a PA would because that would be AGAINST THE LAW. Also, a PAs knowledge base does not end the minute they graduate school. Some PAs chose to do a residency or work in the same field for 30+ years. They acquire knowledge over their career. Don't you think this also happens as a physician? You don't think that a doctor who has worked in their field for 30+ years is different then someone right out of residency? I don't really care for your responses.

Good. Maybe you will know what I'm talking about in 3 years. Everyone with some medical experience before medical school thinks they're hot stuff until they realize that they're doing a lot of things wrong with the wrong mindset for x amount of years.

The good PAs and good docs strive to accumulate knowledge throughout their careers. However, 90% of the docs and PAs stop caring and learning after 3 years of practice. Medical knowledge doesn't end after school. I never said that. But, the plateau of medical knowledge among PAs is unimpressive.

 

[NicMouse64]

You're not hurting my ego. I'm going to be a doctor just like you. You are speaking completely ignorantly because you did not sign orders for those patients as their provider like a PA would because that would be AGAINST THE LAW. Also, a PAs knowledge base does not end the minute they graduate school. Some PAs chose to do a residency or work in the same field for 30+ years. They acquire knowledge over their career. Don't you think this also happens as a physician? You don't think that a doctor who has worked in their field for 30+ years is different then someone right out of residency? I don't really care for your responses.

Sorry, borntowin, PA-C. They aren't equivalent no matter how much legislation you push out saying otherwise. MD/DO applicants are the best applicants as far as academic and humanistic accomplishments overall. They learn more in school and train longer and under a more intense model through 3rd year-end of residency. PAs are great and have a role but not as a leader on a healthcare team. That is reserved for physicians, sorry. I worked with many great older PAs and a family member of mine knew one of the founders of the profession. The role (and intent) of a PA was always that of a practitioner in a physician-led healthcare team.

 

[borntowin]

Yes, I believe that especially for a sincerely hardworking 4th yr medial student who has spent at least 1 month on that service. There's minimal or no knowledge gap between the two people.

That's my honest opinion after working with a lot of PAs.

Sorry, borntowin, PA-C. They aren't equivalent no matter how much legislation you push out saying otherwise. MD/DO applicants are the best applicants as far as academic and humanistic accomplishments overall. They learn more in school and train longer and under a more intense model through 3rd year-end of residency. PAs are great and have a role but not as a leader on a healthcare team. That is reserved for physicians, sorry. I worked with many great older PAs and a family member of mine knew one of the founders of the profession. The role (and intent) of a PA was always that of a practitioner in a physician-led healthcare team.

I never said they were equivalent. As I stated I'm going to be a doctor. My argument was he was not working the same way as a PA would in his rotations because he cannot sign orders for labs and imaging and did not prescribe medications. I disagree that a PA is not a leader of healthcare teams. I personally know of PAs that work completely alone with their supervising physicians literally across the country. People may not agree with that, but it's the reality of rural communities. I also met a nurse practitioner at a conference last year who worked completely solo in an emergency department in rural Texas.

 

[Black Coffee 24/7]

I never said they were equivalent. As I stated I'm going to be a doctor. My argument was he was not working the same way as a PA would in his rotations because he cannot sign orders for labs and imaging and did not prescribe medications. I disagree that a PA is not a leader of healthcare teams. I personally know of PAs that work completely alone with their supervising physicians literally across the country. People may not agree with that, but it's the reality of rural communities. I also met a nurse practitioner at a conference last year who worked completely solo in an emergency department in rural Texas.

Just bc they're unsupervised doesn't mean that they're practicing properly safe medicine.

I don't feel arguing about this point any longer. But, if you do in fact go to a DO / MD medical school, you will see my point upon reflection in 3 or 4 years.

 

[NicMouse64]

I never said they were equivalent. As I stated I'm going to be a doctor. My argument was he was not working the same way as a PA would in his rotations because he cannot sign orders for labs and imaging and did not prescribe medications. I disagree that a PA is not a leader of healthcare teams. I personally know of PAs that work completely alone with their supervising physicians literally across the country. People may not agree with that, but it's the reality of rural communities. I also met a nurse practitioner at a conference last year who worked completely solo in an emergency department in rural Texas.

Did they do a RCT to make sure their outcomes weren't worse than that of a physician? No. They haven't. This is a dangerous precedent and just because it happens doesn't make it good for patients. Like I already said, they belong on physician led teams. Even if they aren't, that's where they belong. It's not a jab, they are completely necessary with our current healthcare state of affairs. If you want to be in charge of the patient medically go to medical school. Otherwise accept the place of being on a physician led team and not being the leader.