DO vs. PA

[stephenm]

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I am sure this question has been discussed in great length on here. But I am constantly going back and forth about pursuing DO or PA school. I am at a point in my schooling where I need to make a decision to determine which courses I take next. I would love to here from medical students who can give sound advice from the "inside," so to speak. I am married with two young children and want to make the best decision for my future and theirs. Thanks.

 

[DbDan]

ummm do whats best for you? Do you want to be a doctor or an assistant. Thats the choice, they are two very different life paths, commitments and earning potentials.

 

[GoodmanBrown]

I am sure this question has been discussed in great length on here. But I am constantly going back and forth about pursuing DO or PA school. I am at a point in my schooling where I need to make a decision to determine which courses I take next. I would love to here from medical students who can give sound advice from the "inside," so to speak. I am married with two young children and want to make the best decision for my future and theirs. Thanks.

That's a very tough call. If I were in your shoes, I'd go PA. I am married, but with no kids. I find it is hard to make enough time for my wife, myself, and our dog. I can categorically say that it will be impossible to attend medical school without asking significant sacrifices of your family.

We have one student who is 38 and has two young children. They are 2 and 5. Though she lives in the same house in the same city, she routinely goes a day or two a time without seeing her children awake. Before tests, she goes about 3 days without seeing them. I'm not saying this is absolutely necessary, but yeah, it happens routinely for her.

I couldn't be that kind of father, and I'd rather fail out of medical school than not see my wife and (imaginary) kids for 2-3 days at a time. But we're talking spending 1-2 hours/day with your husband/wife & kids instead of whatever time you spend now. Just my 2 cents.

 

[Limvostov]

These are very different options, but you need a 4 year degree to do either so why not start there. PA school is faster and less expensive, but you'll be a physician's assistant and have more limitations. DO school is longer just like MD school and you'll need to complete a residency, but you'll be a physician and have a full scope of practice in whatever area you end up choosing. You need to choose what's right for you and your family, but since both have similar degree and course prerequisites getting those done first and shadowing people in each field would be a great start.

 

[GoodmanBrown]

ummm do whats best for you? Do you want to be a doctor or an assistant. Thats the choice, they are two very different life paths, commitments and earning potentials.

Give me a break, man. This response reeks of very little exposure to PAs. PAs are assistants largely in name. In many settings they have as much autonomy as they are interested in. In an FM practice, the PA and the doc are working most of the same patients. The doc maybe has gets a few more interesting cases, but for the most part, the census is identical.

In surgery, yeah, a PAs going to be doing more assisting, but even then, they're probably opening and closing a decent number of routine surgeries.

Commitments, I'll give you, school-wise. MD/DO school is longer and residency is pretty brutal as well. PAs have a rough 2 years, but are out after that in the real world. In the real world, expect call and overtime as a PA.

Earning potential is a maybe. In FM, your doc and your PA probably aren't making vastly different sums. In surgery (especially sub-specialties), yeah, you're earning pretty different salaries. But even there, PAs make out pretty well and probably earn more than an FM doc does.

 

[Limvostov]

That's a very tough call. If I were in your shoes, I'd go PA. I am married, but with no kids. I find it is hard to make enough time for my wife, myself, and our dog. I can categorically say that it will be impossible to attend medical school without asking significant sacrifices of your family.

We have one student who is 38 and has two young children. They are 2 and 5. Though she lives in the same house in the same city, she routinely goes a day or two a time without seeing her children awake. Before tests, she goes about 3 days without seeing them. I'm not saying this is absolutely necessary, but yeah, it happens routinely for her.

I couldn't be that kind of father, and I'd rather fail out of medical school than not see my wife and (imaginary) kids for 2-3 days at a time. But we're talking spending 1-2 hours/day with your husband/wife & kids instead of whatever time you spend now. Just my 2 cents.

Agreed. I am also married with a dog and I have so little time for them now its the hardest thing. There are some stretches of days that I actually have none left at all. Med school is an insane sacrifice for the spouse. While you're off learning for 14+ hours doing volunteering, student government, clubs, ect. they're at home. Busy days are long, but longs days alone are longer especially if you end up relocating and know no one, like what we did. It takes a special someone to stay strong during that.

 

[wolverinepwns]

this question means you have not done your research on either! find out what a DO does and what a PA does. You are asking Should I be a doctor or a Doctors assistant!

 

[Limvostov]

this question means you have not done your research on either! find out what a DO does and what a PA does. You are asking Should I be a doctor or a Doctors assistant!

Don't know I would say it like that. PA's can (in some states) have their own patients, and have a more limited scope of practice much like NP's. Some work under a physician and do the more routine checkups, others assist in surgeries and such things, but I guess what I am saying is PA's are quite capable individuals and I know many that chose that path instead of med school (and they had better stats than myself). Just because you choose to do one career over another does not make you less of a person. Make sure to always treat your coworkers with respect and I hope you never say something to the effect of "you're just a PA". PA is a perfectly respectable profession and nothing to ever be put down. They work hard and put up with a tremendous amount of crap.

 

[DbDan]

Give me a break, man. This response reeks of very little exposure to PAs. PAs are assistants largely in name. In many settings they have as much autonomy as they are interested in. In an FM practice, the PA and the doc are working most of the same patients. The doc maybe has gets a few more interesting cases, but for the most part, the census is identical.

In surgery, yeah, a PAs going to be doing more assisting, but even then, they're probably opening and closing a decent number of routine surgeries.

Commitments, I'll give you, school-wise. MD/DO school is longer and residency is pretty brutal as well. PAs have a rough 2 years, but are out after that in the real world. In the real world, expect call and overtime as a PA.

Earning potential is a maybe. In FM, your doc and your PA probably aren't making vastly different sums. In surgery (especially sub-specialties), yeah, you're earning pretty different salaries. But even there, PAs make out pretty well and probably earn more than an FM doc does.

Assistant should have been preceded by physician, bad phrasing on my part. I'm tired and about to go to sleep.

I was just saying that only he can make the choice based on his family and thats what it really comes down to in his situation. Med school is a VERY long and time consuming commitment. PA school is 2 years vs. the 4 in a DO program plus residency.

Financially they are also very different. CoA is obviously going to be different for a 2 year program vs. a 4 year, plus PAs get to go out and make money after 2 years while DOs will be in residency for a period of time after. Earning potential is just that though, potential. With a DO degree you have the potential to make much much larger sums of money in certain specialties. A successful FP doc should make more money than a PA and yes I know that PAs have begun getting a much larger scope and autonomy in practice.

So let me rephrase/reiterate my original point to the OP. Do what is best for you. In the situation with a family it is a choice that only you are going to be able to make. By posting on a DO forum, you are going to get ALOT of DO biased answers. Similarly you are going to get alot of PA biased answers posting on a PA forum.

Do some research and see if the time and monetary commitment of a DO program are right for you. See if you would be happy practicing as a PA vs. a DO. We can pro/con DO vs PA indefinitely for you but its going to be biased here. In the end speak with your wife and decide between the two of you what is best for you and your family. In your situation it very well may be PA school

 

[DbDan]

this question means you have not done your research on either! find out what a DO does and what a PA does. You are asking Should I be a doctor or a Doctors assistant!

Gotta be careful with that. I wrote it in haste and fatigue but a PA isn't a doctor's assistant for the most part. Medical Assistant is more to that side of things and even that is a respectable profession. Like Limvostov, I have a couple of friends going to PA school that did better than I did in school. One friend even has a 3.8 and a 40T who decided he didn't want to spend the 4 years in med school and wanted to start a family sooner (27 already) so he's going the PA route.

I've heard that there are docs now that open a couple of practices and staff them with NPs and PAs having them see patients just as the doc would. They then bounce between the two to check charts. PA and NP are growing professions currently and their scope of practice is expanding for better or worse.

I think the OP may have done a disservice to his post by titling it the way he did. After re-reading it sounds more like a "Med school with a family" question than purely a DO vs. PA question. On that side of things, its more of a commitment issue and how they would be happy than an issue over the practice of the profession.

 

[wolverinepwns]

Don't know I would say it like that. PA's can (in some states) have their own patients, and have a more limited scope of practice much like NP's. Some work under a physician and do the more routine checkups, others assist in surgeries and such things, but I guess what I am saying is PA's are quite capable individuals and I know many that chose that path instead of med school (and they had better stats than myself). Just because you choose to do one career over another does not make you less of a person. Make sure to always treat your coworkers with respect and I hope you never say something to the effect of "you're just a PA". PA is a perfectly respectable profession and nothing to ever be put down. They work hard and put up with a tremendous amount of crap.

Definately not saying "you're just a PA". Personally I work with PA in the ER that are far superior diagnosticians than a lot of doctors, So but no means am I implying that! Although I generalized the term PA, what I got out of the question for this thread was like should I buy this car versus that car, I just wanted to make sure the OP knows that they are two different entities with different Lifestyles and commitments.

 

[Limvostov]

Definately not saying "you're just a PA". Personally I work with PA in the ER that are far superior diagnosticians than a lot of doctors, So but no means am I implying that! Although I generalized the term PA, what I got out of the question for this thread was like should I buy this car versus that car, I just wanted to make sure the OP knows that they are two different entities with different Lifestyles and commitments.

👍

 

[CALLR001]

I disagree that you will have to sacrifice significant time with your family while attending med school. I have been married for four years and have a child and find plenty of time to spend with them. I commute an hour both ways and still feel like I have plenty of time to dedicate to my family. While in undergrad I worked and went to school full time and I actually feel like I have significantly more time with my family now, than I did then. However, PA school is definitely not a bad idea. I seriously considered it, but was worried about being an "assistant" for my entire career. If you truly feel like you can be happy as a PA and don't have an ego issue, it can be a great career. Good luck.

 

[PharmBound2011]

PA and DO have different roles, it's quite important to note that. Although, as Goodman Brown said, they're hardly a "Doctor's Assistant."

My PCP is a PA and sometimes I feel she is more competent then my previous doctor. PAs have some limitations, but they're quite competent and I wouldn't go as far to say that they're assisting anyone. Btw, PAs have prescriptive authority and have their own patients in all 50 states.

To the OP, the truth is that it will be equally as time consuming to be in MD/DO/PA school. From what I hear, some people who went to both PA and MD school even say that in PA school you are required to process more information in a shorter time, while in MD school you learn more complex information and are able to spread it out to learn more details. Although PA school will only be 2-3 years, while as an MD/DO, your guaranteed a minimum 7 year plan before you'll have time for family and such. I think that is the biggest deciding factor for most people.

As a PA, just be sure you will be okay with knowing that sometimes in your care, you won't be able to have the "last word" with your patients and that there may be some cases where you will have to consult with your collaborating physician to properly diagnose your patient.

Also, commitments and lifestyle are definitely different

 

[stephenm]

Thank you all for your input. I should have clarified. I am a post-bac student (have my BS in business), so my bachelors is already under my belt. I understand that a PA and a doc are two different professions. What I am trying to do is weigh out all the pros and cons of each and make my decision based on that. While I ultimimately want to be a doc, no amount of money in the world will be worth it if I end up missing my kids' pre-teen years. If that is what will end up happeneing, than being a doc is not right for me.

Making the decision is proving to be difficult. From one of you I read that a married classmate will go a few days without seeing her kids. Then I hear people say that being a PA can be difficult because you're practically doing all that your doc is but getting payed significantly less.

I have two married friends with kids in DO school (one at LECOM Bradenton and one at Des Moines University). I will talk to them and get their input.

I know that both are huge sacrifices. I am completely willing to put in the time and effort in studying and learning. But as I mentioned, if it's going to come at the expense of missing all my daughter's dance recitals and my son's t-ball games, no amount of money can buy those years back.

I think what I'm hoping to hear is that I can still be a med-student and have a family as well. I know they will be asleep when I come home many nights and that I will be gone a lot, but at the present moment, being self-employed and in school, I'm already very busy as it is.

 

[koennen]

Personally I work with PA in the ER that are far superior diagnosticians than a lot of doctors,

Please let me know the name of the hospital where you work. I want to make sure I am never taken there. 🙄

 

[Rollo]

So your main differentiating factor that will separate DO from PA school is lifestyle issues.

There are some residencies where you will have a good lifestyle (such as FM, EM, Psych, Rads, Anesthesiology, Derm, ENT, Urology) and you won't have to sacrifice much family life.

I recommend you figure out your top 5 specialty choice now. In doing this, you will see if you are looking at lifestyle-favored specialty or not.

I'd also recommend posting this question in PA forum that's about half a page down from here.

 

[pianoman511]

What you may also want to consider is that while PA school may take less time, in the long run it may impact your lifestyle more than medical school. Many times, the PA takes call and/or rounds more frequently than the physician and actually has to do more of the "scutwork". I agree with a majority of the posters who advise evaluating what you may want to do first, but realize that the educational process may affect your decision (i.e. you may find out after doing a rotation in surgery that you really like that and if you consider PA school the scope is very limited).

For me, personally, I had considered both options extensively before deciding on DO school. A PA that I worked with (in a primary care practice) told me that if she could do it all over again, she would have gone to medical school because she felt that she did just as much work if not more than the doctors did. Another thing I realized is that I wanted autonomy and while there is a great deal of autonomy (like it or not) for midlevels which is growing daily, it will never be the same as being a doctor. As much as lifestyle may affect your decision, you have to be content with your role in the health care team. Once I started med school, there were at least 3 PAs in my class who were going back to get their DO degree because of that very reason (and as a sidebar my school just started a PA -> DO program - LECOM-Erie).

Good luck !

 

[TOLDUSO]

I disagree that you will have to sacrifice significant time with your family while attending med school. I have been married for four years and have a child and find plenty of time to spend with them. I commute an hour both ways and still feel like I have plenty of time to dedicate to my family. While in undergrad I worked and went to school full time and I actually feel like I have significantly more time with my family now, than I did then. However, PA school is definitely not a bad idea. I seriously considered it, but was worried about being an "assistant" for my entire career. If you truly feel like you can be happy as a PA and don't have an ego issue, it can be a great career. Good luck.

I completely understand your view on being an "assistant." While I am sure that in certain settings a PA can act near independently, that's not to say that you will be granted an opportunity like that. Coming from a stint in the military, I am more than aware of how it feels to be a pawn. I was married and had a child, and was of legal age to drink when I first went in, but was still treated as an 18 year old punk like the majority of people around me.

It was a slap in the face nearly every day. I can remember one time it got to me enough (when they were basically being counselors to junior enlisted people, asking them to talk about our home situation and feelings and yada yada) that I simply didn't fill out the questionnaire they passed out. When confronted, I ended up telling my department head that I had more children than he had pubic hair and that I wasn't going to fill out a damned thing that wasn't pertaining to anything of their business. It didn't go over so well, but I got my point across and never had to participate in those things again.

I guess it is important to state that everyone has to work their way up the pipes but, at this point in my life and with the jobs I have worked before, I am only willing to pursue something to where I will eventually be in a position of authority or able to work for myself. I know it requires more work overall to operate one's own practice, but that's a small sacrifice to be able to answer to only yourself.

I couldn't go into being a PA, personally, but that's just me. My wife and children have made too many sacrifices already for me not to pursue medical school, and they want it as bad as I do. Even if you don't get to see them as much as you might like, it's only for a set number of years that it will be a factor and then you stand a more likely chance of being able to have every other Friday off with them and able to afford nice vacations, not to mention being able to offer them an opportunity for college that you may not have had.

Lastly, I see no fair comparison in choosing between PA and DO. Why not PA and MD? The fact that the OP sees DO as an underdog comparison at all makes me hopeful that they do pursue the PA route.

 

[traitorman]

What you may also want to consider is that while PA school may take less time, in the long run it may impact your lifestyle more than medical school. Many times, the PA takes call and/or rounds more frequently than the physician and actually has to do more of the "scutwork". I agree with a majority of the posters who advise evaluating what you may want to do first, but realize that the educational process may affect your decision (i.e. you may find out after doing a rotation in surgery that you really like that and if you consider PA school the scope is very limited).

For me, personally, I had considered both options extensively before deciding on DO school. A PA that I worked with (in a primary care practice) told me that if she could do it all over again, she would have gone to medical school because she felt that she did just as much work if not more than the doctors did. Another thing I realized is that I wanted autonomy and while there is a great deal of autonomy (like it or not) for midlevels which is growing daily, it will never be the same as being a doctor. As much as lifestyle may affect your decision, you have to be content with your role in the health care team. Once I started med school, there were at least 3 PAs in my class who were going back to get their DO degree because of that very reason (and as a sidebar my school just started a PA -> DO program - LECOM-Erie).

Good luck !

in the ED I work at, this is a common sentiment. and seeing how hard both the PAs and physicians work, I can understand why. I too also considered whether I should go PA or MD/DO (but without the family). ultimately, I decided on medical school because after seeing the kinds of cases I would come across, I wanted to make sure I had the most schooling and most preparation I could possibly have if i was ever in a position where someone's life was in my hands.

I do have a lot of respect for the PAs I work with because many of them are very capable. but they also acknowledge that at the end of the day, the doctor is gonna be more informed and be more knowledgeable especially with the amount of medical schooling and training. (i guess you can also argue that PAs start earlier and thus are able to develop years of experience)

and this is all opinion based on only the one hospital I work at so take it for what its worth!

 

[kuanileqa]

PAs kick ass. I know a bunch and they are extremely enthusiastic and capable at treating patients. Many of them also feel very autonomous and not restricted or questioned of their credentials/training. Anyone who undermines PAs should really do some research. In many ways their program is much more competitive than DO school and while physicians are doing clinicals and residencies PAs are making money and their debt load is much less.

However, over the course of a career the physician will make substantially more money, thus allowing the possibility for more time--whatever that means to you (family, travel, volunteer, etc.). I know several friends who would make great doctors but somehow think that a full time PA will be able to spend more time with their family. The reality is, your life is what you decide it to be. I am sure their are PAs who never see their family, and I know physicians who spend enormous amounts of time with their families. Do what fits your personality and career goals.

I heavily considered being a PA. I decided DO over PA because I would like to run my own practice and would be bothered having somebody oversee me. Also, I really want the extra clinical education and training that PAs do not receive. Finally, I want to make more money. Simple 😉

 

[nlax30]

Honestly, depending on what exactly you are looking for either route could be good for you.... not necessarily a right or wrong choice, just one that works for you.

If I had this to do all over again, was a few years older, and had kids/family... I would seriously consider PA. Ultimately I wanted the autonomy of being the physician with the ultimate say, but I think PA is a terrific profession and have worked alongside several that were terrific.

In regards to lifestyle... both can suck. A couple of cardiothoracic surgery PA's I see a good bit basically put in just as many hours as the surgeons do. They get paid well but not nearly what the surgeon makes.

The big advantage in my mind of going PA is the ability/possibility of working in different fields of medicine. The FP office I was at a few months ago had a PA who had previously done inpatient hospital work, and when she moved to the area with her child she took a more part time job at a FP office that fit her schedule. Meant another PA who used to do FP/Peds, and now joined a Derm group. Not really practical as a physician.

So if you really don't think you'd be content in one specific field/specialty then maybe PA would be ideal. If you do think you'd enjoy working in one field then IMHO the few extra years of residency training after med school would be worth it to have the autonomy and earning potential that comes along with it.

 

[NYDOC112]

PA and DO have different roles, it's quite important to note that. Although, as Goodman Brown said, they're hardly a "Doctor's Assistant."

My PCP is a PA and sometimes I feel she is more competent then my previous doctor. PAs have some limitations, but they're quite competent and I wouldn't go as far to say that they're assisting anyone. Btw, PAs have prescriptive authority and have their own patients in all 50 states.

To the OP, the truth is that it will be equally as time consuming to be in MD/DO/PA school. From what I hear, some people who went to both PA and MD school even say that in PA school you are required to process more information in a shorter time, while in MD school you learn more complex information and are able to spread it out to learn more details. Although PA school will only be 2-3 years, while as an MD/DO, your guaranteed a minimum 7 year plan before you'll have time for family and such. I think that is the biggest deciding factor for most people.

As a PA, just be sure you will be okay with knowing that sometimes in your care, you won't be able to have the "last word" with your patients and that there may be some cases where you will have to consult with your collaborating physician to properly diagnose your patient.

Also, commitments and lifestyle are definitely different

NO. PAs do not have prescriptive rights and their own patients in all 50 states. Also PAs are not allowed to prescribe any controlled substance, or narcotic, among many other drugs. In many of the states where PAs do have prescriptive abilities they are limited in what they can prescribe, how much, and how long. Many states only allow PA prescriptions to fulfill 72 Hours, in which time a physician must see the patient and give a prescription for a longer course. In the Hospital I work at, in the ER the PAs are given only the "urgent care" cases, which are people coming in with colds, ear aches, minor lacerations. etc.... all cases other than those are reserved for the physicians. The PAs must present EVERY case to one of the ER physicians, who then will give a treatment plan, and write the prescription since PAs are not allowed to write prescriptions. On the patient record sheets there is a section that must be completed only by a physician in which they basically need to agree and re-write everything the PA wrote. The PAs are basically used as historians giving the physicians more time to spend with more serious patients. This is in NYC...

 

[NYEMMED]

NO. PAs do not have prescriptive rights and their own patients in all 50 states. Also PAs are not allowed to prescribe any controlled substance, or narcotic, among many other drugs. In many of the states where PAs do have prescriptive abilities they are limited in what they can prescribe, how much, and how long. Many states only allow PA prescriptions to fulfill 72 Hours, in which time a physician must see the patient and give a prescription for a longer course. In the Hospital I work at, in the ER the PAs are given only the "urgent care" cases, which are people coming in with colds, ear aches, minor lacerations. etc.... all cases other than those are reserved for the physicians. The PAs must present EVERY case to one of the ER physicians, who then will give a treatment plan, and write the prescription since PAs are not allowed to write prescriptions. On the patient record sheets there is a section that must be completed only by a physician in which they basically need to agree and re-write everything the PA wrote. The PAs are basically used as historians giving the physicians more time to spend with more serious patients. This is in NYC...

I have to agree with you. I live in NY and whenever I go to my PCP or a specialist they have PAs working in their practice. I come into the room the medical assistant takes my vitals. Then PA then comes in and takes my history/chief complaint and then leaves. Then My physician comes in and makes sure everything written is correct, does the physical exam, and gives me whatever treatment (prescriptions, etc...) that I may need. This happens at both my Primary, and a specialist I had to go see... The PA was used as a historian in both cases.

 

[BestDoctorEver]

Go DO because I have worked with too many PAs that always look back and wish that they had gone to medical school.

 

[PharmBound2011]

NO. PAs do not have prescriptive rights (?!- See 1) and their own patients in all 50 states. Also PAs are not allowed to prescribe any controlled substance, or narcotic, among many other drugs ( See 1). In many of the states where PAs do have prescriptive abilities they are limited in what they can prescribe, how much, and how long (See 2). Many states only allow PA prescriptions to fulfill 72 Hours, in which time a physician must see the patient and give a prescription for a longer course (See 2). In the Hospital I work at, in the ER the PAs are given only the "urgent care" cases, which are people coming in with colds, ear aches, minor lacerations. etc.... all cases other than those are reserved for the physicians. The PAs must present EVERY case to one of the ER physicians, who then will give a treatment plan, and write the prescription since PAs are not allowed to write prescriptions (See 2). On the patient record sheets there is a section that must be completed only by a physician in which they basically need to agree and re-write everything the PA wrote. The PAs are basically used as historians giving the physicians more time to spend with more serious patients. This is in NYC...

1) Prescribing authority - "PAs write more than 225 million prescriptions a year. PAs have prescriptive privileges in 50 states, of which 46 allow for prescription of controlled substance. "

Source- Western New York Physician Assistant Association (http://www.wnypaa.org)

2) http://www.aapa.org/advocacy-and-practice-resources/state-government-and-licensing/prescribing

Clearly shows which states allow for SchII drugs. All states in America allow prescriptive rights and 46 states allow for controlled drugs being prescribed. Of the restrictions for controlled substances, most states are 30-day supply while only a handful are 72 hours (n=3). The others that allow it only allow until SchIII unfortunately. Most states however allow narcotics/drugs. BTW, NYC allows for SchII prescription for PAs, although certain SchII's are excluded.


-I haven't seen PAs being used as historians, and I shadowed 3 PAs in Long Island, which I assume is very similar to NYC. All three saw their own patients and had no MD/DO making the diagnosis/treatment plan. Using PAs as historians seems to be inefficient IMO, although I'm sure it happens in some of the larger cities where there is no shortage of physicians like NYC. Also seems terribly inefficient to have the PA see every case the PA does, at that point might as well just not have a PA... I'm guessing when you mentioned that PAs can't prescribe, you meant in your specific clinic/hospital?...as every PA I talked to told me they had prescriptive rights including SchII and they all had their own DEA license; the only drawback is that they were not "completely independent," as they had a collaborating physician oversee their practice. Also, their prescription pad also had the physician's name along with the PA's name. Any help is appreciated in your feedback, especially being NYC'ers...

That being said, the paths are different. If you want to "know it all," go DO and don't look back. Although, a career as a PA is certainly very rewarding as well. Many people regret it, although most people I've talked to seem really happy in their decision. As a PA won't make top$$, you won't have all the independence in the world, but it's a respectable career none-the-less. You won't have the authority of a physician, but don't let anyone let you think that you'll be doing anything close to a historian's job.
​

 

[deleted6669]

PA'S DO have prescriptive authority in all 50 states but not all states allow full sch 2-5 dea, although many do. that is the difference. in my state I have my own dea and can write anything a doc can.
the difference between pa and md/do is maximal scope of practice. as a pa I can run an er solo(and do as my primary job) without presenting a single case to a doc( because there is no doc there) but someone still reviews all my charts and gives feedback, so while I still have the "final word" in regards to my pts it is still open to review by others after the fact(within 1 month) who can "suggest" alternate ways of doing things should similar patients present again. it has taken me a long time to reach this level of autonomy and only 5% of em pa's practice at the level that I do. salary is good but I do work considerably more hrs than the docs in my group ( 180-190 hrs/mo vs 140 or less for docs).
if I had to do it over I would go to med school. to get the scope of practice I want I work inner city and rural departments, mostly on night shifts and I have taken and become certified in a considerable # of "physician life support courses" not taken by avg pa's(atls, fccs, difficult airway, apls, etc).

 

[NYDOC112]

1) Prescribing authority - "PAs write more than 225 million prescriptions a year. PAs have prescriptive privileges in 50 states, of which 46 allow for prescription of controlled substance. "

Source- Western New York Physician Assistant Association (http://www.wnypaa.org)

2) http://www.aapa.org/advocacy-and-practice-resources/state-government-and-licensing/prescribing

Clearly shows which states allow for SchII drugs. All states in America allow prescriptive rights and 46 states allow for controlled drugs being prescribed. Of the restrictions for controlled substances, most states are 30-day supply while only a handful are 72 hours (n=3). The others that allow it only allow until SchIII unfortunately. Most states however allow narcotics/drugs. BTW, NYC allows for SchII prescription for PAs, although certain SchII's are excluded.


-I haven't seen PAs being used as historians, and I shadowed 3 PAs in Long Island, which I assume is very similar to NYC. All three saw their own patients and had no MD/DO making the diagnosis/treatment plan. Using PAs as historians seems to be inefficient IMO, although I'm sure it happens in some of the larger cities where there is no shortage of physicians like NYC. Also seems terribly inefficient to have the PA see every case the PA does, at that point might as well just not have a PA... I'm guessing when you mentioned that PAs can't prescribe, you meant in your specific clinic/hospital?...as every PA I talked to told me they had prescriptive rights including SchII and they all had their own DEA license; the only drawback is that they were not "completely independent," as they had a collaborating physician oversee their practice. Also, their prescription pad also had the physician's name along with the PA's name. Any help is appreciated in your feedback, especially being NYC'ers...

That being said, the paths are different. If you want to "know it all," go DO and don't look back. Although, a career as a PA is certainly very rewarding as well. Many people regret it, although most people I've talked to seem really happy in their decision. As a PA won't make top$$, you won't have all the independence in the world, but it's a respectable career none-the-less. You won't have the authority of a physician, but don't let anyone let you think that you'll be doing anything close to a historian's job.
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Yes, I work in NYC hospital and the hospitals official policy is that no PAs can write any prescriptions. They must ask their supervising physician to write a script. In the ER all PAs have to present their cases to one of the attending physicians, and that physician must enter a medical note and sign off on the PAs work. Many of the doctors also end up going to see the patients themselves as well. The PAs are used usually in urgent care taking care of the non-critical, non ER requiring patients. I believe this is pretty standard in NYC area hospitals (long island is a separate county and board of health). PAs have the most rights in a rural setting. I know of one case recently in NYC where a PA took a hospital prescription pad home, and a friend wrote out prescriptions for himself. That PA lost his right to practice and their license because he possessed a prescription pad and was not a physician, he also lost his job because that hospital also had a policy in which PAs were not allowed to write prescriptions. In NYC prescription pads are highly regulated, even a physician if they loose their pad etc, must call the DOH to get a release to order more pads. I have worked with many great PAs, but the ones who made it really far in the field (usually older PAs with lots of experience) all expressed that if they could they would go to medical school, so that they didn't need to have a physician sign off on every case and write out the scripts for them.

 

[deleted6669]

sounds like your experience in new york is specific to just one hospital with weird bylaws. I know several ny pa's who have great autonomy and scope of practice. there are several pa residencies in ny( see www.appap.org) as well as opportunities for pa's to staff rural ed's solo.
new york law does not restrict pa prescribing in the way you describe.
ps: I just checked the ny state laws. pa's can have their own sch 2-5 dea credentials and a physician need not be present when a pa delivers care. I can't imagine why any pa would work at your facility.

 

[NYDOC112]

If you notice every single NYS health law says "PA employed or extended privileges by a hospital may, if permissible under the hospital bylaws" before chart counter signature law, the PA prescribing rights law etc etc... Im also talking about NYC in which the hospitals take the line "if permissible by hospital bylaws" all the way to the bank in restricting rights, not NYS. On a personal level I feel the NYC area hospitals should open up more practice rights for PAs in their bylaws especially in the EDs. It is frustrating having to navigate the current system with PAs needing countersignatures, and scripts for every case they have. It would certainly save a lot of time. In my hospitals ED their are 10 attending physicians on duty each night, along with several residents and about 5-6 PAs. The 5-6 PAs and 1 attending physician staff the Urgent Care units for the non-ER requiring visits. It really helps the ED a lot though because it gets more critical patients in faster...

 

[PharmBound2011]

Yes, I work in NYC hospital and the hospitals official policy is that no PAs can write any prescriptions. They must ask their supervising physician to write a script. In the ER all PAs have to present their cases to one of the attending physicians, and that physician must enter a medical note and sign off on the PAs work. Many of the doctors also end up going to see the patients themselves as well. The PAs are used usually in urgent care taking care of the non-critical, non ER requiring patients. I believe this is pretty standard in NYC area hospitals (long island is a separate county and board of health). PAs have the most rights in a rural setting. I know of one case recently in NYC where a PA took a hospital prescription pad home, and a friend wrote out prescriptions for himself. That PA lost his right to practice and their license because he possessed a prescription pad and was not a physician, he also lost his job because that hospital also had a policy in which PAs were not allowed to write prescriptions. In NYC prescription pads are highly regulated, even a physician if they loose their pad etc, must call the DOH to get a release to order more pads. I have worked with many great PAs, but the ones who made it really far in the field (usually older PAs with lots of experience) all expressed that if they could they would go to medical school, so that they didn't need to have a physician sign off on every case and write out the scripts for them.

NYDOC,

Just wondering, what's the advantage of even hiring a PA? I mean, the case in your specific hospital, wouldn't you agree that it would be more efficient to rather just hire two less PAs and hire another physician? I mean I guess the legislatures are to blame, although it seems to be a lose-lose situation for both sides. In all the cases I have heard/seen, PA's decrease the patient load/increase revenue, but it hardly seems the case in your hospital. I mean I have never heard of a PA working in a setting of which you describe (especially in NY!), although I'm not suggesting that it's not true. My point is just that I personally feel that with such a narrow role, that PA(s) is being severely underused to the point that I'm sure more patients could be helped if they weren't used at all...

 

[NYDOC112]

NYDOC,

Just wondering, what's the advantage of even hiring a PA? I mean, the case in your specific hospital, wouldn't you agree that it would be more efficient to rather just hire two less PAs and hire another physician? I mean I guess the legislatures are to blame, although it seems to be a lose-lose situation for both sides. In all the cases I have heard/seen, PA's decrease the patient load/increase revenue, but it hardly seems the case in your hospital. I mean I have never heard of a PA working in a setting of which you describe (especially in NY!), although I'm not suggesting that it's not true. My point is just that I personally feel that with such a narrow role, that PA(s) is being severely underused to the point that I'm sure more patients could be helped if they weren't used at all...

I agree 100%... The problem is the NYS laws give a lot of governing power to hospitals directly, who then place these ridiculous limits... I think the PAs should be used more, it would make the entire process a lot better.

 

[princekc]

sounds like your experience in new york is specific to just one hospital with weird bylaws. I know several ny pa's who have great autonomy and scope of practice. there are several pa residencies in ny( see www.appap.org) as well as opportunities for pa's to staff rural ed's solo.
new york law does not restrict pa prescribing in the way you describe.
ps: I just checked the ny state laws. pa's can have their own sch 2-5 dea credentials and a physician need not be present when a pa delivers care. I can't imagine why any pa would work at your facility.

..Very true! I'm a NYS PA with background in Hospital Medicine, ED & IM. At the IM clinic where I work, I run the show solo 2-says per week with my sp a ph call away.

 

[PharmBound2011]

NYDOC112...I'm a practicing PA in upstate NY with background in ER/Hospital Medicine/IM & PA in NYS has full prescription previleage. Double check the source of your info. Not sure if what you describe are typical for all NYC hospital (bylaw) which I doubt. Don't tell me that you've read "every single NYS health law." It's not true that PA need countersignatures & script for every patients. When I work in the ED (urgentcare), I write my own script & run things by myattending only when necessary (e.g difficulty case). NYS is very PA friendly!

Princekc,

NY is a very PA friendly state and I would've never imagined such a situation before really.

It is important to note however though that more than 99% of PAs don't practice in such a setting and would probably not work in such a setting. The setting NYDOC states is a true exception.

All PAs I came in contact with in NY had their own DEA, own license and also had their patients.

 

[BLKPA2MD]

NO. PAs do not have prescriptive rights Also PAs are not allowed to prescribe any controlled substance, or narcotic, among many other drugs. In many of the states where PAs do have prescriptive abilities they are limited in what they can prescribe, how much, and how long. Many states only allow PA prescriptions to fulfill 72 Hours, in which time a physician must see the patient and give a prescription for a longer course.

....You need to stop going around saying stuff like this. Get your facts straight prior to commenting on PA scope of practice. I'm astonished to read comment like this from a DO. Wonder where you had your training vs extent of your exposure with PAs.

 

[Mohammed1989]

I've been shadowing three different PA's in the ER for about three years now and all of them prescribe meds all the time. This is in upper Manhanttan and I've also seen them write prescription for controlled substances and etc. A physician doesn't come in or double check the PA, this is what I have witnessed. I'm sure it's a different environment when comparing it to a clinc.

What I would think is the PA's experience would play a major role. I'm sure after a while the physician trusts the PA enough but in the begining it's probably like "residency" for the PA. It's just my guess because the PA I've worked with have been there about 15+ years except one who is young and no one even double checks him.

 

[painmd87]

The cost could also be a factor. One PA program in my state costs $19,500 for the entire program. Most medical schools will cost at least that, if not double it, per YEAR.

I had a long debate with myself and my family about PA or DO/MD. I chose the physician pathway because that's what I can see myself doing for the rest of my life. I didn't want to feel in 30 years that I had taken the shorter route to save time/money and ended with a midlevel degree. I fully understand that PAs practice in the same level as many physicians, but there are some closed doors in reality. For 95% of PAs, that won't be a problem. Maybe I'd end up in the other 5%.

Anecdotally, a number of recent med school and residency grads have told me they'd rather have gone to PA school because their PA friends have been out for years and are already seeing patients and getting paid. On the other end, a handful of PAs have said they'd rather have gone to med school for various reasons.

The grass is always greener.....

 

[christina30]

....You need to stop going around saying stuff like this. Get your facts straight prior to commenting on PA scope of practice. I'm astonished to read comment like this from a DO. Wonder where you had your training vs extent of your exposure with PAs.

I actually had a similar experience with PAs in the ED I worked at (in a very busy urban-area hospital) - they had to run the cases by the ED attending after they saw the patient and before they made any major decisions re: management of said patient. The attending also had to sign off on the chart before discharge/transfer/admission. It really varies by hospital in NY, by the looks of it.

 

[princekc]

The cost could also be a factor. One PA program in my state costs $19,500 for the entire program. Most medical schools will cost at least that, if not double it, per YEAR.

...very rare. @ my sch tuition was 26+/yr. I'm currently paying 160k student loan debt (undergrad & PA sch training).

 

[deleted6669]

...very rare. @ my sch tuition was 26+/yr. I'm currently paying 160k student loan debt (undergrad & PA sch training).

agree- most pa schools cost about the same as med school yr for yr so 50% of the total cost of med school. > 100k debt is not uncommon for pa students now.
a few states have both cheap in state pa and medschools(tx for example).