I chose PA school over MD/DO!? AMA

[StudyLater]

It IS autonomy, there is nothing pseudo about it. When you say a physician signs off their work that implies someone is, at the very least, looking over their charts every day, in time to call the patient back and change the management if appropriate. In a lot of these positions there is no such supervision, there isn't even a cosignature that ever makes it onto the charts. There's just some legal agreement stuck in a drawer somewhere that designates a supervising physician.

BTW I do think that PAs/NPs in these positions deserve equal pay for equal work. I'm not a big fan of the physician who derives a lot of income from 'overseeing' someone he's not actually overseeing. If we're going to work midlevels like physician then mildevels should get the pay (and the liability for that matter) and be allowed to practice under their own license. In several states this is already legal.

I didn't think it was anywhere for PAs. That's why I was saying pseudo-autonomy; I meant from a legal standpoint. De facto, though, yeah, it's autonomy.

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[MyNameWasUsed]

PAs are our friends, but they have their place, and are not competent enough to take the place of a physician. That's just the reality of things. I wouldn't mind training a few PAs to work alongside me someday, but they have their limits and need some level of cooperative oversight.

Competent and educated are two different things. People choose PA because of a distinctive difference, not because they can't attend MD school. I can attend MD school if I wanted to and this isnt directed to you, but the whole BS about "oh but you havn't even take the MCAT yet" doesn't hold. I really doubt its that hard to score a 30 on the MCAT with proper studying and yes I'm using the old scale because I'm unaware of the new scale. I'll bet in favor of anyone who has a 3.7 GPA at age 19 to score a 30+ on the MCAT anyday as long as they study properly ( as in like 3 hours a day for 3 months).

What a misleading thread title. OP, you must realize you make it sound as if you gained an MD acceptance and turned it down to go PA instead. You had an average GPA and never even took the MCAT.../QUOTE]

Misleading? Yes, possibility, however, I don't believe this thread doesn't provide any insight at all. My junior year of college, I had a short conversation with an ACQUAINTANCE who introduced me briefly to the PA profession and from then I just did basic research which convinced me to switched from the MD route to PA route. I was all about MD before then much like most of you guys for reasons that doesn't really justify at the end of the day. If this thread can't help just ONE ambiguous premed in deciding their path, then it would have been completely worth it. Some might argue this thread would have changed that so called ambiguous premed for the worse for choosing PA, but you'll never know.

Nice post rogueunicorn. You said everything I wanted to say. OP is obviously someone who just got into pa school and is trying to tell us what he thinks medicine is like.

God forbids he's actually trying to help premeds who are unsure of which health profession path to pursue. This post would have been extremely helpful to me about 1.5 years ago.

I will throw a different perspective out there and say that I DO think there is something wrong with being a PA, at least the way the OP is going about it. It was also wrong of his school to offer him this opportunity. I think he should have chosen to be a physician instead.

Midlevel degrees were very specifically designed to draw upon the experience of their students. For the NP programs this meant floor and ICU nurses, for the PA programs that meant military Medics/Corpsmen and experienced Paramedics. Half of medical school and all of residency is really just seeing, reading, and rounding on one case after another. These were men and women had been doing that, patient after patient, for a decade or more. The theory, which I agree with, was that it shouldn't take 7 years to turn someone with that kind of experience into something equivalent to a physician. The midlevels I know who came up this way, particularly the ones with extensive ICU nursing experience or former independent duty corpsmen, often were indistinguishable from physicians in the quality of their care.

In just the last decade, though, both PA and NP programs (with the exception of CRNA programs) have increasingly shifted their focus towards fresh college grads who have no real world experience. That's not a midlevel in the sense the degrees were designed for, that's just a third year medical student who has decided that he is ready to take life and death responsibility for his patients with no further training. Its unethical. Also my experience with grads of these programs has been almost completely negative.

Now I don't think this pathway to being a midlevel should exist at all, but the OP is in it now and obviously just turning back isn't really possible. My advice to the OP would be, upon graduation, to try and simulate a medical school/residency experience as closely as possible. I would recommend a PA residency, and at least 3 years working on an inpatient team (wards and/or ICU) when you are directly supervised by a physician who rounds with you and reads your note. Those positions do exist, especially I large tertiary medical centers. Read every day and, if you can work in a academic hospital, go to didactics with the residents. If you ultimately switch to more independent practice, only practice in a field where you've had a chance to see a lot of pathology with real supervision (i.e. if you did all adult inpatient don't suddenly start covering kids outpatient).

There are lots of effectively unsupervised ER, urgent care, and even inpatient positions out there for a new grad. Don't take them, at least not at first. You need to get the experience after PA school that you should have gotten before it. You owe it to your patients. And to your conscience.

You know what? You're an attending so you got more experience, but come on really? Times change. PA used to be directed towards medics/corpsmen, but that was 1965 (first PA program). 100 years ago we didn't have civil rights for women or African Americans. Times change. Medicine is advancing every day. MDs now have to learn more than they ever did 60 years ago. PAs now has to learn more than they did 60 years ago.

Overall, I don't get the hate for this thread. Several of my friends that I graduated with in biochemistry/biology this May are switching to PA/PT/Forensics/Nutrition/Dental because they don't want to do MD/DO anymore. Is it possible that they don't have the stats for med school? Sure and I do believe some of them aren't competitive enough, but that's not the case for everyone who switches. SDNers need to understand that some people choose a different path in medicine because it suits them better.

edit: i messed up the quoting lol. It's late.

 

[deleted480308]

This thread went exactly as I predicted

 

[Gastrapathy]

I liked the part where I was told that I might run into these strange beings called midlevels in the future.

If the OP wants to be a junior member of the team forever, so be it. But many young PAs regret that decision after 5-10 years and the prospect of going back to school is godawful.

 

[Gastrapathy]

Our midlevels practice at the very top of their level. They do endoscopy (heresy, I know) and manage complex hepatology and IBD patients. Still...I joined the group years later but I'm immediately senior. That can get old when you know you are just as capable. Everyone keeps talking work life balance. A big part of that is liking your job as much as possible.

 

[Petrichor1]

I don't have a problem with PAs one of my best friends is in her second year. The problem I have is with OP trying to make it seem that PAs are somehow equivalent to MD/DOs. I know what PAs do and I have been around them many times.

For me, I don't want to be a 50 year old PA with more experience and knowledge about a certain speciality an have a newly graduated attending who is 30 years old telling me how to go about doing things.

lol it's more frustrating to have the attending get berrated by the PA...After all, sure PA know more at the moment but like to have to be entirely taught by them is a little nonsensical because then you wonder why PAs get so much of the same training as doctors. It's bound to create conflict and then you see trends where PAs open their own clinics and seem to expound the fact that they are basically doctors.

 

[Petrichor1]

So you're essentially against the whole idea of training college students as PAs. Instead, it should be people that already have extensive experience treating patients.

Though you're saying if one is going to take this path (which is morally wrong),then they should do at least 3 years of highly supervised work?

I think that's pretty fair. One would think it would be almost a licensing requirement in order to practice autonomously -- although with PAs it's tricky since it's not real autonomy; it's just this kind of intra-institutional pseudo-autonomy (that the doc signs off on), which actually looks quite a lot like independent practice. But yeah that definitely makes sense, in the same way that a PGY2 taking a moonlighting gig should be doing it with at least dual coverage. Just overall safer, and I don't think that most who have only 1 year of training post-didactics in PA school are really going to think they're ready enough to do one of these "autonomous" gigs. At least personally if it were me, I'd like to have someone covering my a*s for sure.

3 years of highly supervised work? Have you been at a medical facility?? Noone got time for that son. Places are always short-staffed and then you want a mentor to follow this kid around...

 

[StudyLater]

3 years of highly supervised work? Have you been at a medical facility?? Noone got time for that son. Places are always short-staffed and then you want a mentor to follow this kid around...

I have. At the facility I shadow at, PAs consult with docs all. the. time. when they are not sure about something.

Hell. Docs do the same with each other.

 

[Petrichor1]

I have. At the facility I shadow at, PAs consult with docs all. the. time. when they are not sure about something.

Hell. Docs do the same with each other.

by highly supervised work, what do you mean? Do you have a person follow you around everytime and verify it in the system for you?

 

[Mad Jack]

Competent and educated are two different things. People choose PA because of a distinctive difference, not because they can't attend MD school. I can attend MD school if I wanted to and this isnt directed to you, but the whole BS about "oh but you havn't even take the MCAT yet" doesn't hold. I really doubt its that hard to score a 30 on the MCAT with proper studying and yes I'm using the old scale because I'm unaware of the new scale. I'll bet in favor of anyone who has a 3.7 GPA at age 19 to score a 30+ on the MCAT anyday as long as they study properly ( as in like 3 hours a day for 3 months).



Overall, I don't get the hate for this thread. Several of my friends that I graduated with in biochemistry/biology this May are switching to PA/PT/Forensics/Nutrition/Dental because they don't want to do MD/DO anymore. Is it possible that they don't have the stats for med school? Sure and I do believe some of them aren't competitive enough, but that's not the case for everyone who switches. SDNers need to understand that some people choose a different path in medicine because it suits them better.

edit: i messed up the quoting lol. It's late.

I knew a lot of kids with 3.8+ GPAs that studied hard and bombed the MCAT. Doing well on four to five courses at a time and actually retaining and applying the information from your entire science (and now some of your humanities) education all at once are entirely separate things. That's why the MCAT has been shown to be three times better at predicting medical school performance than GPA- one measures hard work, while the other measures your ability to retain and apply massive quantities of information. Plenty of PAs would have been successful in medical school, but, then again, plenty would not have.

 

[StudyLater]

by highly supervised work, what do you mean? Do you have a person follow you around everytime and verify it in the system for you?

I don't think any actual PA job would have that kind of workflow -- it would defeat the whole purpose of hiring a PA in the first place. I more meant that you're checking everything you're doing with the physician instead of assuming it's all gonna be just swell without you bringing it up at all (which you would do when you're more experienced). It's usually, from what I've observed, about a (max) 5min interaction. They report to the physician while the physician is at his/her desk reviewing history/putting in orders. Physician gives input. PA leaves to go do what they're gonna do.

I've actually seen it annoy physicians when they have to talk for greater than a few minutes with a PA, or if they've got to go see a patient the PA just saw to clear something up because of the PA not getting proper info or whatever.

 

[Petrichor1]

I don't think any actual PA job would have that kind of workflow -- it would defeat the whole purpose of hiring a PA in the first place. I more meant that you're checking everything you're doing with the physician instead of assuming it's all gonna be just swell without you bringing it up at all (which you would do when you're more experienced). It's usually, from what I've observed, about a (max) 5min interaction. They report to the physician while the physician is at his/her desk reviewing history/putting in orders. Physician gives input. PA leaves to go do what they're gonna do.

I've actually seen it annoy physicians when they have to talk for greater than a few minutes with a PA, or if they've got to go see a patient the PA just saw to clear something up because of the PA not getting proper info or whatever.

see, I find that then you are not really "highly supervised". That's basically like the physician is your supervisor and at some time you have to report back to them so they review your activity. This happens at every medical job but this usually entails that the person under the supervisor is working independently.

 

[StudyLater]

see, I find that then you are not really "highly supervised". That's basically like the physician is your supervisor and at some time you have to report back to them so they review your activity. This happens at every medical job but this usually entails that the person under the supervisor is working independently.

Well then I'm not really sure what @Perrotfish was referring to. I agree there's going to be varying levels of autonomy, but I'm pretty sure either way a proactive PA that likes to cover their own a*s is going to be checking with physicians on the things they're not sure about. I just assume that in the beginning you'll be checking with the doc a lot more because you're not going to be sure about a lot more things.

 

[deleted480308]

For me, I don't want to be a 50 year old PA with more experience and knowledge about a certain speciality an have a newly graduated attending who is 30 years old telling me how to go about doing things.

You wouldn't know more as the 50yr old...

 

[Gastrapathy]

You wouldn't know more as the 50yr old...

But you'll think you do.

 

[Perrotfish]

Well then I'm not really sure what @Perrotfish was referring to. I agree there's going to be varying levels of autonomy, but I'm pretty sure either way a proactive PA that likes to cover their own a*s is going to be checking with physicians on the things they're not sure about. I just assume that in the beginning you'll be checking with the doc a lot more because you're not going to be sure about a lot more things.

What I mean by close supervision is that the midlevel should be functioning as an Intern or second year resident. In an outpatient clinic that means that, at least twice a day, the midlevel presents every patient they've seen to an attending and reviews their management (in plenty of time to call the patient back if an error was made) In an inpatient environment that means the midlevel is rounding on all the patients with the attending once in the middle of the day and then signing out the list before going home at night.

I do NOT mean that the physician would follow the midlevel from room to room and repeat their work. That would be appropriate supervision only for a medical student or maybe an Intern in July, and would make the midlevel an effectively useless worker.

 

[Perrotfish]

see, I find that then you are not really "highly supervised". That's basically like the physician is your supervisor and at some time you have to report back to them so they review your activity. This happens at every medical job but this usually entails that the person under the supervisor is working independently.

Appropriate supervision, for a resident or a midlevel, means that the supervisor checks EVERY patient, and they do in time to fix problems they find rather than just document and discuss it (the same day). In many clinics the 'supervision' is a cosignature which may appear days later, or even just a periodic chart review of a small random selection of charts to make sure that the provider's management was appropriate. That's effectively not being supervised at all.

 

[deleted480308]

What I mean by close supervision is that the midlevel should be functioning as an Intern or second year resident. In an outpatient clinic that means that, at least every 4 hours, the midlevel presents every patient they've seen to an attending and reviews their management (in plenty of time to call the patient back if an error was made) In an inpatient environment that means the midlevel is rounding on all the patients with the attending once in the middle of the day and then signing out the list before going home at night.

I do NOT mean that the physician would follow the midlevel from room to room and repeat their work. That would be appropriate supervision only for a medical student or maybe an Intern in July, and would make the midlevel an effectively useless worker.

The em situation I shadowed in was appropriate. Less critical patients were triaged to fast track and seen by a midlevel. Who did the evaluation and prepared a suggested plan. Every hour or so a doc would come by and get presented all the patients and their proposed plans. Doc would then sign off on patients for plans to move forward or evaluate them himself.

 

[totter2]

What are you even talking about? I haven't seen any premeds saying they can outperform a PA.

I literally can do a PAs job during a surgery. All they do is suction blood and suture at the end.

Honestly. There will always be someone telling you what they think about your job. Whether you become an MD, PA, NBA player, I-banker, whatever. Anyone who thinks their future profession is 100% the best and superior to everything needs a reality/ego check. Different people have different needs/wants.

Go into PA because you have shadowed and worked with PAs for a significant amount of time and believe you will enjoy the job. There are many positives to the PA profession, as people already know. Do not go into PA thinking that, with experience, you will know as much as the MD. Do not go into PA if you have an ego and feel the need to be the team leader. If you are 19 years old and going for PA because it's "faster" and "easier," than you probably won't like being a PA. At the same time, anyone who think MD equals unrivaled power, money, and prestige in the medical field is being willfully ignorant.

Are there PAs that have worked for decades and love their job? Yes. Are there unhappy PAs who get sick of their limited autonomy? Yes.

Are there doctors who have worked for decades and love their job? Yes. Are there doctors who are miserable and hate their job? Yes.

Wow, it's almost like every profession has their ups and downs and whether you enjoy yours depends on your individual traits.

If anyone here is seriously considering PA over MD or DO, please do not use SDN as your main source of information. Actually talk to experienced PAs and MDs who work with them.

 

[Perrotfish]

The em situation I shadowed in was appropriate. Less critical patients were triaged to fast track and seen by a midlevel. Who did the evaluation and prepared a suggested plan. Every hour or so a doc would come by and get presented all the patients and their proposed plans. Doc would then sign off on patients for plans to move forward or evaluate them himself.

Its amazing how much variation I've seen when it comes to supervising residents and midlevels. What you're describing does sound completely appropriate for even a fresh grad.

 

[StudyLater]

@sb247 that situation is the kind I've experienced as well in the ER I shadow at. About every hour they'd have a 5min discussion.

 

[cbrons]

They do endoscopy (heresy, I know) and manage complex hepatology and IBD patients. Still...I joined the group years later but I'm

Lol

If doctors keep saying stuff like this there will be literally no reason to go to med school.

 

[Psai]

Our midlevels practice at the very top of their level. They do endoscopy (heresy, I know) and manage complex hepatology and IBD patients. Still...I joined the group years later but I'm immediately senior. That can get old when you know you are just as capable. Everyone keeps talking work life balance. A big part of that is liking your job as much as possible.

They're not practicing at the top of their level. They're practicing at yours. Makes no sense to limit GI spots if you're going to let midlevels run wild unless your goal is to make as much money off their backs as you sell out your profession

 

[efle]

Where do Caribbean MD's factor in on this totem pole? Is it MD and DO >> PA, RN, NP >> nutritionist >> Carib?

 

[cbrons]

The theory, which I agree with, was that it shouldn't take 7 years to turn someone with that kind of experience into something equivalent to a physician. The midlevels I know who came up this way, particularly the ones with extensive ICU nursing experience or former independent duty corpsmen, often were indistinguishable from physicians in the quality of their care.

So why didnt they award them with an MD?

What the hell is the purpose of this expensive waste of time called med school. Posts like this literally make my blood boil. Why are we sacrificing so much of our lives and money and family time when you could just get the same thing through some on the job training.

 

[Stagg737]

Competent and educated are two different things. People choose PA because of a distinctive difference, not because they can't attend MD school. I can attend MD school if I wanted to and this isnt directed to you, but the whole BS about "oh but you havn't even take the MCAT yet" doesn't hold. I really doubt its that hard to score a 30 on the MCAT with proper studying and yes I'm using the old scale because I'm unaware of the new scale. I'll bet in favor of anyone who has a 3.7 GPA at age 19 to score a 30+ on the MCAT anyday as long as they study properly ( as in like 3 hours a day for 3 months).

Spoken like someone who's never taken the MCAT. It's not nearly as easy as other standardized tests like the GRE and there are plenty of students that have 3.7 or even 3.8+ that can't hit 30 on the MCAT. DO schools, and even MD schools are filled with them. Besides, a 3.7 at one school does not equal a 3.7 at other schools, that's why the MCAT is there, to create a single standard.

Go into PA because you have shadowed and worked with PAs for a significant amount of time and believe you will enjoy the job. There are many positives to the PA profession, as people already know. Do not go into PA thinking that, with experience, you will know as much as the MD. Do not go into PA if you have an ego and feel the need to be the team leader. If you are 19 years old and going for PA because it's "faster" and "easier," than you probably won't like being a PA. At the same time, anyone who think MD equals unrivaled power, money, and prestige in the medical field is being willfully ignorant.

Are there PAs that have worked for decades and love their job? Yes. Are there unhappy PAs who get sick of their limited autonomy? Yes.

The majority of PAs that I've interacted with were in their mid-40's or older. All of the older guys regretted taking the PA route. Most of them said they did it because it was either faster or they didn't think they could get into med school. However, most of them were more frustrated by the fact that they had 20+ years experience and were making half as much as physicians that were barely out of residency than they were by a lack of autonomy.

The younger guys seemed pretty happy, and I'm sure there are plenty of PAs who are happy throughout their careers. But someone mentioned earlier, there's significantly less room to grow as a PA than as a physician, and that's something that I think starts to wear some of the PAs down in their later years.

 

[MyNameWasUsed]

If anyone here is seriously considering PA over MD or DO, please do not use SDN as your main source of information. Actually talk to experienced PAs and MDs who work with them.

I feel like SDN is a great source for information especially for midlevels providers because SDN gives alot of negative and realistic feedback for pursuing PA/NP. While talking/shadowing PAs/MDs is great, I feel like it doesn't give you a realistic perception of the profession. On the internet, people don't have to hold back what they really think and that is far more valuable to me.

 

[Gastrapathy]

They're not practicing at the top of their level. They're practicing at yours. Makes no sense to limit GI spots if you're going to let midlevels run wild unless your goal is to make as much money off their backs as you sell out your profession

No they aren't and they know it. Huge difference between doing an inevitably normal EGD for a 25 yo with dyspepsia and taking off a 5cm flat cecal polyp. It wasn't my choice and it isn't to make money but I'm fine with it.

 

[Perrotfish]

nevermind

 

[moisne]

I don't understand the original posting of this message? I only got a 6 on VR so I never understand main ideas but my impression was "Look, I'm so awesome, I'm smart, Got the grades and finished at 19 - thus I totally would've gone into MD.. but decided PA in the end"?

Graduated College at 19. cGPA: 3.7+ / sGPA: 3.6+
For anyone who is interested or don't know what the profession is... Also, for some who may even be contemplating their decision pursuing medicine

@SuperSlim - I'm so glad I read your message. I needed a break from studying and a good laugh.

M



Never said 100% but surely more than PAs.

 

[SuperSlim]

I don't understand the original posting of this message? I only got a 6 on VR so I never understand main ideas but my impression was "Look, I'm so awesome, I'm smart, Got the grades and finished at 19 - thus I totally would've gone into MD.. but decided PA in the end"?




@SuperSlim - I'm so glad I read your message. I needed a break from studying and a good laugh.

You guys keep quoting me. Jeez u guys. Yal don't understand exaggeration/sarcasm. Of course I can't do a PAs job. Didn't think I needed to explain this.


Also, what is the true purpose of OPs thread. I feel like he's trying to raise his self-esteem and tell himself it's okay that I'm going into Pa school. I think he was hunting positive posts.



Again congrats to you OP, you will be living a hella of a better life in your 20s. While we ( if I get in) will be eating ramen and driving beat up Honda civics.




Jeez