Is the PA route tempting to anyone else?

[deleted128562]

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Hi everyone,

This may have been discussed before but if so I'm going to ask it again and search engines be darned. (They never work for me anyway).

After working in industry for several years and hating it, I went back to school a few years ago with the intention of becoming an MD. I've worked hard and will soon start the process of applying (for 2009 matriculation). I certainly don't know for sure that I'll even get in but I think my stats are competitive enough that I atleast have a reasonable shot.

Thing is though, now that I've had some experience in the medical field (I work full time in the hospital while going to school) and am close to applying, I'm starting to have my doubts. A lot of the PA's I work with seem happier than the MD's and seem to have more family time on the whole. And my wife and kids are the world to me.

I had many reasons for not wanting to go the PA route but the more I talk with MD's and PA's, the more these reasons seem to get shot down. My reasons will follow, but I'd love to hear discussion from other students on if 1) Do you ever think you're making the wrong choice going MD instead of PA? 2) How much water does my reasoning hold?

Here are/were my reasons for MD over PA along with why they have been getting shot to heck:

1) MD's are the "top" of the ladder, call the shots, and have the autonomy.
RESPONSE: It is true that MD's make final calls more so than PA's. However, PA's do have a lot of decision making autonomy on 95% of stuff (especially the good ones who work for good docs). However, it seems that the idea that MD's are top of the food chain and calling the shots may not be so correct. A lot of the MD's I've been talking to have said they may as well be PA's for as much bowing down as they have to do to administrators, government burocracy, etc. The prevailing comment I've heard from them is along the lines of "there was a time when MD's were in charge of medicine but those days are gone." So it seems that either way you'll have someone telling you what to do.

2) MD's get a bigger knowledge base and are more intellectually challenged
RESPONSE: This is probably absolutely true. Medical training is much more rigorous than PA training and has a much bigger knowledge base. However, there is one area where this thinking fails. An MD generally picks one field to specialize in and has to stick with it forever (unless he/she is masochistic enough to do another residency). On the other hand, a PA can generally move around much like a nurse - Peds for give years, ER for five years, Ortho for five years, FP for a few years, OB for a few, etc etc etc. Granted, even having worked in several fields the PA will never actually "know more" than an MD, but they will have had a broader base of practice and experiences in the sense that they weren't in one subfield forever.

3) MD's are more respected and make a better living
RESPONSE: More respected, yes. But those days may also be dying. You see it on these boards all the time, and the MD's I've talked to - especially the older ones - have confirmed that the respect doctors receive from the general public is going down down down to the point where they feel 98% of patients don't even know (or care) whether they are being treated by an MD or PA. As for the money, I have the unfortunate distinction of being someone who is interested particularly in peds. I've talked to a few pediatricians whom I know pretty well and have been open about what they make, and if you look at the loans I'll have to pay back from med school, I'll probably be making the same $$ as a good PA would once all is said and done with much more $$ lost due to longer schooling plus less time for family.

4) Higher feeling of accomplishment
RESPONSE: There is probably no argument to this one. To me, becoming an MD would give me more personal pride then becoming a PA. But then again, personal pride isn't everything. I mean, if my pride is intact but I'm divorced, my kids hate me, I end up hating the bull(&*$ of modern medicine (read: government), and I'm exhausted at 60 from years and years of taking call (as is my kids' pediatrician) then pride ain't really worth much is it? On the other hand, everything might turn out great and I'll have few regrets. (And who knows, if I do become a PA I might always regret that).

The problem is, there is no crystal ball and there is no way to tell without actually doing it. Which is the bugger about medicine - unlike many other things, once you get both feet into it it's VERY hard to get out because of the HUGE debt as well as time (read: my wife would understandably kill me) that's been put into it. And becoming a PA first and then doing med school if I don't like it isn't an option. If I do med school NOW at least I'll be all done by the time my kids are in middle school or starting high school at worst. If there's any delay my poor kids will be dealing with my educational pursuits their whole growing up lives and that's not fair to them.

So WOW, that's my lengthy post, but I needed to get this out. If you're still reading thanks for listening. I'M INTERESTED TO HEAR EVERYONE'S THOUGHTS, STORIES, EXPERIENCES, ANECDOTES, ETC!!!! THANKS!!!! 🙂

 

[Bacchus]

If you're going to say could've, would've, should've then I would go through with your plans for medical school. You can always apply for residency in specialties that are "9-5."

 

[Phoenix.]

Mr. Hat: I'm moving this thread to the Non-Traditionals Forum where I think you'll get more advice relevant to your situation.

 

[deleted128562]

And so the thread dies....

 

[deleted6669]

if family time and outside pursuits are important to you as an older applicant go pa. if you want to live medicine go md/do. you will never know everything as a pa. you will never know anything as an md. as an md in peds you would probably make 140k/yr or so and about half that as a pa(in peds).
the difference between a pediatrician and a peds pa in an outpt setting is almost zip. in an inpatient peds setting the peds doc wins hands down with a better knowledge base in management of acutely ill kids.
for more pa info see:
www.aapa.org for general pa info
www.physicianassistant.net for a pa specific forum
www.appap.org for info on optional pa residencies.
good luck whatever you decide.

 

[Beast11]

And so the thread dies....

Just look on the same page of non-trads and you will see the thread about PA vs. MD/DO (a DO is prolly much closer to your original intended message anyway). It is continually updated (3 pages of threads and counting). Add you $0.02 there.

 

[Tiretrauma]

I think you have to look at why you started down this path and decide from there. From my experiences PA's and Doctors are not equal and no matter how much bowing down any of them do, I can guarentee that the bowing is to a lot less at the doctor level then at the pa level. Good luck on your decision...if your wife and kids are as much as an influence as you say...maybe you should discuss this with them. 👍

 

[8744]

Hi everyone,

This may have been discussed before but if so I'm going to ask it again and search engines be darned. (They never work for me anyway).

After working in industry for several years and hating it, I went back to school a few years ago with the intention of becoming an MD. I've worked hard and will soon start the process of applying (for 2009 matriculation). I certainly don't know for sure that I'll even get in but I think my stats are competitive enough that I atleast have a reasonable shot.

Thing is though, now that I've had some experience in the medical field (I work full time in the hospital while going to school) and am close to applying, I'm starting to have my doubts. A lot of the PA's I work with seem happier than the MD's and seem to have more family time on the whole. And my wife and kids are the world to me.

I had many reasons for not wanting to go the PA route but the more I talk with MD's and PA's, the more these reasons seem to get shot down. My reasons will follow, but I'd love to hear discussion from other students on if 1) Do you ever think you're making the wrong choice going MD instead of PA? 2) How much water does my reasoning hold?

Here are/were my reasons for MD over PA along with why they have been getting shot to heck:

1) MD's are the "top" of the ladder, call the shots, and have the autonomy.
RESPONSE: It is true that MD's make final calls more so than PA's. However, PA's do have a lot of decision making autonomy on 95% of stuff (especially the good ones who work for good docs). However, it seems that the idea that MD's are top of the food chain and calling the shots may not be so correct. A lot of the MD's I've been talking to have said they may as well be PA's for as much bowing down as they have to do to administrators, government burocracy, etc. The prevailing comment I've heard from them is along the lines of "there was a time when MD's were in charge of medicine but those days are gone." So it seems that either way you'll have someone telling you what to do.

2) MD's get a bigger knowledge base and are more intellectually challenged
RESPONSE: This is probably absolutely true. Medical training is much more rigorous than PA training and has a much bigger knowledge base. However, there is one area where this thinking fails. An MD generally picks one field to specialize in and has to stick with it forever (unless he/she is masochistic enough to do another residency). On the other hand, a PA can generally move around much like a nurse - Peds for give years, ER for five years, Ortho for five years, FP for a few years, OB for a few, etc etc etc. Granted, even having worked in several fields the PA will never actually "know more" than an MD, but they will have had a broader base of practice and experiences in the sense that they weren't in one subfield forever.

3) MD's are more respected and make a better living
RESPONSE: More respected, yes. But those days may also be dying. You see it on these boards all the time, and the MD's I've talked to - especially the older ones - have confirmed that the respect doctors receive from the general public is going down down down to the point where they feel 98% of patients don't even know (or care) whether they are being treated by an MD or PA. As for the money, I have the unfortunate distinction of being someone who is interested particularly in peds. I've talked to a few pediatricians whom I know pretty well and have been open about what they make, and if you look at the loans I'll have to pay back from med school, I'll probably be making the same $$ as a good PA would once all is said and done with much more $$ lost due to longer schooling plus less time for family.

4) Higher feeling of accomplishment
RESPONSE: There is probably no argument to this one. To me, becoming an MD would give me more personal pride then becoming a PA. But then again, personal pride isn't everything. I mean, if my pride is intact but I'm divorced, my kids hate me, I end up hating the bull(&*$ of modern medicine (read: government), and I'm exhausted at 60 from years and years of taking call (as is my kids' pediatrician) then pride ain't really worth much is it? On the other hand, everything might turn out great and I'll have few regrets. (And who knows, if I do become a PA I might always regret that).

The problem is, there is no crystal ball and there is no way to tell without actually doing it. Which is the bugger about medicine - unlike many other things, once you get both feet into it it's VERY hard to get out because of the HUGE debt as well as time (read: my wife would understandably kill me) that's been put into it. And becoming a PA first and then doing med school if I don't like it isn't an option. If I do med school NOW at least I'll be all done by the time my kids are in middle school or starting high school at worst. If there's any delay my poor kids will be dealing with my educational pursuits their whole growing up lives and that's not fair to them.

So WOW, that's my lengthy post, but I needed to get this out. If you're still reading thanks for listening. I'M INTERESTED TO HEAR EVERYONE'S THOUGHTS, STORIES, EXPERIENCES, ANECDOTES, ETC!!!! THANKS!!!! 🙂

If I wasn't a doctor, this career would be so not worth it and there is no way I would have considered being a PA, an NP, a nurse, or any other skilled medical professional. It's not even a money issue.

I also cannot understand why you folks think doctors are not respected. I'm just a resident and I get plenty of respect from patients, friends, family, and etc. Am I missing something? Is there some quantity of disgusting, ass-kissing adulation that some of you expect but are not getting?

 

[Phoenix.]

And so the thread dies....

Mr. Hat: If you feel that strongly about it, PM me. But I've found the posters in the Non-Trad Forum to be incredibly helpful and level-headed. You may not get as many responses as in Pre-Allo, but I think the quality and usefulness of the responses here will make up for it. And, as suggested, check out the thread the poster above mentioned - this has definitely been debated many times before:

http://forums.studentdoctor.net/showthread.php?t=271413
http://forums.studentdoctor.net/showthread.php?t=468663
http://forums.studentdoctor.net/showthread.php?t=466869
http://forums.studentdoctor.net/showthread.php?t=466869

And above all else, good luck with your decision.

 

[Valvool]

I am thirty years and old and the mother of young children. I am applying to medical school this cycle and have had one interview thus far. If I am not accepted during this cycle I can't apply next cycle unless I retake the MCAT as my score is from 2005 and nearing obsolescence. I think, if I am not accepted into an MD or DO program this cycle, I will take the GRE and apply to a PA program next fall. I lived in Alaska for over a year and just returned this June; up there our town doc is a PA and functions autonomously (the physician overseeing him is rarely on the island), he makes 120K a year, and he seems happy. While I was there I became an EMT and loved every minute of my time with patients (except that one time doing CPR for forty minutes in the back of the ambulance while speeding toward the nearest large facility forty miles away, trying to do chest compressions and throw up from motion sickness at the same time, the ambulance slipping and sliding through snow and ice the whole way...god, that day was horrible); the PA became a sort of mentor to me and I learned a lot about what he does. I think I would like it. I prefer to go to medical school, PA school is definitely my second choice, but I don't think--since I want to do rural primary care medicine, maybe in Alaska--it's actually going to make much difference in terms of my day-to-day existence once I am practicing.

 

[alpha62]

If I wasn't a doctor, this career would be so not worth it and there is no way I would have considered being a PA, an NP, a nurse, or any other skilled medical professional. It's not even a money issue.

I also cannot understand why you folks think doctors are not respected. I'm just a resident and I get plenty of respect from patients, friends, family, and etc. Am I missing something? Is there some quantity of disgusting, ass-kissing adulation that some of you expect but are not getting?

Yeah, you're missing something.

You're in what alcoholics in Rehab call the " Pink Cloud " Once reality sets in and you're out of the protected enviroment things get a little tougher.

1) yeah, your pts like you, they're probably crackheads and you got a Prescription Pad.
2) you're not working in an HMO...... yet
3) My friends respect me, I hook them up with cheap care, of course they
" respect" me. My military friends respect me, cause I'm really good at helping them get more disablity.
4) My professional friends " respect " me cause they're stuck in the same sinking boat I'm in.
5) My family admires me.... well, of course they do. I'm employed and not asking them for a loan. They admire my cousin at the Tire Shop too, he hooks them up on oil changes.
6) It's not your persona bud. It's the white coat, it's called a trophy wife and it comes with the package, along with the divorce at age 40 , the really bad rug, the blue nose, the 46 inch waistline that comes from overwork, the sports car (it's a lease). By then, you'll just be a dirty old man, not Dr. McDreamy and dammit, you better fill my Vicoden, you work for ME Docteer !
7) Ex-military ? You've seen 50 year old aviators with the velcro let out all the way on the flight suit that still think they're Tom Cruise. Already been to Officer Candidate School, then bitch slapped in your first platoon as a butter bar ? You ought to know better by now.

 

[8744]

Yeah, you're missing something.

You're in what alcoholics in Rehab call the " Pink Cloud " Once reality sets in and you're out of the protected enviroment things get a little tougher.

1) yeah, your pts like you, they're probably crackheads and you got a Prescription Pad.
2) you're not working in an HMO...... yet
3) My friends respect me, I hook them up with cheap care, of course they
" respect" me. My military friends respect me, cause I'm really good at helping them get more disablity.
4) My professional friends " respect " me cause they're stuck in the same sinking boat I'm in.
5) My family admires me.... well, of course they do. I'm employed and not asking them for a loan. They admire my cousin at the Tire Shop too, he hooks them up on oil changes.
6) It's not your persona bud. It's the white coat, it's called a trophy wife and it comes with the package, along with the divorce at age 40 , the really bad rug, the blue nose, the 46 inch waistline that comes from overwork, the sports car (it's a lease). By then, you'll just be a dirty old man, not Dr. McDreamy and dammit, you better fill my Vicoden, you work for ME Docteer !
7) Ex-military ? You've seen 50 year old aviators with the velcro let out all the way on the flight suit that still think they're Tom Cruise. Already been to Officer Candidate School, then bitch slapped in your first platoon as a butter bar ? You ought to know better by now.

Just this morning, the daughter of one of my patients who had a heart-attack in the Emergency Department and who we got up to the cath lab in about fifteen minutes stopped me to say how much she and her family appreciated what I had done for them, my bedside manner, and the time I took (before the heart attack, I mean) to explain what we were going to do.

This happens to me all the time, and it is even starting to happen out in town where a patient will recognize me at Wal Mart and go out of their way to thank me.

Now, as many of you know I am perhaps the biggest cynic and critic of the medical proffession on SDN but "lack of respect" is not something you folks need to worry about provided you live up to your end of the deal and act like a physician.

You are just flat out wrong about this. I can separate the ass-kissing of a drug-seeker from the respect of a normal patient.

 

[Lokhtar]

It's not very tempting for me. If, for whatever reason, I cannot become a physician, I would get a PhD.

 

[deleted6669]

Just this morning, the daughter of one of my patients who had a heart-attack in the Emergency Department and who we got up to the cath lab in about fifteen minutes stopped me to say how much she and her family appreciated what I had done for them, my bedside manner, and the time I took (before the heart attack, I mean) to explain what we were going to do.

This happens to me all the time, and it is even starting to happen out in town where a patient will recognize me at Wal Mart and go out of their way to thank me.

Now, as many of you know I am perhaps the biggest cynic and critic of the medical proffession on SDN but "lack of respect" is not something you folks need to worry about provided you live up to your end of the deal and act like a physician.

You are just flat out wrong about this. I can separate the ass-kissing of a drug-seeker from the respect of a normal patient.

this isn't unique to md's though. pa's, nurses, paramedics, etc also get respect from their pts and colleagues. I also get the thank you notes, thank you at the market, etc from former pts.....

 

[Nasrudin]

For they and their patients I am pro mid level provider. For me I am pro not getting sandwiched in the thick bureaucracy of modern health care. The physician role is the only one with room enough to live breath and create in as limited as that is so no need to cue the desultory discussion of the "realities" of being a physician.

And while pleasant thankyou's are by no means the sole propriety of physicians respect is nearly their monopoly. But that's not the real issue.


OP, I have heard discouraging sentiments from physicians posing many of the argument you have suggested in favor of going the PA/NP route and yet their is something fundamentally wrong with heeding such advice--the physician does not wear the shoes of the PA.

The strongest evidence to me come is the form of action taken. PA's or nurses or NP's on this board and elsewhere frequently take up the path towards becoming a physician. If a physician grows weary of their field there are options for them to do other if less lucrative roles; so that they are stuck only by the choice and preservation of lifestyle.

For instance, although I've never seen it done, a physician could probably go to an easy AA program for nursing if they wanted less stress and more flexibility or they could be supervised by other physicians in a PA type role if they wanted to maintain their freedom outside of work. Or with a night EMT course at a community college they could even take my job if they really just wanted to say the hell with it.

But no. This won't happen. So retrospective advice of the road not taken by those ahead of me will remain unheeded by me.

 

[alpha62]

Just this morning, the daughter of one of my patients who had a heart-attack in the Emergency Department and who we got up to the cath lab in about fifteen minutes stopped me to say how much she and her family appreciated what I had done for them, my bedside manner, and the time I took (before the heart attack, I mean) to explain what we were going to do.

This happens to me all the time, and it is even starting to happen out in town where a patient will recognize me at Wal Mart and go out of their way to thank me.

Now, as many of you know I am perhaps the biggest cynic and critic of the medical proffession on SDN but "lack of respect" is not something you folks need to worry about provided you live up to your end of the deal and act like a physician.

You are just flat out wrong about this. I can separate the ass-kissing of a drug-seeker from the respect of a normal patient.

Wait till they come up and stick a gun in your face in the parking lot. They can see your house on Google Earth too. You're ER, got a metal detector in the waiting room ?

BTW, the worst drug seekers are the driving miss daisy types. If you'd had done your medical training in the military, you'd be ordered to write those Rxs and keep your mouth shut

Talks cheap, " respect " usually evaporates when the billing is due. You know who the worst is ? The wealthy. They think you're on a par with their gardener. Try sitting out in the waiting room sometime in street clothes and just listen for an hour.

 

[sexyman]

Alpha- Why such anger and bitterness against physicians?

What do you do? I am just curious as to what you are doing that makes you so content to be honest.

 

[t-funk]

Alpha- Why such anger and bitterness against physicians?

What do you do? I am just curious as to what you are doing that makes you so content to be honest.

He's a PA.

 

[sexyman]

o ok.

 

[8744]

Wait till they come up and stick a gun in your face in the parking lot. They can see your house on Google Earth too. You're ER, got a metal detector in the waiting room ?

BTW, the worst drug seekers are the driving miss daisy types. If you'd had done your medical training in the military, you'd be ordered to write those Rxs and keep your mouth shut

Talks cheap, " respect " usually evaporates when the billing is due. You know who the worst is ? The wealthy. They think you're on a par with their gardener. Try sitting out in the waiting room sometime in street clothes and just listen for an hour.

Are you for real? a) I did not do my medical training with the military so what this has to do with me is a mystery and b) I never said that I didn't have some demanding, drug seeking, and frankly verminous patients but only that most of them are decent people who appreciate good bedside manner, good humor, and the "C" word. (Compassion)

The wealthy, by the way, are some of my politest and least demanding patients.

Just as only Nixon could go to China, I think that on this topic I have the 'cred to assure all of you pre-meds that lack of respect is not, repeat not a problem in the medical profession.

 

[sexyman]

Panda Bear- you really don't have to explain yourself. I definitely understood exactly what you were saying in your original post.

I am not sure what the Alphas agenda is, but I suppose I can see why he would be upset with some of the posts in this thread.

I also hope that when I graduate my PA doesnt hate my guts! lol

 

[Nasrudin]

So from all of us who respect the work of our physicians enough to seek to become one of them and those physicians among us here that state it is not a problem we have established only a minimal criteria for one occupation vs. another.

Once your occupation surpasses the chronically disrespected and climbs past a modicum of respect to the level of people trust you with their life sight unseen in both the case of PA's and MD's the OP will have arrived at no useful criteria for distinguishing them. Even if there is some small difference between them at this stage you really are dealing with your inner napoleonic issues to make a decision on that alone.

What I've noticed from mid-level providers, my mother included, is that to be satisfied with the role requires that your supervising physician and you must get along rather well. Furthermore, there is only a certain type of person, who can place themselves into a middleman position and have the issue of one's ownership of task not bother them. In my opinion these blessed souls are rare and neither criteria is acceptable to me.

What I notice with many mid-levels instead is heated justification of their professional dignity, (a warning sign to me) which implies that the defense of it is necessary either for internal or external reasons. In fact I've noticed this from top to bottom up and down the entire chain of command in health care. Very few people are fully satisfied being the extension of somebody else's brain wherein the impetus to think is an obstruction to efficient care, Now clearly the PA/NP role is not that simply delineated as essentially they are providers. But I suspect that most if not some large percentage of them do not like the idea deferring critical thinking upwards rather than laterally as physicians in consult with one another. I see the large contingency of mid-level providers mixing it up here at the "Student Doctor Network" as exhibit A for this thesis.

What separates those who feel this way (and let's be honest most of us do--from nurse's assistant to X-ray tech--secretly or openly we all want to be physicians) from those who make good on their feeling is the effort to get into and to complete a medical education including residency. This is where the real decision making begins for those who might imagine themselves arriving at the various fixed destinations in the spectrum within health care.

Is it worth it...? My cautionary inclination is...do not make a regretful decision during a period of your life where you may be just in a phase of being tired or something of that sort.

 

[deleted6669]

Panda Bear- you really don't have to explain yourself. I definitely understood exactly what you were saying in your original post.

I am not sure what the Alphas agenda is, but I suppose I can see why he would be upset with some of the posts in this thread.

I also hope that when I graduate my PA doesnt hate my guts! lol

I'm a pa and I don't hate your guts, or the pandas. see, we can all get along.
peace brother.-e

 

[tiredfeetED]

Mr.HAT, I wish you the very best on your tough decision. I am soon to be PA graduating next month who like your self had decide which route to take.
The number one reason for me to go to pa school was having a family. Overall the experience has been great especially since i worked with doctors that were very pro midlevel.

Sure part of me still wishes that i went to med school. Like you stated more about pride than anything else. I talk about this with my preceptor quite often, he tells me that goes away real quick when you start residency.

Panda Bear, love your blogs! Even the one about PAs.
(now i am going back to bed)😴

 

[alpha62]

No MD hate here. I feel sorry for them. They bit off on the scam.
Wait till these baby boomers gain some ramming speed. They're going to wreck this country and this medical system. Being the captain of a sinking ship ain't something to gloat about. Blowing the happy smoke up people's ass here isn't really doing them a favor.

We're all going to wind up being nothing but socialized slaves to this retiring population. They've pissed away their lives partying and debauching and the majority of them have less than 50k saved. They figure we all owe them.

If you cherry-boys want to keep singing around the camp fire, that's ok with me, I'll have to admit, at this point I do get a sadistic kick out of watching your light bulbs go off everyday when you figure out how screwed you are.

If you're ex-military, you know the Jessica Lynch Story.... soft training, soft duty, lots of rainbows and unicorns, then all of the sudden, you and your positive attitude put you in a situation you're not ready to handle.

 

[notdeadyet]

Wait till these baby boomers gain some ramming speed. They're going to wreck this country and this medical system. ...
We're all going to wind up being nothing but socialized slaves to this retiring population. They've pissed away their lives partying and debauching and the majority of them have less than 50k saved. They figure we all owe them.

Sorry, this made me laugh. I love the idea of someone from a younger generation looking at the baby boomers and criticizing their sense of entitlement and lack of retirement savings.

They feel more entitled and saved for less than their parents, but the young now feel more entitled and saving less than the boomers. Ain't a specific generation thing, it's just the way of the world. It's like inflation.

 

[notdeadyet]

If you cherry-boys want to keep singing around the camp fire, that's ok with me, I'll have to admit, at this point I do get a sadistic kick out of watching your light bulbs go off everyday when you figure out how screwed you are.

Workplace sadism is a symptom of someone unhappy with their job. I'm sorry if things aren't working out.

There are lots of happy PAs and lots of unhappy PAs, some of whom are on this board looking for how to become MDs.

There are lots of unhappy MDs and lots of happy MDs. Do you know what one interesting trend is? All of the bitter MDs I know are the ones that came straight through at 22, fresh out of college.

The risk with choosing medicine as your career in your late teens is that you haven't become much of a frame of the adult you'll be yet. It's normal for folks to grow and change their minds through their early 20s. Lots of them become people who will be unhappy in mediicne. But unlike other careers, with the student loan and other binds, lots of folks feel stuck and unable to change. Hence the disgruntled physicians.

For those of us choosing medicine after working around in other fields first (most of us on this particular board), we have a better idea of what color the grass is over yonder. The next time you meet a bitter physician who talks about not getting paid what he deserves, having to work too many hours, and not having enough autonomy, ask him when he went into medicine. Probably at 22. Those of us who worked for years in other fields, especially professional ones, will tell you that many of the gripes are the same. Welcome to the working world.

 

[TarHeel55]

There are lots of unhappy MDs and lots of happy MDs. Do you know what one interesting trend is? All of the bitter MDs I know are the ones that came straight through at 22, fresh out of college.

That is interesting, and perhaps not surprising.

The unhappy MDs I know are all people who went into medicine because they felt intense pressure from their parents all their lives to be doctors. Some of them went to med school straight out of college. Others worked in business for a few years, and then went to med school. Strangely enough, though, even the people who took time off don't really like medicine.

 

[Instatewaiter]

Wait till these baby boomers gain some ramming speed. They're going to wreck this country and this medical system. Being the captain of a sinking ship ain't something to gloat about.

We're all going to wind up being nothing but socialized slaves to this retiring population. They've pissed away their lives partying and debauching and the majority of them have less than 50k saved. They figure we all owe them.

If you cherry-boys want to keep singing around the camp fire, that's ok with me, I'll have to admit, at this point I do get a sadistic kick out of watching your light bulbs go off everyday when you figure out how screwed you are.

If you're ex-military, you know the Jessica Lynch Story.... soft training, soft duty, lots of rainbows and unicorns, then all of the sudden, you and your positive attitude put you in a situation you're not ready to handle.

The sky is falling.

 

[Instatewaiter]

Wait till these baby boomers gain some ramming speed. They're going to wreck this country and this medical system.

Wait till they come up and stick a gun in your face in the parking lot.

They've pissed away their lives partying and debauching and the majority of them have less than 50k saved.

So angry old people are going to accost me in a parking lot?

 

[8744]

...If you're ex-military, you know the Jessica Lynch Story.... soft training, soft duty, lots of rainbows and unicorns, then all of the sudden, you and your positive attitude put you in a situation you're not ready to handle...

Perhaps the most nonsensical comment ever on SDN.

 

[notdeadyet]

Perhaps the most nonsensical comment ever on SDN.

Yeah, but I liked the rainbows and unicorns reference. Made me feel all cuddly inside...

 

[alpha62]

the sky isn't falling, the floor under you is dropping.

Due to Social Security Taxes, I'll take home about $2000 less this year. I doubt they'll be able to d/c the AMT. Within 5 years SS tax will be life long at any income. The boomers have raised the retirement age to 67 protecting themselves and socking it to the prime earnings years workers. They'll raise it again within the next 10 years. 401k ? it's a scam. what do you think the tax rate will be in 2030 ? You'll never pay less taxes.

What that leaves is you sucker,The 100k-500k income bracket. You know, a physician's avg pay range. The poor will pay no tax. Your income bracket will pay over 95% of the Taxes, and the ultra wealthy will pay less than you. They got wealthy starting a business or studying something else while in school.

The good new is you get to be called " Doctor " people give you high fives at Walmart. Of course they can, they're retired fool. They looted the natioal treasure and spending away your future. They got tons of time. Of course they'll pat you on the back.

 

[SN2BexpAt]

Methinks alpha62 needs a scrip for PO diazepam, 10 mg q4h?

This is the answer for my armchair Dx of PTSD with a chaser of falling asleep on Commusist Manifesto and a co morbidity of Conspiriosis.

 

[alpha62]

So angry old people are going to accost me in a parking lot?

Stay in Family Practice and as long as you keep driving the Ford Focus, you'll probably be allright. They'll figure you need the money more than they do.

 

[alpha62]

Methinks alpha62 needs a scrip for PO diazepam, 10 mg q4h?

This is the answer for my armchair Dx of PTSD with a chaser of falling asleep on Commusist Manifesto and a co morbidity of Conspiriosis.


Actually, my generation kept the communists at bay long enough to give you the luxury of making jokes about a collapsed system like that.

 

[alpha62]

Sorry, this made me laugh. I love the idea of someone from a younger generation looking at the baby boomers and criticizing their sense of entitlement and lack of retirement savings.

They feel more entitled and saved for less than their parents, but the young now feel more entitled and saving less than the boomers. Ain't a specific generation thing, it's just the way of the world. It's like inflation.

I'm 45 y/o and I've already saved more than the avg 65 y/o. Don't confuse California with the rest of the world. I've lived there and California deserves it's own planetary status since Pluto lost it's designation.

 

[notdeadyet]

Actually, my generation kept the communists at bay long enough to give you the luxury of making jokes about a collapsed system like that.

If you're 45 years old, you were 27 when the Berlin wall came down. I hate to break it to you, but it's the folks you're currently slamming for their lack of foresight and sense of indulgence are the ones who "kept the communists at bay". Oh, sweet irony.

Anyway, hope things improve at work. At the end of the day, it's just a job. No sense in letting it ruin the rest of life...

 

[notdeadyet]

I'm 45 y/o and I've already saved more than the avg 65 y/o.

Yeah, on a PA's salary, you should. Your average American family pulls in $32K/year. Let's keep some perspective.

 

[alpha62]

Yeah, on a PA's salary, you should. Your average American family pulls in $32K/year. Let's keep some perspective.

and that..... is my whole point. Why go to med school ? They're just going to redistribute you hard earned wealth and you're not really going to pull ahead.

Actually I'm quite happy, I've got a great job, work 4 on 4 off. I've probably got more time saved up in sick leave and vacation than some of these posters have in their entire time in medicine thus far.

Look, we've got to have MDs, but it's not what it used to be and I've been in this racket for 25 years. It's going to get worse and every Doc I know would love to get the hell out of it.

I've got a way better deal than most F.P. have. Some of the people on this board think their paycheck is generated from some mystical black box. They have absolutely no idea how under attack their lifestyle actually is, until it's too late and they close down the facility.

I help with the billing, I help with the Insurance claims and the collections. People on this board, particularly the students have no clue what they're walking into.

 

[alpha62]

If you're 45 years old, you were 27 when the Berlin wall came down. I hate to break it to you, but it's the folks you're currently slamming for their lack of foresight and sense of indulgence are the ones who "kept the communists at bay". Oh, sweet irony.

Anyway, hope things improve at work. At the end of the day, it's just a job. No sense in letting it ruin the rest of life...

Somebody should have told Ronald Reagan I was wasting my time and I could have gone to Panama instead. Those people you speak of didn't have a student deferrment. they went to school on the GI bill. Everybody else is sleeping on daddy's couch mooching off his GM pension.

You live in california, there's probably one of them in your office tomorrow getting treated for Hep C after the last days of disco. Selling t-shirts on the beach has a really crappy insurance plan. I'm sure you don't mind seeing Mr. Purple Haze for free.

 

[Instatewaiter]

Due to Social Security Taxes, I'll take home about $2000 less this year.

What that leaves is you sucker,The 100k-500k income bracket. You know, a physician's avg pay range. The poor will pay no tax. Your income bracket will pay over 95% of the Taxes, and the ultra wealthy will pay less than you. They got wealthy starting a business or studying something else while in school.

And due to income taxes you'll probably take home 20+K less. Big whoop.

I dont really see how your "dooms day scenario" changes anything. Already the wealthiest 1% earn 21% of all income yet pay 35% of the taxes. You can thank the graduated tax system.

The poor already dont pay taxes if they make below a certain amt.

In reality the ultra wealthy have to pay more than me for a number of reasons:
1) They make more money than me so even if we were to pay the same percentage of our income, just by the sheer fact that they make more money means they will pay more taxes
2) Graduated income tax- they do pay a larger percentage of their income

You're starting to be ridiculous.

The sky is not falling. There is still a solid job with good pay that will be waiting for us. Will it be as lucrative as it once was- no. Will I get the same respect that my grandfather or father got- no.

Hell when my grandfather was in practice everyone would come to see him wearing their Sunday best just because he was the doctor and they felt he deserved that level of respect. I'm not expecting that to happen.

So back to the OP:
It sounds like you have thought out the options. You are relatively old and medical school, residency and potentially fellowship are long. If I were in your shoes I would probably opt for the PA route just because it carries with it less debt, less time commitment and would allow me to practice for longer. Really if you had more time to practice it would be different.

But what do I know, I'm just a sucker.

 

[notdeadyet]

Somebody should have told Ronald Reagan I was wasting my time and I could have gone to Panama instead. Those people you speak of didn't have a student deferrment. they went to school on the GI bill. Everybody else is sleeping on daddy's couch mooching off his GM pension.

You live in california, there's probably one of them in your office tomorrow getting treated for Hep C after the last days of disco. Selling t-shirts on the beach has a really crappy insurance plan. I'm sure you don't mind seeing Mr. Purple Haze for free.

Sorry, bud, I'd love to play, but your posts are starting to read as nonsensical. I don't know if it's alcohol or just a personal writing style, but I have to scratch my head to understand what you're trying to communicate.

Anyway, no worries. I'm glad you're glad with your decision to go PA. Some of us wouldn't be. And if every Doc you know would really like to flee medicine, you might look into a new environment. Your institution sounds dodgy....

 

[Perrotfish]

The unhappy MDs I know are all people who went into medicine because they felt intense pressure from their parents all their lives to be doctors. Some of them went to med school straight out of college. Others worked in business for a few years, and then went to med school.

Uggh, you can see them even in their M1 year. It's always the ones who are doctors' kids, too. They're also always the ones who have the longest, most elaborate stories about their 'passion for medicine' that you have to wade through before you can find out that Mommy and Daddy both just happen to be Orthos.

No question, though, that one thing I've seen in a lot of M1s I've met it that they seem to expect that when they get through residency it's going to be non-stop fun and intersting. No real expectectation that it might feel sorta like every other kind of work on the planet.

 

[8744]

...The good new is you get to be called " Doctor " people give you high fives at Walmart. Of course they can, they're retired fool. They looted the natioal treasure and spending away your future. They got tons of time. Of course they'll pat you on the back...

A sincere expression of gratitude, given sincerely and humbly received is not a "high five" at Wal Mart. I bite my toungue to say it but not everything is about money.

 

[alpha62]

And due to income taxes you'll probably take home 20+K less. Big whoop.

I dont really see how your "dooms day scenario" changes anything. Already the wealthiest 1% earn 21% of all income yet pay 35% of the taxes. You can thank the graduated tax system.

The poor already dont pay taxes if they make below a certain amt.

In reality the ultra wealthy have to pay more than me for a number of reasons:
1) They make more money than me so even if we were to pay the same percentage of our income, just by the sheer fact that they make more money means they will pay more taxes
2) Graduated income tax- they do pay a larger percentage of their income

You're starting to be ridiculous.

The sky is not falling. There is still a solid job with good pay that will be waiting for us. Will it be as lucrative as it once was- no. Will I get the same respect that my grandfather or father got- no.

Hell when my grandfather was in practice everyone would come to see him wearing their Sunday best just because he was the doctor and they felt he deserved that level of respect. I'm not expecting that to happen.

So back to the OP:
It sounds like you have thought out the options. You are relatively old and medical school, residency and potentially fellowship are long. If I were in your shoes I would probably opt for the PA route just because it carries with it less debt, less time commitment and would allow me to practice for longer. Really if you had more time to practice it would be different.

But what do I know, I'm just a sucker.

You're not a sucker, just a socialist. Keep Castro on your xmas card list for at least one more year.

 

[alpha62]

look at your own quarterly lic. board report sometime.

Believe me, the whole outfit is " dodgy "

 

[sexyman]

I don't believe in income tax at all- so obviously you can imagine how I feel about a graduated income tax system as opposed to a flat rate.

- But I dont see why I should purposely not try and make as much money as possible in the field I am most interested in because I am going to have to pay more taxes....it just seems like I will be letting them win that way.

 

[Perrotfish]

EDIT
This is a problem?

 

[alpha62]

This is a problem?

Not if you plan on moving to South Dakota and buy her lots of big bulky sweaters.

If you choose F.P. or Peds, you might have problems finding an extra $ 15k for these types of expenses, but then finding the extra money to replace the water heater will probably be a problem so boobs may not ever get to be an issue.