MD or PA?..

[qwe7791]

I've always wanted to pursue MD because it was what everyone was telling me to do and I personally like the idea of calling the shots, making good money, and have a respectable job. However, I would have to be in medical school 4 years in addition to years in residency.

On the other hand, there's PA school. I like the idea of having more time to myself and my future wife and kids, not having take care of the intricacies of paperwork, making low six figure salary which I'm okay with, but I would be giving up the authority to call the shots and the level of respect I will be given will vary..

I'm so torn that I can't decide which to pursue. I've spoken to some doctors and some say if they had to do it all over again, they would. Others disagree. As for PA's, some tell me that they absolutely love their job, but others regret their decision and wished to have pursued medical school instead..

Help?

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[MyNameWasUsed]

I was on the MD path until after junior year of college and decided to pursue PA. For me it was a more balanced lifestyle. There are pros and cons of both profession. Doctors have 4 years of med schools and at least 3 years of residency and they make more money depending on what you want to specialize in. I think a common misconception is that "PAs have more time for family/life than doctors" and I dont think thats true. It might be true in terms of education but once you're in the profession, both PA and doctors can choose to have a more balanced lifestyle. There are doctors that work 36 hr/weeks in emergency and there are those who work 80 hr/week. There are PAs who work shifts that doctors don't want to work such as graveyard and holidays and then there are PAs that work 36hr/week in ER. Balanced lifestyle is a choice.

 

[imitatepl]

Are there any more views on this, please? I'm considering PA/MD and am confused. I talked to a MD this morning and she suggested PA. She said she loves her job and lifestyle, but politically, the future holds less and less rewards for MD/DO.

Any thoughts?

 

[qwe7791]

Are there any more views on this, please? I'm considering PA/MD and am confused. I talked to a MD this morning and she suggested PA. She said she loves her job and lifestyle, but politically, the future holds less and less rewards for MD/DO.

Any thoughts?

What kind of doctor is she? Family doc? Specialty?

 

[shapoopie]

I just finished medical school, and am about to start general surgery residency, so I of course have not experienced all the difficulties of a hardcore resident life yet. But if I were given the opportunity to choose between those 2 options, I would pick MD every time. Yes med school is hard, but I think in the end it is worth it if its what you truly love. As an MD (and I'm not belittling PAs), you will call the shots, you are in charge, and your fund of knowledge is vastly greater.

 

[deleted480308]

I was on the MD path until after junior year of college and decided to pursue PA. For me it was a more balanced lifestyle. There are pros and cons of both profession. Doctors have 4 years of med schools and at least 3 years of residency and they make more money depending on what you want to specialize in. I think a common misconception is that "PAs have more time for family/life than doctors" and I dont think thats true. It might be true in terms of education but once you're in the profession, both PA and doctors can choose to have a more balanced lifestyle. There are doctors that work 36 hr/weeks in emergency and there are those who work 80 hr/week. There are PAs who work shifts that doctors don't want to work such as graveyard and holidays and then there are PAs that work 36hr/week in ER. Balanced lifestyle is a choice.

it's a misnomer that PAs "work the shifts the MDs don't want to"....they aren't interchangable

 

[W19]

it's a misnomer that PAs "work the shifts the MDs don't want to"....they aren't interchangable

It's not quit a misnomer because many PA work for physicians. If a PA, for instance, is working for me, he/she will have to cover calls on holidays that I don't want to work. A friend of mine who is an NP told me that and that is the reason she no longer wants to work for physician.

 

[deleted6669]

it's a misnomer that PAs "work the shifts the MDs don't want to"....they aren't interchangable

while I would agree that PA training does not equal MD training, they ARE often interchangeable in many settings.
at 2 of 3 of my jobs I am scheduled interchangeably with docs. I cover their shifts, take sign out on their pts when they leave, etc.
these are both solo coverage shops staffed with either a doc or me. when I (or another pa) is there we direct medics in the field, do all procedures and see all patients, run codes, intubate, cardiovert, give tpa for cva/mi, admit pts, etc.
In fact, the last code I ran (at shift change earlier this week) the doc was glad I was there to do it because I am more comfortable running codes that he ( an fp doc) is.
that being said- if deciding md vs pa, I would do md at this point. it took me almost 20 years to work myself into a quality job that an er doc could have had day 1 out of residency. I have to drive hours to rural facilities to have that scope of practice as well.

 

[Makati2008]

while I would agree that PA training does not equal MD training, they ARE often interchangeable in many settings.
at 2 of 3 of my jobs I am scheduled interchangeably with docs. I cover their shifts, take sign out on their pts when they leave, etc.
these are both solo coverage shops staffed with either a doc or me. when I (or another pa) is there we direct medics in the field, do all procedures and see all patients, run codes, intubate, cardiovert, give tpa for cva/mi, admit pts, etc.
In fact, the last code I ran (at shift change earlier this week) the doc was glad I was there to do it because I am more comfortable running codes that he ( an fp doc) is.
that being said- if deciding md vs pa, I would do md at this point. it took me almost 20 years to work myself into a quality job that an er doc could have had day 1 out of residency. I have to drive hours to rural facilities to have that scope of practice as well.

Agreed. My last rural job(which was actually 3 critical access hospitals in a 30mi radius) scheduled us interchangeably with Physicians. Now the urban/suburban jobs this is not going to happen. I've been in both set of shoes(PA and now physician) and both are good jobs with pros/cons. If you are wiling to do rural EM then I would recommend PA+EM fellowship.

 

[deleted480308]

Rural staffing is not something I'm familiar with.....are you saying I can walk into a rural em and find 2 pas there with no doc?

 

[Makati2008]

Rural staffing is not something I'm familiar with.....are you saying I can walk into a rural em and find 2 pas there with no doc?

Those jobs are usually single coverage and it wasn't uncommon for a PA to cover 6 out of 7 days per week(we had a Doc that worked every Tuesday night consistently). The Physicians were available via phone support. Some abused this privilege( the docs were supposed to be within 30 min radius but some would be much farther away and sometimes working at another ED.)

Is having single coverage with MLP ideal- I don't know. But when these hospitals recruit Physicians heavily and they won't come then a MLP is providing an invaluable service. I just wish the Physicians that are quick to judge a midlevel working in a ED alone(rurally) would at least be willing to work in that same area.(most don't just like the great majority of MLP don't either)

 

[deleted480308]

Is having single coverage with MLP ideal-

It's not ideal at all. But if the pay isn't enough to get a doc to show up, and MLP is still far better than nothing

 

[betamale]

I wanted to be called a doctor so I went the MD route, plus, I have issue with authority so working for somebody is not an option. If you want a well-paying career with better FLEXIBILITY, go be a PA. Being able to pick up, move, and change specialties is just a hell lot harder as an MD.

 

[Makati2008]

It's not ideal at all. But if the pay isn't enough to get a doc to show up, and MLP is still far better than nothing

It's not pay but location. I did VERY well there. But with the way medicine is, it could be much less now.

 

[deleted6669]

I make $20 more/hr to see 8-10 pts in a 12 hr shift at a rural facility than I do to see 30-35 pts/12 hr shift at an urban trauma ctr.
the difference is that the acuity is MUCH higher at the rural facility. I have never cardioverted at my urban job. I cardiovert regularly at my rural job. also do stuff usually done by specialists in the big city like inject phenylephrine into the cavernosum for priapism, etc (no urologist within 3 hrs drive).
I agree that in a perfect world a residency trained/boarded em doc would be the ideal staffing for every ER. a good em pa though is better than the vast majority of non-em physicians if that is not an option. I have seen rural facilities staffed by moonlighting dermatologists and nephrologists. that is really not ideal at all.
ps I have never called the back up doc when on at a rural facility. I call specialists for advice and the hospitalist to admit, but have never called the call doc (generally an fp doc). don't think any of the other pas have either.

 

[deleted6669]

It's not ideal at all. But if the pay isn't enough to get a doc to show up, and MLP is still far better than nothing

gee thanks.

 

[deleted480308]

gee thanks.

I like pas....but the gold standard in em is an em doc. It's not personal

 

[dr.1Day@Atime]

while I would agree that PA training does not equal MD training, they ARE often interchangeable in many settings.
at 2 of 3 of my jobs I am scheduled interchangeably with docs. I cover their shifts, take sign out on their pts when they leave, etc.
these are both solo coverage shops staffed with either a doc or me. when I (or another pa) is there we direct medics in the field, do all procedures and see all patients, run codes, intubate, cardiovert, give tpa for cva/mi, admit pts, etc.
In fact, the last code I ran (at shift change earlier this week) the doc was glad I was there to do it because I am more comfortable running codes that he ( an fp doc) is.
that being said- if deciding md vs pa, I would do md at this point. it took me almost 20 years to work myself into a quality job that an er doc could have had day 1 out of residency. I have to drive hours to rural facilities to have that scope of practice as well.

Because you ARE a PA, and you are NOT happy with your decision of becoming one... what would you say are the 3 BIGGEST issues you have with being a PA? Just your top problems...?

 

[Makati2008]

Because you ARE a PA, and you are NOT happy with your decision of becoming one... what would you say are the 3 BIGGEST issues you have with being a PA? Just your top problems...?

For me it was lack of true autonomy, respect and not being micromanaged when I am 50years old. Also the pay is better for physicians in my specialist vs PAs

 

[CircadianRhythm]

I understand the desire to take council from more experienced providers but the answer needs to come from within. There are just too many variables at play here.

There could be a CT surgery PA who takes call and works 80 hours a week along side the surgeon who might think "you know I have the stamina, I could have made it through residency and fellowship". That realization could cause regret. On the flip side I know an ENT who loathes operating and the responsibility associated. She couldn't wait to go into a purely admin position. She is young too, she became a doctor for the prestige and hated the reality of practice.

Shadow providers of both, do your research and ask yourself what your ultimate priorities are. And make the best of whichever path you choose and things should be fine.

 

[deleted6669]

Agreed. My last rural job(which was actually 3 critical access hospitals in a 30mi radius) scheduled us interchangeably with Physicians. Now the urban/suburban jobs this is not going to happen. I've been in both set of shoes(PA and now physician) and both are good jobs with pros/cons. If you are wiling to do rural EM then I would recommend PA+EM fellowship.

just happened. I got recruited out of the blue and unsolicited to cover a suburban community hospital emergency dept on nights. low volume, but still not rural by any means. I (and the other pas who work this job) will be the only pas in the state working solo coverage at a community hospital in a non-rural location...for $25/hr more than I make at my regular job. If I like it after a few months I may quit my day job and just do this + the 2 rural sites.

 

[Makati2008]

just happened. I got recruited out of the blue and unsolicited to cover a suburban community hospital emergency dept on nights. low volume, but still not rural by any means. I (and the other pas who work this job) will be the only pas in the state working solo coverage at a community hospital in a non-rural location...for $25/hr more than I make at my regular job. If I like it after a few months I may quit my day job and just do this + the 2 rural sites.

What's the volume roughly and thats a good setup

 

[deleted6669]

What's the volume roughly and thats a good setup

8-10 PTS/12 HR SHIFT

 

[Makati2008]

8-10 PTS/12 HR SHIFT

That's a nice gig.

 

[Boatswain2PA]

........I'm so torn that I can't decide which to pursue. ....Help?

Right now, go for both. Since the preparation for MD is much harder than the preparation for PA, prepare yourself to apply to MD schools. While you're at it, apply to PA schools. If you don't get into either, time for something else. If you get into PA school but not MD school....then the decision is made for you. If you get into both, then ya gotta figure it out.

I was on the MD path until after junior year of college and decided to pursue PA. For me it was a more balanced lifestyle. There are pros and cons of both profession. Doctors have 4 years of med schools and at least 3 years of residency and they make more money depending on what you want to specialize in. I think a common misconception is that "PAs have more time for family/life than doctors" and I dont think thats true. It might be true in terms of education but once you're in the profession, both PA and doctors can choose to have a more balanced lifestyle. There are doctors that work 36 hr/weeks in emergency and there are those who work 80 hr/week. There are PAs who work shifts that doctors don't want to work such as graveyard and holidays and then there are PAs that work 36hr/week in ER. Balanced lifestyle is a choice.

If you're an BC/BE EM Doc making $250 an hour, you can work 20 hours a week and make $250,000 a year. I make great money as a PA (will probably gross $170K this year), but that's working much more than full time. Who has the better balanced lifestyle??

Rural staffing is not something I'm familiar with.....are you saying I can walk into a rural em and find 2 pas there with no doc?

I work locums in several places, all but one is single coverage. Sometimes you can go in and find a physician (usually FP), othertimes you can go in and find a PA. Sometimes you can even find an NP.

It's not ideal at all. But if the pay isn't enough to get a doc to show up, and MLP is still far better than nothing

I would suggest that, perhaps, having a PA who specializes in EM would be better than having a family practice physician. As the PA profession continues to specialize (with CAQs & such) the benefit of having a specialist PA may become even greater.

I wanted to be called a doctor so I went the MD route, plus, I have issue with authority so working for somebody is not an option. If you want a well-paying career with better FLEXIBILITY, go be a PA. Being able to pick up, move, and change specialties is just a hell lot harder as an MD.

Hate to break it to you Doc, but you're always gonna work for someone. If you're at the top of the food chain you suddenly realize that YOU work for ALL of your CUSTOMERS.

Agree that it is still much easier to change specialties as a PA. That is changing though.

I like pas....but the gold standard in em is an em doc. It's not personal

Absolutely agree. Just last night my son's girlfriend got into an MVA. I made sure she went to tertiary care center with a BC EM physician (who I trained with) because they are, indeed, the gold standard. He didn't do anything I wouldn't have done, but I wanted to make sure she got the absolute best care possible.

But on the other end of the spectrum, a year ago my daughter got into an MVA and went to the other tertiary care center in town, also staffed with BC EM physicians, and she got absolutely terrible care. Absolutely terrible care. She would have gotten better care if I had taken her to one of the surrounding rural hospitals that I work in and seen the PA on duty that night.

But bottom line is that not every community can afford to have a BC EM physician on board 24/7.

 

[deleted480308]

Right now, go for both. Since the preparation for MD is much harder than the preparation for PA, prepare yourself to apply to MD schools. While you're at it, apply to PA schools. If you don't get into either, time for something else. If you get into PA school but not MD school....then the decision is made for you. If you get into both, then ya gotta figure it out.



If you're an BC/BE EM Doc making $250 an hour, you can work 20 hours a week and make $250,000 a year. I make great money as a PA (will probably gross $170K this year), but that's working much more than full time. Who has the better balanced lifestyle??



I work locums in several places, all but one is single coverage. Sometimes you can go in and find a physician (usually FP), othertimes you can go in and find a PA. Sometimes you can even find an NP.



I would suggest that, perhaps, having a PA who specializes in EM would be better than having a family practice physician. As the PA profession continues to specialize (with CAQs & such) the benefit of having a specialist PA may become even greater.



Hate to break it to you Doc, but you're always gonna work for someone. If you're at the top of the food chain you suddenly realize that YOU work for ALL of your CUSTOMERS.

Agree that it is still much easier to change specialties as a PA. That is changing though.



Absolutely agree. Just last night my son's girlfriend got into an MVA. I made sure she went to tertiary care center with a BC EM physician (who I trained with) because they are, indeed, the gold standard. He didn't do anything I wouldn't have done, but I wanted to make sure she got the absolute best care possible.

But on the other end of the spectrum, a year ago my daughter got into an MVA and went to the other tertiary care center in town, also staffed with BC EM physicians, and she got absolutely terrible care. Absolutely terrible care. She would have gotten better care if I had taken her to one of the surrounding rural hospitals that I work in and seen the PA on duty that night.

But bottom line is that not every community can afford to have a BC EM physician on board 24/7.

In our socialized, everyone gets it even if they can't afford it world? Yes they can

Market driven? You are correct

 

[Boatswain2PA]

In our socialized, everyone gets it even if they can't afford it world? Yes they can

That would involve a Komrad Komissioner issuing orders for EPs to go to Galt's Gulch Arkansas (Population 2500) to be available in the ED 24/7/365. While that is, indeed, the direction we are heading, I'm not sure we will actually get that far before a true revolution starts.

 

[deleted480308]

That would involve a Komrad Komissioner issuing orders for EPs to go to Galt's Gulch Arkansas (Population 2500) to be available in the ED 24/7/365. While that is, indeed, the direction we are heading, I'm not sure we will actually get that far before a true revolution starts.

Yeah, the powers that be will simply start declaring other professionals as interchangable in order to increase the available pool and lower costs...

 

[W19]

@sb247 To be honest, it will come to a point where medical education has to change because of market forces... I have seen a youtube video in the gas forum and I think it was appalling that even physicians (surgeons) were somewhat saying: Oh well! there is no difference b/t CRNA and MD/DO...It's long overdue to dump the Flexner Report and come up with a shorter and more effective way to train physicians. I believe that can be done anywhere from 7 to 10 years...(2-year prereq+ 3-year med school and 2-5 years residency).

 

[deleted480308]

@sb247 To be honest, it will come to a point where medical education has to change because of market forces... I have seen a youtube video in the gas forum and I think it was appalling that even physicians (surgeons) were somewhat saying: Oh well! there is no difference b/t CRNA and MD/DO...It's long overdue to dump the Flexner Report and come up with a shorter and more effective way to train physicians. I believe that can be don anywhere from 8 to 11 years...(2-year prereq+ 3-year med school and 2-5 years residency).

I think there is a wide gulf between, "people don't care enough about the difference to pay for it" and "there is no difference". That being said, I think your prediction is underway

 

[MrsNonTraditionalMD]

I wanted to be called a doctor so I went the MD route, plus, I have issue with authority so working for somebody is not an option. If you want a well-paying career with better FLEXIBILITY, go be a PA. Being able to pick up, move, and change specialties is just a hell lot harder as an MD.

This is my sentiment exactly. This confirms that MD is the best route for me.