P.A. vs M.D. job satisfaction?

[j2n]

Like many nontraditional students, I'm grappling with the decision as to which direction to take in medicine. I have extensive experience in research, wilderness medicine, as an EMT, and most recently as a medical case manager for a wilderness therapy program. I have had the opportunity to work directly under two physicians for the past two years and work autonomously, along with being the primary caretaker for a terminally ill parent (extensive exposure to the patient/family perspective). I have also had the opportunity to observe my older sister's path as a medical student and now a neurologist, along with a long term relationship with an M.D/Ph.D. student. What is interesting is that every single physician that I interact with has discouraged me from pursuing an M.D. They all wish they had chosen a different career and they all have a negative outlook on the future of medicine. The most resounding negative voices were from my sister and the M.D./Ph.D. student, who are both incredibly high achieving and attended ivy league institutions (so I'm wondering if their perspective is skewed due to their high pressure environments). What is more concerning to me is the increased incidence of depression and suicidal ideation among physicians (http://emedicine.medscape.com/article/806779-overview). I'm wondering if these trends are the same for physician assistants. I would greatly appreciate any contributions from practicing physicians and P.A.s.

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[QofQuimica]

You have to take everything a trainee says with a grain of salt, because yes, medical training does suck in many ways. Some of that suckiness does get better once you graduate from residency. That being said, there are many unhappy docs who feel trapped in medicine just as there are many unhappy people in any other profession. The difference is that in medicine, it's hard to be able to afford to quit if you find that you don't like it once you get here. So keep talking to lots of people, and shadow some more docs and some PAs too. You want to make your decision for the right reasons. Best of luck to you.

 

[chooks]

There is one very powerful trait that non-traditional students bring to medical training: perspective. If you have had a job in the "real" world you know that there are s*** days, s*** jobs, s*** coworkers, and that medicine is no different in that respect. I think that people who are straight traditional students or MD/Phds do not have that perspective and so get bogged down in the negative side of things. Additionally if you go into medicine for the wrong reasons (e.g. money, stable job, pens with pharma logos, ..., whatever) then of course you may feel negatively about the profession if some of those things are less than your expectation.

A neurosurgery resident told me "...if there is anything other than neurosurgery that can make you happy...do it" and I think that is actually good general advice for a career in medicine. If there is something else that will make you happy, then do it and don't do medicine. There are certainly much easier ways to make a stable living, make good money, get pharma pens, etc... without taking 10 years or so out of your life and racking up $$$$$ in debt.

So ultimately you need to look at what you want to get out of life and put everyone's advice into perspective. When I was struggling with the choice of leaving my nice-comfy job for medical school, an advisor told me that "ships are built to sail, not sit in the harbor". You just need to decide what kind of ship you want to be. As has been mentioned, shadowing/volunteer work is a good way to help figure this out.

For my part, I am in my final year of residency training and would do it all over again in a heartbeat. It has been a wild crazy upside down trip but awesome in so many ways and I am grateful that I was able to make the career switch. Aside from the day I cut myself on contaminated equipment, my worst day in medicine has been better than my best day in my 6 figure salary, 40 hour work week job (this statement may make other residents/attendings think I am crazy for having left said job, but...my ship has thankfully sailed 🙂.

- chooks

 

[Family practice PA]

I am a PA, and will be applying to medical school. Ultimately, I love my job and my patients, but feel like I don't know enough. At my clinic, I practice very independently with little support. I have friends that practice in clinics where the docs are very supportive, love to teach, and are always available for questions. They are of the opinion that I am crazy to go back to school, and that I should look for another job where I can find more supportive MDs. Personally, I think that I will always feel like I don't know enough, but then again, I am in family practice (which I think is very difficult). If I had specialized, I might not feel this way.

I know many PAs that are very glad they did not go to med school, and many docs who wish they went to PA school instead. It is a very personal decision, and I don't even know that I am making the right one! I just know that if I don't, I will regret it. Feel free to PM me if you have any specific questions.

 

[dorothyntoto]

I as a non-trad also contemplated PA vs MD/DO. As a 3rd year, I'll say this, you better really REALLY want to be a doctor because med school DOES suck for non-trads. I think for 22 year olds who have never had a real job or lived away from their parents besides at college, or whatever, sure it's not so bad. For non-trads, it's hard. I contemplated dropping out in the middle of second year. All of that is not to say that you should go to PA school however. You need to decide what is best for you as a career. Do you want the easier schooling, less pay, similar work, less responsibility of a PA? Or do you want the whole shebang? As hard as medical school has been, I have never told a single person not to go, unless there is a caveat. Make no mistake, there are days it F'ING sucks *&*(&#)(*%)@&%^& (fill in your own expletive), but I also know everyday in rotations it will be worth it 5 years from now...

 

[Darth Doc]

I am also a PA, and I'm in my first year of medical school. I'm back in school because I love medicine and am thrilled to learn to practice it better. Yes, the future has the potential to be horrible for doctors. One of the docs I worked with recently encouraged me to go to medical school, but encouraged his daughter not to do it. Medicine isn't right for everyone and not everyone who goes into it is happy (statistically it's about 50/50 depending on specialty).

Some (most) PA's don't understand why I went back to school. They love what they do and can't understand why anyone would go back to medical school. One even got offended when she found out.

My version of the old saying about the grass being greener on the other side of the fence.... there's spots of green grass just about everywhere, what matters is whether the brown dead spots in that field bother you or not.

 

[JW2020]

I as a non-trad also contemplated PA vs MD/DO. As a 3rd year, I'll say this, you better really REALLY want to be a doctor because med school DOES suck for non-trads. I think for 22 year olds who have never had a real job or lived away from their parents besides at college, or whatever, sure it's not so bad. For non-trads, it's hard. I contemplated dropping out in the middle of second year. All of that is not to say that you should go to PA school however. You need to decide what is best for you as a career. Do you want the easier schooling, less pay, similar work, less responsibility of a PA? Or do you want the whole shebang? As hard as medical school has been, I have never told a single person not to go, unless there is a caveat. Make no mistake, there are days it F'ING sucks *&*(&#)(*%)@&%^& (fill in your own expletive), but I also know everyday in rotations it will be worth it 5 years from now...

This really depends what type of non trad we are talking about. Married with a family/expecting kids during med school, then yes that is certainly significantly harder than your 22 yr old medical student. But I'd argue a non trad who did a post-bacc while working/knows the grind of studying for the MCAT round the clock at home while working a full 40 hour week on top of it/insert comparable scenario etc would be more comfortable in terms of time management and would have a better idea of what it takes to stay balanced. I think this is something that someone who is 22 and straight out of undergrad would be the most likely to struggle with. If you're a single non trad or in a relationship but don't have kids +supportive SO, I would argue you may be more ready for the overall grind and rigor, depending on your life experience and adaptivity.

 

[dorothyntoto]

This really depends what type of non trad we are talking about. Married with a family/expecting kids during med school, then yes that is certainly significantly harder than your 22 yr old medical student. But I'd argue a non trad who did a post-bacc while working/knows the grind of studying for the MCAT round the clock at home while working a full 40 hour week on top of it/insert comparable scenario etc would be more comfortable in terms of time management and would have a better idea of what it takes to stay balanced. I think this is something that someone who is 22 and straight out of undergrad would be the most likely to struggle with. If you're a single non trad or in a relationship but don't have kids +supportive SO, I would argue you may be more ready for the overall grind and rigor, depending on your life experience and adaptivity.

Hi... 3rd year non-trad med student here (maybe it was missed)... You can make assumptions all you want about what med school is going to be like and who is going to be successful. I do not have kids. I can promise you my younger 22-25yr old friends by and large do better than I do especially with stamina. I get tired, I need sleep. I didn't need as much sleep at 22, now I need at least 6hrs prior to a test. I worked 40+ and did full-time courses; med school is still hard, and I'd argue harder for me than my friends. It isn't always about ability to study or organization; there are intangible things like being used to autonomy that you no longer have. Having to remember that your new place is at the absolute bottom of the totem pole, versus being somewhere in the middle, and should you not remember it, you will swiftly be reminded of it... So you can argue all you'd like about what you think is or isn't going to happen in medical school. Until you're actually there, you really have no idea. I was in the same position you are in 2011-12... then whamo it hits you like a 2x4. It's like a male OB trying to say he understands anything about having a uterus... just one of those things you'll never know until you experience it first hand.

 

[baronzb]

There is one very powerful trait that non-traditional students bring to medical training: perspective. If you have had a job in the "real" world you know that there are s*** days, s*** jobs, s*** coworkers, and that medicine is no different in that respect. I think that people who are straight traditional students or MD/Phds do not have that perspective and so get bogged down in the negative side of things. Additionally if you go into medicine for the wrong reasons (e.g. money, stable job, pens with pharma logos, ..., whatever) then of course you may feel negatively about the profession if some of those things are less than your expectation.

A neurosurgery resident told me "...if there is anything other than neurosurgery that can make you happy...do it" and I think that is actually good general advice for a career in medicine. If there is something else that will make you happy, then do it and don't do medicine. There are certainly much easier ways to make a stable living, make good money, get pharma pens, etc... without taking 10 years or so out of your life and racking up $$$$$ in debt.

So ultimately you need to look at what you want to get out of life and put everyone's advice into perspective. When I was struggling with the choice of leaving my nice-comfy job for medical school, an advisor told me that "ships are built to sail, not sit in the harbor". You just need to decide what kind of ship you want to be. As has been mentioned, shadowing/volunteer work is a good way to help figure this out.

For my part, I am in my final year of residency training and would do it all over again in a heartbeat. It has been a wild crazy upside down trip but awesome in so many ways and I am grateful that I was able to make the career switch. Aside from the day I cut myself on contaminated equipment, my worst day in medicine has been better than my best day in my 6 figure salary, 40 hour work week job (this statement may make other residents/attendings think I am crazy for having left said job, but...my ship has thankfully sailed 🙂.

- chooks

I would actually disagree with this statement, about it being better after one has worked. Contrarily, one needs to be an idealistic, naive, maybe young? student to do medicine. It is so hellish, that having another life to compare it to is bad news for morale, which one needs in abundance to get through; however, I have heard people say it gets better after residency. How so?

 

[W19]

I'll echo what another poster said above: If there is something else that can make you happy, do it instead. Med school sucks for nontrad.

 

[sandstone]

I was a climbing guide and have been into wilderness medicine and stuff for a long time. I went through the intense internal debate of med school vs. PA school for a while. I'm now in my mid-30s, have two small kids, and am in my third year of medical school. It definitely sucks sometimes, and having to handle two huge life challenges (med school and parenting) is extremely difficult at times. As said above, it totally sucks to be at the bottom of the totem pole.

However, I am so happy I chose medical school. I want to be an orthopedic surgeon now and I'm SO happy that I have that option! I think being an ortho PA would not cut it for me and I would be quite regretful if I hadn't gone to med school to become an actual surgeon.

Med school doesn't have to be that bad for non-trads. I've done well in school and spent tons of time with my family over these past three years. While having a family can make school harder because of the time commitment, in some ways it's really helped me. I have been forced to become ultra efficient and to not constantly think about and stress about school all the time. This has helped me substantially and I think it's partly why I've been able to do better than most of my younger, single classmates who spend way more time studying than I do.

Even if I don't make it into ortho, I'll still be happy in whatever backup specialty I choose (FM or EM probably). I'll know that I went as far as I could and tried my hardest and didn't limit myself. While the schooling is hard, I find it overall enjoyable to learn so much interesting material, much of which I wouldn't have gotten in PA school. As someone above said, being a non-trad gives you good perspective. While guiding was awesome, I also worked plenty of ****ty manual labor jobs. I'll tell you I think some of my younger classmates are a bunch of whiners and have no idea how much more ****ty than med school it is to work 50 hours/week of landscaping or something like that.

Sure I've met some unhappy docs. However, most of the docs I've worked with so far are super happy in their jobs. It really comes down to personality. Some would be unhappy no matter what they were doing while others appreciate how great their job and pay is compared to what most people in the world have.

Taking the PA path would be awesome in many ways, but I've always kind of been a "go big or go home" type of person and PA school would not have worked for me. For some, it's an excellent option. You'll just have to figure out if you'd be okay being a PA or if you want to have the option to go as far as you can in your training and become the true expert in your field who's calling the shots.

 

[sandstone]

Someone sent me a PM with some followup questions and I realized that my response may be helpful for others. So here it is.



"It is a really tough call that's for sure. As I said, I went through the PA vs med debate for quite a while. In the end, I decided go to med school. It's kind of leap of faith that's for sure, and technically I can't say if it's worth it since I'm not even in residency yet. Med school is really hard and sometimes very stressful. My wife and I both have had our moments where we're not happy with the choice. I've had moments where I wish I chose PA school for the reasons you mentioned. Overall it's gone well though and we are happy that I'm in med school. I've met lots of really happy docs who love their jobs, which makes me pretty confident that I'll continue to love it.

I get the whole entering the workforce sooner thing, I still sometimes consider just doing three years of FM instead of ortho just so I can get working and have a more normal life again sooner. Although, I am definitely still planning on ortho because it's awesome and when I keep the big picture in mind, I think ortho will be better in the long run for job satisfaction and earning potential. I'll be 39 or 40 by the time I finish ortho residency, but I don't at all worry about stamina issues. Most practicing ortho docs I've worked with so far are that age or older and do just fine. At my age now, I feel more energetic, do better, and complain less than many of my younger and single classmates. It's all about taking care of yourself and keeping a good attitude. I go for two big trail runs a week and have a power tower at home to workout on. I try not to worry about my huge $400,000 debt, especially with ortho since I'll make an excellent salary. A lot of docs get themselves in trouble when as soon as they start making an attending salary they buy a mansion and sports car. I'm not worried about this and know my wife and I can continue to live modestly and just pay off the debt within five years.

You do have to have an understanding and hard-working wife. She will have to step it up a lot in terms of childcare and household responsibilities at times. The difficulty of med school comes in waves. This month on peds GI I worked 9-3 most days and was given a whole week off by my preceptor. Last month on ortho I worked 5-7 most days and sometimes wouldn't see my kids for days (this was at a residency program that was not lifestyle friendly). During the first two years its similar, some days I didn't have that much to do, other days I'd have to study for 15 hours straight. She'll also have to be flexible and willing to handle the lack of routine since the schedule changes so much depending on what year you're in and what rotation you're on.

It really has helped us to have my parents 20 minutes away. Having some support is super important, both for childcare help and finances. We live in an expensive area and have had to borrow some additional money from my folks since the cost of attendance is calculated for single people with roommates. We probably could have made it financially without this if we moved into a much smaller place in a worse part of town and drastically changed our lifetyle. We are thankful to have some extra financial help so that we can maintain a pretty nice life in a nice house in a good neighborhood. My wife worked as a teacher for the first two years, but now she stays at home, which is great. Paying for daycare would be super expensive for two kids (we had our second kid recently) and logistically challenging since my schedule changes drastically each month this year depending on which rotation I'm on.

Overall my wife has been happy and doing well with it all. I think she sees the big picture as well and knows that it will all be worth it in the end.

You have to go to a school that has non-required lectures. This was so important in terms of spending time with my family during the first two years. I only showed up to campus when absolutely required. This opened up lots of time to spend quality time with my wife and kids. You also have to really prioritize your family. I don't really rock climb these days, which is what I used to live for. It's okay though, I'm perfectly happy putting my personal hobbies on hold for now to get to spend time with my family. I know that one day I'll have time for that stuff again. Again, it's all about keeping a good attitude and accepting and enjoying the fact that your life revolves around nothing but kids and studying.

So overall I'm VERY happy I chose med school and not PA school. If you think you may want to do a specialty, especially surgical or other procedural, go for med school since this will keep open the most options. It seems like ortho PA's are stuck forever doing things that 4th year med students do and there's a big difference between PA and ortho physician salaries, even if you start making that bigger number later. I'm so glad I have the option to be a surgeon (hopefully I'll match ortho!)"

 

[ehwhatsupdoc]

I'm a nontrad with a similar predicament. I'm 100% all for medical school even with the future unknowns (especially with the impact of advancement in technology and possible change in market saturation of Physcians), but the one thing holding me back is the debt level. I too am interested in surgery and with 5 year residency and another 1 to 2 years of fellowship I would be 600-700k in the hole (with interest accruing). I wish there was a law to stop interest from accruing until after residency. So yea my brain s telling me it's a bad decision but my heart is telling me to go for it.

Someone sent me a PM with some followup questions and I realized that my response may be helpful for others. So here it is.



"It is a really tough call that's for sure. As I said, I went through the PA vs med debate for quite a while. In the end, I decided go to med school. It's kind of leap of faith that's for sure, and technically I can't say if it's worth it since I'm not even in residency yet. Med school is really hard and sometimes very stressful. My wife and I both have had our moments where we're not happy with the choice. I've had moments where I wish I chose PA school for the reasons you mentioned. Overall it's gone well though and we are happy that I'm in med school. I've met lots of really happy docs who love their jobs, which makes me pretty confident that I'll continue to love it.

I get the whole entering the workforce sooner thing, I still sometimes consider just doing three years of FM instead of ortho just so I can get working and have a more normal life again sooner. Although, I am definitely still planning on ortho because it's awesome and when I keep the big picture in mind, I think ortho will be better in the long run for job satisfaction and earning potential. I'll be 39 or 40 by the time I finish ortho residency, but I don't at all worry about stamina issues. Most practicing ortho docs I've worked with so far are that age or older and do just fine. At my age now, I feel more energetic, do better, and complain less than many of my younger and single classmates. It's all about taking care of yourself and keeping a good attitude. I go for two big trail runs a week and have a power tower at home to workout on. I try not to worry about my huge $400,000 debt, especially with ortho since I'll make an excellent salary. A lot of docs get themselves in trouble when as soon as they start making an attending salary they buy a mansion and sports car. I'm not worried about this and know my wife and I can continue to live modestly and just pay off the debt within five years.

You do have to have an understanding and hard-working wife. She will have to step it up a lot in terms of childcare and household responsibilities at times. The difficulty of med school comes in waves. This month on peds GI I worked 9-3 most days and was given a whole week off by my preceptor. Last month on ortho I worked 5-7 most days and sometimes wouldn't see my kids for days (this was at a residency program that was not lifestyle friendly). During the first two years its similar, some days I didn't have that much to do, other days I'd have to study for 15 hours straight. She'll also have to be flexible and willing to handle the lack of routine since the schedule changes so much depending on what year you're in and what rotation you're on.

It really has helped us to have my parents 20 minutes away. Having some support is super important, both for childcare help and finances. We live in an expensive area and have had to borrow some additional money from my folks since the cost of attendance is calculated for single people with roommates. We probably could have made it financially without this if we moved into a much smaller place in a worse part of town and drastically changed our lifetyle. We are thankful to have some extra financial help so that we can maintain a pretty nice life in a nice house in a good neighborhood. My wife worked as a teacher for the first two years, but now she stays at home, which is great. Paying for daycare would be super expensive for two kids (we had our second kid recently) and logistically challenging since my schedule changes drastically each month this year depending on which rotation I'm on.

Overall my wife has been happy and doing well with it all. I think she sees the big picture as well and knows that it will all be worth it in the end.

You have to go to a school that has non-required lectures. This was so important in terms of spending time with my family during the first two years. I only showed up to campus when absolutely required. This opened up lots of time to spend quality time with my wife and kids. You also have to really prioritize your family. I don't really rock climb these days, which is what I used to live for. It's okay though, I'm perfectly happy putting my personal hobbies on hold for now to get to spend time with my family. I know that one day I'll have time for that stuff again. Again, it's all about keeping a good attitude and accepting and enjoying the fact that your life revolves around nothing but kids and studying.

So overall I'm VERY happy I chose med school and not PA school. I think if you're bent on FM or something, PA school could be fine since they can do a lot of what FM docs do. However, if you think you may want to do a specialty, especially surgical or other procedural, go for med school since this will keep open the most options. It seems like ortho PA's are stuck forever doing things that 4th year med students do and there's abig difference between 90k/year and 300k/year, even if you start making that bigger number later. I'm so glad I have the option to be a surgeon (hopefully I'll match ortho!)"

 

[CannonballComin]

When I read sandstone's post about being in school with kids I feel like I wrote it myself. I am a PA-C who is now rotating as an M3 and I log on to SDN every couple months to make myself available to folks trying to make this decision like you are. Anyone reading this please feel free to PM me with specific questions. OP I think that your decision should be made based on this question: do you want to take care of sick people? I don't mean healthy people who get normal sick, I mean truly sick people and old sick people. As a PA I was good at what I was asked to do. But if medical school has taught me one thing it's that I had no business caring for the occasional truly sick person that made their way to seeing me in the ED. Medicine is far too complex to be learned in 2 years; you're just scratching the surface at 2 years. That being said...PA is like the best career ever if you don't have the desire to be a physician. I mean that, best career ever.

 

[W19]

When I read sandstone's post about being in school with kids I feel like I wrote it myself. I am a PA-C who is now rotating as an M3 and I log on to SDN every couple months to make myself available to folks trying to make this decision like you are. Anyone reading this please feel free to PM me with specific questions. OP I think that your decision should be made based on this question: do you want to take care of sick people? I don't mean healthy people who get normal sick, I mean truly sick people and old sick people. As a PA I was good at what I was asked to do. But if medical school has taught me one thing it's that I had no business caring for the occasional truly sick person that made their way to seeing me in the ED. Medicine is far too complex to be learned in 2 years; you're just scratching the surface at 2 years. That being said...PA is like the best career ever if you don't have the desire to be a physician. I mean that, best career ever.

Wow... You won't find many PA/NP who will admit that