PA and MD/DO, what's the difference?

[puppypaws]

Hey everyone,
I've been trying to weigh out the question of DO or PA, and I realized, that even after researching them both quite a bit, I really don't understand the difference between them. I've read that PA's can be very autonomous, and can perform most of the duties of a doctor, so what really is the difference, discounting salary, time in school, and the ability of a PA to switch between specialties more easily? None of those really influence my decision one way or the other too much. Is one more stressful than the other? I've read that PAs in general work less hours than doctors, but that they sometimes have to work just as many or more, and that doctors too can have a 40 hour work week if they want. I feel like I have to be missing something big, or a bunch of little things, that should be influencing my decision.
Thanks for any input.

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[deleted6669]

pa is really designed as a second medical career after working as a paramedic, nurse, rt, etc
pa's are dependent providers meaning we can not practice without an association with a physician. different states have different requirements for supervision or sponsorship.
md/do have unrestricted medical licenses and once done with residency do not legally require oversight. pa school is around 2 yrs after an undergrad degree. md/do is 4. while the coursework is similar md/do go into much more depth in the basic medical sciences.physicians must complete residency(or at least an internship) while residencies for pa's are strictly optional at this point-although that may change. see www.appap.org for links to pa residencies.
pa's make about 1/4 to 1/3 what physicians do working similar hrs in the same specialty. hours and responsibilities for pa's vary widely.
in emergency medicine for example some pa's work only fast track and present every case to a physician before the pt goes home while while others run entire depts solo with a physician available on call who they never see except at staff meetings. the majority of em pa's do something in the middle of these 2 extremes such as only presenting pts who are triaged as level 1-3( out of 5, 1 being sickest) for example. if you are starting from scratch and have no prior medical experience md/do is the way to go. if you are older and have prior training pa may be an option.
there are stressful and non-stressful jobs for both pa's and docs.really depends what you want. either can work as much or as little as they want( or need). this month due to retirements, sick leaves, providers(both docs and pa's) quitting, etc I am working almost every day of the month and working doubles many of those days.. I could choose an easier job but that's not the path I have decided to follow.
for more on the pa profession see www.physicianassistantforum.com and www.aapa.org

 

[puppypaws]

if you are starting from scratch and have no prior medical experience md/do is the way to go. if you are older and have prior training pa may be an option.

I'm a junior biology major, and don't have medical experience. I was considering becoming a PA because I thought it would be a less stressful and less time consuming job compared to a doctor's job, as well as less time in school. Basically I wanted to go into the one where I could have a more family friendly life, because both of them make enough money for me to live well on. But I've been thinking now that they both have the potential to be very stressful and time consuming, maybe both equally so.

 

[deleted6669]

once training is complete md/do is more family friendly.
as a doc you can make > 100k/yr working 20 hrs/week.
to make that kind of money a pa has to work full time.
one local er near me staffs their fast track with retired fp docs so they can say" we only use physicians in our emergency dept."
they work four 5 hr shifts/week and are considered full time with benefits for doing so.

 

[mydogtobbi]

It is possible to work part-time as a physician. However, with the large debt, it is not possible for many, at least not as a new attending. I for one could not have afforded to do that.

In general, MD/DO is definitely not more family friendly. It really depends on your specialty. I am not in a family friendly specialty. To read more about this see: http://www.momMD.com

 

[puppypaws]

In general, MD/DO is definitely not more family friendly. It really depends on your specialty. I am not in a family friendly specialty. To read more about this see: http://www.momMD.com

I've heard that a lot, but how is being an MD/DO less family friendly and more stressful? Is it the hours, or more like an internal thing from having to be the one who makes the final decisions about patients?
Thanks for the website, its interesting. It shows me one side of the story.

 

[deleted6669]

FWIW a lot of pa's make "final decisions about pts".
many states require 5-10% chart review within 1 month. that means the first time a physician is aware of a pa decision may be a month later or if in the 90% of unreviewed charts they would never know. they may disagree with it but at that point it's a done deal. the pt has already completed their course of medication, gone to their specialty referral, etc.
for example I see my sponsoring physician maybe 3-4 times/yr at staff mtgs. he works day shifts and I work solo night shifts. every now and then he might leave me a message like" did you consider sotalol instead of metoprolol for this pt? just a thought".

 

[puppypaws]

FWIW a lot of pa's make "final decisions about pts".
many states require 5-10% chart review within 1 month. that means the first time a physician is aware of a pa decision may be a month later or if in the 90% of unreviewed charts they would never know. they may disagree with it but at that point it's a done deal. the pt has already completed their course of medication, gone to their specialty referral, etc.
for example I see my sponsoring physician maybe 3-4 times/yr at staff mtgs. he works day shifts and I work solo night shifts. every now and then he might leave me a message like" did you consider sotalol instead of metoprolol for this pt? just a thought".

I'm sorry for saying that. I knew that in some states PAs can even own a clinic as long as they have a physician to their review charts a few times a year, I just didn't know how common that much PA autonomy was. I was more under the impression that PAs worked with an MD/DO more closely. From what I've read, the only real difference between a PA and a DO/MD is the amount of schooling and salary, given how much autonomy that PA's do have.

 

[VA Hopeful Dr]

once training is complete md/do is more family friendly.
as a doc you can make > 100k/yr working 20 hrs/week.
to make that kind of money a pa has to work full time.
one local er near me staffs their fast track with retired fp docs so they can say" we only use physicians in our emergency dept."
they work four 5 hr shifts/week and are considered full time with benefits for doing so.

Sign me up!

 

[deleted6669]

From what I've read, the only real difference between a PA and a DO/MD is the amount of schooling and salary,.

That's like saying the only difference between the mayor of buffalo, ny and the president of the u.s. is a national election....

 

[NYEMMED]

I'm sorry for saying that. I knew that in some states PAs can even own a clinic as long as they have a physician to their review charts a few times a year, I just didn't know how common that much PA autonomy was. I was more under the impression that PAs worked with an MD/DO more closely. From what I've read, the only real difference between a PA and a DO/MD is the amount of schooling and salary, given how much autonomy that PA's do have.

The autonomy depends on the state, specialty, and facility... If going into GP in some states there is full autonomy. In NY many PAs in specialties are used to expand a doctors coverage. IE in the ER if there is a non emergent surgical patient, the surgical PA will come down write the admitting orders and go back upstairs, for complicated cases the attending or chief resident himself comes down. In my particular ER PAs staff only the urgent care portion (broken bones, stitches, INDs, etc..) with an attending in the urgent care area to oversee them, sign charts, and write prescriptions. Everything else is handled in the main ER by residents/attendings. It all just depends on the state and facility...

Note: Im not at a rural/community hospital ER, Im at a massive tertiary level 1 trauma center, this may be the difference...

 

[deleted6669]

an attending in the urgent care area to oversee them, sign charts, and write prescriptions. ...

You do know that pa's have sch 2-5 dea prescriptive rights in NY state, right?
a pa in ny can write for anything an md can....pa's in upstate ny staff rural e.d.'s solo as well...

 

[NYEMMED]

You do know that pa's have sch 2-5 dea prescriptive rights in NY state, right?
a pa in ny can write for anything an md can....pa's in upstate ny staff rural e.d.'s solo as well...

Yes, but that does not happen at many NYC area hospitals, whether they can or not is great, but in this ER PAs run urgent care, and are not solo... Furthermore, PAs can write prescriptions but do not at my facility, whether that is a personal choice or a hospital policy im not sure, but they always ask the attending or resident to write a script. Im not against PAs at all, so please dont take it the wrong way, just pointing out that in more population dense area, and specifically in trauma 1 facilities, PAs tend to be more restricted and perform roles less than a resident...
This could have to do with the fact that this trauma 1 is fully staffed with EM residents 24/7, this may be way the PAs are in urgent care only... Not many hospitals have EM residents

 

[deleted6669]

I work per diem at a level 1 on the west coast where pa's work in main, intubate, etc so It appears to be facility dependent.
we also have both IM and EM residents but it is busy enough that everyone gets to do some of the fun stuff.

 

[BLKPA2MD]

.....Furthermore, PAs can write prescriptions but do not at my facility,

...What's the name of that facility? I bet they do.

 

[NYEMMED]

...What's the name of that facility? I bet they do.

I wont name the hospital, for confidentiality reasons

Here is our employment breakdown, As you can see we dont employ many PAs in the first place...

Employees FTE*
* Full Time Equivalent
Physicians: 93
Registered Nurses (RN): 496.8
Licensed Practical or Vocational Nurses (LPN/LVN): 118.9
Physician Assistants: 11.2
Respiratory Therapists: 32.8
Physical Therapists: 24.8
Occupational Therapists: 3.2
Dietitians: 11.6
Residents (Physicians): 80
Nurse Practitioners: 7.3
Medical Social Workers: 12
Nuclear Medicine Technicians: 5.6


Here is our policy on PAs

D. The physician assistant is subject to the limitations set by the supervising physician and to the policies of the Medical Center, in addition to state laws, rules, and regulations.
E. Medical Orders
If authorized by the supervising physician, physician assistants may write medical orders. In an inpatient setting, the physician assistant may order medications including Schedule II - V controlled substances. Countersignature of such orders are required.

It may be very possible that they are able to prescribe but the physicians or PAs personally like to just have the physicians write out the scripts rather than countersigs etc...

Anyway im not attacking PAs so please dont feel defensive, just giving an example of how policies are different in another hospital.

Just wanted to add: Emedpa: I really like reading your posts elsewhere on this site, and have learned from them, just wanted to thank you for the contributions

 

[redroses1100]

once training is complete md/do is more family friendly.
as a doc you can make > 100k/yr working 20 hrs/week.
to make that kind of money a pa has to work full time.
one local er near me staffs their fast track with retired fp docs so they can say" we only use physicians in our emergency dept."
they work four 5 hr shifts/week and are considered full time with benefits for doing so.

I just want to say thanks to all of your posts. They are very informative!

 

[Heicepify]

Hi. Im looking at the Studiospares S900 and S980 Condenser mics. Whats the difference between them - anyone know? Also, does anyone know what the self-noise figure for each of these is?Thanks. Mike