PA/DO/MD Crossroad

I think that it is really important that you figure out how much responsibility you want and how well you are able to be subordinate to a doctor. As a PA in Peds you will do a lot and have a lot of autonomy and responsibility. But there will always be the MD/DO who has the final word and who shoulders the responsibility. Some people don't want all that responsibility and are content with choosing to become a PA. Others want more responsibility and wish they had applied to Medical School.

I have been a PA for 8 years. I have a great job with a lot of autonomy. I am paid well and have good hours. But I am lacking the satisfaction of having responsibility for the patients I care for. I don't think this is an uncommon feeling for people in the PA profession.

 

If you are sure that you want peds, becoming a PA might be the way to go, especially if you are interested in outpatient, office based practice. you would be looking at 2-3 years of training instead of 7-8 as an md/do. the salary would obviously be lower(probably in the 55-65k range to start) but peds has never been known as a big money specialty anyway. the peds docs I work with only make about 115-120k .
the stat thrown around by PA schools is that a new grad has 80% of the FP md outpatient scope of practice and 90% of the peds md outpatient scope of practice. if you are at all interested in inpatient peds, you could always do a 1 year residency in pediatrics. there is a really good 1 at Yale/newhaven hospital.the peds PA's I work with have their own patient panels and minimal md interaction. they send 10% of their charts to the doc for review and present cases in which they want a second opinion only. anyway check out the aapa website and the association of postgraduate pa programs for residency info. best of luck whatever you decide.

 

This is more of a question/reply...first of all to greniedgal: I struggled with the same decision about a year ago and I'm now almost finished with my first summer in PA School and let me tell you, I don't regret this decision at all! I feel like I'm getting a great preparation/education, in fact in talking to some medical students here at school they say that so far they see no differences in the way they are treated and the way we are treated as PA students--the expectations are just as high, the exams just as tough, and the lecturers for the great majority of the blocks for clinical medicine and basic sciences are the same for both programs. My interest also lies in pediatrics and I agree with emedpa that if all you want to do is well baby checks and work in an outpatient setting, PA is the way to go. Realize, however, that you'll be doing that pretty much for the long run so if the idea of that doesn't thrill you, then Medical school might be more of what you're looking for. It all depends on how comfortable you are with working as part of a team and not necessarily seeing the most exciting cases. As far as my experience is concerned, PA School has been a great choice and investment. Let me know if you want to know more.
Now, EMEDPA, question: I'm really interested in going into pediatrics when I graduate (not for a while!) and I'm not willing to go into anything else. However, my professors keep harping on us how pediatricians don't like to hire PA's...how true is this and do you have any advice??
Thanks and Gig 'em!
AggiePA
UT Southwestern Class of 2004

 

Several questions in the last 2 posts so I will try to answer them all.first of all regarding peds positions for pa's. this seems to be a regional issue. lots of peds jobs on both coasts, but not a lot in the middle of the country. there are also a decent # of peds subspecialty jobs out there( surgery, neonatology, etc.)the yale/newhaven program is great. a buddy of mine went there and they treated him just like an md resident. he also got a generous stipend and free room and board with a good benefit package.
hmo's tend to also hire lots of pa's to work at their facilities.the advantage of doing a residency is that you have much more experience with sick kids, especially in inpatient settings. this is a big resume booster and also gives you the key to desirable subspecialty jobs. while most pa programs do not allow specifically for specialization, one can tailor a program around certain goals by choosing rotations to fit that goal.. for instance I knew all along that I wanted to do ER so my rotations were as follows:
surgery: trauma surgery
medicine: inpatient Infectious disease, trauma ICU
ER: full scope ER rotation(not urgent care)
peds: emergency peds at peds hospital
psych: inpatient emergency psych
ob: inner city ob rotation with clinic/L+D and OR
family practice: busy inner city FP
elective: emergency medicine
going to an older/established program generally will give you better rotation choices. my program has been around since 1971 and we had >25 sites for each rotation so if you wanted to do peds you could do peds surgery,peds inpatient medicine, peds psych,peds ER, etc
MD residencies vary in length quite a bit. most peds residencies are 3-4 years and there are also 5 year peds/im residencies.surgery residencies are at least 5 years, with some being much longer when you consider reqired fellowships.hope this helped. best of luck to you both-e

 

First, a correction -- peds MD residencies are 3 years, peds/internal medicine combined is 4 years. subspeciality fellowship training varies (ie if you want to be a pediatric neurologist)

The flip side of the coin:

A mantra in medicine is "the eyes won't see what the brain doesn't know" An MD pediatrician graduates from the residency program with quite a bit of experience, and they are generally confident to handle whatever comes their way. Their training is MUCH longer than a PA (2 years with OPTIONAL residency). But let's break it down:

MD school: first two years coursework. sucks.
third year: core clerkships (ob/gyn, peds, internal med, surgery, psych, family med). These aren't modified based on interest. You are to learn each of these specialties enough to get a decent feel.
fourth year: electives
three year residency, where you are finally earning money, seeing interesting patients, and doing what you signed up for!

So the way i see it, the training is much longer, but it's not bad (in that it's really quite interesting).

Now, if I were interested only in well baby checks, I would most certainly go to PA school. however, if I were the least bit concerned that I would get bored with handing over the interesting cases and getting nothing but respiratory tract infections and ear infections, I would choose med school.

best of luck! we need both good pas and good mds!

 

A few points... the reason that I said peds residencies are 3-4 years is that DO peds residencies are 4 years in length while MD peds residencies sre 3. DO's have to do a 1 year rotating internship before starting peds training. some residencies allow for a specialty rotating internship, but it is still 4 years.there are several 5-6 year peds/md/do residencies out there. I was unaware of the 4 year option, but if pimple popper knows of some then I guess they exist. peds PA's in outpatient settings see the same type of case load as their md counterparts in those situations in which they have their own panels(mostly HMO, I admit). the peds pa's I work with admit patients to the hospital and schedule consults, etc. they may have their supervising doc look at the kid for a second opinion but they generally do not hand the case over. Pimple popper seems to think that I was able to get out of required rotations. I wasn't. I was able (as many med schools allow) to pick required rotations from a list. for instance I had to do an ob rotation, so I picked 1 with a lot of high risk/high acuity patients. I did not skip my rotation. peds pa's do more than just"baby checks", however pimple popper was correct that a lot of interesting(read really sick) kids are seen by pediatricians because they are seen in the hospital, not the clinic. however I (an emergency med PA) do end up doing a lot of these in the ER because that is where they show up when peds clinic is closed. I do septic baby workups on almost every night shift, then admit to the peds service.there are jobs out there where peds pa's work at community health centers or rural practices without a pediatrician present, so they see whatever comes in the door and the docs only hear about it during chart review weeks later.
having said all that, if you do want guaranteed, unrestricted, full scope peds practice you should go MD/DO. as a pa you would certainly need to do a residency and land a great job to have a similar scope. not trying to start a flame war here. peace-e
PS GRENIEGAL: if you are in philadelphia, go to hahnemann. accept no substitutes. the rest of the philadelphia programs aren't even close when it comes to quality instruction and rotations.

 

First of all, to emedpa, you are right on about the residency lengths. Just as in EM, there are varying lengths of programs in DO as well as MD. 80% of MD EM programs are 3 year which makes the 20% 4 year easier to get into. EM in DO world is mimum 4 year.

Now as for pimplepopper, you should be a little less condescending in your reflection of what you believe a PA does. Let me be the first to tell you that I believe there is a large difference between a PA/ physician's education, but in reality there is little difference in what they do in primary care medicine. Most PA's get to do as much as they feel comfortable with in primary care, s with me. When I worked as a PA, I was seeing my own clinic schedule of patients who wanted to see me. They were never triaged out for the presumed severity of their illness. I might have discussed cases with my physician, but never did I hand over a patient. And most docs I know wouldn't want it that way. They usually enjoy the rare trip down the hall to "back-up" a PA and give advice without having to write any of the chart BS. Hell, my future fantasy job is doing just that!! A good PA can absolutely make a practice, make a doc money, and make patients very satisfied. However, and this is the punch line, the PA must be happy not being the doc. For me that was not possible, but for most I think it is. There is definitely a huge difference in the basic science foundation between a PA and a physician's curriculum, and I have only just started medical school this month. Already the cellular science is very much more detailed than my PA program, but to be expected. Now do I expect rotations to be any more difficult? Absolutely not, because a PA is a medical student on rotations no matter what anyone thinks.

Be a PA if you want to have the shortcut to the good life, and have the ability to recognize and admit that there are some holes in your education. And believe it or not, you can go to medical school later. Perhaps you would have to go to grad school anyway if you did not get accepted to med school, and no grad school looks as good on a med school application as a PA program!!! Now the sparks start flying! I'll be in my foxhole.

Matt, MPAS, PA-C
MS1, DO program

 

Go for the MD. Why bother deliberating whether or not you want to do well-baby check ups vs. subspecialty care, office vs. inpatient when you haven't really tried any of it yet? Why not get your MD, have all of the options open and have spent enough time in all settings to make an informed decision before you decide what type of peds medicine you want to practice? The only real time difference in training between a PA and MD is the extra year of basic science and the extra year of electives in MS4. The residency can be seen as a job (albeit a very poorly paying job). An MD residency is two years longer than a PA residency but it also offers a broader range of experiences which can only make you a better clinician.

Finally, Meds/Peds residencies are 4 years in length. Psych/Peds, EM/Peds, Genetics/Peds, and PMR/Peds are five years in length. An actual pediatric residency is three years (MD and DO). Some DO's choose to do an internship which makes their total postgraduate training four years in length.

 

PONYBOY-THERE IS THE SMALL MATTER OF THE EXTRA 150K DEBT INCURRED IN MEDSCHOOL.
also the 1st few years(residency) you make squat while a PA makes 60k+/yr(often closer to 100k)
but, yes if in the long run you want unlimited scope of practice go md/do. it's all about time committment and acceptable debt vs professional goals. good luck.

 

People worry about money a little too much. When was the last time you saw an MD at the soup kitchen?
Regardless, is PA school free? I don't quite see how you can incur an extra $150K in two years of additional schooling. The only real monetary difference is two extra years of schooling and two extra years at a resident's salary. I think that you will more than well compensated once you get out into practice as a pediatrician.

I really fail to see the argument here. You incur larger debts but you make more money in the end as an MD. In addition, you have more options available, larger knowledge base and greater responsibility. What's the problem?

 

Pony says it much better than I.

My point was misinterpreted. I don't think that ALL PAs do is well baby checks. I simply mean to say that the practice of a PA is directly influenced by his or her employer, the physician. The MD/DO could be more or less controlling, and allow for total independence or not. That will be the job. I expect that if you were to practice in a rural setting, you'll have no problem finding a job with a close to unlimited scope of practice. A more popular setting, ie suburbs or city, will potentially allow for less.

That's why I warn that unless you can see yourself happy with the worst-case scenario, you should think about going full hog toward an MD/DO. Why limit yourself, unless you're SURE that yo'ull be satisfied with a limited scope of practice?

I had PAs on one of my rotations, and I agree that many of the rotations are similar, or exactly the same, as medical school rotations, with the caveat: they're HALF as long. That makes a huge difference. And many of the rotations aren't the same.

Doing a pediatric emergency medicine rotation instead of inpatient peds really limits the exposure to many different aspects of the field. Undoubtedly. I could go on, but won't

Best of luck with your decision. This has been an interesting discussion.

 

Greenied - what did you decide?

I've been having a similar delimma in recent months/days and I'd be interested to know what you came up with.

One issue that no one has brought up yet is quality of life after graduating. I know that I want to have a family and I don't think that I want my kid(s?) to be raised by a nanny. So - is it worth it to go to med school + residency and then take time off or do part time? Or would it be better to go to PA school, finish before I even am really thinking about kids and then later cut back hours? Does anyone else have all the answers - because I sure don't!

 

To answer the last questio posed to me about why I left the PA professio nto become a doc, I cannot truly answer for sure because I am not sure myself. I think I was not happy knowing that I would have to work my fingers to the bone day in and day out in order to keep up with the lifestyle I was used to living. Yes I was pulling in 6 figs, but it required being on my feet for 9 hours a day, 5 days a week and seeing probably 150-200 patients a week. Then I had charts to do at home. It was somewhat depressing to see that my collections for my doc were 4-5 times my salary. Since hindsight is 20/20, I was able to determine that because I was so well received as a PA that things could only be better as a doctor. And I love school truthfully, so what better than to get a better education and be a physician in the end. I will be 38 after my residency which is not too old to enjoy life as a physician. And in Texas, medical school is dirt cheap. I will probably owe 100K when I am done but I am supporting 2 children and a wife who stays home with them. And last but not least, although this statement is true in my opinion, it is very controversial. The drop dead, bottom line truth is that medicine is simply designed to be delivered by a physician in America, and anyone else who trties to provide such care will always face an uphill struggle to fit in and be accepted. Whether it be a chiropractor, a PA, an NP, an optometrist, a podiatrist, a dietician, a nurse, or a PhD or a psychologist, the average American associated the word doctor with physician, and equates a physician with care in general. This is not to say that all these healthcare providers are not highly trained and worthy of respect, but my statement is simply one of personal experience. The top of the food chain in medicine is a physician, and no one can come up with a credible argument to the contrary. Some people may be happy being a non-physician provider, but I was not. I hope I have not offended anyone and I hope I have not deterred anyone from going down a certain career path. Every individual is different when it comes to self-satisfaction.

 

I have the utmost respect for Matt (PACtoDOC) and his opinion and view on this particular matter. In fact, he and I have much in common and have had similar experiences as PAs. As with Matt, they resulted in my decision to pursue becoming a physician. For almost 2-years I studied for the MCAT, applied to one medical school, was accepted to it?s Biomedical Science program (which is basically a 5-year medical school program) only to withdraw my application. In a way, I now believe I needed to go through the experience in order to feel the satisfaction and happiness I now feel as a PA.

I used to say ?I?m not so much unhappy with being a PA as much as I am unhappy with not being a physician.? Only recently, and for the first time, did I stop to honestly self-examine why I felt that way. The bottom line was that, as Matt said, as a PA I was not at the ?top of the food chain?. That bothered me. I knew that I knew as much medicine as many physicians, less than some, and more than others. I did not, however, get the same respect, recognition, or compensation as physicians. That was what bugged me, ate at me, and motivated me into pursuing 8 more years of schooling at the age of 37 and with a wife and two young children. Finally and thankfully, a light came on inside of me as I was filling out my FAFSA. Why did I go into medicine to begin with? Was it to be the big honcho, the main man, the top of the food chain? No, it was not. I went into medicine to make a difference in people?s lives. To effect change through my medical knowledge, skills, and compassion. That was the most important reason and although it may sound a bit altruistic and hokey, it was my reason. So what was I going to do, put myself and my family through the ringer for the next 8-years of my life to make more money and be at the top of the medical food chain even though I was already making good money and doing what I originally set out to do? Suddenly, my reasons for being ?unhappy with not being a physician? seemed superfluous and in a way, kind of shallow and selfish.

To my wife?s extreme relief, I withdrew my application and decided to go back into cardiothoracic surgery. Within 2-months, an amazing position presented itself with one of the top institutions in the country known for cardiac surgery. I am fortunate enough to be associated with two of the finest surgeons I have ever known, one of whom was the first surgeon in the world to perform closed chest robotic coronary artery bypass grafting. I am now involved in minimally invasive heart surgery, research, teaching, and am compiling data to publish my first paper on endoscopic radial artery harvesting, a technique performed by only a handful of people in this country. Additionally, I have started working on my doctorate to facilitate teaching at a university level?and no, I will not be referred to as ?Doctor? in a clinical setting. Its amazing how the doors seemed to open up after I made this decision. I believe things happen for a reason.

So in the end, I have come full circle. I now truly understand what the most important aspects of practicing medicine are. Being at the top of the food chain, making more money, and having prestige while undeniably appealing, are the least important aspects of medicine. I learned something else; it?s easy for one to say these things, its quite another to truly believe them and base one's life decisions on them. Unfortunately for me, it took a sledgehammer to drive home that point.

 

This is a very interesting post. CVPA, your thoughts on your career undoubtedly will help many in their pursuit for a satisfying career.

Physician assistants can without question have a great career, with groundbreaking research, and lead a very satisfying practice.

Physicans can also.

My advice to those who are undecided is to NOT SETTLE. Shadow a FEW PAs. Shadow a FEW MDs. And don't settle for an MD *JUST* for the prestige. And don't settle for being a PA *JUST* to shorten your education. Take a longer look, and the positives and negatives, of each career choice for YOU.

NOBODY will be able to tell you what's going to be right for you, nobody will tell you the correct decision. People will only tell you WHAT WAS RIGHT FOR THEM. For CVPA, the choice to become a PA turned out to be best. For me, an MD was the best decision, and I don't regret it.

My main point in previous posts, which have been grossly misunderstood (& miscommunicated) is the following --

As a PA you are dependent on the most current job situation in the field, and on the specific physician/group/hospital for whom you will work. Some employers, as CVPAs, will assist in nurturing you and teaching you and allowing you to blossom. Others will use you in another setting to take cases that physicians don't want (I have personally seen both, so you can't tell me differently!) I don't know the percentages, obviously, but both exist. So beware.

As a physician, you have a broader range of scope of practice without having to depend on your superiors. And though medicine is lifelong learning, residency allows MDs to enter the workforce WITHOUT being dependent on further mentoring (though it's helpful!)

Anyway, good PAs and MDs are needed, and both are important. I hope this post has helped someone in their career path.

Best of luck!

 

I would love to add one more simple factor to the mix...current litigations.
I know some great Physician Assistants that work surgery and I personally believe that is the ideal position for the Assistant. (many LPNS and RN's used to do the same things 10 years ago, but now PA's do the job, and with broader scope). They work directly with the Physician, and do tasks that are mundane but also the jobs that are alot of fun...directly under the physician's umbrella. Great for everyone.
Now, we see the current state of Law and the ever hungry tiger-shark lawyers...just waiting for a Doc to screw up...or even better a mid-level. I was having a discussion with a radiologist a few months ago, and he stated "why a mid level would ever want to take the medico-legal risks of anything more than the most basic of care, is beyond me" And I really see his point. With more and more Assistants out there (and honestly some of the schools granting degrees are a bit questionable), it takes a simple mistake for a lawyer to cry "FOUL" and go after the poor PA primarily because HE IS A PA. Weird concept, but I wonder if at one point the idea of the NON-surgical PA will be more of a liability. Or will the PA work solely on a protocol basis like paramedics.
Really, if Physician liability is going through the roof...at what point will mid-level liability be crippling? You would think that perhaps PA's would then be handcuffed to the most basic tasks so as to decrease hospital/physician liability. I really do think this may be the way of the near future. Legal risk driving practice changes.

 

I like what you had to say! I too am about to start a PA program in about a month. I am however, prepping for the August MCAT. This has been a long and arduous decision for me...and I am finally taking matters into my own hands and taking the plunge so to speak! While, the PA program initially impressed me with its flexibility and center around primary care, I have developed a true interest in pediatric subspecialties, especially the NICU. I feel that my goals will be better served as the MD or DO in this case. I have been in school for quite some time now and am willing to go the extra mile to come out on top! I am really excited about the possibility of going to med school and am hopefully going to make it happen!

I wish you best of luck in all of your pursuits! Let me know how you make out!

 

Ggal,

Theres actually lots of insightful discussion on the thread entitled, "What's the A stand for.." Forums that call into question the meaning of a physician's assistant often make for lively debates. The cast of characters is familiar: you'll see time honored performances by PACtoDOC, EMEDPA, and others. You'll watch in amazement as spirited objections from newbies and indignant practicing PAs fly across your computer monitor.

In all seriousness, there's lots of info about why people chose MD/DO vs PA and how personal motivations affect career options. It looks like you've already decided, but a bit more perspective never hurts.

Best of luck!

PS: I heard that EMEDPA is running a marathon soon. Someone should tell him about the risks of femoral neck fractures in the aging, "18+ years in EM" population. I hope he takes his calcium.

 

"PS: I heard that EMEDPA is running a marathon soon. Someone should tell him about the risks of femoral neck fractures in the aging, "18+ years in EM" population. I hope he takes his calcium."

twice a day sonny.....