PA vs MD i know i know it's probably been done before...

[Nina027]

Hey,
As my title implies this kind of thread probably has already been asked many times over but i just wanted some opinions from physicians, and I might sound naive throughout some parts...
I don't know if I should become a doctor or a PA. My mother is a nurse and she advises against going to medical school because you have loans to pay until your middle age, the amount of work you put in doesn't equal the amount you get out, health insurance is a huge hassle, malpractice insurance is through the roof, and you go through seven years of life on hold. What do you all think about this? Did any of these things affect your decision on going to medical school? Is it all worth it to you in the end?
As a PA, it seems like (from reading around on some threads) that PA's get the "easy" stuff with patients and they aren't highly respected with their colleagues as well as patients in some instances. I'm probably wrong in some cases but this is just what I gathered from reading around.
I just don't know if I want to be the middleman or if I'd rather have acquired the most skill and knowledge that medical school has to offer when I look back at my life in the future. I hope to follow around a PA and a physician just to see what it's like but I'd really appreciate some solid feedback. Again sorry if this is a redundant post buttt I just don't know what's best for me , thanks 🙂

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[Faebinder]

Hey,
As my title implies this kind of thread probably has already been asked many times over but i just wanted some opinions from physicians, and I might sound naive throughout some parts...
I don't know if I should become a doctor or a PA. My mother is a nurse and she advises against going to medical school because you have loans to pay until your middle age, the amount of work you put in doesn't equal the amount you get out, health insurance is a huge hassle, malpractice insurance is through the roof, and you go through seven years of life on hold. What do you all think about this? Did any of these things affect your decision on going to medical school? Is it all worth it to you in the end?
As a PA, it seems like (from reading around on some threads) that PA's get the "easy" stuff with patients and they aren't highly respected with their colleagues as well as patients in some instances. I'm probably wrong in some cases but this is just what I gathered from reading around.
I just don't know if I want to be the middleman or if I'd rather have acquired the most skill and knowledge that medical school has to offer when I look back at my life in the future. I hope to follow around a PA and a physician just to see what it's like but I'd really appreciate some solid feedback. Again sorry if this is a redundant post buttt I just don't know what's best for me , thanks 🙂

PA

even better...a CRNA.

Probably the best two money-rewarding careers out there. Believe me when you are working 70 hours a week at age 45 you start wishing you had all "easy" patients and when you go home at 5 pm, no one calls you at 1 am in the morning to ask if benadryl is q6 hours or q4 hours.

"Oh hi, Dr Nina027, sorry to wake you up, that KCL you wrote earlier today, 40 meq PO and 20 meq IV, well the patient did not tolerate the IV this evening.... can we give the rest to her as PO?"

 

[Dr JPH]

PA

even better...a CRNA.

Probably the best two money-rewarding careers out there. Believe me when you are working 70 hours a week at age 45 you start wishing you had all "easy" patients and when you go home at 5 pm, no one calls you at 1 am in the morning to ask if benadryl is q6 hours or q4 hours.

"Oh hi, Dr Nina027, sorry to wake you up, that KCL you wrote earlier today, 40 meq PO and 20 meq IV, well the patient did not tolerate the IV this evening.... can we give the rest to her as PO?"

I have one thats even better. Pharmacist. 👍

 

[Nina027]

so , you are not happy that you chose an MD?

 

[Tired]

so , you are not happy that you chose an MD?

I've got one: carpenter. You're union, make great money once you've been in the business for a while, and you get to work outside all day building muscle.

 

[DoctorPhud]

.

 

[jennyboo]

Hey,
As my title implies this kind of thread probably has already been asked many times over but i just wanted some opinions from physicians, and I might sound naive throughout some parts...
I don't know if I should become a doctor or a PA. My mother is a nurse and she advises against going to medical school because you have loans to pay until your middle age, the amount of work you put in doesn't equal the amount you get out, health insurance is a huge hassle, malpractice insurance is through the roof, and you go through seven years of life on hold. What do you all think about this? Did any of these things affect your decision on going to medical school? Is it all worth it to you in the end?
As a PA, it seems like (from reading around on some threads) that PA's get the "easy" stuff with patients and they aren't highly respected with their colleagues as well as patients in some instances. I'm probably wrong in some cases but this is just what I gathered from reading around.
I just don't know if I want to be the middleman or if I'd rather have acquired the most skill and knowledge that medical school has to offer when I look back at my life in the future. I hope to follow around a PA and a physician just to see what it's like but I'd really appreciate some solid feedback. Again sorry if this is a redundant post buttt I just don't know what's best for me , thanks 🙂

The question is whether you are happy being a midlevel, or whether you desire the finality, authority and respect of being the top dog.

Your mom is an RN, so obviously she comes from the perspective of someone who doesn't care about or want to be "the final say." RNs are generally satisfied with not being the ultimate authority and decision-maker. In fact, as your mom has already expressed, most would rather not have the responsibility. Thus, from an RN's perspective, a PA's life is definitely much better.

A PA has less responsibility, less liability, and fewer hours, still for great pay. You also get to start working years sooner without the years of grueling residency training. You generally aren't responsible for earning and paying expenses such as office staff, equipment, liability insurance and so on. In terms of hours, family friendliness, and pay, being a PA is an excellent choice.

This of course will make sense to your mom, to most RN's and, indeed, to most physicians. These are big lifestyle perks in favor of being a PA. As a PA, you will not make as much as a physician in the same specialty if you compare the annual pay side by side, but you get a lot more free time and most adults who have the perspective of having a family would see that as a great compromise.

The trouble is that some people can't stand not to be "top dog" when it comes to providing patient care. They want not only to participate in patient care but to be one who has the ultimate knowledge and makes the ultimate decisions. Despite a lot of the work being THE SAME (physical exams, procedures, rounding on patients if in hospital), the perspective is very different.

• Even if a PA and a physician say the same thing in exactly the same words, patients really crave hearing it directly from a physician. It's a psychological thing.
• Being an MD allows you greater opportunities for a career in scientific research.
• Physician culture is, I think, a lot more intellectual in general. If you are interested in twisting your mind around questions such as, "Does this treatment show any greater benefit than X for this group of patients?" and "Do I think this patient of mine would benefit from X, or should I not offer it?" then you'll get to think a lot more about these issues as a physician than as a PA. As a PA, when you're not sure, the physician decides. As a physician, when you're not sure, you have to weigh the pros and cons yourself and decide yourself.
• The social respect associated with physicians is absolutely huge and there is no comparison for any other health career. Even compared to dentistry, which in many other ways is very close to being a physician.
• It's a pride thing. Doctors are often pretty darn proud of being doctors.

As a PA, you will manage the bread-and-butter of whatever type of work you do. If, for example, you work in cardiothoracic surgery, you literally will do a lot of the surgery. You can crack open that chest, harvest the vein graft, place the lines and chest tubes, run the codes, and basically manage the patients. You won't do the fiddly stuff or handle the most complicated parts of cases. Your education and training are for you to handle the basics of normal, average cases. An MD education is supposed to make you able to also handle the "wall of weird" stuff that PA's generally don't go near. PA's are great at what they do, but they are not "the experts." PA's do what they know. When cases go beyond the usual, MD's make decisions in situations that are not black-and-white. When we run into conditions we're not particularly familiar with, PA's aren't the ones who go looking up how to treat it. MD's do.

Ultimately, it's entirely up to you and it depends on your priorities. Older people frequently would choose PA because they realize there are more important things than needing to be "top dog" and working their butts off for it, and would instead have a little less pride and spend more time outside of work. It's easier for younger people to go to medical school, often because they don't have the time constraints and financial burdens of a family. If you're ambitious and wouldn't feel comfortable settling for anything less than the absolute highest you can reach and the absolute best you can be, then there's nothing for it -- you've got to be a doctor, not a PA.

Suffice to say, though, that I would not want to be in health care if I were not a physician. I would not be a PA, a CRNA, an RN, or a nurse practitioner. I would do something else.

 

[Faebinder]

Could be a dentist... Must be nice not needing to deal with insurance if you dont want to.

 

[elwademd]

The question is whether you are happy being a midlevel, or whether you desire the finality, authority and respect of being the top dog.

Your mom is an RN, so obviously she comes from the perspective of someone who doesn't care about or want to be "the final say." RNs aren't "the buck stops here" type of people in that sense, and are generally satisfied with not being the ultimate authority and decision-maker. In fact, as your mom has already expressed, most would rather not be. From an RN's perspective (which is a very insightful one), a PA's life is definitely much better.

A PA has less responsibility, less liability, and fewer hours, still for great pay. You also get to start working years sooner without the years of grueling residency training. You generally aren't responsible for earning and paying expenses such as office staff, equipment, liability insurance and so on. In terms of hours, family friendliness, and pay, being a PA is an excellent choice.

This of course will make sense to your mom, to most RN's and, indeed, to most physicians. These are big lifestyle perks in favor of being a PA. As a PA, you will not make as much as a physician in the same specialty if you compare the annual pay side by side, but you get a lot more free time and most adults who have the perspective of having a family would see that as a great compromise.

The trouble is that some people really cannot stand not to be "top dog" when it comes to providing patient care. They want not only to participate in patient care but to be one who has the ultimate knowledge and makes the ultimate decisions. Despite a lot of the work being THE SAME (physical exams, procedures, rounding on patients if in hospital), the perspective is very different.

• Even if a PA and a physician say the same thing in exactly the same words, patients really crave hearing it directly from a physician. It's a psychological thing.
• Being an MD allows you greater opportunities for a career in scientific research, if this interests you.
• Physician culture is, I think, a lot more intellectual in general. This is of course not universally the case, but if you are interested in twisting your mind around questions such as, "Does this treatment show any greater benefit than X for this group of patients?" and "Do I think this patient of mine would benefit from X, or should I not offer it?" then you'll get to think a lot more about these issues as a physician than as a PA.
• The social respect associated with physicians is absolutely huge and there is no comparison for any other health career. Even some dentists have told me this.
• It's a pride thing. Doctors are often pretty darn proud of being doctors.

As a PA, you will manage the bread-and-butter of whatever type of work you do. If, for example, you work in cardiothoracic surgery, you literally will do a lot of the surgery. You can crack open that chest, harvest the vein graft, place the lines and chest tubes, run the codes, and basically manage the patients. Your education and training are for you to handle the basics of normal, average cases. An MD education is supposed to make you able to also handle the "wall of weird" stuff that PA's generally don't go near. PA's are great at what they do, but they are not "the experts." PA's do what they know. When cases go beyond the usual, MD's make decisions in situations that are not black-and-white. When we run into conditions we're not particularly familiar with, PA's aren't the ones who go looking up how to treat it. MD's do.

Ultimately, it's entirely up to you and it depends on your priorities. Older people frequently would choose PA because they realize there are more important things than needing to be "top dog" and working their butts off for it, and would instead have a little less pride and spend more time outside of work. Younger people are easier to convince to go to medical school because perhaps they don't have those priorities yet.

Suffice to say, though, that I would not want to be in health care if I were not a physician. I would not be a PA, a CRNA, an RN, or a nurse practitioner. I would do something else.

very well said!

 

[elizabeth5863]

I hope to follow around a PA and a physician just to see what it's like but I'd really appreciate some solid feedback. Again sorry if this is a redundant post buttt I just don't know what's best for me , thanks 🙂

Make sure you follow PA's from a variety of fields. There are PA's in family medicine, rheumatology, orthopedics, etc. The orthopedic PA's do the same stuff that orthopods do in the office but may not do joint injections; they help out in surgery but don't do the surgery. The rheumatology PA's are difficult to come across but there were 2 at my med school and they saw all the pts that the rheumatologists saw and managed them (except the pts needed to be seen by the physician every x months.) Good luck! I recommend really sitting down, doing some soul searching, and thinking about your personality and goals (i.e. do you want to have the final say in things, want the extra prestige, etc. or are you okay with physicians overlooking your work when you need it?)

Although I really enjoy my work with pts, often times I feel that my life with the people I care about, esp. my family, are non-existent. I'd recommend learning about all the different health care fields as well, incl. pharmacy, dentistry, physician assistant, optometry, before making a final decision. Then, if you discover that going into medicine is what would make you ultimately happy and satisfy your intellectual curiosity, then great!

Good luck!

 

[Chronic Student]

The question is whether you are happy being a midlevel, or whether you desire the finality, authority and respect of being the top dog.

Your mom is an RN, so obviously she comes from the perspective of someone who doesn't care about or want to be "the final say." RNs are generally satisfied with not being the ultimate authority and decision-maker. In fact, as your mom has already expressed, most would rather not have the responsibility. Thus, from an RN's perspective, a PA's life is definitely much better.

A PA has less responsibility, less liability, and fewer hours, still for great pay. You also get to start working years sooner without the years of grueling residency training. You generally aren't responsible for earning and paying expenses such as office staff, equipment, liability insurance and so on. In terms of hours, family friendliness, and pay, being a PA is an excellent choice.

This of course will make sense to your mom, to most RN's and, indeed, to most physicians. These are big lifestyle perks in favor of being a PA. As a PA, you will not make as much as a physician in the same specialty if you compare the annual pay side by side, but you get a lot more free time and most adults who have the perspective of having a family would see that as a great compromise.

The trouble is that some people can't stand not to be "top dog" when it comes to providing patient care. They want not only to participate in patient care but to be one who has the ultimate knowledge and makes the ultimate decisions. Despite a lot of the work being THE SAME (physical exams, procedures, rounding on patients if in hospital), the perspective is very different.

• Even if a PA and a physician say the same thing in exactly the same words, patients really crave hearing it directly from a physician. It's a psychological thing.
• Being an MD allows you greater opportunities for a career in scientific research.
• Physician culture is, I think, a lot more intellectual in general. If you are interested in twisting your mind around questions such as, "Does this treatment show any greater benefit than X for this group of patients?" and "Do I think this patient of mine would benefit from X, or should I not offer it?" then you'll get to think a lot more about these issues as a physician than as a PA. As a PA, when you're not sure, the physician decides. As a physician, when you're not sure, you have to weigh the pros and cons yourself and decide yourself.
• The social respect associated with physicians is absolutely huge and there is no comparison for any other health career. Even compared to dentistry, which in many other ways is very close to being a physician.
• It's a pride thing. Doctors are often pretty darn proud of being doctors.

As a PA, you will manage the bread-and-butter of whatever type of work you do. If, for example, you work in cardiothoracic surgery, you literally will do a lot of the surgery. You can crack open that chest, harvest the vein graft, place the lines and chest tubes, run the codes, and basically manage the patients. You won't do the fiddly stuff or handle the most complicated parts of cases. Your education and training are for you to handle the basics of normal, average cases. An MD education is supposed to make you able to also handle the "wall of weird" stuff that PA's generally don't go near. PA's are great at what they do, but they are not "the experts." PA's do what they know. When cases go beyond the usual, MD's make decisions in situations that are not black-and-white. When we run into conditions we're not particularly familiar with, PA's aren't the ones who go looking up how to treat it. MD's do.

Ultimately, it's entirely up to you and it depends on your priorities. Older people frequently would choose PA because they realize there are more important things than needing to be "top dog" and working their butts off for it, and would instead have a little less pride and spend more time outside of work. It's easier for younger people to go to medical school, often because they don't have the time constraints and financial burdens of a family. If you're ambitious and wouldn't feel comfortable settling for anything less than the absolute highest you can reach and the absolute best you can be, then there's nothing for it -- you've got to be a doctor, not a PA.

Suffice to say, though, that I would not want to be in health care if I were not a physician. I would not be a PA, a CRNA, an RN, or a nurse practitioner. I would do something else.

That is one of the best posts I've ever read about PA vs. MD. Kudos.

-Mike

 

[Nina027]

i agree ^
thank you so much for taking the time to give me advice, it really does help yet the decision is still so difficult

 

[RockfordWF]

Hey,
As my title implies this kind of thread probably has already been asked many times over but i just wanted some opinions from physicians, and I might sound naive throughout some parts...
I don't know if I should become a doctor or a PA. My mother is a nurse and she advises against going to medical school because you have loans to pay until your middle age, the amount of work you put in doesn't equal the amount you get out, health insurance is a huge hassle, malpractice insurance is through the roof, and you go through seven years of life on hold. What do you all think about this? Did any of these things affect your decision on going to medical school? Is it all worth it to you in the end?
As a PA, it seems like (from reading around on some threads) that PA's get the "easy" stuff with patients and they aren't highly respected with their colleagues as well as patients in some instances. I'm probably wrong in some cases but this is just what I gathered from reading around.
I just don't know if I want to be the middleman or if I'd rather have acquired the most skill and knowledge that medical school has to offer when I look back at my life in the future. I hope to follow around a PA and a physician just to see what it's like but I'd really appreciate some solid feedback. Again sorry if this is a redundant post buttt I just don't know what's best for me , thanks 🙂

It's easy. Both do the same thing: see patients. The only difference is that doctors make alot more money and can be their own boss.'

If you want to make little money and do what your told, be a PA.

 

[deleted6669]

It's easy. Both do the same thing: see patients. The only difference is that doctors make alot more money and can be their own boss.'

If you want to make little money and do what your told, be a PA.

actually most states allow a pa to own a practice and hire a physician to review a few charts/mo to meet the min requirement for supervision. I have several friends who do this.they are "their own boss".
agree about the money issue. in any field an md will always make more $ than a pa but a specialty pa( derm, ortho, surgery, em) can make more $ than a primary care md and have no overhead of any kind.

 

[toxic-megacolon]

actually most states allow a pa to own a practice and hire a physician to review a few charts/mo to meet the min requirement for supervision. I have several friends who do this.they are "their own boss".
agree about the money issue. in any field an md will always make more $ than a pa but a specialty pa( derm, ortho, surgery, em) can make more $ than a primary care md and have no overhead of any kind.

How much does it pay to sign charts from a PA working 35-45 hours/week in an outpatient/urgent care setting? Signing a few charts per week sounds pretty lifestyle friendly

 

[deleted6669]

How much does it pay to sign charts from a PA working 35-45 hours/week in an outpatient/urgent care setting? Signing a few charts per week sounds pretty lifestyle friendly

$1500-3000/MONTH for maybe 1 hr of work/week plus carrying a pager for questions whenever the clinic is open.
most of the docs who do this are retired.
pa's who own their own clinics purchase huge malpractice policies for themselves and the docs they hire so everyone is covered in the event of a lawsuit. also they have a very low threshold for referal to md specialists. most of these practices do not follow ob pts but refer them out( the exception being rural clinics which do essentially everything if they are the only show in town).

 

[Dr JPH]

When patients are seen in this type of practice are they informed that there is no physician directly overseeing their care?

 

[deleted6669]

When patients are seen in this type of practice are they informed that there is no physician directly overseeing their care?

YES. they have a form that the pt signs before they are ever seen that described the practice. the waiting room and each pt room have a notice that says " care given here is provided by physician assistants indirectly supervised by xyz md."
are you aware that in many practices( both inpt and outpt)that this is the case? surgery is pretty much the only area in which direct supervision occurs as the surgeon is right across the table from the pa. most practices have the pa consult as needed and require a certain % of charts to be reviewed per month. having an md see every pt seen by the pa is terribly inefficient and at that point why not just hire another doc?
I am working right now in a major trauma ctr and there is no physician "directly overseeing my care". there is someone available for consult and I haven't talked to them all day and my shift is almost over.....in a typical 45-60 hr work week I consult an em physician maybe twice. I talk to lots of specialists(surgeons, ent, etc) to arrange admissions and facilitate care but it isn't often that I discuss a case with any of the docs I am working with. at this point in my career the majority of the time I ask them a question they don't know the answer either and I end up just consulting the appropriate specialist.
we have 1 chart rack. they see their pts, I see mine. we talk to each other about interesting and unique cases but I don't "consult" very often within my own specialty much anymore. as a new grad I did all the time but that was a long time ago. in fact the docs I work with consult me about as much as I consult them.

 

[Dr JPH]

in fact the docs I work with consult me about as much as I consult them.

I have no doubt. Working in a particular field for a long time, just about everyone can ascend to the same level of knowledge and understanding, regardless of degree or 'formal' education.

 

[deleted6669]

I have no doubt. Working in a particular field for a long time, just about everyone can ascend to the same level of knowledge and understanding, regardless of degree or 'formal' education.

thank you.

 

[deleted87716]

Reality check: "x" years of experience just makes you a more experienced PA; it doesn't make you a doctor.

 

[deleted6669]

reality check: doctors don't have the market cornered when it comes to medical knowledge or skills.

 

[funkless]

reality check: doctors don't have the market cornered when it comes to medical knowledge or skills.

...But they are the dominant stockholders. Yet everyone seems to think that having a few shares in their portfolio automatically makes them a frickin' Rockefeller.

 

[RockfordWF]

actually most states allow a pa to own a practice and hire a physician to review a few charts/mo to meet the min requirement for supervision. I have several friends who do this.they are "their own boss".
agree about the money issue. in any field an md will always make more $ than a pa but a specialty pa( derm, ortho, surgery, em) can make more $ than a primary care md and have no overhead of any kind.

In my area, NP's can have their own license and run a clinic, but PA's need the supervision.

I haven't seen anywhere where PA's are making 150,000 a year. It seems they average more like 70k-100k.

Most Primary care physicians average 150k a year.

 

[deleted6669]

In my area, NP's can have their own license and run a clinic, but PA's need the supervision.

I haven't seen anywhere where PA's are making 150,000 a year. It seems they average more like 70k-100k.

Most Primary care physicians average 150k a year.

pa supervision at a clinic can be indirect(md never on site) with chart review weeks to a month later. this meets the legal requirements in most states for supervision. some states require x hrs of onsite md coverage per week( some require 4-8 hrs/week for example).
starting for an fm md in my area is 90-110k.
starting for an (experienced)em pa is 120k with many making 125-160k.
many surgical and derm pa's make > 150k.

 

[deleted87716]

starting for an fm md in my area is 90-110k.
starting for an (experienced)em pa is 120k with many making 125-160k.

It's pointless to compare incomes across specialties.

How much does a newly-minted PA make in primary care where you live, and how much do the EM docs make?

 

[deleted6669]

It's pointless to compare incomes across specialties.

How much does a newly-minted PA make in primary care where you live, and how much do the EM docs make?

NEWLY MINTED FM PA AROUND 75K
RESIDENCY TRAINED/BOARDED EM MD 200K+/YR(RANGE 200-350)

 

[PeepshowJohnny]

...youhave loans to pay until your middle age, the amount of work you put in doesn't equal the amount you get out, health insurance is a huge hassle, malpractice insurance is through the roof, and you go through seven years of life on hold

And here's what's going to make all those decision easy for you:

Are you willing to stare all those things in the face and say "This is still something I have to do for myself"? Maybe you're doing it for autonomy. Maybe you're doing it for pride. Maybe you're doing it for intellectual curiosity. Hell, maybe you're even doing it for the money. Doesn't matter. If your desire is there, you'll push through it.

P.S. If you DO decide to go down the doctor's road, that doesn't mean you don't have the right to complain about it. We all do, it's fun!

P.P.S. It'll probably be more like 10 years of life on hold in my case. And I've only got two years, one month, and one Step exam finished.

P.P.P.S. Jennyboo's post is fantastic.

 

[RockfordWF]

pa supervision at a clinic can be indirect(md never on site) with chart review weeks to a month later. this meets the legal requirements in most states for supervision. some states require x hrs of onsite md coverage per week( some require 4-8 hrs/week for example).
starting for an fm md in my area is 90-110k.
starting for an (experienced)em pa is 120k with many making 125-160k.
many surgical and derm pa's make > 150k.

The actual physician more than doubles that salary in each of those specialties. Why do the same work for half the pay?

Just because you don't want to go to school for 2 more years?

 

[deleted6669]

The actual physician more than doubles that salary in each of those specialties. Why do the same work for half the pay?

Just because you don't want to go to school for 2 more years?

the difference around here in primary care between starting pa and md is around 15k/yr.
also it's not 2 yrs difference, it's 2 + the residency.if it was only 2 lots of folks would do it. the residency at 40k/yr is a bit painful for those who could make 80k+/yr for those 3 yrs vs 40k/yr. and then there is the debt issue. although pa school is starting to get expensive it's still not as bad as 4 yrs of medschool + loans to live on as a resident( for those with families and a mortgage 40k isn't going to cut it....). I've looked into going back(several times) and the numbers just don't make sense for me to do it. lost salary + loans = over 1 million dollars. I would have to double my salary for at least a decade to break even.

 

[NonTradMed]

Hey,
As my title implies this kind of thread probably has already been asked many times over but i just wanted some opinions from physicians, and I might sound naive throughout some parts...
I don't know if I should become a doctor or a PA. My mother is a nurse and she advises against going to medical school because you have loans to pay until your middle age, the amount of work you put in doesn't equal the amount you get out, health insurance is a huge hassle, malpractice insurance is through the roof, and you go through seven years of life on hold. What do you all think about this? Did any of these things affect your decision on going to medical school? Is it all worth it to you in the end?
As a PA, it seems like (from reading around on some threads) that PA's get the "easy" stuff with patients and they aren't highly respected with their colleagues as well as patients in some instances. I'm probably wrong in some cases but this is just what I gathered from reading around.
I just don't know if I want to be the middleman or if I'd rather have acquired the most skill and knowledge that medical school has to offer when I look back at my life in the future. I hope to follow around a PA and a physician just to see what it's like but I'd really appreciate some solid feedback. Again sorry if this is a redundant post buttt I just don't know what's best for me , thanks 🙂

The biggest differences between PA and MD (from a work perspective) is the level of authority you have in a patient's care. PAs are more limited in what they do. But they also have less liability, less malpractice, and they get to do much of what a doctor does but minus the extra years of school and residency.

The one thing I would NOT worry too much about is loans since doctors typically have had no problems paying them back. It's the long hours, calls and insurance hassles which seems the bane of most doctors that I know of.

You should try to shadow a few PAs and MDs to see where you would most be interested in doing.

One more thing, you can more easily go to PA school at an older age than an MD school. If you are leaning towards MD, I suggest not waiting too long for it. Good luck.

 

[deleted6669]

"The biggest differences between PA and MD (from a work perspective) is the level of authority you have in a patient's care. PAs are more limited in what they do."

this is true in most instances however in practices without a physician present( say a rural family practice or rural emergency dept) the pa is the only one there or they are scheduled interchangeably with physicians. in this circumstance the pa and the md do the exact same job the only difference is that the pa has some of his/her charts audited every month long after the patient has left the practice. with regard to "authority" in these examples the pa is the only clinician present and the only decision maker around.
most pa's(even in situations where they work side by side with an md) do not present every pt before they leave the clinical site, just those they have questions or concerns about. md's do this too, it's called a consult.

 

[abefromann]

I'm almost done with med school and have experienced PA's in my family, and have good perspective from both sides of the coin. The bottom line is that as a PA you'll be done with school quicker, have less responsibility, and get out of debt sooner that your counterparts. The salaries are pretty good, too, depending on location. You'll be above a nurse, and feel like it, but you'll never really be on par with a doctor. Hospitals are like high school, and sort of like the military when it comes to hierarchy. As a PA you really won't have the same depth of understanding across the board that a doctor does (2.5 years versus 8 years). You may feel like it, but honestly if you take the short route you must realize there's a lot that you just won't know. That said, being a doctor is a stressful experience. Medical school is terrible, the four steps of boards are painful, and residency applications are grueling. It's a long long road. But there is nothing like it. If you want to be done soon and enjoy working and making money, with a good amount of respect from patients and co-workers, PA is fine. Just realize you'll never be the queen of the roost, king of the castle, or whatever. And I've heard that it can get annoying. Plus, friends and family will invariably at one time or another ask something like, "so you can go on to be a real doctor if you want?", implying you're on your way and couldn't possibly want to be just an assistant all your life. Last point -- PAs do have the freedom to move from specialty to specialty, and don't have to make a decision early on that could affect the scope of their lifetime practice. That is something I am sort of envious of, and it's valuable.

 

[Kajukenbo]

Quote:Originally Posted by emedpa
reality check: doctors don't have the market cornered when it comes to medical knowledge or skills.

...But they are the dominant stockholders. Yet everyone seems to think that having a few shares in their portfolio automatically makes them a frickin' Rockefeller. Funkless

Funkless, I agree!

 

[Kajukenbo]

reality check: doctors don't have the market cornered when it comes to medical knowledge or skills.

Seriously, this is one of the most assinine posts I have ever read on here.

 

[TRAMD]

I'm almost done with med school and have experienced PA's in my family, and have good perspective from both sides of the coin. The bottom line is that as a PA you'll be done with school quicker, have less responsibility, and get out of debt sooner that your counterparts. The salaries are pretty good, too, depending on location. You'll be above a nurse, and feel like it, but you'll never really be on par with a doctor. Hospitals are like high school, and sort of like the military when it comes to hierarchy. As a PA you really won't have the same depth of understanding across the board that a doctor does (2.5 years versus 8 years). You may feel like it, but honestly if you take the short route you must realize there's a lot that you just won't know. That said, being a doctor is a stressful experience. Medical school is terrible, the four steps of boards are painful, and residency applications are grueling. It's a long long road. But there is nothing like it. If you want to be done soon and enjoy working and making money, with a good amount of respect from patients and co-workers, PA is fine. Just realize you'll never be the queen of the roost, king of the castle, or whatever. And I've heard that it can get annoying. Plus, friends and family will invariably at one time or another ask something like, "so you can go on to be a real doctor if you want?", implying you're on your way and couldn't possibly want to be just an assistant all your life. Last point -- PAs do have the freedom to move from specialty to specialty, and don't have to make a decision early on that could affect the scope of their lifetime practice. That is something I am sort of envious of, and it's valuable.

This is an EXCELLENT point and the only thing that I feel was left out of jennyboo's near-perfect post.

The best idea is to become a PA, CRNA, dentist, orthodontist, optometrist, pharmacist, etcetera and MARRY someone in one of those fields. People in these fields regularly make over $100k. Together you will make more than most physicians and have a great lifestyle! I know a couple that are both part-time to full-time CRNAs and LOVE their life.

 

[arrhythmia7]

$120k a year is great, until you're 30.

 

[deleted6669]

dude....120k is reasonable money if you have no debt. if you want more as a pa just work em, ortho, surgery, or derm...the money is there.....

 

[TRAMD]

the difference around here in primary care between starting pa and md is around 15k/yr.
also it's not 2 yrs difference, it's 2 + the residency.if it was only 2 lots of folks would do it. the residency at 40k/yr is a bit painful for those who could make 80k+/yr for those 3 yrs vs 40k/yr. and then there is the debt issue. although pa school is starting to get expensive it's still not as bad as 4 yrs of medschool + loans to live on as a resident( for those with families and a mortgage 40k isn't going to cut it....). I've looked into going back(several times) and the numbers just don't make sense for me to do it. lost salary + loans = over 1 million dollars. I would have to double my salary for at least a decade to break even.

Are you honestly attempting to defend that being a PA makes more sense financially than being an MD? There are advantages to the PA route but money is NOT one of them.

Let's take an average Joe with a family who is the sole breadwinner and has only school loans to support him.

If you have a family and are the sole support for that family you will taking out the maximum amount in loans for every year you are in school. Also realize that this scenario actually favors the PA position as the absolute difference in debt will be greater. Also realize that most of this loan amount will go to living expenses, not tuition (at average schools).

So debt would be around:
$80,000 for PA school (about $500 per month in payments for 30 years)
$160,000 for MD school (about $1000 per month in payments for 30 years)

Before I get into further numbers, let me say a few things:
You can definitely have a family and a mortgage on a resident salary (I am doing it right now). You will probably have to defer your loan payments, however. I will assume that all things are equal except loan debt and salary. For simplicity I will assume only federal income tax, not state. According to salary.com the median salary for a PA is about $77k or about $64k after federal income taxes. The median salary for a GP (the lowest paid of all physicians, median for all physicians in all specialties would be higher) is about $145k or about $114k after taxes. I will assume that both Joes make their payments monthly for 30 years and don't pay off their loans. I will also just assume that both make the median for the specialty for all years. This also favors the PA as absolute salary increase would be greater for the physician. I will be judging based on surplus salary after taxes and loan payments and not for other expenses which are not dependent on career.

Years 1 and 2: (being first two years of school) - both just go into debt

Year 3 and 4: MD goes more into debt, PA starts to make money.
MD: $0 surplus
PA: $71,000 each year ($77k-$6k for loan payments) for a total of $142,000 surplus

Years 5-8: MD makes money as a resident (about $45k or $39k after federal taxes), but doesn't make payments on loans. The interest increases the loan amount by about $30k for a total of $190,000--we'll say payments will now be about $1250 per month. Note: a GP actually only needs 1 year of residency, but we'll say three--as for a family resident--to again favor the PA.
MD: $177k surplus
PA: $355k surplus

Year 9: The MD starts to make his real salary and after loan payments adds $99k to his surplus per year.
MD: $276k
PA: $426k

Year 15: At this year the MD overtakes the PA.
MD: $870k
PA: $852k

He continues to get ahead by $18k per year after that. Realize that numbers used favor PAs and that true median salary for all physicians would be even worse for the PA in this comparison.

 

[deleted6669]

your #s are a bit off. the avg pa last yr made 84,396. the avg em pa made 93 k. if you use those #s the md will still catch up and overtake the pa but we are probably looking at 20 yrs or so then instead of 15. also do you know any md's who really did medschool for only
160k?. that's in state living with your parents maybe.....there are lots of pa programs that can be done for less than 50k total. so do the math again with real salaries, 200k for the md debt and 50 k for the pa debt and see where that gets you.....there is a lot more to pa vs md than salary obviously but it is still something to consider.....
PA Salaries by State 2006

The AAPA reported mean total income (MTI) from primary employer for clinically practicing PAs working at least 32 hours a week in its 2006 census report. ADVANCE compiled this chart using data from AAPA's individual state reports.

State MTI
Mississippi $95,712
California $95,205
Nevada $94,244
Alaska $92,912
Connecticut $91,444
Delaware $89,634
Texas $88,982
New Jersey $88,792
Florida $88,632
Arizona $88,556
Massachusetts $88,343
D.C. $87,826
Oklahoma $87,415
Washington $87,040
Arkansas $86,624
Georgia $86,511
Hawaii $86,472
Rhode Island $85,876
Alabama $85,660
Tennessee $85,171
Maryland $85,106
Louisiana $84,770
Utah $84,589
Michigan $84,493
U.S. Mean $84,396
Idaho $83,908
Minnesota $83,870
Oregon $83,751
N. Carolina $83,126
Wisconsin $83,119
N. Hampshire $82,958
Iowa $82,918
Virginia $82,754
New Mexico $82,590
Missouri $82,474
Vermont $82,470
Illinois $82,173
New York $82,005
Nebraska $81,196
S. Carolina $80,732
Maine $79,528
Wyoming $78,994
Kentucky $78,633
Ohio $78,615
Montana $78,423
Indiana $78,157
Colorado $77,972
Kansas $77,512
S. Dakota $77,248
West Virginia $75,672
North Dakota $74,222
Pennsylvania $73,383


Source: American Academy of Physician Assistants



PA Salaries by Specialty 2006
In its 2006 census report, the AAPA reported mean total income (MTI) from primary employer for clinically practicing PAs working at least 32 hours a week. ADVANCE compiled this chart using data from AAPA's individual specialty reports.

Specialty MTI
Cardiovascular/Cardiothoracic surgery $104,681
Dermatology $100,735
Neurosurgery $93,979
Emergency medicine $92,896
Surgical subspecialties $91,364
Orthopedics $90,093
Critical care medicine
$89,113
Plastic surgery $88,900
Pediatric cardiology $88,086
Interventional radiology $87,603
Anesthesiology $86,801
Trauma surgery $86,752
Geriatrics $86,712
Pain management $85,014
Occupational medicine $84,801
National mean $84,396
Urology $84,204
General surgery $83,296
Diagnostic radiology $82,837
Surgical oncology $82,571
Medical cardiology $82,374
Addiction medicine $82,034
Otorhinolaryngology $81,233
Hospital medicine $80,563
Psychiatry $79,104
Medical oncology $78,972
Family medicine $78,893
Radiation oncology $78,514

Pediatric gastroenterology $78,504
Allergy $78,241
Pediatric neurology $77,664
Pediatrics $77,452
Pediatric oncology $77,047
Medical gastroenterology $76,858
Medical rheumatology $76,366
Medical neurology $76,361
Medical nephrology $76,295
Medical endocrinology $75,157
Obstetrics/Gynecology $74,658
Public health $73,180


Source: American Academy of Physician Assistants

 

[TRAMD]

your #s are a bit off. the avg pa last yr made 84,396. the avg em pa made 93 k. if you use those #s the md will still catch up and overtake the pa but we are probably looking at 20 yrs or so then instead of 15. also do you know any md's who really did medschool for only
160k?. that's in state living with your parents maybe.....there are lots of pa programs that can be done for less than 50k total. so do the math again with real salaries, 200k for the md debt and 50 k for the pa debt and see where that gets you.....there is a lot more to pa vs md than salary obviously but it is still something to consider.....

My salary numbers aren't off. I got them directly from the salary.com site. I suppose their numbers could be off . . .

Anyways, you will notice that I posted MEDIAN salaries, not MEAN. There is a difference. Mean is the outright average: total of all values divided by number of values. The mean for the number set 2, 4, 6, 20 is 8. Median is the value where there is an equal number of values above and below. It is the same as the 50th percentile. The median for the same number set is 5. Median tends to be lower than mean when there are some very high values (such as with physician salaries that can be into 7 figures). The number I gave is also the median salary for a GP. Very few GPs are even being made anymore and they are the lowest paid of all physicians. Mean (or average) salary for all physicians in all specialties would be right around $200k.

As far as debt . . . for the purposes of my scenario I was using a specific family model where they take out 40k per year. I should state again that at most PA AND medical schools the cost of living (essentially the same regardless) is a bigger number than tuition when you are talking about raising a family.

Also, take a look at this:
"The median debt burden for graduates of public medical institutions has risen to over $119,000 while that for private school graduates has increased to nearly $150,000."
from this site . . . http://www.amsa.org/meded/studentdebt.cfm
. . . so my number for med school debt was actually high. I did inform you that I was using PA-friendly numbers. Using average numbers would only create a scenario where the MD overtakes the PA earlier. I hope I don't have to refigure all of that for you to see this.

 

[deleted6669]

fair enough. docs make good money. no debate here.
fyi salary.com is usually years behind the actual #s when it comes to the official pa salaries from our national organization (based on a survey sent to all working pa's every year.)

 

[TRAMD]

fair enough. docs make good money. no debate here.
fyi salary.com is usually years behind the actual #s when it comes to the official pa salaries from our national organization (based on a survey sent to all working pa's every year.)

If that is true then they are likely just as behind on physician salaries.

 

[deleted6669]

If that is true then they are likely just as behind on physician salaries.

yup, probably true as well

 

[core0]

If that is true then they are likely just as behind on physician salaries.

MGMA is probably the best place for physician salaries. The PA data is a little off because they don't have as many surgical practices as members. Otherwise their data seems to be pretty good.

David Carpenter, PA-C

 

[Sharn Penndroen]

As far as "putting life on hold" for 7+ years during med school and residency, I'm not sure what is meant by that. I am married and have had two children during med school. Maybe it's different for some people, but from my experience, life doesn't wait around for you to finish up training. It just keeps on rolling.

I wouldn't let the difference in training time affect your decision. Instead decide what you want to be doing eventually and then just go with that. If you let time of training and money made be your sole determining factor you may be disappointed in your decision later.

Also, it is good to get advice from people, your parents included, but ultimately it is YOUR career so take everything you hear with that under consideration.

Good luck.

 

[TRAMD]

As far as "putting life on hold" for 7+ years during med school and residency, I'm not sure what is meant by that. I am married and have had two children during med school. Maybe it's different for some people, but from my experience, life doesn't wait around for you to finish up training. It just keeps on rolling.

I wouldn't let the difference in training time affect your decision. Instead decide what you want to be doing eventually and then just go with that. If you let time of training and money made be your sole determining factor you may be disappointed in your decision later.

Also, it is good to get advice from people, your parents included, but ultimately it is YOUR career so take everything you hear with that under consideration.

Good luck.

Excellent point. I feel the same way. "Life" isn't all about making money.

 

[montessori2md]

The actual physician more than doubles that salary in each of those specialties. Why do the same work for half the pay?

Just because you don't want to go to school for 2 more years?

Do the math, esp if you're a bit older when you're starting school. Add up the interest on loans, the lost income from the years not worked, and if you are "typical" as of 2007 figures for indebtedness ($120,000+), then it will take you about 10 years in primary care to match what you would have made as a surgical PA, starting at, say $80,000 and working up to $120,000/yr, with 2 years in school instead of 4, and making more than 2x what an MD makes in residency, and with a much, much smaller debt coming out of school.

I figured, if I get no finaid besides loans, given the stats at the schools I applied to, I'm taking a half million dollar loss (based on my region) by going MD instead of PA. There are some nice posts over on the PA forum that write out the details.

 

[oldManDO2009]

I will probably die before I pay off my loans. No, actually I will pay off my loans before I change my poor a$$ life style.

As for life on hold while training - not here. My kids are getting older and are not waiting for me to finish school. So I invest heavily in their futures by being there for them while they grow up. Medc school training is like a job, when I am done (and I am always eventually done) I go home to my family.

I am an older student and wanted the knowledge more than the prestige. I am fascinated by the biochemistry of the body ( a near perfect ballet) and could not satisfy my curiosity with the level of education I had attained in previous endeavors.

I may never finish school - If my wife dose not kill me maybe a PhD is in my future????

 

[TexPre-Med]

For those lucky enough to have their med school paid for:
M.D.'s quickly make more than P.A.'s


Sorry. Had to do it.