PA vs. MD

[eagle1970]

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That is Physician Assistant vs. Physician.

I would like to know if anyone has considered becoming a PA instead due to the shorter program length. The extensive (and in some MD's opinions, excessive) residency of the MD program can be a turn-off.

How about co-applying to PA and MD simultaneously?

If this has been discussed before then maybe someone can redirect me to the thread.

thanks.

 

[sylvanthus]

I actually applied to both PA and DO schools and somehow managed to get into both. The deciding factor for me was the location and other considerations regarding my fiancee as well as knowing I may get frustrated over time being a PA. Don't get me wrong, being a PA is a great career and the one my fiancee is choosing. For me, though, I think I would eventually become frustrated and feel like I wanted to have more independence.

In the end, I chose DO.


Justin

 

[crazydiamond]

I seriously considered PA school too.

The deciding factor for me was the legalities surrounding what an MD/DO can do versus a PA. My dream is to open my own practice and you just can't do that as a PA. As an MD I may choose to work in a group practice or forsomeone (like a hospital) but then again I may not. As a PA, you're going to always have to work directly for someone.

 

[bkpa2med]

If you want good pay/lifestyle/less debt choose PA, if you're ready to sell your soul -- MD/DO.

 

[FourMoreYears]

I seriously considered PA school too.

The deciding factor for me was the legalities surrounding what an MD/DO can do versus a PA. My dream is to open my own practice and you just can't do that as a PA. As an MD I may choose to work in a group practice or forsomeone (like a hospital) but then again I may not. As a PA, you're going to always have to work directly for someone.

You actually can open your own practice as a PA. You just need to hire a doctor to sign charts and be your supervising physician. This really applies to FP/Urgent care settings. There are lots of clinics/offices where the PA owns and operates everything.

 

[crazydiamond]

You actually can open your own practice as a PA. You just need to hire a doctor to sign charts and be your supervising physician. This really applies to FP/Urgent care settings. There are lots of clinics/offices where the PA owns and operates everything.

Having to hire an MD is not my idea of being my own boss. I would still be working for someone. That is, the MD may not pay me but he/she can make a difference in how I practice. The point I'm making is I want no part of that. I don't want to answer to someone else (save for the unavoidable insurance companies and law makers) and I certainly don't want anyone "supervising" me, no matter how superficially.

 

[take the shot]

As an ARNP, I could actually open my own practice without MD authority. It's never been clear to me why that difference exists between NPs and PAs as I see them as interchangeable.

I have always wanted to be a doctor, but have had a couple of bumps in my life preventing this along the way and getting my Masters as an NP was quicker. Although people would tell you I am a very good clinician, my knowledge base (or lack thereof) limits me from being the best I can be. I hate not being able to give the best care possible to patients and med school will give me that. There are surely lots of jobs available for midlevels and you can make a wonderful contribution to medicine. I agree with the others, however, when they talk about wanting the independence that comes with being an MD. No question, though, it is quicker to become a PA. If you are trying to do this ASAP, it's not like you couldn't go after med school in the future.

 

[Bearferret]

I'm going the MD route for the aforementioned autonomy reasons, plus, frankly, for the level of expertise. I'd really like to learn something - and eventually know something - to about the greatest degree you can know it, and then have the opportunity to apply that knowledge. That's also why I plan to specialize (in what, exactly, I'm not sure) rather than go into primary care.

However, PA is an attractive option for the reasons the OP already posted, but also because of some flexibility; as a PA, you can work in, say, a Neurosurgery clinic for a while, and then if that gets boring, you can just leave and go work for, say, a group of cardiologists. And then change again once you get tired of that. It's a lot harder to do something like that as a physician.

 

[unsung]

I'm going the MD route for the aforementioned autonomy reasons, plus, frankly, for the level of expertise. I'd really like to learn something - and eventually know something - to about the greatest degree you can know it, and then have the opportunity to apply that knowledge. That's also why I plan to specialize (in what, exactly, I'm not sure) rather than go into primary care.

However, PA is an attractive option for the reasons the OP already posted, but also because of some flexibility; as a PA, you can work in, say, a Neurosurgery clinic for a while, and then if that gets boring, you can just leave and go work for, say, a group of cardiologists. And then change again once you get tired of that. It's a lot harder to do something like that as a physician.

Yes, agreed. Autonomy is something I value in a profession. But even more important to me is how intellectually fulfilling the profession is... I would be driven nuts if I were a nurse because I'm the type of person who is always asking (even if it's just in my head) "why does that happen?" or "how does that work?"

Even just working around nurses, I can see that those questions aren't really all that welcome. I feel like the oddball in the group 'cuz I'm curious about why things work. Most other folk are comfortable just being told "do X procedure this way" without understanding why they're doing it. Oftentimes, nurses will even feel like you're challenging their authority or something by asking "why"... whereas around doctors, I always got the sense that they welcomed questions of that nature, even if they didn't know the answer, they'd reply "good question." Not that there isn't plenty of memorization/regurgitation in medicine... but still I get a sense that curiosity is a welcome trait in the profession, whereas in the allied healthcare professions, I don't really get that same sense.

That was a little off topic... but similarly for PAs, I don't think I'd be satisfied with my more limited knowledge base. Yes, it's one thing to be a "good clinician" or to become better at one's job through experience... but STILL, there is a huge difference between learning through experience that " X amt of drug Y is good for condition Z" and actually understanding the science/mechanisms behind why that occurs... the former is just a kind of rote memorization due to experience. Knowing that tidbit and regurgitating it in relevant situations makes one LOOK smart or SOUND like one knows what's going on... but it's still memorization all the same. And if prodded, there's nothing behind that knowledge that would allow one to reason out what to do in a novel situation. That's the whole appeal of medicine for me.

Well, one thing the PA profession does have going for it is that it employs the medical model, unlike nursing. But still, I could never do it.

 

[deleted6669]

I seriously considered PA school too.

The deciding factor for me was the legalities surrounding what an MD/DO can do versus a PA. My dream is to open my own practice and you just can't do that as a PA. As an MD I may choose to work in a group practice or forsomeone (like a hospital) but then again I may not. As a PA, you're going to always have to work directly for someone.

actually most states allow a pa to own a practice and hire md(s) as supervisors. my pcp is a pa who is sole owner of his practice.

 

[deleted6669]

Having to hire an MD is not my idea of being my own boss. I would still be working for someone. That is, the MD may not pay me but he/she can make a difference in how I practice. The point I'm making is I want no part of that. I don't want to answer to someone else (save for the unavoidable insurance companies and law makers) and I certainly don't want anyone "supervising" me, no matter how superficially.

suervision in some states is as simple as a 30 min mtg to discuss the practice every 6 months. a buddy of mine has this arrangement. his sponsoring md is a friend and they play golf together twice a yr and write it off as a business expense. the md NEVER is present at the clinic and NEVER has to review charts. he has to be "aware of practice trends" per the state requirement. for this he gets a malpractice policy and 1000 dollars/month.

 

[crazydiamond]

suervision in some states is as simple as a 30 min mtg to discuss the practice every 6 months. a buddy of mine has this arrangement. his sponsoring md is a friend and they play golf together twice a yr and write it off as a business expense. the md NEVER is present at the clinic and NEVER has to review charts. he has to be "aware of practice trends" per the state requirement. for this he gets a malpractice policy and 1000 dollars/month.

What about "no matter how superficially" didn't you understand?????

I am completely aware of how PAs can operate. I do not want to HAVE to have someone else associated with my practice. Period. I want to be an MD because I get that autonomy and PAs do not. End of story. And to pay $1000 for someone who doesn't actually do anything? Yeah, I want to be the MD in that gig, not the PA!

Look, if it's not a big deal to you, then by all means do it yourself. But it's a big deal to me and so I won't pursue that route.

Clearly, you're feeling defensive. This thread was about all of our opinions. The very nature of your title "resident PA defender" says it all. I'm not bashing PAs, I'm just saying it's not for me.

 

[deleted6669]

What about "no matter how superficially" didn't you understand?????

I am completely aware of how PAs can operate. I do not want to HAVE to have someone else associated with my practice. Period. I want to be an MD because I get that autonomy and PAs do not. End of story. And to pay $1000 for someone who doesn't actually do anything? Yeah, I want to be the MD in that gig, not the PA!

Look, if it's not a big deal to you, then by all means do it yourself. But it's a big deal to me and so I won't pursue that route.

Clearly, you're feeling defensive. This thread was about all of our opinions. The very nature of your title "resident PA defender" says it all. I'm not bashing PAs, I'm just saying it's not for me.

that's fine. no reason for the hostility. I'm not feeling defensive. I was honestly trying to educate folks who read the thread about the details of being your own boss as a pa.
I'm happy with my job as a pa, with my scope of practice and the income I generate and the lifestyle it provides.
fyi-the solo pa I described above does very well financially so 1000/mo is nothing when his practice brings in as much or more than the local md practices.

 

[crazydiamond]

that's fine. no reason for the hostility. I'm not feeling defensive. I was honestly trying to educate folks who read the thread about the details of being your own boss as a pa.
I'm happy with my job as a pa, with my scope of practice and the income I generate and the lifestyle it provides.
fyi-the solo pa I described above does very well financially so 1000/mo is nothing when his practice brings in as much or more than the local md practices.

My response was not so much one of hostility but rather sheer amazement that my response was apparently so unclear about my preferences that it warranted further discussion. I mean, really, what else could I have said to make it clear that I was not looking for advise regarding PA practice? I recognize your goal was to educate others but that leaves me a little confused why you directly quoted me, turning your response into a rebuttal of sorts.

But, I will say that your post brought up a good point that I had forgotten about. The scope of practice of PAs really depends on state regulation. I don't want to be tied to a particular state to practice the way I want to. The laws regarding MD practice are much, much more uniform.

 

[deleted6669]

But, I will say that your post brought up a good point that I had forgotten about. The scope of practice of PAs really depends on state regulation. I don't want to be tied to a particular state to practice the way I want to. The laws regarding MD practice are much, much more uniform.

this is very true.
for pa's individual state laws are based on restriction of activities while md laws mostly grant additional priviledges. for example in my state md/do folks specifically are all assumed to be able to practice accupuncture as part of their basic scope. if they choose to do so it is up to them to obtain any training they feel they need.

 

[UNMorBUST]

Ill admit I was interested in PA because the program at my college is a BS degree. I would ,however, not be pleased over time. If i want something it is not satisfying taking the easy way out. But who knows i might change my mind.

 

[dragonfly99]

You all have raised some salient points above the pluses/minuses of being a PA. I do think that some of you may be overestimating the degree of independence you'll have as an MD or DO, though. It's getting harder and harder to own one's own practice, or even practice in a small group, particularly if you go the primary care route. Similarly, in many fields such as anesthesia, pathology and emergency medicine, radiology almost all docs are employed by hospitals or part of a large group. So even if part of a large group you have your partners to deal with, plus all the insurance companies, etc. In addition to that, you have pharmacists, RN's, advanced practice nurses and PA's all carving out their practice areas now and with expanded scope of practice, and they aren't going to just all jump when you say jump like they would have perhaps 20 or 30 years ago. It's just a part of modern medicine. But I'm not trying to discourage anyone from going the MD/DO route...to each his own. It's just something to be aware of.

 

[rnnpmaybe]

Even just working around nurses, I can see that those questions aren't really all that welcome. I feel like the oddball in the group 'cuz I'm curious about why things work. Most other folk are comfortable just being told "do X procedure this way" without understanding why they're doing it. Oftentimes, nurses will even feel like you're challenging their authority or something by asking "why"...

I understand wanting more knowledge, but honestly, I'm a nurse, and I ALWAYS want to know why. If I don't know something at work, I go home and look it up. The nurses I supervise also ask the doctors and myself plenty of questions. I understand wanting autonomy - nurses don't have that. Please don't generalize the nursing profession because of your unfortunate experience. In school, I was held to know a. why I was giving a medication b. was it the correct dose of the medication c. was it the appropriate medication? d. what else would you expect the doctor to order, etc. The NCLEX, licensure exam, asks these questions as well. In defense of the nurses you encountered, patients/families/other practitioners question nurses all the time. As in, question that they really know what they are talking about. (ie, RN says 130/90 is a high blood pressure. patient says, Oh, well, I'd really like to hear the doctor say that.) They (the nurses you experience) should not get defensive, that's bad for all of us but everyone is human.

 

[TexasPhysician]

I understand wanting more knowledge, but honestly, I'm a nurse, and I ALWAYS want to know why. If I don't know something at work, I go home and look it up. The nurses I supervise also ask the doctors and myself plenty of questions. I understand wanting autonomy - nurses don't have that. Please don't generalize the nursing profession because of your unfortunate experience. In school, I was held to know a. why I was giving a medication b. was it the correct dose of the medication c. was it the appropriate medication? d. what else would you expect the doctor to order, etc. The NCLEX, licensure exam, asks these questions as well. In defense of the nurses you encountered, patients/families/other practitioners question nurses all the time. As in, question that they really know what they are talking about. (ie, RN says 130/90 is a high blood pressure. patient says, Oh, well, I'd really like to hear the doctor say that.) They (the nurses you experience) should not get defensive, that's bad for all of us but everyone is human.

While I am glad you want to know "why", this is not the case with the majority of nurses I have met. Sure, the percentage gets higher with each advanced nursing degree, but I still see many nurses who don't care to get that deep into medicine. They may have cared enough to pass the NCLEX, but that should be just the starting point. It would be wonderful if all nurses cared to continually learn more like you, and if I had to guess, I'd say you are the type of person to push yourself to become an NP or equivalent (nurses have so many degrees now its hard to keep up).

Going back to the poster's question; I think PA is a great profession. The majority that I have met are very smart individuals. For PA's that find an MD that they enjoy working with, life is sweet. Just because you don't get the MD degree, doesn't mean you can't be a life-long learner and out-smart those with higher degrees than you.

 

[princekc]

I think PA is a great profession. The majority that I have met are very smart individuals. For PA's that find an MD that they enjoy working with, life is sweet. Just because you don't get the MD degree, doesn't mean you can't be a life-long learner and out-smart those with higher degrees than you.

....strongly agree! thanks for your remark about PA profession.

 

[justtesting]

While I am glad you want to know "why", this is not the case with the majority of nurses I have met. Sure, the percentage gets higher with each advanced nursing degree, but I still see many nurses who don't care to get that deep into medicine. They may have cared enough to pass the NCLEX, but that should be just the starting point.

i appreciate you explaining that you are referring to the "majority of nurses you have met" but from the 'nurses i have met' i must respectfully disagree with you. i have worked in a number of units at a trauma 1 hospital in my nursing career (neuro critical care, burn trama, medical ICU, surgical ICU) and have not known a single nurse, no not one, who is comfortable doing a procedure, giving meds, or providing specific care to patients without knowing why. it is unfortuante that you have encountered nurses who are fine doing whatever they are asked just because they are told to do it and not understanding why, but this (from my experience) is not the norm- though i come from all ICU experience which might make a difference. while it is true nurses do not understand everything in the same depth a physician would, they generally know the basics. when you think of a nurse, it is important to remember they are frequently the liason between the phycisian, the pt, and the pts family and are required to teach the basics about what is going on. i only hope your future experiences with nursing will show you that the majority of nurses do actually care about knowing what is going on and to some depth, why.

 

[TexasPhysician]

i appreciate you explaining that you are referring to the "majority of nurses you have met" but from the 'nurses i have met' i must respectfully disagree with you. i have worked in a number of units at a trauma 1 hospital in my nursing career (neuro critical care, burn trama, medical ICU, surgical ICU) and have not known a single nurse, no not one, who is comfortable doing a procedure, giving meds, or providing specific care to patients without knowing why. it is unfortuante that you have encountered nurses who are fine doing whatever they are asked just because they are told to do it and not understanding why, but this (from my experience) is not the norm- though i come from all ICU experience which might make a difference. while it is true nurses do not understand everything in the same depth a physician would, they generally know the basics. when you think of a nurse, it is important to remember they are frequently the liason between the phycisian, the pt, and the pts family and are required to teach the basics about what is going on. i only hope your future experiences with nursing will show you that the majority of nurses do actually care about knowing what is going on and to some depth, why.

Very well should be the case that an ICU has VERY dedicated nurses. You have life and death situations every hour. I do not have extensive experience with ICU nurses as I have most of my experience with inpatient/outpatient nurses.

 

[unsung]

i appreciate you explaining that you are referring to the "majority of nurses you have met" but from the 'nurses i have met' i must respectfully disagree with you. i have worked in a number of units at a trauma 1 hospital in my nursing career (neuro critical care, burn trama, medical ICU, surgical ICU) and have not known a single nurse, no not one, who is comfortable doing a procedure, giving meds, or providing specific care to patients without knowing why. it is unfortuante that you have encountered nurses who are fine doing whatever they are asked just because they are told to do it and not understanding why, but this (from my experience) is not the norm- though i come from all ICU experience which might make a difference. while it is true nurses do not understand everything in the same depth a physician would, they generally know the basics. when you think of a nurse, it is important to remember they are frequently the liason between the phycisian, the pt, and the pts family and are required to teach the basics about what is going on. i only hope your future experiences with nursing will show you that the majority of nurses do actually care about knowing what is going on and to some depth, why.

Hmm, well when I was referring to nurses not being all that curious or enjoy asking or being asked "why", I wasn't referring to knowing why they were giving a specific medication or doing a procedure. The nurses I've met were all perfectly clear on those practical "why"s. If asked, they'd clearly respond that "vistaril is for anxiety" and of course they're perfectly clear about the dosages they're using, as well as any possible drug interactions, etc.

BUT. It pretty much stops there. I'm that annoying person who when someone tells me "vistaril is for anxiety", a zillion questions pop into mind like "so how does it work? how does vistaril differ from other drugs that could also be used for anxiety?" etc. etc.

It doesn't have to be about drugs. It could be about something as simple as blood pressure. I have the suspicion that a significant portion of the nurses on my floor would not be able explain exactly what 140/80 means in terms of physiology or HOW a sphygmomanometer actually works (as opposed to whether or not the numbers are in the "normal range" or how do you USE a sphygmomanometer).

It's been my experience that a lot of nurses really feel put on the spot, put off, or even intimidated when asked "why" in that context of how does this thing actually work... I really wasn't trying to be an a** about it either... but the few times I've asked stuff like that, the nurse I was with clearly got displeased with me. I was just trying to learn, but it seemed like the nurse thought I was trying to *test* her or something... bizzare. Whereas with physicians, I've never had that experience... even when the physician never considered that question before, s/he would usually be like "oh good question!" Yeah, nurses were really nice if asked questions like "how do you do this?" and they'd be happy to show you... but the other types of conceptual questions I've learned to just keep to myself.

The other thing about nurses I've learned is... it's really really bad to establish yourself as the weird one asking all those questions others don't ask about... there are cliques galore and here's that independence thing again. Sure there are office politics in every workplace... but at least as a doctor, I'd get to work more independently, in the sense that the evaluation of my work will be based in large part on my actual performance... as opposed to what my nurse buddy on that same shift says about me to my supervisor who never actually sees me work on the unit...

Okay, that's a bit of a diatribe. Yeah, it hasn't been ALL bad tho' 😉 The plus side of the whole nursing thing is the increased patient contact, of course. Oftentimes, the docs will just waltz onto the floors, talk really really briefly to the patients and really have no idea what's going on with them. So it's up to nursing and co. to really keep track of what's going on. It's just a different role than physicians. I do feel like, through this experience, however, that I have absolutely NO questions about which role is more suited for my personality type. 😎

It's really not about autonomy issues (altho' I do like to be my own boss). It's certainly not about the patient interaction (considering I do like working with the patients). It's primarily about being curious and pursuing the answer to a question to very very basic depths and not resting until an adequate answer is obtained. That's what I love about medicine and that's why I'd never be satisfied as a nurse or PA.

 

[justtesting]

It doesn't have to be about drugs. It could be about something as simple as blood pressure. I have the suspicion that a significant portion of the nurses on my floor would not be able explain exactly what 140/80 means in terms of physiology or HOW a sphygmomanometer actually works (as opposed to whether or not the numbers are in the "normal range" or how do you USE a sphygmomanometer).

It's been my experience that a lot of nurses really feel put on the spot, put off, or even intimidated when asked "why" in that context of how does this thing actually work... I really wasn't trying to be an a** about it either... but the few times I've asked stuff like that, the nurse I was with clearly got displeased with me. I was just trying to learn, but it seemed like the nurse thought I was trying to *test* her or something... bizzare. Whereas with physicians, I've never had that experience... even when the physician never considered that question before, s/he would usually be like "oh good question!" Yeah, nurses were really nice if asked questions like "how do you do this?" and they'd be happy to show you... but the other types of conceptual questions I've learned to just keep to myself.

The other thing about nurses I've learned is... it's really really bad to establish yourself as the weird one asking all those questions others don't ask about... there are cliques galore and here's that independence thing again. Sure there are office politics in every workplace... but at least as a doctor, I'd get to work more independently, in the sense that the evaluation of my work will be based in large part on my actual performance... as opposed to what my nurse buddy on that same shift says about me to my supervisor who never actually sees me work on the unit...

yeah, i agree with the whole cliques thing. it has been a big deterrent for me working on certain units. i still just think it is unfortunate about your experiences with nursing, i guess maybe i'm biased because i've always worked at a university hospital which means its a teaching institution. The nurses i have worked with EXPECT to have students and EXPECT a lot of questions. they get annoyed when you dont ask questions. and as far as how a sphygmomanometer, all it takes is a basic understanding of knowing which pressure is greater between systole, diastole and cuff pressure to be able to explain the concept. i would hope most nurses know that, but maybe not. now ask a nurse to spell sphygmomanometer im sure youll be met with blank stares
i'm a nurse. i have to stick up for the good ones. but i'm obviously not completely satisfied with the field or i wouldnt be here on sdn looking to be a physician. i guess you just need to learn what can from them and what they dont know or wont tell you, you can come back and teach them when your their attending 🙂

 

[The Clash]

Trust me, after 4 years of undergrad, the thought of starting at the bottom again is gut-wrenching. But I think you should ask yourself if you would ever regret the decision. P.A.s are an integral and important part of the medical system today, (my doctor is a P.A. and I LOVE her) but if you're considering a specialty, I would do some research to see if the particular branch of medicine is available for practice by P.A.s. I tossed and turned about this decision for about a year, the thought of actually beginning to practice medicine years before other MD or DO students (not to mention the savings on tuition) was very alluring! But when I really asked myself, I knew that I would always regret not going the distance, and having more options available to me.
Good luck, I'm sure you'll make the right choice for yourself.

 

[deleted6669]

but if you're considering a specialty, I would do some research to see if the particular branch of medicine is available for practice by P.A.s..

FYI- pa's practice in every medical and surgical subspecialty including oncology, interventional rads, nephrology,critical care, derm, ophtho, transplant teams, medical forensics, etc
the question to ask yourself is would you be satisfied with the scope of practice of a pa in that specialty as this vaies greatly by specialty, state, and medical setting.

 

[justtesting]

(my doctor is a P.A. and I LOVE her)

what does that mean? do you mean your doctor used to be a PA?

 

[princekc]

what does that mean? do you mean your doctor used to be a PA?

I think what s/he meant is that her primary care provider is a PA.

 

[dragonfly99]

<... but at least as a doctor, I'd get to work more independently, in the sense that the evaluation of my work will be based in large part on my actual performance>

Unfortunately, it ain't necessarily so (in either 3rd/4th year of medical school or residency). There will be a component of your evaluation that is based on your actual performance, yes, but in many cases the evaluations are almost completely subjective. This means that workplace politics, and especially whether a particular attending doctor "likes" you or not, can affect your grade (or evaluation, in the case of a resident) as much or more than your actual knowledge or how well you took care of your patients.

I don't think anyone but you (the OP) can really answer the PA vs. MD or DO question for you, but I don't think your reasons for wanting to possibly do the MD or DO are completely invalid. Just realize that some people are a**es and there are both nurses and physicians like this. And there ARE physicians who will insult and humiliate you for asking a question, and/or not knowing something. It's not just nurses. I do think that sometimes we women sabotage each other (due to insecurity and the feeling that we all have to compete, but can't do so in a blatant way due to societal pressures to be "nice") and that may be behind some of what you have experienced. But that is just my 5 cent psychological evaluation and I'm certainly not a psychologist or psychiatrist.

p.s. I do think that when you are a female resident you will probably have a few more problems with female nurses vs. what most male residents experience.

 

[Frankdotcom]

<

p.s. I do think that when you are a female resident you will probably have a few more problems with female nurses vs. what most male residents experience.

As a male nurse working in a teaching hospital I can definitely agree with this statement. The female nurses are so catty sometimes towards the female attendings, residents, and med students. This isn't solely directed towards coworkers either. In my experience female nurses tend to not get along with female patients more than male patients. I have been asked more times that I can remember to go place an IV in Female Patient because they are "difficult". I walk in and have no problem with the patient whatsoever. Its definitely a weird phenomenon.

 

[KeeganN]

Having to hire an MD is not my idea of being my own boss. I would still be working for someone. That is, the MD may not pay me but he/she can make a difference in how I practice. The point I'm making is I want no part of that. I don't want to answer to someone else (save for the unavoidable insurance companies and law makers) and I certainly don't want anyone "supervising" me, no matter how superficially.

This exactly captures what in my mind differentiates PAs and MDs. I feel there is a fundamental personality difference that attracts people to one of these two professions. MDs are very independent and seem to have a need to feel they can work entirely on their own, whereas I feel PAs have dare I say it a bit less of an ego and don't mind sharing the spotlight. There is nothing wrong with either, it's just a matter of what will fulfill you the most. One unrelated thing I must mention since I know a lot about NP vs MD/DO vs PA since I have considered all three is that any advisor will tell you: PA school is harder to get in to than medical school. Yes, there is no MCAT and the prereqs are undeniable easier, but there is simply not enough room for the amount of applicants. Many see PA as a fallback if you cannot get in to med school and this is simply not the case. However, with all the med school prereqs (and MCAT-some PA schools will look at that) under your belt you will be a strong applicant, but keep in mind you need health care experience (sometimes extensive) as opposed to MD/DO schools that do not stress this as much. Just my two cents...I'm obviously biased as everyone else on this thread is and I bet you can guess I chose PA. But I know a lot about all three paths and pursued all of them at one point and have many opinions if anyone is interested.

 

[crazydiamond]

. MDs are very independent and seem to have a need to feel they can work entirely on their own, whereas I feel PAs have dare I say it a bit less of an ego and don't mind sharing the spotlight.

The need for the ability to be independent (i.e., not working for someone) has nothing to do with an inability to share the spotlight (i.e., not working with someone). Make no mistake -- I have no problem with the latter. It's not about ego as much as it is about the desire to be autonomous. I've always been a bit of a free bird and the idea of being tied down seems oppressive. I realize full autonomy will almost never be achieved as an MD, but I'd like to come as close to it as possible. There's a well-respected doctor in my town who practices "out of the system" completely and I'd like to emulate his practice as much as possible. It's very appealing to me, even though he's got a bunch of PAs and nurses working for him.

I'm glad you found your niche as a PA. Certainly, there's no right or wrong answer here. Different professions for different folks, is all.

 

[KeeganN]

While I am glad you want to know "why", this is not the case with the majority of nurses I have met. Sure, the percentage gets higher with each advanced nursing degree, but I still see many nurses who don't care to get that deep into medicine. They may have cared enough to pass the NCLEX, but that should be just the starting point. It would be wonderful if all nurses cared to continually learn more like you, and if I had to guess, I'd say you are the type of person to push yourself to become an NP or equivalent (nurses have so many degrees now its hard to keep up).

I am finishing nursing school in May and have recently decided to attend a PA school i was accepted to after graduation almost entirely due to this very same experience I have had personally. In my experience, ICU nurses are very good about knowing pathophys and understanding diseases and the reasons why they do what they do and are very interested in learning more. In fact many of them study endless hours to get CCRN credentialing, which ultimately does not really do anything besides add letters on to their name just because they want to be informed and provide quality nursing care. This being said, the majority of nurses are not ICU nurses and IN MY EXPERIENCE I have found that when I ask those "why" questions, I often get very unsatisfying answers such as "That is just how we've always done it"--even from instructors!!! I have encountered so many floor nurses that think their job consists of med passing, turning patients, charting and putting butt cream on them. I could not handle this and thus am going to PA school. One thing I like is that PA school is based on the medical model and thus will be more satisfying for my curiosity and interest and also the profession affords close relationships with physicians that can answer my questions and fill in any gaps that my PA training may have had. One prop I have to throw out there for PAs though is that the majority of our didactic training is almost identical to medical school and some PA schools the PA and med students are even in the same classes together. It is just a little more condensed. I actually have done 5 years undergrad and will do 3 years graduate for my Masters of PA Studies and thus this adds up to the total time in medical school, yet I do not see this as "settling" and it upsets me to see people that believe that. It is a personal choice and I am so sick of people in this field always having to enforce a hierarchy. Can't we all just admit none of us would be able to function without the other?? One shoutout to nurses: they work their asses off day in and day out and they smooth over many hostilities patients may have against you as the doctor or provider. You need to give more respect to these people, it is not an easy job. Ok, enough of my rant.

 

[KeeganN]

The need for the ability to be independent (i.e., not working for someone) has nothing to do with an inability to share the spotlight (i.e., not working with someone). Make no mistake -- I have no problem with the latter. It's not about ego as much as it is about the desire to be autonomous. I've always been a bit of a free bird and the idea of being tied down seems oppressive. I realize full autonomy will almost never be achieved as an MD, but I'd like to come as close to it as possible. There's a well-respected doctor in my town who practices "out of the system" completely and I'd like to emulate his practice as much as possible. It's very appealing to me, even though he's got a bunch of PAs and nurses working for him.

I'm glad you found your niche as a PA. Certainly, there's no right or wrong answer here. Different professions for different folks, is all.

I completely respect that. Just know though (you may already) that you will have the completely opposite of autonomy throughout med school rotations and residency. I work in a teaching hospital and intimately see the interactions between residents/fellows/attendings. There is a very strict hierarchy enforced and you basically answer to your attending, thus a number of years are going to be spent subservient to a "boss". But, nonetheless you are right that after you've "paid your dues" you will be more independent than a PA. I just don't find this personally to be enough of a reason to consider MD since health care is so much about collaboration. I also do plan to start a nonprofit someday and have a free clinic as a PA. Knowing this, I am going to work to cultivate relationships with MDs to find an interested partner. I see them as a partner, rather than a boss, and would be interested in their services not just for legal purposes, but for collaboration. Any MDs in the Minneapolis area interested?!

 

[Lokhtar]

I personally want to do a lot of bench or translational research, so you need a doctorate for that (MD or PhD, or ideally, both), pretty much.

 

[meister]

In my opinion, to be quite honest, if you're female and want to start having kids before you're 35, then PA is pretty obviously the better choice. If you're male, then you can do either one. I know at least a couple dozen guys in my class who have kids including me, and only one woman. And she's 45.

If the family issue isn't something you're thinking about, then the other big issue would be trying to figure out if you want to do research/academics. If so, MD is the way to go. If all you want to do is work in a clinic and see patients, then PA can be rewarding, provided you don't mind less autonomy and a restricted scope. On the plus side, you'll graduate PA school with MUCH less debt, and presumably by age 24 could be pulling in $80k/year. Me? I'll be graduating with $300k in debt at 28, and won't make anything until I'm 32. I'm only 24. Definitely a long and winding road.

 

[MermaidMD]

In my opinion, to be quite honest, if you're female and want to start having kids before you're 35, then PA is pretty obviously the better choice.

Look me up in 5 years--I'll be the med student with the kid that's cuter than yours.

...and no one has mentioned the deterrent that made me officially rule out a PA program:

Over 90% of the programs require you to work for 1-3 years as an RN, EMT or Medical Assistant. I thought that was kind of ridiculous--I don't WANT to be an EMT, RN or Medical Assistant. Boohiss.

 

[MissIrish]

...

 

[deleted6669]

presumably by age 24 could be pulling in $80k/year. Me? I'll be graduating with $300k in debt at 28, and won't make anything until I'm 32. I'm only 24. Definitely a long and winding road.

better than 80k actually for most specialties...these are the 2007 averages....
Specialty MTI
CV/CT surgery $104,363
Dermatology $103,295
Neurosurgery $95,042
Emergency medicine $94,684
Critical care medicine $92,927
Pediatric cardiology $92,611
Surgical subspecialties $92,409
Interventional radiology $91,156
Orthopedics $90,501
Anesthesiology $88,236
Trauma surgery $88,145
Plastic surgery $88,135
Surgical oncology $87,399
Urology $87,121
Occupational medicine $87,003
General surgery $86,325
Diagnostic radiology $86,297
All specialties $86,214
Pain management $86,054
Hospital medicine $84.470
Medical cardiology $83,931
Pediatric oncology $82,306
Otorhinolaryngology $82,242
Internal medicine subspec. $81,992
Medical oncology $81,956
Addiction medicine $81,927
Radiation oncology $81,703
Geriatrics $81,231
Pediatric subspecialties $81,157
General internal medicine $80,971
Psychiatry $80,967
Family medicine $80,534
Medical gastroenterology $80,051
Medical neurology $78,923
Nephrology $78,863
Allergy $77,901
General pediatrics $77,825
Rheumatology $77,134
Endocrinology $76,467
Pediatric gastroenterology $76,170
Obstetrics/gynecology $75,275
Public health $74,864
Pediatric neurology $74,509
Source: American Academy of Physician Assistants

 

[KidXFiz]

Hi all-
So, I've been posting about my current path and getting great advice/suggestions. I am doing a PhD right now but miss working with people. SOOO...my hubby and I thought that maybe I could do the PA thing and then I would be able to pick up my doctorate and be able to do more in depth clinical research than I could with just the PhD. I want to do pediatric genetic/endocrine research related to obesity. I also want to treat obese kids in a children's hospital. The MD is nice but we (as a couple) really don't want that kind of debt at the moment. I have a chronic illness and if I couldn't finish, we would be s.o.l. (anybody would though). Anyway, with the PA, you can have the patient contact and clinical experience to get really involved with clinical research and then finish the PhD and you're a PI but have the flexibility to work anywhere (1) and change specialties (2). As a grad student, getting out faster is also an issue. I have read a lot about people not wanting the PA because of lack of independence and what-not. I think a career is what you make it. If you don't take risks and drive like hell, then you may not be independent and may not get what you want out of it. I think, however, that if you go balls to the wall and work efficiently and professionally, you can get respect and autonomy. Anyway, 'scuse the rant, plz. Any feedback would be welcome and appreciated🙂

 

[Handyman73]

You should definately be able to find PA programs that do not have requirements for extensive clinical experience. The PA profession is changing, and the policy makers are slowly recognizing it. The profession was initially almost all male and composed almost exclusively of men with extensive military medical experience.

It is now becoming much more common for PA students to be straight from college and not having had the opportunity for extensive clinical experience. The profession is also becoming much more female...

 

[njbmd]

In my opinion, to be quite honest, if you're female and want to start having kids before you're 35, then PA is pretty obviously the better choice. If you're male, then you can do either one. I know at least a couple dozen guys in my class who have kids including me, and only one woman. And she's 45.

If the family issue isn't something you're thinking about, then the other big issue would be trying to figure out if you want to do research/academics. If so, MD is the way to go. If all you want to do is work in a clinic and see patients, then PA can be rewarding, provided you don't mind less autonomy and a restricted scope. On the plus side, you'll graduate PA school with MUCH less debt, and presumably by age 24 could be pulling in $80k/year. Me? I'll be graduating with $300k in debt at 28, and won't make anything until I'm 32. I'm only 24. Definitely a long and winding road.

Being female and starting a family is not counter to being a physician and should not be a reason not to attend medical school if that is your goal. Knowing what you want in terms of scope of practice and ultimate career satisfaction is your main factor in choosing between these two careers. If either is more "right" for you then that's the career you should choose.

I finished four years of medicial school with $35K in debt at 2% interest thus finances should not rule your choices either as medicine can be done (military/public health service/scholarship) with little debt if you are creative, adaptable and able to secure these types of funding (many students in my class were military or public health and are happily debt free now).

Choose what you want to do in terms of a career and go for it. The bottom line is that you have to love what you do in either of these professions.

 

[UNMorBUST]

👍Agree with Njb above.

 

[ProLogic]

I agree with the personality difference. For me, I want to go into a PA program. I work better when told what to do, and have no problem in that. I also respond well to guidelines and understand what I can and can't do. However, I doubt the supervision is how people on here make it out to be. I don't think the physicians are on your butt the entire time - they have better things to do.

Addressing the Medical background require to start PA school.. some schools DO NOT require it. I believe UC Davis its optional, but STRONGLY encouraged. I also know that Stanford requires 3,000 hours, unlike most schools whose minimum is around 2,000 hours. Personally, I want to go into an EMT program to get experience. 2,000 hours is around 1-2 years.

I thought long and hard about going into a 4-year out of high school (Currently 18 yrs old) and getting that biology degree. Decided it wasn't for me, and knew I wanted to be a PA. That's why I went to community college, and my first semester is almost over. I'm going to start to take science classes next semester. 1.5 years more for me, and EMT program will be the next step.

 

[unsung]

<... but at least as a doctor, I'd get to work more independently, in the sense that the evaluation of my work will be based in large part on my actual performance>

Unfortunately, it ain't necessarily so (in either 3rd/4th year of medical school or residency). There will be a component of your evaluation that is based on your actual performance, yes, but in many cases the evaluations are almost completely subjective. This means that workplace politics, and especially whether a particular attending doctor "likes" you or not, can affect your grade (or evaluation, in the case of a resident) as much or more than your actual knowledge or how well you took care of your patients.

Oh I'm sure you're right. Anyway, med students seem to be complaining all the time about the "subjectivity" of their rotation evaluations too... so I'm going into it kind of prepared for that BS 😉 I do think there's a difference between why a nurse might like an underling and why an attending might like an underling-- in the former case, I've seen a lot of underlings do ZERO work, and basically gab with the nurses, then get preferential treatment. These folks don't even do their job right and don't know much either. Otoh, I assume residents or even med students have to demonstrate a basic modicum of knowledge in order to be "liked".

Plus given how docs seem to like to "pimp" their underlings, I kind of think part of why docs might like someone in particular is due to how intelligent that person seems. I.e. knowledge/expertise is valued! In nursing, I've seen much of the opposite-- if you show you're too curious or too knowledgeable about anything, nurses sometimes act jealous or intimidated by you, rather than liking you more. Which is kinda bizarre considering in most jobs, supervisors LIKE knowledgeable workers... I guess the diff is, out on the floor the nurses who are the de facto supervisors don't really have any incentive to appreciate their underlings expertise or what not... the de jure supervisors off the unit would surely appreciate the expertise, but they're basically not ever on the floor so they don't know what's going on at all.

Anyway, I do take your pt on how work politics exists everywhere. I don't know. The docs I've shadowed seemed to like me just fine and appreciated questions. My experience with nursing hasn't been that hot, but maybe it just has to do with the particular department and particular hospital I'm in.

I don't think anyone but you (the OP) can really answer the PA vs. MD or DO question for you, but I don't think your reasons for wanting to possibly do the MD or DO are completely invalid. Just realize that some people are a**es and there are both nurses and physicians like this. And there ARE physicians who will insult and humiliate you for asking a question, and/or not knowing something. It's not just nurses. I do think that sometimes we women sabotage each other (due to insecurity and the feeling that we all have to compete, but can't do so in a blatant way due to societal pressures to be "nice") and that may be behind some of what you have experienced. But that is just my 5 cent psychological evaluation and I'm certainly not a psychologist or psychiatrist.

p.s. I do think that when you are a female resident you will probably have a few more problems with female nurses vs. what most male residents experience.

Very very true. Actually the MALE nurses I've worked with have been for the most part *much* more appreciative of questions, etc. At the very least they don't seem intimidated by them. I guess they're more understanding for some reason.

 

[unsung]

While I am glad you want to know "why", this is not the case with the majority of nurses I have met. Sure, the percentage gets higher with each advanced nursing degree, but I still see many nurses who don't care to get that deep into medicine. They may have cared enough to pass the NCLEX, but that should be just the starting point. It would be wonderful if all nurses cared to continually learn more like you, and if I had to guess, I'd say you are the type of person to push yourself to become an NP or equivalent (nurses have so many degrees now its hard to keep up).

I am finishing nursing school in May and have recently decided to attend a PA school i was accepted to after graduation almost entirely due to this very same experience I have had personally. In my experience, ICU nurses are very good about knowing pathophys and understanding diseases and the reasons why they do what they do and are very interested in learning more. In fact many of them study endless hours to get CCRN credentialing, which ultimately does not really do anything besides add letters on to their name just because they want to be informed and provide quality nursing care. This being said, the majority of nurses are not ICU nurses and IN MY EXPERIENCE I have found that when I ask those "why" questions, I often get very unsatisfying answers such as "That is just how we've always done it"--even from instructors!!! I have encountered so many floor nurses that think their job consists of med passing, turning patients, charting and putting butt cream on them. I could not handle this and thus am going to PA school. One thing I like is that PA school is based on the medical model and thus will be more satisfying for my curiosity and interest and also the profession affords close relationships with physicians that can answer my questions and fill in any gaps that my PA training may have had. One prop I have to throw out there for PAs though is that the majority of our didactic training is almost identical to medical school and some PA schools the PA and med students are even in the same classes together. It is just a little more condensed. I actually have done 5 years undergrad and will do 3 years graduate for my Masters of PA Studies and thus this adds up to the total time in medical school, yet I do not see this as "settling" and it upsets me to see people that believe that. It is a personal choice and I am so sick of people in this field always having to enforce a hierarchy. Can't we all just admit none of us would be able to function without the other?? One shoutout to nurses: they work their asses off day in and day out and they smooth over many hostilities patients may have against you as the doctor or provider. You need to give more respect to these people, it is not an easy job. Ok, enough of my rant.

Wow, truer words have not been said. I have to say some of the med nurses I've encountered (esp ones in surg, etc.) have seemed much more conscientious and curious, just personality-wise. They seem open to questions and less intimidated by questions.

Many other nurses are not nearly as interested in thinking about how/why they're doing something... for lack of a better way to describe it. It doesn't even have to be about medicine... it could be as simple as "how do you work the coffee machine on this unit?" Some people if they don't know will spend a few minutes tinkering with it till they figure out how that particular contraption works. If they can't figure it out, they'll call the people who can fix the issue. Most others usually just kind of putz around with it for a sec, and if it doesn't work, they'll just shrug & leave the problem be *for someone else* ... i.e. THEY GIVE UP. Of course for coffee, this isn't a big deal. But take that same attitude and apply it to something med-related...

Don't want to slander nursing too much, as I've met some very good nurses. But the entire climate/culture in nursing is something I just don't fit well in.. it's like my strong personality pts (being curious, not giving up) are viewed as weak pts, or that other women get jealous/intimidated. And my weak pts (not being good at gossiping & successfully navigating cliques) are overblown and really costly.

That said, you're right that nurses work terribly long hours! And the ones that don't burn out and keep at it are certainly impressive. I think actually as a doctor I'd get along better with the nurses than currently as an underling... I mean, nurses kind of expect to get asked questions by the docs or med students... not so much by the people below them (seen as more of a "challenge" to their authority?) It just doesn't help me right now to have the "personality" of a med student without actually being one.. yet.

I guess I need to sorta "curb my enthusiasm" for medicine/understanding things at the moment and just focus on getting along with everyone instead of focusing on all the negatives or deficiencies I see. Certainly it's not an environment I could ever see myself being happy in long-term. PA seems like it would be an infinitely better alternative for me, should this med school thing not work out. But we'll see how this application cycle goes. 😉

 

[bigserve99]

If you have a doubt between the 2, Pa vs. MD, I'm not sure you are ready to commit to MD. To do MD, i really think you have to know beyond ALL doubt that that is what you want for your life.

 

[Bearferret]

If you have a doubt between the 2, Pa vs. MD, I'm not sure you are ready to commit to MD. To do MD, i really think you have to know beyond ALL doubt that that is what you want for your life.

I get really tired of this sentiment - and I'm not trying to call you out on it specifically, but it's something I see a lot of on here. Yes, you need to be very committed to becoming a doctor, and you'd be a lot better off in your decision if you put a ton of time, research, and thought into it, but this superhuman devotion to a career that no pre-med has actually experienced before is myth - it's impossible to know beyond ALL doubt; and I'd say that if you haven't doubted it, there's a good chance you just haven't given it enough thought.

If you want to become an MD, I think the responsible thing to do is to consider it from all angles; you should think about its pros and cons, and of course your personal commitment to and passion for it will enter significantly into your thought process. Like any other major life decision, it's not easy, and demands your doubts and consideration. I guess the bottom line is just because someone considers PA school as an alternative to med school does not preclude them from being a good doctor, should they choose the MD anyway.

 

[scurred09]

I like to know where you are at now? PA school?

This exactly captures what in my mind differentiates PAs and MDs. I feel there is a fundamental personality difference that attracts people to one of these two professions. MDs are very independent and seem to have a need to feel they can work entirely on their own, whereas I feel PAs have dare I say it a bit less of an ego and don't mind sharing the spotlight. There is nothing wrong with either, it's just a matter of what will fulfill you the most. One unrelated thing I must mention since I know a lot about NP vs MD/DO vs PA since I have considered all three is that any advisor will tell you: PA school is harder to get in to than medical school. Yes, there is no MCAT and the prereqs are undeniable easier, but there is simply not enough room for the amount of applicants. Many see PA as a fallback if you cannot get in to med school and this is simply not the case. However, with all the med school prereqs (and MCAT-some PA schools will look at that) under your belt you will be a strong applicant, but keep in mind you need health care experience (sometimes extensive) as opposed to MD/DO schools that do not stress this as much. Just my two cents...I'm obviously biased as everyone else on this thread is and I bet you can guess I chose PA. But I know a lot about all three paths and pursued all of them at one point and have many opinions if anyone is interested.

 

[Giovanotto]

In my opinion, to be quite honest, if you're female and want to start having kids before you're 35, then PA is pretty obviously the better choice. If you're male, then you can do either one. I know at least a couple dozen guys in my class who have kids including me, and only one woman. And she's 45.

If the family issue isn't something you're thinking about, then the other big issue would be trying to figure out if you want to do research/academics. If so, MD is the way to go. If all you want to do is work in a clinic and see patients, then PA can be rewarding, provided you don't mind less autonomy and a restricted scope. On the plus side, you'll graduate PA school with MUCH less debt, and presumably by age 24 could be pulling in $80k/year. Me? I'll be graduating with $300k in debt at 28, and won't make anything until I'm 32. I'm only 24. Definitely a long and winding road.

How do you feel about your decision today?