Physician's Assistant v. MD/DO

[flyingbridge]

Folks,

I recently spoke with the assoc dean of admissions for the coll of medicine of a large, respected private university in the northeast. Among other things, he commented that someone who really wanted to do a lot of patient care and who wanted to be hands-on, and in particular wanted to get out there relatively quickly, should strongly consider becoming a physician's asst. or nurse prac. rather than an MD. He said MDs spend so much time nowadays in admin and related activities that to really do a lot of the kind of patient care MDs used to do, and get to it soon, one should look into these areas. He also said they were just as lucrative for the most part, a lot more satisfying generally if you wanted to do a lot of direct-patient contact work, and the liability was a lot less. Also, it could happen in 2-4 years instead of 9-12 years, with a lot less debt.

So now, I am in a tizzy. I have spent the last 2 years focused on doing whatever it takes to get myself ready for application to med school, including relocating, etc., and someone of this man's position has told me: think again, your actual work-life goals may not get met if you take the path you have planned.

I would like some informed and sincere comments please to this question. Also, apologies in advance if this is old ground being re-hashed, as I imagine someone else must have brought the topic up already. But the nature of these boards I have seen is one of dealing with particulars. Some re me: age: 37, B.A. (GPA: 2.8) 1989, M.S. (GPA: 3.7) 1996, 10 years' work experience.

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[RxnMan]

I've heard similar suggestions from people trying to discourage me. I only suggest this explanation because your ugrad GPA is low like mine, and I've had people do this to me.

This may not be the case for you - the guy may honestly have these opinions. But always consider the source of the information as important as the information itself (Ask yourself: Was the doc you spoke to doing admin himself? Did he like his job?)

PA pay is not as good as an MD, unless, and this is a maybe, you're talking about a doc doing exclusively research with no research $$$ coming in (Check the aamc website if you doubt it). As a PA, you can't have your own practice; rather, as a physician-extender, you would always be working under an MD or DO. Your hours may be 9-5, and you will be less exposed to risk (malpractice). But your patients will form better connections with you if you're the MD or DO in charge of their care. (I say this because that patient feedback, having them come back and tell you the effect you've had in their life, is important to me.)

Is being out there right away that important? If so, then realize that many schools get MS1s out in the clinics the month they start classes. I've met people who have started med school at 40+ yrs old. And being in debt is not the worst problem in the world. Not achieving your dreams is.

 

[flyingbridge]

Thanks, RxnMan. Where are you at right now in your process of getting to med school? And, why do you think drs. would be interested in being so demotivating? Is this just a test of commitment or what? Seems strange to me, this thing of drs. saying "No, don't do it!! Argghh!!" I am aware of no other profession in the world where practitioners are so seemingly against the addition of new colleagues, yet claim there is this awful shortage of them!

I've heard similar suggestions from people trying to discourage me. I only suggest this explanation because your ugrad GPA is low like mine, and I've had people do this to me.

This may not be the case for you - the guy may honestly have these opinions. But always consider the source of the information as important as the information itself (Ask yourself: Was the doc you spoke to doing admin himself? Did he like his job?)

PA pay is not as good as an MD, unless, and this is a maybe, you're talking about a doc doing exclusively research with no research $$$ coming in (Check the aamc website if you doubt it). As a PA, you can't have your own practice; rather, as a physician-extender, you would always be working under an MD or DO. Your hours may be 9-5, and you will be less exposed to risk (malpractice). But your patients will form better connections with you if you're the MD or DO in charge of their care. (I say this because that patient feedback, having them come back and tell you the effect you've had in their life, is important to me.)

Is being out there right away that important? If so, then realize that many schools get MS1s out in the clinics the month they start classes. I've met people who have started med school at 40+ yrs old. And being in debt is not the worst problem in the world. Not achieving your dreams is.

 

[deleted6669]

TIME TO, YET AGAIN, SPEAK TO SOME ONGOING MISSTATEMENTS REGARDING PA'S:
1st of all pa stands for PHYSICIAN ASSISTANT, there is no 's.
pa's can own their own practice in many states. they only need to have an md employee on staff to review their charts to the min standard required by the state. in many states this md never needs to be in clinic and in some only for a limited time, like 8 hrs/wk. in nc the requirement for supervision is a 30 min in person meeting with an md every 6 months. no chart review. in ca the requirement is review of only those charts for which sch 2 narcotic is written.many states require only 10% of charts as chosen by the pa to be reviewed within 1 month. certainly a solo practice is no place for a new pa grad but an experienced pa can certainly function as a pcp if they have an appropriate specialty referal network available.many of the nations larger HMO's( kaiser for example) have been using pa's as pcp's for > 30 yrs.....
the avg pa last yr made 81K and many specialty pa's make > 100 k/yr.
em/ortho/surgical pa's can make more than primary care md's.

 

[flyingbridge]

And thank you, emedpa. Let's tauuaallk. Mind if I send you a PM?

TIME TO, YET AGAIN, SPEAK TO SOME ONGOING MISSTATEMENTS REGARDING PA'S:
1st of all pa stands for PHYSICIAN ASSISTANT, there is no 's.
pa's can own their own practice in many states. they only need to have an md employee on staff to review their charts to the min standard required by the state. in many states this md never needs to be in clinic and in some only for a limited time, like 8 hrs/wk. in nc the requirement for supervision is a 30 min in person meeting with an md every 6 months. no chart review. in ca the requirement is review of only those charts for which sch 2 narcotic is written.many states require only 10% of charts as chosen by the pa to be reviewed within 1 month. certainly a solo practice is no place for a new pa grad but an experienced pa can certainly function as a pcp if they have an appropriate specialty referal network available.many of the nations larger HMO's( kaiser for example) have been using pa's as pcp's for > 30 yrs.....
the avg pa last yr made 81K and many specialty pa's make > 100 k/yr.
em/ortho/surgical pa's can make more than primary care md's.

 

[jackb960]

I was in a similar situation. Last year I decided that I could no longer avoid what had been my dream all along: clinical medicine. Since I was older (31) I decided that I should pursue a PA masters degree. I was accepted to a good program and offered scholarships. What appealed to me most was that I would be finished in two years with much less debt and still be able to treat patients. You do need to work under the supervision of an MD/DO though and I was going to be taking a salary cut to do that. Since my end goal was to be able to have a free clinic on the side, I finally decided to decline my spot in the PA program and apply to an allopathic school. I know that having a free clinic will be hard enough without having to recruit an MD to oversee the thing when I feel I could do it myself. It is a longer path, but I see more opportunities so in the end that was my decision. You can go into administration if you want, you can teach if you want (although PA's can do both of these), another difference was that with an MD, you can apply for grants as the PI. I am pretty sure that PAs can't do this.

You need to really examine your motivation for practicing medicine. If you want to help people and that is what matters, then maybe the PA is for you. I know lots of people who see PAs exclusively for their PC and I know PAs who work in the ED very independently. I believe you will get a lot of satisfaction from being a PA if that is what you want. There is a pay gap between them and unfortunately, there is also a respect gap.

Good luck with your decision.

 

[RxnMan]

TIME TO, YET AGAIN, SPEAK TO SOME ONGOING MISSTATEMENTS REGARDING PA'S:
1st of all pa stands for PHYSICIAN ASSISTANT, there is no 's.
pa's can own their own practice in many states. they only need to have an md employee on staff to review their charts to the min standard required by the state. in many states this md never needs to be in clinic and in some only for a limited time, like 8 hrs/wk. in nc the requirement for supervision is a 30 min in person meeting with an md every 6 months. no chart review. in ca the requirement is review of only those charts for which sch 2 narcotic is written.many states require only 10% of charts as chosen by the pa to be reviewed within 1 month. certainly a solo practice is no place for a new pa grad but an experienced pa can certainly function as a pcp if they have an appropriate specialty referal network available.many of the nations larger HMO's( kaiser for example) have been using pa's as pcp's for > 30 yrs.....
the avg pa last yr made 81K and many specialty pa's make > 100 k/yr.
em/ortho/surgical pa's can make more than primary care md's.

Yikes! Came down with the hammer on me! I was going from what a PA I work with has said. She's in peds/ortho, and she's just graduated.

flyingbridge: There's lots of reasons why docs are against new people coming in. Just like any other profession, people can get tired of it, even frustrated. Some get into a position after many year's hard work and will feel threatened by anyone who comes along. Others have been beaten down by malpractice claims and the legal system. And then a lot of docs see people die day after day and they get tired of the stress.

Some may have less selfish, but more arrogant motives. They may think you're not worthy to be a doc, and so they'll make you think a 'lower' profession is more 'suitable' for someone of your talents. I ran into many of these. I'm going through the end of my 3rd application process and I'm about to start my fourth. Feel free to PM me about the drama.

Interestingly, the MD field is in some ways similar to women in the hard sciences. Many women are discouraging for many of the same reasons I mentioned above.

 

[flyingbridge]

I just looked at your profile, RxnMan. I am wondering to myself, just what does it take then to get into med school if after all you have done, they won't let you in? Publications, actual biomed engineering work, all before age 25. And still, they are turning you away? Gadzooks. My own background includes ten years in IT work (computer programmer), but no publications or inventions, and not that much volunteer work either (though a little), but I will be getting more soon.

Holy cripes. Anyway, good luck on round 4 of applying. Four years of apps?? Good God.

Yikes! Came down with the hammer on me! I was going from what a PA I work with has said. She's in peds/ortho, and she's just graduated.

flyingbridge: There's lots of reasons why docs are against new people coming in. Just like any other profession, people can get tired of it, even frustrated. Some get into a position after many year's hard work and will feel threatened by anyone who comes along. Others have been beaten down by malpractice claims and the legal system. And then a lot of docs see people die day after day and they get tired of the stress.

Some may have less selfish, but more arrogant motives. They may think you're not worthy to be a doc, and so they'll make you think a 'lower' profession is more 'suitable' for someone of your talents. I ran into many of these. I'm going through the end of my 3rd application process and I'm about to start my fourth. Feel free to PM me about the drama.

Interestingly, the MD field is in some ways similar to women in the hard sciences. Many women are discouraging for many of the same reasons I mentioned above.

 

[RxnMan]

I just looked at your profile, RxnMan. I am wondering to myself, just what does it take then to get into med school if after all you have done, they won't let you in? Publications, actual biomed engineering work, all before age 25. And still, they are turning you away? Gadzooks. My own background includes ten years in IT work (computer programmer), but no publications or inventions, and not that much volunteer work either (though a little), but I will be getting more soon.

Holy cripes. Anyway, good luck on round 4 of applying. Four years of apps?? Good God.

Thanks, but please don't feel intimidated - I'm a special case. I've been overcompensating for the last 5 years, trying to out run a bad GPA, and I'm proof that you can't.

10 years of IT work is a good thing. There are many places where this knowledge helps in medicine. Designing new medical devices, the advent of electronic medical records, the biological imaging environment - these are all places for an MD with computer experience.

And on those volunteer experiences, make sure you get some clinical time with patients, and that you get your hands dirty.

 

[live2theedge]

Folks,

I recently spoke with the assoc dean of admissions for the coll of medicine of a large, respected private university in the northeast. Among other things, he commented that someone who really wanted to do a lot of patient care and who wanted to be hands-on, and in particular wanted to get out there relatively quickly, should strongly consider becoming a physician's asst. or nurse prac. rather than an MD. He said MDs spend so much time nowadays in admin and related activities that to really do a lot of the kind of patient care MDs used to do, and get to it soon, one should look into these areas. He also said they were just as lucrative for the most part, a lot more satisfying generally if you wanted to do a lot of direct-patient contact work, and the liability was a lot less. Also, it could happen in 2-4 years instead of 9-12 years, with a lot less debt.

So now, I am in a tizzy. I have spent the last 2 years focused on doing whatever it takes to get myself ready for application to med school, including relocating, etc., and someone of this man's position has told me: think again, your actual work-life goals may not get met if you take the path you have planned.

I would like some informed and sincere comments please to this question. Also, apologies in advance if this is old ground being re-hashed, as I imagine someone else must have brought the topic up already. But the nature of these boards I have seen is one of dealing with particulars. Some re me: age: 37, B.A. (GPA: 2.8) 1989, M.S. (GPA: 3.7) 1996, 10 years' work experience.

Hi, Flyingbridge,

I would just like to respond to your post from the perspective of a nurse practitioner. First of all, in order to pursue your degree as a NP, you must first be an RN--usually with a bachelors degree in nursing. There are a few schools out there that will take RNs with an associate degree, but there are added "bridge classes" required before beginning the masters program in nursing. Therefore, if you are not already a nurse, you would spend 4 years getting a BSN and 2+ years getting an MSN. (Not exactly the fast track that this associate dean led you to believe).

When you get out of your NP program, you are still limited by your scope of practice (just like a PA is limited)--that's why they are called mid-level providers. My desire to not "settle" for practicing as a NP was the fact that what I aspire to do in medicine goes beyond the NP scope of practice. Plus, my dream had always been to be a physician, so once the opportunity to go to medical school presented itself, I was not about to say NO to that opportunity!

For me what it boiled down to was that there was a voice in my head that wouldn't let the dream of being a doctor die. I had to give it a shot. Fortunately, I will be attending medical school somewhere beginning Fall 2006. What you need to ask yourself is how strong your desire is to be a doctor. Would you be satisfied with practicing as a mid-level provider? If so, then, go for it. However, if that voice in your head just won't let you stop short of medical school, you may later regret settling for PA / NP school.

 

[RxnMan]

...My desire to not "settle" for practicing as a NP was the fact that what I aspire to do in medicine goes beyond the NP scope of practice...Would you be satisfied with practicing as a mid-level provider?...However, if that voice in your head just won't let you stop short of medical school, you may later regret settling for PA / NP school.

The word "settling" may not be right. The PA I mentioned was accepted to CU med school (as was her husband), but she decided it would interfere with other life goals she had set. For her, the PA degree seemed a good fit with everything else in her life, and she's happy with her decision.

I agree that the "scope of care" is different. I, for one, love surgical procedures. There's no high like putting in a plate to fix a fracture. That includes all of the gross things like placing the plate, cutting, sinking the screws, and using a sterile stainless steel cordless power drill of all things! No other type of training will allow you to affect another's life on such a basic and profound level. That is why I'm chasing the MD.

 

[deleted6669]

The word "settling" may not be right. The PA I mentioned was accepted to CU med school (as was her husband), but she decided it would interfere with other life goals she had set. For her, the PA degree seemed a good fit with everything else in her life, and she's happy with her decision.

I agree that the "scope of care" is different. I, for one, love surgical procedures. There's no high like putting in a plate to fix a fracture. That includes all of the gross things like placing the plate, cutting, sinking the screws, and using a sterile stainless steel cordless power drill of all things! No other type of training will allow you to affect another's life on such a basic and profound level. That is why I'm chasing the MD.

rxn- given your example of ortho- many pa's work in ortho and 1st assist including take 1st er call, etc
often when there are b/l procedures to be done in the o.r. the pa does 1 while the md does the other. there are even postgrad residencies in ortho for pa's( see www.appap.org for links to all residencies in all specialties for pa's)
granted you are not the md, but pa's in ortho and general surgery do quite a lot including preop/intraop and postop management as well as 1st call to the er and the floor in many institutions.

 

[georgiapeachmd]

flyingbridge, I have been a practicing PA in gastroenterology for three years. While the role of a Physician Assistant has always been to assist physicians in patient care, the role of a PA in today's society varies. I myself have decided to apply to med school after three years of practice for reasons that are very specific to me. What you decided to do just depends on your goals and what you want out of a career in health care. PM me if you have any questions.

 

[njbmd]

Folks,

I recently spoke with the assoc dean of admissions for the coll of medicine of a large, respected private university in the northeast. Among other things, he commented that someone who really wanted to do a lot of patient care and who wanted to be hands-on, and in particular wanted to get out there relatively quickly, should strongly consider becoming a physician's asst. or nurse prac. rather than an MD. He said MDs spend so much time nowadays in admin and related activities that to really do a lot of the kind of patient care MDs used to do, and get to it soon, one should look into these areas. He also said they were just as lucrative for the most part, a lot more satisfying generally if you wanted to do a lot of direct-patient contact work, and the liability was a lot less. Also, it could happen in 2-4 years instead of 9-12 years, with a lot less debt.

So now, I am in a tizzy. I have spent the last 2 years focused on doing whatever it takes to get myself ready for application to med school, including relocating, etc., and someone of this man's position has told me: think again, your actual work-life goals may not get met if you take the path you have planned.

I would like some informed and sincere comments please to this question. Also, apologies in advance if this is old ground being re-hashed, as I imagine someone else must have brought the topic up already. But the nature of these boards I have seen is one of dealing with particulars. Some re me: age: 37, B.A. (GPA: 2.8) 1989, M.S. (GPA: 3.7) 1996, 10 years' work experience.

Hi there,
The key words that your advisor put out to you was "get out there quickly". Sure it takes less time to become a PA but you are limited in what you can do and you will always be limited. If you want to become a physician, then the extra time is worth it.

I promise you that I am very hands on as I am a surgeon. At this point in my career, I have plenty of options and I do everything. My next rotation in Hepatobiliary where I will learn to perform some intricate but great surgeries and not assist. I will do transplants and not assist. In short, the buck stops with me and that is why the extra years were worth it for me. I never had any interest in the role of being an assistant.

PAs assist me in the OR and with patient care but they assist me and are not a lower paid substitute for me. I will eventually complete a fellowship in vascular surgery and I will be the person evaluating and designing the surgery for my patients. Their outcome will rest in my hands and I have spent the past eight years honing the skills that will enable me to save limbs, prevent strokes, and prolong lives.

Figure out what you want and go for it. If you want to be an assistant, then PA is a viable option for you. You will make a good salary and you will stay at the assistant level for the rest of your career. For many people, this is very rewarding. If your goal is to be a physician, then being a physician assistant is not going to satisfy you. This is what you need to be sure of and no amount of selling you on the wonders of the profession of being a PA is going to deter you from your goal.

Shadow some PAs and make sure that you shadow some physicians to see how much administrative versus clinical duties they have. The one thing that my MD degree has given me is options and plenty of them. As I look at the end of my General Surgery residency, I can honestly say that this road was not that long and ardurous. I have loved every second of what I do and I have learned to do it well. I look forward to my fellowship and to my practice. Most likely, I will employ a couple of good PAs along the way.

njbmd

 

[viostorm]

I'd echo some of the things people have said here, but I think it is a time/benefit tradeoff.

MD is 4 med school + 3 residency (min) = 7 years
PA is 2 years (maybe someone can be more specific on exactly how long)

Here are the tradeoffs in my opinion:

* PA - quick to practice, limited in what you can do, responsible to physician, $100-120K regardless of what other PA's say, you aren't going to do heart transplants as a PA ... there are some limitations. I think most PA's are suited to seeing minor medical conditions that match their education and training level.

MD - 7+ years, lots of hellacious school, lots of responsibility, lots of knowledge, lots of job options. 120K -> 800K depending on specialty.

http://www.allied-physicians.com/salary_surveys/physician-salaries.htm

Let me assuage your fears of ending up in a desk job with an MD, you definitely see patients, and lots of them.

 

[viostorm]

As I look at the end of my General Surgery residency, I can honestly say that this road was not that long and ardurous.
njbmd

I would be suspicious of NJBMD with a claim like that. He must be superhuman! Gen surg not arduous! I'm worried about my 8 week gen surg rotation let alone 5 years of it!

 

[hunter1077]

From what I heard, I thought PAs did what MD/DO's did not want to do like being on call every night.
example: Ortho surg hires a PA to review midnight ER pages/cases and determine if it can wait until morning or is it actually an emergency case to wake up Ortho surg.
Just what I have heard 2nd hand.

 

[RxnMan]

...Sure it takes less time to become a PA but you are limited in what you can do and you will always be limited. If you want to become a physician, then the extra time is worth it...I will learn to perform some intricate but great surgeries and not assist. I will do transplants and not assist. In short, the buck stops with me and that is why the extra years were worth it for me. I never had any interest in the role of being an assistant...PAs assist me in the OR and with patient care but they assist me and are not a lower paid substitute for me...I will be the person evaluating and designing the surgery for my patients. Their outcome will rest in my hands...

njbmd said it best.

The only person I want to be limited by is myself. I strive for the fullest freedom (and attendant responsibility) to affect positive change in people's lives in the most basic, hands-on way possible.

 

[eccles1214]

He must be superhuman!

For the record, NJBMD is a woman -- and a superwoman -- at that. Go Dr. B!

 

[aggie-master]

flyingbridge, if you are considering becoming a PA, I think you should shadow a few of them and talk to several more and see if it something that you'd be happy doing.

 

[Taurus]

I'm all for PA's because of the reasons the OP cited. Medicine is using more mid-levels, you finish ealier and less debt, less liability, good hours, and good money. You won't have as much autonomy, but that's probably ok to many people. I find it funny that some people gripe that PA's make less money and therefore go for being a doctor. Looking at the money doctors can make is so narrow-minded. There are so many other factors like the ones mentioned above that people don't consider. Go for whatever will make you happy.

 

[viostorm]

For the record, NJBMD is a woman -- and a superwoman -- at that. Go Dr. B!

Whoops! sorry about the gender! lol!

 

[r0b0tafflicti0n]

PA is 2 years (maybe someone can be more specific on exactly how long)

This is assuming that you've met all of the pre-PA prerequisites in undergrad, in addition to at least a year's experience in direct care.

I'd initially planned to become an NP, but have found that I'd actually have to take MORE prerequisites than I would for med school to even get into the BSN program offered at my school, then get my masters on top of that. Then come 2015, new NPs will supposedly be required to have a doctorate (DNP). Not to say it wouldn't be an easier courseload, but yeah. . .not the career fast-track I'd had in mind. What IS nice, though, is that the "baby steps" are far less daunting/overwhelming than the marathon-session which is medical school.

Either way, I'm still on the fence.

 

[r0b0tafflicti0n]

TIME TO, YET AGAIN, SPEAK TO SOME ONGOING MISSTATEMENTS REGARDING PA'S:
1st of all pa stands for PHYSICIAN ASSISTANT, there is no 's.
pa's can own their own practice in many states. they only need to have an md employee on staff to review their charts to the min standard required by the state. in many states this md never needs to be in clinic and in some only for a limited time, like 8 hrs/wk. in nc the requirement for supervision is a 30 min in person meeting with an md every 6 months. no chart review. in ca the requirement is review of only those charts for which sch 2 narcotic is written.many states require only 10% of charts as chosen by the pa to be reviewed within 1 month. certainly a solo practice is no place for a new pa grad but an experienced pa can certainly function as a pcp if they have an appropriate specialty referal network available.many of the nations larger HMO's( kaiser for example) have been using pa's as pcp's for > 30 yrs.....
the avg pa last yr made 81K and many specialty pa's make > 100 k/yr.
em/ortho/surgical pa's can make more than primary care md's.

If I may, then. . .Why are you going to med school now (assuming you are, or are considering it)? I still haven't made up my mind entirely (I've never worked as a PA or NP, so I really can't say whether I'd be satisfied in that capacity or not), so it would be nice to have a PA's perspective on all this.

 

[Raven Feather]

Just FYI, there are some schools, Rush (Chicago), I believe (if I am remembering correctly), being one where you do not have to have a nursing degree to start working toward/accepted into a NP track. Believe it or not. It will take longer, like one of the previous posters mentioned. I am assuming they integrate clinical experience (for those with degrees other than nursing) in their curriculum.

I'm a registered nurse who will start med school in August (just for background purposes for those reading this), anyway, I have a friend who will be graduating her NP program this May and she says she yearns for more in-depth knowledge like the physicians she has rotated with. She told me she feels that they are only taught the basics--like treating the straight forward cases. But that is just one person's experience in a particular program.

 

[dnw826]

live2theedge, actually, I have found several colleges that offer the NP Master's Program without the necessity of a previous Nursing degree. They prefer it, but not all programs require it. Just a Bachelor's in any field. You may or may not be required to have some kind of healthcare experience, though.

I was thinking about the NP/PA route for awhile. I used to work with several NP's. They had great jobs. But I am a supernerd and I love to have my head crammed in a book about strange cases and every disease and condition imaginable. I found that NP's and PA's dealt more with common problems and such. I also prefer the autonomy of being a doctor, and I suppose a bit is the prestige. I am an overachiever and I want the challenge. Not that the NP or PA route isn't challenging by any means, I just have found that a MD/DO is more my thing.

Good luck!

 

[mfradin2]

I've looked very hard into MD, PA, and NP routes, Here's what I have to share. It's not pretty, but it's real and current.

There's a lot to know. There are significant barriers to entry for each option, and there are time and financial consequences to the decisions.

General rules: the best path is straight out of high school to whatever program you choose. Any of them will probably carry a true cost of at least $120,000, plus 100K in interest unless mommy and daddy are paying for it. If you are a career changer, add more money to the pile. For all but the most talented, going to public school, even out of state, could significantly change your standard of living in the future.

Also, bear in mind that 95% of patients don't know or care what the difference is between a PA or NP is...., but they definitely know that an MD is "better". It takes a lot of personal integrity to confront a career full of that, but there are many fine role models who have, and you should find one to model or you'll get burned out.

EVERY MD I know, including some really lovely human beings, have warned me about uppity nurses, which how NPs are regarded. Mostly their points of view about training of NPs are very dated and self-serving. The nursing profession has contributed by not escalating and controlling the proliferation of degrees and certifications; a nurse can have anything from an associates degree to a doctorate. Check out the AMA's self-protective new task force to write the rules of practice of allied health fields. Physicians are very very defensive about scope of practice creep. This is a losing battle, but it helps to frame the environment you'll be working in, no matter which side you want to come down on.

a) Prep time. The task-oriented barriers are lowest for medical school. Yep that's right. It takes less time and fewer courses to apply to med school. Volunteer, take your science courses, study like hell for the MCAT. Hell comes later. The extended residency is very daunting and since it pushes back the period in which you'll be earning poor wages, it is not a great choice for the over 30 set. Median debt load is $120K and rising. Getting into a higher paying specialties is partly talent and partly career management.

b) If you want much of a career as a PA you'll need a Master's degree, or a Ph.d. 99% of Master's programs require a minimum of 1-2 years of experience in healthcare before applying, which is a chicken and egg problem. Notice I said experience, not shadowing, or volunteering. Those are minimum requirements. These schools are VERY competitive, and there just aren't enough spots. So check out the profiles of who is getting in and you'll find that they are pharmacists, nurses, medical technicians. You'll also have to take at least a full year of extra academic prereqs to be competitive, and this is implied in the previous statement. GPAs are in the 3.3-3.7 range.
Yes there are undergraduate programs, but they typically admit freshman. Upper division transfer students are going to get openings available due to attrition. If you want to earn that $120K, you'll need additional training, and you'll want to get into a PA school with emergency medicine, orthopedics and/or surgical training. You'll start as a PA in the 50's or 60's, so you'll be servicing those big loans on a tight salary. More on that later. Ignore the median salary numbers. They are highly skewed with experienced people and often include about 20% in benefits. It won't mean anything until you have 2 to seven years of experience.
Don't assume that the past predicts the future. Speaking from experience, when you accept that a B.S. is all you need, and then the licensure requirement moves to M.S. or Ph.d (check out what has happened to physical therapists), you are suddenly less marketable unless you have a boatload of experience, or the doc hiring you just needs some cheaper labor for the uninsured patients. Basically, you will get paid what you can bill an insurer for. They pay lots of money for surgical procedures and acute care, lots less for everything else. Unless you want to go to a dermatology spa, then you get to bill the patients directly.

c) Nurse Practitioners: More education. To get into an MSN program, you'll need a BSN. A bridge program is 3 years, and will require about a year or year and a half of academic prerequisites and at least some history of altruistic volunteer or work experience. GPAs 3.3 min, but I'm seeing MBAs, JDs, biochemists and microbiologists with advanced degrees entering these programs in droves and actual GPAs are hovering in the 3.6 range. If you want to be a nurse anesthetist, you'll need 3.7 or better to be admitted at some public schools. So add it up. This is 3-4 years of extra schooling and living costs. A new MSN nurse will make $50K and an experienced NP with years of work experience will cap out at 75K, maybe $100K in the right gig with her/his own practice. Upside, you can hange out your own shingle.
NPs are experiencing a lot of growth in opportunity because they are perceived as a lower cost provider to insurers and finally to Medicare. The implication is that these third party payors will want drive reimbursement levels down, just as this field is expanding in investment in training costs.
Did you ever notice the string of redundant looking credentials on a nurse's name tag? ACN, FNP, FAN, .... You need lots of coursework to get those credentials. New skill, specialized training. Pull up your pants with some respect for advanced practice nurses here. They have a boatload of formalized education that is very specific to patient care. Don't let those jammies and huggie bear pins fool you. Advanced practice nurses work very hard and long for their profession, and whatever road you choose, your ability to work on a team will benefit if you take the time to investigate the training alternatives and understand how the socialization of the nursing profession differs from that of the medical branch.
Do not confuse advanced practice nurses with bedside or "technical" nursing. You can become an NP without ever doing bedside nursing, but in reality, the culture is such that it is hard to get preceptorships or work supervising care without hands on experience.

ECONOMIC REALITY CHECK: 4 years of school, whether it's medical school or "just" nursing school costs about the same. A Doctorate of Nursing practice takes 5-7 years. You get to cut out the residency period to 1-2 years, but you get to finance that yourself. Nobody has been able to explain to me how nurses and physician assistants are immune to the cost pressures that make primary care medicine so unattractive to MDs.

To recap with numbers. 4 years of school costs 4 X 45,000 + Living Expenses (private) = >180,000. 4 x 20,000 + Living Expenses (public) = >80,000. Servicing a student loan of $100,000 at 6.8% will require a monthly payment of $887. for 15 years. Before taxes, that's $1000 per month gross income. Scale that number up or down or go to FINAid.org/calculators and do it for yourself. Finaid estimates that you need a salary of $106.5K to service this loan, by the way.

Now debt isn't everything--until it runs your life. These payments are the size of mortgages. You may not care if you have a debt free spouse with a good job and prenup. There are a lot of physicians in financial trouble who are unable to save for retirement. But at least there's a better upside in the earning potential. There are loan forgiveness programs that can take the edge off if you are serious about being a do-gooder, or want to work in federal prisons.
Also note and this is REALLY important, that when you have debt making your choices for you, you may not be able to work in that free clinic, or do pro bono work. You will have to work for billings and that means patient throughput. There is a lot of merit in studying what physicians are saying is upsetting them about their careers. News flash, you may be very special, but you do not get the special-case-exemption from concern about finances.

Best wishes to you all. Em

 

[r0b0tafflicti0n]

My research has turned up about the same things you've mentioned above, with the exception of this:

A new MSN nurse will make $50K and an experienced NP with years of work experience will cap out at 75K, maybe $100K in the right gig with her/his own practice.

Wha? I'm finding that to be true of PAs, but not NPs or even RNs in general. . .The DON at a major hosptial in Chicago last night told me that a Master's level NP could start at $100,000 easily (at least here). She claims that a PA is never going to make that kind of money, but of course she's biased. . .

As for Masters entry programs in nursing. . .if you don't have really rich parents, well, good luck. You're not "officially" a grad student until you've completed the RN component, so it's nearly impossible to get more than $18,000 in student loans for that first year. Most programs cost either considerably more than that, not to mention the cost of living during school (most say you can't hold a job, as if you'd have time for one anyway).

Also, I'm not sure what schools you're talking about that cost $45,000 a year (with the exception of a few private med schools).

Either way, I'm slightly leaning toward becoming a PA (for today, ha ha). I'm not sure I'm willing to give up having a child or children in order to become a physician. At my age (31, no kids), it's very possible that would happen.

 

[ceg]

I am currently a direct-entry nursing student. I just wanted to clarify so the OP can take into consideration:
To get into a direct entry program you need a BA or BS plus all of your pre-requisites- for me this was 4 years for a BA and one year for pre-reqs. My GPA was 3.5 and my GRE was around 1200. I was the lower end of the applicants for my program.

Then I will spend one year doing my RN certificate- this is clinicals and class. We will actually graduate with nearly twice the amount of clincal hours as a BSN.

Once I pass the NCLEX I will work as a nurse while working on my MSN which will take at least three years. I will be eligible for graduation until I have two years of experience as a nurse in the field of my MSN.

So, it will take 9 years at a minimum for me to get to NP (actually CNM). And I am paying > $45000 a year for my tuition at a public university. At my school we are considered graduates throughout the entire program. This helps us get more financial aid, but also means tuition costs more.

Just my input since direct-entry programs for NP vary. My school is ranked very highly in US News and World Report in all nursing disciplines. There are also a lot of misconceptions out there about these programs.

 

[deleted6669]

"The DON at a major hosptial in Chicago last night told me that a Master's level NP could start at $100,000 easily (at least here). She claims that a PA is never going to make that kind of money, but of course she's biased. . ."

she's just plain wrong...the avg pa makes more than the avg np. this is because pa's tend to work more in hospital based practices and specialities and np's tend to work more in primary care and psych. a pa and an np of the same seniority working in the same place doing the same thing generally make the same salary as places that use them both tend to clump them together as midlevels.
lots of pa's make more than 100k/yr. there are 12 pa's in my em group. they range in salary from 110-160k/yr based on how many nights and weekends they do and if they just do the min( 10 shifts/month) or do 16-18 shifts/month. ortho/surgery/derm pa's also frequently make more than 100k. the pa's who make 70-90 k are the ones working in primary care or the new grads with zero experience before pa school as medics, nurses, rt's, etc
don't ever let a nurse, np, or anyone else for that matter tell you what someone else does or makes. check the facts.
www.aapa.org
www.physicianassistant.net
www.appap.org

 

[kate_g]

Nobody has been able to explain to me how nurses and physician assistants are immune to the cost pressures that make primary care medicine so unattractive to MDs.

I'm going to make one of those broad sweeping generalizations that will probably make a whole lot of people mad and get a couple of nasty replies, but...

I think there are a lot of people who start out wanting to become doctors because they think it's a lucrative and prestigious career - oh, and because it's nice to help people. Only much later, after you've got a lifetime of expectations about what it's like to be a doctor, do you go through the math and hit reality. People I know who never considered being an MD and wanted from the start to go into nursing don't seem to be expecting a huge financial payoff, so maybe they're less dismayed by the cost of getting there? I dunno, I don't have a huge sample of people on either side to make comparisons, but that's my general impression.

 

[RxnMan]

Nobody has been able to explain to me how nurses and physician assistants are immune to the cost pressures that make primary care medicine so unattractive to MDs.

I think it is a fact not so much as 'immunity' to to cost pressures, as a change in how primary care is practiced in this country. Originally docs would meet with folks and that's it - all of these mid-level providers didn't exist. PAs and NPs all the rest come on the scene as physician-extenders. They do much of the routine patient interaction, enabling the doc to spend less time per patient (very important in these days of managed care) while providing the same level of care. This lowers cost/per patient and raises #of patients seen, while lowering exposure to litigation (as you would have with a practice of 100% physicians). Thus, physician-extenders make good buisness sense, and are seeing more use as the buisness of medicine changes.

 

[MaryWrathers]

njbmd said it best.

The only person I want to be limited by is myself. I strive for the fullest freedom (and attendant responsibility) to affect positive change in people's lives in the most basic, hands-on way possible.

I agree with the above statement.

 

[burntcrispy]

I worked as a nurse for 6 years before attending medical school. I considered PA, NP, CRNA but found MD to be more of what I was looking for.

All of the jobs have their advantages and disadvantages. But, after working for a nurse for a while and getting to know some PAs, NPs and CRNAs pretty well I found that I would not be satisfied in that role.

If you're looking for a fun job with decent pay those are good options. Many of the "midlevels" that I met had a chip on their shoulder from always being "second best" to the MD. For me, I just couldn't take a career of being treated or feeling that way.

As far as the MD route: yes, it is more challanging. I've had some PA students on my rotations and the knowledge base between med students and PA students is almost uncomparable. You learn SO MUCH in medical school. You will have a very in depth understanding of the pathophysiology of diseases and how they are treated. Also, you have many specialties to choose from once you are done: from primary care to neurosurgery and everything in between.

The downside of MD: 1. expensive (I've got around 140K in debt right now and am graduating in 1 month. Upside of that is you can pay it back very quickly depending on what specialty you choose). 2. Medical school is fairly grueling. I studied about 40+ hours per week during the first 2 years. You are studying to compete with some very smart people for the best residencies. In undergrad its nothing to get all As. In medschool you're with alot of people that made straight As who are very smart and hard working. The amount of material that you have to learn is mindblowing to say the least. The 3rd year is clinical rotations where you will spend many 80 hour work weeks. This is something to consider if you like spending alot of time outside of school with family or doing other things. (There are people in my class with families that did just fine) 3. Life outside of work: most MDs average 65+ hours per week with some specialties pushing over 80+. This is NOT RESIDENDY but out in the real world of private practice. Yes, you can find jobs that don't have that many hours but those hours are the averages. You should consider this if you are looking to have more of a family life. The jobs with the better hours (anesthesiology, radiology, optho, derm) are more competitive so you will have to work harder in medical school than the average student if you want one of those residencies.

I would advise you to shadow some NPs, PAs, CRNAs and MDs to get more of a feel for what you're looking for and do alot of research. Of course, when shadowing them every PA, NP, CRNA, MD etc will tell you that their job is great and whatnot so you will have to "look with your own eyes" to see through that.

Good luck with your choice.

 

[nikibean]

I'm in an odd spot- last year when I didn't get into med school, I applied for a master's entry FNP program, and also went to a local university and appealed for waivers of most of the BSN pre-reqs. I have three classes to take before I start the 16 month practical nursing (a state history one-unit course, lifespan devleopment psych and communications) if I choose to do so. Med school is sort of working out this year- I'm really hoping for UC Davis, but we'll see what happens ultimately. I can't go to Tulane due to some family stuff and the cost of education there, but I haven't put in my withdrawal yet (maybe I'll hit the lottery and my dad will go into remission?). I am also worried about losing my connection to the outdoors, because that's my sanity.
Any thoughts? I love what I do with regards to patient care in my clinic, but I also love being able to trek around in the wilderness. If I did the BSN, I'd go further- obviously head for ACN/MICN or FNP. Not interested in CRNA. What do you think?
And emedpa, are you PA-C or with a Master's? I have a friend who's an Everest guide and a PA in Denver, he works in the ER and he loves it. Curious.

 

[r0b0tafflicti0n]

she's just plain wrong...

I hope so!!! I mean, I'm going to do what I want to do either way (regardless of whether the salary is lower, within reason, or if I have to relocate). . . At the same time, I obviously want to be in demand/employable.

 

[deleted6669]

"And emedpa, are you PA-C or with a Master's? I have a friend who's an Everest guide and a PA in Denver, he works in the ER and he loves it. Curious."

pa-c, ms, emt-paramedic
I know of your friend jeff. he was the head guide for the blind guy who summited everest a few yrs ago

 

[star22]

I am currently applying to MD programs, but I have been volunteering in a local ER and I am really impressed by how much autonomy PAs have. Our ER is broken into the acute care department and the minor care department (probably like all ERs?) and MC is run exclusively by PAs. Here in Oregon, PA school 26 months beyond a bachelor's degree and you are then eligible to practice (no residency). You need to be loosely affiliated with an MD/DO, but they (the PA) have a lot of independence. I was told that some of the rural towns around here only have a PA, who is affliated with a doc in Portland (so it is not like you would be directly working for a doc). I think it sounds like a really sweet option if you are interested in primary care and want to start working soon. If I don't get into school this year, I think i am going to reapply to MD programs and PA programs and see how it all pans out.

 

[nikibean]

"
pa-c, ms, emt-paramedic
I know of your friend jeff. he was the head guide for the blind guy who summited everest a few yrs ago

Yeah, Jeff's rad - I met him at a Wilderness Med conference in Big Sky over the summer. Great person.

In any case, one reason I have been hesitatnt towards becoming a PA is that I've heard the requirement is soon going to be a PA-M. UC Davis is the ONLY PA school in california that doesnt offer a PA-M, and that bothers me- I know that PA-Cs will be grandfathered in for california, but nationwide I've heard it would be difficult to transfer. What do you know about this?

 

[deleted6669]

Yeah, Jeff's rad - I met him at a Wilderness Med conference in Big Sky over the summer. Great person.

In any case, one reason I have been hesitatnt towards becoming a PA is that I've heard the requirement is soon going to be a PA-M. UC Davis is the ONLY PA school in california that doesnt offer a PA-M, and that bothers me- I know that PA-Cs will be grandfathered in for california, but nationwide I've heard it would be difficult to transfer. What do you know about this?

there are still many non-masters programs out there. only 2 states require an ms( mississippi and ohio) to practice. if you graduated from a non-ms program and started working and a law came about mandating an ms it would only apply to folks graduating after a certain date, so you would be grandfathered . no such national law is in the works. some of the best programs out there( u.wa for example) still offer a bs.
for more info about pa's than you ever wanted check out:
www.aapa.org (national organization)
www.physicianassistant.net (pa specific forum)
www.appap.org ( optional residencies)

star22- there are also pa's running er's, clinics, icu's etc all over the country without an md present. md is available for phone consults and to come in as needed. I work in such a setting( em) a few times a month and am treated the same as the docs who sometimes work there( we are scheduled interchangeably). many states now allow a pa to own their own primary care practice and have a physician employee who only reviews a few charts a month as required by state law.

 

[MyChoice]

First of all, for all of those individuals who feel that my opinion is biased - IT IS! That is why they call it an opinion. My perspective comes from choosing to be a physician assistant (note that there is no 's - this would denote the possessive form of the word, and this is not the case). I was pre-medicine with a 4.0 GPA, preseident of the college senate, had more academic & merit scholarships than you could shake a stick at, & had previous medical experience. I aced the MCAT, & all of my medical school interviews (public & private). I had my choice of where to go & who I wanted to be, & I chose PA school. Here's why:
1) Formal education time is reduced.
2) Flexibility in career choices. I could be in orthopedic surgery for a few years, then I could be in cardiothoracic surgery or pediatrics or even critical care medicine if I chose, without having to endure another complete residency program.
3) Money, financial enumeration, salary (whatever you want to call it; it's still just a paycheck). A PA earns in the upper $70k's annually, but this includes the thousands in rural primary care medicine. I graduate in a few months, & I have been offered over 2 dozen confirmed positions between $100k-$140k plus full benefits. This is for a new graduate. I believe residents make $40K & most residencies are between 3-5 years, then there are always the fellowships to follow.
4) Owning a practice was one topic another writer mentioned. I don't know about you, but I am not interested in being a businessman. I do not want to worry about corporate taxes, limited liability partnerships, the IRS, insurance, worker's compensation, etc. I just want to see and treat my patients. And yes, they are my patients. They come to see me, not the physician. Just ask Medicare/MedicAid. PAs have their own provider number, their own DEA number. We bill. We are licensed. Our names are on the marquis & letterhead.
5) So much more I don't have time to write it all down. Let me say this. If you have a particular area of medicine that you are dying to be in, GREAT! Talk with MD/DO's in those practices. Then find out if there are PAs also in that area of medicine & talk with them. Then way the pros & cons. For me the biggest pro was that I could spend more time with my patients than if I were an MD/DO needing to cover my overhead. The only real con was that one of the areas I especially enjoy is a subspecialty of medicine that does not readily utilize PAs yet in the area of the country I wish to live. The other pros/cons such as salary, educational cost, etc. need to be considered by the individual not as a profession. Let's face it, advanced degrees vary in cost be state & institution.

In closing, here are some facts many "doctors" do not know:
1) A PA can bill 100% of the physician fee in many/most office cases
2) A PA can bill 85% of the balance not covered in #1.
3) An MD/DO who assists in the OR can only bill 16% of the primary surgeon's fee. A PA can bill 85% of that 16% assisting fee (or approximately 14%). If both doctors are in the same practice, whenever they work together they are only 58% effective in their billing. However, if these same surgeons work wih a PA, & time their OR & office times correctly, each doctor is maximized to 100%, & the practice gains an additional 28% in billings from the PA, who can also pre-op & post-op round on these patients as well.

For any more information, contact the AAPA (American Academy of Physician Assistants) at www.aapa.org. Additionally, more & more PA programs are affiliated with a medical program.

Remember, all enzymes are proteins, but not all proteins are enzymes. To that end, all physicians are health care providers who diagnose & treat the sick & injured, but not all health care providers are physicians.

Best of luck in whatever choice you make, I am sure you & your patients will do extremely well!

 

[chocopinipig]

the best opinion i've heard so far came from those PA's who decided to become MD's. At least they went through both setups and decided to choose to become MD's instead.

 

[burntcrispy]

I have a friend who was a PA and went back to med school. He said it was the best decision he ever made. At my school at least every other class has a PA in it who decided to go back to med school.

Best advice is to do your research thoroughly to decide what is best for you. You don't want to end up wanting to go to med school later in your career and having wasted alot of time.

I definately regret my time wasted working as an RN. I'm 32 and just starting residency. If I would have gone straight through I would be done by now. Medical school is a very timely endevor if you include the prerecs, medschool and residency. I've found it very challanging and rewarding and look forward to starting my residency but that is alot of time that one could be "living life".

Other advice is don't worry about the money in whatever you choose. You want to find a job that you are satisfied with regardless of the pay. It's not worth it to be in a job that you don't enjoy no matter what the salary may be. Also, about residency, yes the pay is about 40-50K for 3 years but you can double or triple that by moonlighting depending on what specialty you are in. DONT WORRY ABOUT MONEY.

Good luck.

 

[shenanigans]

I have a friend who was a PA and went back to med school. He said it was the best decision he ever made. At my school at least every other class has a PA in it who decided to go back to med school.

Best advice is to do your research thoroughly to decide what is best for you. You don't want to end up wanting to go to med school later in your career and having wasted alot of time.

I definately regret my time wasted working as an RN. I'm 32 and just starting residency. If I would have gone straight through I would be done by now. Medical school is a very timely endevor if you include the prerecs, medschool and residency. I've found it very challanging and rewarding and look forward to starting my residency but that is alot of time that one could be "living life".

Other advice is don't worry about the money in whatever you choose. You want to find a job that you are satisfied with regardless of the pay. It's not worth it to be in a job that you don't enjoy no matter what the salary may be. Also, about residency, yes the pay is about 40-50K for 3 years but you can double or triple that by moonlighting depending on what specialty you are in. DONT WORRY ABOUT MONEY.

Good luck.

If I may ask, what specialty were you in when you were a nurse? And what are you going to specialize in as a doc? The only reason I ask is because I am following the same program as you, I will have my BSN next year and so far, I know I made a mistake in coming to nursing school instead of staying at my undergrad institution...thanks in advance,

Mike

P.S. ---> I apologize for leading this thread off topic, please forgive me...

 

[scpod]

Remember, all enzymes are proteins, but not all proteins are enzymes.

Yes, I know this is kind of picky, but all enzymes are not proteins. There are RNA enzymes as well.

 

[RxnMan]

Yes, I know this is kind of picky, but all enzymes are not proteins. There are RNA enzymes as well.

I thought enzymes had to be proteins by definition. That doesn't mean that RNA can't be a catalyst, it just means that RNA isn't a protein.

 

[scpod]

I thought enzymes had to be proteins by definition. That doesn't mean that RNA can't be a catalyst, it just means that RNA isn't a protein.

Many definitions used to include "proteins" before the discovery of ribozymes. Enzymes are catalysts that promote reactions repeatedly, without being damaged by the reactions. Ribozymes do that. Newer textbooks are saying that.

 

[burntcrispy]

If I may ask, what specialty were you in when you were a nurse? And what are you going to specialize in as a doc? The only reason I ask is because I am following the same program as you, I will have my BSN next year and so far, I know I made a mistake in coming to nursing school instead of staying at my undergrad institution...thanks in advance,

Mike

P.S. ---> I apologize for leading this thread off topic, please forgive me...

I have a BSN. I spent 3 years in ICU, then 3 years in the ER. I'm going into Anesthesiology. Another guy in my class was a nurse for about 8 years, also going into anesthesiology. A guy I used to work with in ICU is now an anesthesiology resident. It seems to be popular with the previous nurses but its hard to say because as of right now (things change all the time) anesthesiology is very popular because of income and lifestyle.

Good luck applying. You won't regret it!!!!!!!

 

[Igni Fera]

Folks,

I recently spoke with the assoc dean of admissions for the coll of medicine of a large, respected private university in the northeast. Among other things, he commented that someone who really wanted to do a lot of patient care and who wanted to be hands-on, and in particular wanted to get out there relatively quickly, should strongly consider becoming a physician's asst. or nurse prac. rather than an MD. He said MDs spend so much time nowadays in admin and related activities that to really do a lot of the kind of patient care MDs used to do, and get to it soon, one should look into these areas. He also said they were just as lucrative for the most part, a lot more satisfying generally if you wanted to do a lot of direct-patient contact work, and the liability was a lot less. Also, it could happen in 2-4 years instead of 9-12 years, with a lot less debt.

So now, I am in a tizzy. I have spent the last 2 years focused on doing whatever it takes to get myself ready for application to med school, including relocating, etc., and someone of this man's position has told me: think again, your actual work-life goals may not get met if you take the path you have planned.

I would like some informed and sincere comments please to this question. Also, apologies in advance if this is old ground being re-hashed, as I imagine someone else must have brought the topic up already. But the nature of these boards I have seen is one of dealing with particulars. Some re me: age: 37, B.A. (GPA: 2.8) 1989, M.S. (GPA: 3.7) 1996, 10 years' work experience.

Okay, pull out your bows and arrows...I'm setting up the target...

The rationale for my broad sweeping judgement here is based on personal experience with bedside manner and diagnostic abilities of MDs vs PAs. This is completely subjective, and possibly unfair...I will be the first to admit that.

I have had many a MD over the years that had deplorable bedside manner, but every one of them got the job done efficiently and effectively when it came to diagnosis.

So far, I have only experienced PAs that are deplorable on both fronts, including two encounters in the last year.

A few days ago, in fact, I had to deal with the very real fact that as a patient that had been diagnosed with the condition previously and as a pre-med student that does her research, I knew more about the PROCESS and literature of determining a diagnosis for my possible condition than this PA did. But really, it wasn't even a matter of knowledge, it was her lack of interest and dedication to seeking out thorough clinical evidence and weighing the information presented that really put me off. She didn't even ask why I was there, look at my symptoms, or go over my previous medical history with the condition, as I know even the shoddiest of MDs I have encountered would have done. In fact, she immediately came into the room and presented her backside to me the entire appointment, as she fumbled with my chart on the other side of the room.

I had a similar experience with a PA last year with regards to an acute rotator cuff injury that ended up requiring surgery to repair. He did not even think that an MRI was necessary, despite the fact that I was a pro athlete injured while performing a highly dangerous and risky maneuver.

Both of these PAs worked in clinics that have a minimum of MD supervision. The one last week, in fact, is a community clinic in Santa Monica (LA) completely operated by nurses, PAs, and techs, with the occasional review from the one MD-manager. I am not saying that the people working there are not competent in their particular fields, they well may be. I just think that the overall competency present in a clinic organized in this way is highly insufficient to accurately and completely care for the patient. It keeps cost down, yes, but at the cost of shoddy medical care?

Both of these recent experiences left a very bad taste in my mouth.
So long as these clinicians are being trained in such a minimal amount of time and going into practice with minimal practical experience, I personally feel that this increased reliance on PAs as PCPs is a bad trend in our health care system.

I don't intend to continue going to this clinic. From what I could tell in the aftermath of conversations that I had with the clinic'c staff after I voiced my dissatisfaction with the PA, many others are choosing to go elsewhere as well. The clinic is struggling to keep paying and insured customers. Considering the organizational structure, maybe going out of business would be a good thing for the future health of health care...

The other clinic where I dealt with the PA for the rotator cuff tear, relies primarily on Worker's Comp insurance to stay in business... probably the only way this organizational structure could survive in a consumer-directed market driven economy....

 

[Croooz]

Okay, pull out your bows and arrows...I'm setting up the target...

The rationale for my broad sweeping judgement here is based on personal experience with bedside manner and diagnostic abilities of MDs vs PAs. This is completely subjective, and possibly unfair...I will be the first to admit that.

I have had many a MD over the years that had deplorable bedside manner, but every one of them got the job done efficiently and effectively when it came to diagnosis.

So far, I have only experienced PAs that are deplorable on both fronts, including two encounters in the last year.

A few days ago, in fact, I had to deal with the very real fact that as a patient that had been diagnosed with the condition previously and as a pre-med student that does her research, I knew more about the PROCESS and literature of determining a diagnosis for my possible condition than this PA did. But really, it wasn't even a matter of knowledge, it was her lack of interest and dedication to seeking out thorough clinical evidence and weighing the information presented that really put me off. She didn't even ask why I was there, look at my symptoms, or go over my previous medical history with the condition, as I know even the shoddiest of MDs I have encountered would have done. In fact, she immediately came into the room and presented her backside to me the entire appointment, as she fumbled with my chart on the other side of the room.

I had a similar experience with a PA last year with regards to an acute rotator cuff injury that ended up requiring surgery to repair. He did not even think that an MRI was necessary, despite the fact that I was a pro athlete injured while performing a highly dangerous and risky maneuver.

Both of these PAs worked in clinics that have a minimum of MD supervision. The one last week, in fact, is a community clinic in Santa Monica (LA) completely operated by nurses, PAs, and techs, with the occasional review from the one MD-manager. I am not saying that the people working there are not competent in their particular fields, they well may be. I just think that the overall competency present in a clinic organized in this way is highly insufficient to accurately and completely care for the patient. It keeps cost down, yes, but at the cost of shoddy medical care?

Both of these recent experiences left a very bad taste in my mouth.
So long as these clinicians are being trained in such a minimal amount of time and going into practice with minimal practical experience, I personally feel that this increased reliance on PAs as PCPs is a bad trend in our health care system.

I don't intend to continue going to this clinic. From what I could tell in the aftermath of conversations that I had with the clinic'c staff after I voiced my dissatisfaction with the PA, many others are choosing to go elsewhere as well. The clinic is struggling to keep paying and insured customers. Considering the organizational structure, maybe going out of business would be a good thing for the future health of health care...

The other clinic where I dealt with the PA for the rotator cuff tear, relies primarily on Worker's Comp insurance to stay in business... probably the only way this organizational structure could survive in a consumer-directed market driven economy....

I had the exact same experience only different.
I've had great docs, PA's, and NP's as providers. I've also had horrible docs and a greedy NP. All the PA's in my experience have been exceptional. Doesn't prove anything. It's perspective of limited experience. There are good, bad, and indifferent in every walk of life.

If you want to be a physician then become a physician. If not then become a PA. Choose the path because that is what you want and not because you weren't accepted to medical school.