I've seen you speak elsewhere on the idea that the future of the specialty will likely be a small pool of physicians to act as central nodes in the IDT and that PA/NPs will be more numerous, which to me raises the question of whether it would be 'better' to pursue a PA route that has more flexibility in specialty practice for when positions are sparse — particularly in areas that I'm inclined to live in long term.
Additionally, much of what I've read from the PA perspective is that their autonomy is continuing to grow, seemingly at a clip that implies they may have all but final say in care plans in the coming years. Do you think there's truth to this? And for someone who wants to truly become a specialist, do you think there would be a benefit to entering the field as a PA and completing training as a physician down the line with experience under their belt?
Cheers!
I don't think there will necessarily be a small pool of physicians in the field. I think their positions will continue to grow too. However, the ratio of NP/PA to physician is likely to increase across the field, much as it has across all specialties in medicine. This unfortunately doesn't mean, since numbers have increased, that jobs will open up all over the place. More so that the teams which are growing now will likely continue their growth with NP/PA more often than with additional physicians unless there is good reason for the 2x added cost. Again that is not to say that there will be a shortage of physician positions, just more NP/PA positions comparatively. Right now you can get jobs in southern california, PNW, NYC, etc. those sorts of places. When making the decision to take your medical career NP/PA route or MD/DO route, I don't feel that the gamble on maybe there will be a job in XYZ locale down the road should drive that decision. Rather, the former stuff I mentioned in an earlier post.
That said, you are correct 100% in that if you must live in Laguna Beach, CA (for example) that odds are you will be more likely to find employment as a PA for the very reason you noted: you can just jump to a new specialty and apply to whatever is being offered (family med, obgyn, palliative, surgery, etc). I can't say if that is the best choice for you -- only you can.
Often PA's already have "all but final say" in a care plan. For example, you are on a team in the hospital and have 6 patients assigned to you. You see them and put together your plan of recommendations then that's that -- unless the physician spots something egregious or a better alternative.
I do not like the idea of intentionally going through PA training and then applying/attending medical school, then residency, then fellowship. That is a very bad decision from debt and time lost. From the angle of purposeful intention, pick one or the other and go that route 100% all-in. Don't become a PA in hope to subsequently become a physician. One or the other.
