Practicing PA making the switch to MD

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SHOCKandAWESOME

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Hey all,

Long-time reader, first-time poster :) I've done a fair bit of searching on this topic and nothing truly addressed my specific situation!

I'm currently a practicing PA x4.5 years with my time split 50/50 between ER and ICU (our hospital is trialing an "upstairs care downstairs" model, so there's a lot of crossover). I have a fair bit of autonomy ranging from the initial resuscitation, lines, running codes and (rarely) airway management. It's great and all but often feels a bit protocolized at times with LOTS of physician oversight (as it should be in this environment); some individuals at the hospital refer to us as "the tacticians, not the strategists." Nevertheless, it's a good gig--sounds crazy to want to leave and take on a huge financial/time commitment, right? Hear me out.

I wanted to go to med school initially in undergrad. Graduated with chem degree, 4.0 GPA and completed all pre-reqs for med school. I was killing it. My husband and I were married pretty young (20) and we (intentionally) had a kid at 23. All was well until little one was unexpectedly dx'd with Down Syndrome the year before I graduated (lots and lots of doctors, therapies, surgeries...).

Everything was overwhelming at that time and the thought of entering med school/residency/fellowship was pretty much impossible in my mind. I abandoned my dream, bit the bullet and used my prereqs to get into PA school so I'd be able to finish faster, support our little one and have time to be home. In hindsight, was this the smartest choice? Probably....definitely not. I'm aware of the mistakes I made but it's done and it made perfect sense to me at the time.

Now that I'm in my 30s, I find myself completely dissatisfied with my work life. I can give 500 logical reasons/arguments if needed but I really don't want to take the thread in that direction. The bottom line is that I'm just not happy and I KNOW that I want to go the MD route (and have for a long time). Love the patients, love the medicine but I hit a glass ceiling at 2 years; I certainly can't do this forever.

I gave up on my dreams.

Now that I'm older/wiser, have more support & the little one is more self-sufficient I feel ready to start again. Anyone else out there make the PA-->MD switch?

Next steps will be refreshing all that basic science knowledge and studying for the MCAT...

Someone tell me I'm not crazy.

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Minimum 7 years loss of income. The possibility of having to move far far away for med school and residency. If your spouse has a career, hope it will survive two moves and 7 years. If you and your family can be at peace with this, go for it.
 
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Minimum 7 years loss of income. The possibility of having to move far far away for med school and residency. If your spouse has a career, hope it will survive two moves and 7 years. If you and your family can be at peace with this, go for it.

We are ready! Hub works from home, been saving up for the anticipated income loss.
 
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Good luck! Sounds like you know exactly what you want. I hope that adcoms value applicants that are coming from a healthcare field. We already know what the job entails and definitely want to do it.
 
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do some reading on this site why all the MDs tell people to go the PA route

this seven year ****show that is training has the potential to ruin any part of your life - mental, physical, financial, personal, spiritual

can you be absolved of essentially all childcare duties for the most part for 7 years?

also, what are you thinking of specializing in? you might get there and need to do a fellowship for your sanity which makes this an even longer path
 
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I think it's really exciting that you're prepared for this and if your heart is in it why not? If you have arrangements made for your child, you're ready financially, you're able to move - go for it! As many other parents have said you will likely want to look into schools where attendance at lectures is possible. It's also four years loss of income not seven... You've probably seen residents go through it so you can see how you'd adapt.

My only question is do you think you might be more satisfied in another hospital or setting? Is part of the glass ceiling attributable to the dynamics in your hospital?


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I think it's really exciting that you're prepared for this and if your heart is in it why not? If you have arrangements made for your child, you're ready financially, you're able to move - go for it! As many other parents have said you will likely want to look into schools where attendance at lectures is possible. It's also four years loss of income not seven... You've probably seen residents go through it so you can see how you'd adapt.

My only question is do you think you might be more satisfied in another hospital or setting? Is part of the glass ceiling attributable to the dynamics in your hospital?


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Unless she took a really crappy job, she is making significantly more than a resident right now. Combine that with 4 years of zero income plus six figure debt, and the huge pay cut essentially amounts to 7 years of lost income.

That said, you won't be the first PA to make the switch. @primadonna22274 made the switch and might have something to say about it.
 
A PA probably makes double that of a resident, give or take, depending. Three years of working at a salary of $50-60k is NOT insignificant income! Many people in this country make that much at the peaks of their careers and plenty survive on less.


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A PA probably makes double that of a resident, give or take, depending. Three years of working at a salary of $50-60k is NOT insignificant income! Many people in this country make that much at the peaks of their careers and plenty survive on less.


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It is insignificant income when the earnings, after servicing your debt, leave you at the poverty line for your area.
 
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It is insignificant income when the earnings, after servicing your debt, leave you at the poverty line for your area.

No...IRB and PAYE are very manageable. Sorry if you didn't capitalize on that or if policies were different when you were a resident.


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I don't think you made a mistake at 23. You made a mature responsible decision based on a life event.

Based on your prior experience, you are probably going to train for 8-9 years. I can't tell you if that's worth it. You'll miss a lot of family life but you'll end up a doctor.
 
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No...IRB and PAYE are very manageable. Sorry if you didn't capitalize on that or if policies were different when you were a resident.


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IRB and PAYE also have a tax bomb that I'd much rather like to avoid making larger by stacking interest on my interest. The interest on my loans alone is going to be $30,000/year, and if I can't pay all of it, it gets added right on top of my debt. People treat IBR/PAYE like they're some sort of free ride, but if I utilized then for my entire career, my debt would balloon well into the seven figures and I'd have a half million dollar tax bomb at the end, payable immediately to the IRS that can seize my assets or my retirement funds.
 
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IRB and PAYE also have a tax bomb that I'd much rather like to avoid making larger by stacking interest on my interest. The interest on my loans alone is going to be $30,000/year, and if I can't pay all of it, it gets added right on top of my debt. People treat IBR/PAYE like they're some sort of free ride, but if I utilized then for my entire career, my debt would balloon well into the seven figures and I'd have a half million dollar tax bomb at the end, payable immediately to the IRS that can seize my assets or my retirement funds.

Yeah it's infuriating. Corporations are coddled and students are screwed. By the time I'm done I will be not far from you. I also find it disappointing that the masses of us in similar boats aren't advocating for reform in terms of interest. I do have some friends in the policy world and hope to involve myself in such action. But for now I feel like it's important to handle it day by day... Student debt is a funny thing. My friend had private loans and settled his med school debt for a few payments equating to $70k, negotiated completely on his own - and man were they itching for whatever he would offer. There was also a recent article in SDN about a new graduate who paid of his/ her loans in three years which was interesting. Anyway when I take to the streets in protest I will extend an invite :) lucky for OP it doesn't seem like finances are going to be a major burden (what's your secret?! :))

Nonetheless I would be interested in understanding more about what you're saying re: your ceiling OP. I am obv a non trad pre med and about 10% of me leans toward PA. I don't know if you'd mind elaborating- there are many threads about this of course but I appreciate any further perspectives. It sounds like your heart is really speaking in this situation so if you care to share...


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do some reading on this site why all the MDs tell people to go the PA route

this seven year ****show that is training has the potential to ruin any part of your life - mental, physical, financial, personal, spiritual

can you be absolved of essentially all childcare duties for the most part for 7 years?

also, what are you thinking of specializing in? you might get there and need to do a fellowship for your sanity which makes this an even longer path
Every now and then I think about how I could already be a PA right the **** now. Then I think about the fact that I'd be someone's b**** forever and the appeal subsides. I mean, the government and hospitals are still going to make me their b****, but still...
 
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I don't think you're crazy. I think the "tactician vs strategist" analogy is fair and from your description and the way you write, I'm not really surprised that you're not satisfied as a PA. That's amazing that your husband is on board. My strategy would be to aim to minimize debt by doing as well on the MCAT as you can so you can get into a state MD school (or potentially a highly ranked one with a scholarship), so you don't have to make career decisions based on finances in the future. With a 4.0 GPA, I don't think you'll have trouble on the MCAT. I wouldn't retake any courses if you have all the pre-reqs. Just use MCAT study materials and give yourself sufficient time, and make sure that you're scoring highly.

No kids for me, but if you have a spouse that earns an income that covers your living expenses, and tuition is your only med school expense, it makes a huge difference, especially if you can pay state tuition.
 
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Haha well even to be a PA you'd have to go back and take all these other undergrad classes and train in their program (except in a few states I think where you can bypass this as an MD). But at the end of the day I'm at a point where I'm so f*ed by my loans already I may as well screw myself a little deeper but end up with the bravado and longitudinal income of a doctor. I feel old and under-accomplished now when I shadow residents or new grads who are three years younger than me knowing I'm 8+ years away from them and have a lower net worth... Then I think about being 38 and having one of these kids as my boss? Mmmm yeah.


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Really appreciate the input everyone.

Yeah it's infuriating. Corporations are coddled and students are screwed. By the time I'm done I will be not far from you. I also find it disappointing that the masses of us in similar boats aren't advocating for reform in terms of interest. I do have some friends in the policy world and hope to involve myself in such action. But for now I feel like it's important to handle it day by day... Student debt is a funny thing. My friend had private loans and settled his med school debt for a few payments equating to $70k, negotiated completely on his own - and man were they itching for whatever he would offer. There was also a recent article in SDN about a new graduate who paid of his/ her loans in three years which was interesting. Anyway when I take to the streets in protest I will extend an invite :) lucky for OP it doesn't seem like finances are going to be a major burden (what's your secret?! :))

Nonetheless I would be interested in understanding more about what you're saying re: your ceiling OP. I am obv a non trad pre med and about 10% of me leans toward PA. I don't know if you'd mind elaborating- there are many threads about this of course but I appreciate any further perspectives. It sounds like your heart is really speaking in this situation so if you care to share...

Sure! I'd be happy to elaborate. About the financial piece -- we drilled down on loans hard and paid them off in ~3.75ish years post graduation. We lived on my husband's income and split mine to pay down loans, pay for my little one's healthcare and save for future endeavors (which are obviously still in development, lol).

About the ceiling, being a PA is great. I work 36 hours a week and can pick up as many hours as I want. As a PA you do get a significant amount of respect and people do appreciate what you do. There are always opportunities to learn and apply new skills. I've been consuming CME, procedure and simulation hours like a rabid dog. As a result, I can handle just about any situation that walks through the front door with minimal help. But my practice doesn't play out that way.

At the end of the day, no matter how confident or proficient I am, I signed up to be a dependent practitioner. Four years into it I feel as though I have reached the peak of my career, and I really don't want to ride that out until I retire. There will simply always be things that I can not do and decisions I can't make. Obviously this happens as an MD as you're limited by hospital or group practice admin, but not really to the same degree..

I don't really think it's the hospital per se; on the contrary, in my experience, there aren't many hospitals that use PAs to this caliber in the first place. I feel like this is job is as good as it gets and I really have enjoyed the experience.

Anyone out there considering PA vs MD, take heed (you should know this going into it, but it bears repeating): the desire/expectation of becoming an MD will simply never be satisfied by being a PA.
 
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No...IRB and PAYE are very manageable. Sorry if you didn't capitalize on that or if policies were different when you were a resident.


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Do you have kids? Just curious because I make about 53k/year and my wife makes about 35k/year (she makes great money but cut down to 2-3 days/week when we had our kids). Between car payments, money for all the kids' needs, food, etc., we have only a small cushion in case of emergencies. If I suddenly didn't have income for 4 years then went back to making 53k/year with 200k in debt on top, it would be like I didn't have an income.
 
Then I think about being 38 and having one of these kids as my boss? Mmmm yeah.


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That happens in most careers unless you're the head honcho or unemployed. It will happen whether you do MD, DO, PA, or something totally different. I used to manage people who were older with significantly more experience than me. One of the best things you can do for your personal happiness is to forget about age and to do what you want. If you want more independence, be a doctor. But don't do it because you do'nt want to report to someone younger, because guess what -- there will still be younger, awesome docs out there.
 
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Really appreciate the input everyone.



Sure! I'd be happy to elaborate. About the financial piece -- we drilled down on loans hard and paid them off in ~3.75ish years post graduation. We lived on my husband's income and split mine to pay down loans, pay for my little one's healthcare and save for future endeavors (which are obviously still in development, lol).

About the ceiling, being a PA is great. I work 36 hours a week and can pick up as many hours as I want. As a PA you do get a significant amount of respect and people do appreciate what you do. There are always opportunities to learn and apply new skills. I've been consuming CME, procedure and simulation hours like a rabid dog. As a result, I can handle just about any situation that walks through the front door with minimal help. But my practice doesn't play out that way.

At the end of the day, no matter how confident or proficient I am, I signed up to be a dependent practitioner. Four years into it I feel as though I have reached the peak of my career, and I really don't want to ride that out until I retire. There will simply always be things that I can not do and decisions I can't make. Obviously this happens as an MD as you're limited by hospital or group practice admin, but not really to the same degree..

I don't really think it's the hospital per se; on the contrary, in my experience, there aren't many hospitals that use PAs to this caliber in the first place. I feel like this is job is as good as it gets and I really have enjoyed the experience.

Anyone out there considering PA vs MD, take heed (you should know this going into it, but it bears repeating): the desire/expectation of becoming an MD will simply never be satisfied by being a PA.

Very meaningful advice, thank you so much.


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You are in a somewhat unique position of knowing relatively well what the rigors of medical school and residency are (assuming that your hospital has residents)- just don't underestimate the toll it will take on your family and home life!! You of course can't truly know it until you go through with it, but I would imagine you have a good perspective on what medicine will (and will not) be and can make as informed a decision as possible. With that said, I wish you the best of luck- you will probably make an outstanding med student / resident. Having a stay at home spouse will really help. Best of luck to you! I think that in some ways, going back to medical school later in life makes being a medical student easier, though of course it's also harder in some ways too. I bet you will do great.
 
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I support your decision to pursue medicine. Your reasoning and conclusions for wanting to pursue it are well thought and your husband is on board with it, which is conducive to making it all work. Your drive is there and you'd probably do well on the MCAT since you're quite motivated. Being in your 30s is not old at all and your experience working as a PA is a positive.

Yes, money is important but you will be able to make up for it over the 20+ years working as a physician. Your personal satisfaction and happiness is worth the lost opportunity cost of not being a PA for seven years. There are ways to solve the student debt: PSLF, moonlighting after PGY1, etc. I say go for it!
 
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You are SO not crazy! And I'd even argue that you made the right choice at the time (PA over MD) given the information you were working with and your circumstances at the time. When you do get into medical school and go through residency, imagine juggling that with your IEP meetings and therapy sessions. Not to mention the financial strains...

I have a feeling you're going to do quite well --
 
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Is it an option for OP to sit tight and wait for the chips to fall her way, i.e. PA's getting more autonomy? Or is that never going to happen? What about opening your own practice somewhere under Physician oversight? I say all of this because you seem confident in knowing you can help others and if that is true and it is only legislation that is getting in your way then why not try your best to work around it.
 
Consider carefully, what will having an MD or DO get you that a PA won't?

Of course you are absolutely crazy for going back and your family nuts for supporting, but then if becoming a physician is your passion then you need to be crazy to get through it.

You may or may not be required to retake sciences (>7yrs old) and you'll need to do the MCAT so it will be like starting over. Look at various schools you are interested in applying to and check on their specific requirements. Read on SDN what it would take to be competitive gpa wise. Figure out if DO would help you achieve your goals. You don't want to rush it and make a mistake so research and plan carefully.

Best of luck!

Hey all,

Long-time reader, first-time poster :) I've done a fair bit of searching on this topic and nothing truly addressed my specific situation!

I'm currently a practicing PA x4.5 years with my time split 50/50 between ER and ICU (our hospital is trialing an "upstairs care downstairs" model, so there's a lot of crossover). I have a fair bit of autonomy ranging from the initial resuscitation, lines, running codes and (rarely) airway management. It's great and all but often feels a bit protocolized at times with LOTS of physician oversight (as it should be in this environment); some individuals at the hospital refer to us as "the tacticians, not the strategists." Nevertheless, it's a good gig--sounds crazy to want to leave and take on a huge financial/time commitment, right? Hear me out.

I wanted to go to med school initially in undergrad. Graduated with chem degree, 4.0 GPA and completed all pre-reqs for med school. I was killing it. My husband and I were married pretty young (20) and we (intentionally) had a kid at 23. All was well until little one was unexpectedly dx'd with Down Syndrome the year before I graduated (lots and lots of doctors, therapies, surgeries...).

Everything was overwhelming at that time and the thought of entering med school/residency/fellowship was pretty much impossible in my mind. I abandoned my dream, bit the bullet and used my prereqs to get into PA school so I'd be able to finish faster, support our little one and have time to be home. In hindsight, was this the smartest choice? Probably....definitely not. I'm aware of the mistakes I made but it's done and it made perfect sense to me at the time.

Now that I'm in my 30s, I find myself completely dissatisfied with my work life. I can give 500 logical reasons/arguments if needed but I really don't want to take the thread in that direction. The bottom line is that I'm just not happy and I KNOW that I want to go the MD route (and have for a long time). Love the patients, love the medicine but I hit a glass ceiling at 2 years; I certainly can't do this forever.

I gave up on my dreams.

Now that I'm older/wiser, have more support & the little one is more self-sufficient I feel ready to start again. Anyone else out there make the PA-->MD switch?

Next steps will be refreshing all that basic science knowledge and studying for the MCAT...

Someone tell me I'm not crazy.
 
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I think you will do quite well as a doctor. You have fantastic reasons for a career change, and you are clearly bright and capable.

Good luck!
 
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@SHOCKandAWESOME Based on my discussion with a couple of veteran PA's I've developed an impression that the NCCPA doesn't advocate as hard as it could for advancement of the PA profession. I wanted to know as a younger PA if you shared a similar sentiment and if it's a sufficient enough concern for someone who is considering a mid-level management healthcare field with a bachelor's degree.
 
can someone explain this tactician vs strategist metaphor for me? cuz I don't get it

and if you're going to list it as a reason to make the transition, you may as well prepare a short blurb on what that means since the more experience you have articulating "why the switch" the better
 
@Crayola227 - an example is that a strategist would say "This patient has hypoxemic respiratory failure, diffuse bilateral pulmonary infiltrates and they're not in heart failure or volume overloaded -> looks like ARDS -> let's intubate, admit to ICU and start high PEEP ventilation" whereas a tactician would say "This is ARDS and you want to admit to ICU -> OK, I'll put in ICU admission and ARDSnet ventilation orders."

@SHOCKandAWESOME - I agree with all of the above, you clearly seem motivated and qualified enough to make it through med school, residency and fellowship (critical care?) if you choose. However, I am curious - what exactly are the situations where you don't feel like you are being given enough autonomy? I ask because I have seen senior PAs be treated the same as senior residents - i.e., they run major medical decisions by the attending to get rubber stamp approval, but essentially they run the show. I'm curious as to what delta in autonomy you would gain by 7-10 years additional training (and I expect you will be asked in detail about this on interviews too).
 
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@Crayola227 - an example is that a strategist would say "This patient has hypoxemic respiratory failure, diffuse bilateral pulmonary infiltrates and they're not in heart failure or volume overloaded -> looks like ARDS -> let's intubate, admit to ICU and start high PEEP ventilation" whereas a tactician would say "This is ARDS and you want to admit to ICU -> OK, I'll put in ICU admission and ARDSnet ventilation orders."

@SHOCKandAWESOME - I agree with all of the above, you clearly seem motivated and qualified enough to make it through med school, residency and fellowship (critical care?) if you choose. However, I am curious - what exactly are the situations where you don't feel like you are being given enough autonomy? I ask because I have seen senior PAs be treated the same as senior residents - i.e., they run major medical decisions by the attending to get rubber stamp approval, but essentially they run the show. I'm curious as to what delta in autonomy you would gain by 7-10 years additional training (and I expect you will be asked in detail about this on interviews too).

Spot on description of what I mean by tactician vs strategist. Thanks!

It's not about autonomy per se.. I do get a fair bit of autonomy as a PA in the ICU--they really do use us to the same level of a senior resident. Rather, the big picture for me is long term growth and most importantly career satisfaction. That senior resident who is basically running the show with the attending stamp of approval doesn't continue doing that until they retire. They complete the residency and move on into the attending role or complete additional training. As a PA, the former is exactly what I do and will continue to do no matter how much I study or practice.

Additionally, there are significant gaps in my medical knowledge that I have filled in with a mosaic of experience. Imagine skipping 1st year and throwing out step 1, cramming for step 2 and moving immediately to 1 year of clinicals and then autonomous practice (GROSS over-generalization but sufficient for sake of this example). Don't get me wrong, my PA training was awesome and has enabled me to do what I do now, but 2 years of medicine --> practice is inherently limited without a physician counterpart. To this day I think the PA-MD relationship is an important addition to the healthcare system, but I am not satisfied with my current role in said system and it simply won't hold my interest forever.

Even if my autonomy weren't going to change significantly, to me, it's worth the sacrifice to 1. gain the depth and breadth of knowledge I didn't get the first go-around, 2. complete the training required for me to become an expert in my field and 3. take care of my patients as an expert in my field.

Obv will have to do more soul-searching and sweeten that explanation up come interview time, but that's the raw and honest gist of it as I contemplate making the change.
 
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That makes sense. Good luck! You should know, though, that a decent amount of the knowledge tested on Step 1 and the first two years of medical school is either not clinically relevant (e.g., much of biochemistry) or relatively field specific (e.g., internists don't need to know about the brachial plexus and surgeons don't need to know about the difference between CD15 and CD20), but as you said, is part of the pathway to becoming an attending.
 
When I've poked around the pa forum website, everyone on there said they had no problem with step 1 questions (I posted some out of curiosity). You will probably have a MUCH smoother ride than your peers! That's something to look forward to. More time with your fam!


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As @balatro mentioned above, LECOM has a 3 year, PA-DO program. 6 are non-declared and you can compete for any specialty, 6 are designated as primary. Similarly at the same school, they have a 3-year track for primary care that anyone can apply for (PCSP).

Additionally, there is a school in TX with 3-year primary care pathway. There are a few others as well, but only know of 2 off hand in this case.

Lastly, NYU has a 3-year medical school program where you actually pre-interview for a residency before even beginning (after interviewing for the 3-year pathway), and you can essentially go into any field you'd like with having and early agreement. They do not take many students in this.
 
That makes sense. Good luck! You should know, though, that a decent amount of the knowledge tested on Step 1 and the first two years of medical school is either not clinically relevant (e.g., much of biochemistry) or relatively field specific (e.g., internists don't need to know about the brachial plexus and surgeons don't need to know about the difference between CD15 and CD20), but as you said, is part of the pathway to becoming an attending.

I'm going to disagree with you about the part about the brachial plexus. It's true you don't have to have the whole darn thing memorized, but you should be able to identify common nerve root impingement/injury syndromes.
 
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do some reading on this site why all the MDs tell people to go the PA route

this seven year ****show that is training has the potential to ruin any part of your life - mental, physical, financial, personal, spiritual

can you be absolved of essentially all childcare duties for the most part for 7 years?

also, what are you thinking of specializing in? you might get there and need to do a fellowship for your sanity which makes this an even longer path
Wanna know what's funny? A good amount of PAs will tell you to go the DO/MD route. Work with two PAs that tell me they wanna go back and do it all again, but instead go to medical school.
 
Wanna know what's funny? A good amount of PAs will tell you to go the DO/MD route. Work with two PAs that tell me they wanna go back and do it all again, but instead go to medical school.
It's as the OP stated: long-term growth and career satisfaction. Get in early, get a slice of the pie. Take certification credits and a test every 6/10 years for that one letter at the end of your PA- initials. Not surprising that once you eat your slice you begin to crave the whole pie.
 
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Everything was overwhelming at that time and the thought of entering med school/residency/fellowship was pretty much impossible in my mind. I abandoned my dream, bit the bullet and used my prereqs to get into PA school so I'd be able to finish faster, support our little one and have time to be home. In hindsight, was this the smartest choice? Probably....definitely not. I'm aware of the mistakes I made but it's done and it made perfect sense to me at the time.

I think you're being unnecessarily harsh in your self-assessment. You shouldn't frame your decision making process as a mistake. Never regret decisions made with the best intentions and the best information available at the time. Your actions didn't come from malice, selfishness, or greed. Simply take the results as they stand and move on from there. Dwelling in what-ifs is wasted time. You can't put the toothpaste back in the tube. The past is prologue.
 
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Interesting. In that I have quite a few attendings who would often mention during rounds say, "I wish I went the PA route". Just understand you will ALWAYS play second fiddle to someone regardless. The "man"/Administration or ESPECIALLY CMS unless your ultimate plan is to be a boutique physician who does not take any insurance. Medicare rules American medicine. Arguing against that is futile.

What makes all these attending physicians wax PA is the ol' Spiderman adage (I think). W/ great powers comes great responsibility. All of this physician oversight you so hate, do you want to waste 7 years just that can fall on you???? Do you have a different perspective on medicine where you don't see all the bureaucracy that weighs down practicing any form of medicine? Physicians get it too. Going 7 years into something like this does not free you from s***. It just changes your boss, and your song and dance.

Perhaps, instead of making this plunge, try going somewhere else. At least consider that. As some other have mentioned, certain subspecialties have quite autonomous PA's. The ortho surg and neurosurg PA's basically run the inpatient medicine show. We call them. We can write in our note: "Discussed w/ Neurosurg PA and [intervention]/[recommendation]." Sure at some point the MD has to sign off on it, but our PA's are so smart we really don't have to wait. And hypothetically, let's say that something happens to the patient. And in our litigious world we get sued. Even if my documentation sez: "Discussed w/ PA..." who do you think is getting the subpoena? The MD, who probably 9/10x didn't do a full examination.

Attending physicians do the same thing. I might hear bibasilar crackles, tell my attending at rounds, "heard crackles, slightly hypoxic, pushed 40 of lasix" but if the patient for some reason heads south, I end up sued, my attending is getting the big fat subpoena and almost entirely all the responsibility.

The way medicine works, you should feel the need to cover your own ass. PA has that sweet insulation. And that's the reason why my attendings often wax PA. The ONLY reason I would ever recommend anyone be an MD/DO is because they want to be a bigger shot, in that they want to be an administrator. And I mean if that is truly your goal, by all means, go ahead. But w/ Physician burnout being found to be 45-55%, WHY DO HECK DO YOU WANT THAT?

http://www.ama-assn.org/ama/ama-wire/post/specialties-highest-burnout-rates

Your a grown woman who can make her own decisions, but it is really really something to think about. Having oversight doesn't magically disappear when you change PAC to MD or DO. You just exchange one yoke for another. You answer to a different boss. AND you'll have more responsibility. I can't think of any reason, save the one I mentioned, for you to switch.

EDIT: LOL even dermatologist are getting increasingly burned out.
 
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The average income in the US is ~53K. So if you grew up >= upper middle class or you're just blithly unaware of how most Americans live then yeah, Resident income isn't a lot of money. :rolleyes:
 
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The average income in the US is ~53K. So if you grew up >= upper middle class or you're just blithly unaware of how most Americans live then yeah, Resident income isn't a lot of money. :rolleyes:

Most americans also aren't working 60-80hrs per week or in 200-300K of debt.

Looking at only the salary itself is very misleading.
 
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Hey all,

Long-time reader, first-time poster :) I've done a fair bit of searching on this topic and nothing truly addressed my specific situation!

I'm currently a practicing PA x4.5 years with my time split 50/50 between ER and ICU (our hospital is trialing an "upstairs care downstairs" model, so there's a lot of crossover). I have a fair bit of autonomy ranging from the initial resuscitation, lines, running codes and (rarely) airway management. It's great and all but often feels a bit protocolized at times with LOTS of physician oversight (as it should be in this environment); some individuals at the hospital refer to us as "the tacticians, not the strategists." Nevertheless, it's a good gig--sounds crazy to want to leave and take on a huge financial/time commitment, right? Hear me out.

I wanted to go to med school initially in undergrad. Graduated with chem degree, 4.0 GPA and completed all pre-reqs for med school. I was killing it. My husband and I were married pretty young (20) and we (intentionally) had a kid at 23. All was well until little one was unexpectedly dx'd with Down Syndrome the year before I graduated (lots and lots of doctors, therapies, surgeries...).

Everything was overwhelming at that time and the thought of entering med school/residency/fellowship was pretty much impossible in my mind. I abandoned my dream, bit the bullet and used my prereqs to get into PA school so I'd be able to finish faster, support our little one and have time to be home. In hindsight, was this the smartest choice? Probably....definitely not. I'm aware of the mistakes I made but it's done and it made perfect sense to me at the time.

Now that I'm in my 30s, I find myself completely dissatisfied with my work life. I can give 500 logical reasons/arguments if needed but I really don't want to take the thread in that direction. The bottom line is that I'm just not happy and I KNOW that I want to go the MD route (and have for a long time). Love the patients, love the medicine but I hit a glass ceiling at 2 years; I certainly can't do this forever.

I gave up on my dreams.

Now that I'm older/wiser, have more support & the little one is more self-sufficient I feel ready to start again. Anyone else out there make the PA-->MD switch?

Next steps will be refreshing all that basic science knowledge and studying for the MCAT...

Someone tell me I'm not crazy.
Yes people have made the switch.

Check out some of the PA to MD bridge programs too, if you took some basic sciences classes in med school you may qualify for one of these. It doesnt save you much time, but its something
 
Most americans also aren't working 60-80hrs per week or in 200-300K of debt.

Looking at only the salary itself is very misleading.

Most Americans don't have the opportunity to make 150K+ in their careers either.

Focusing on the 3-5 average years of working 50-60 hrs/week at 50K+, is not only misleading, it's kinda ridiculous.

PS- People go into debt to live in 200K-300K homes ALL THE TIME. And they don't have incomes in the upper 10% of all US incomes like Docs do either.

IMHO, investing 200K-300K in an education is rarely going to be a bad move. But the housing market collapse showed us that spending 200K-300K on a house could be.

In the end, it's ALL relative to your goals, financial priorities, and more importantly, how you see life in general i.e. half empty or my preference, half full! ;)
 
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IMHO, investing 200K-300K in an education is rarely going to be a bad move. But the housing market collapse showed us that spending 200K-300K on a house could be.
Counterpoint: Lawyers.

I think med is awesome and I'm all for it, but anything can backfire.
 
Most Americans don't have the opportunity to make 150K+ in their careers either.
OP has the chance already as a PA to make $150K and is debt free..... so is job satisfaction worth the new, prolonged financial stresses?

Focusing on the 3-5 average years of working 50-60 hrs/week at 50K+, is not only misleading, it's kinda ridiculous.
Do you have a family? Car payments? Do you want to start saving for retirement? It's not misleading at all

PS- People go into debt to live in 200K-300K homes ALL THE TIME. And they don't have incomes in the upper 10% of all US incomes like Docs do either.

IMHO, investing 200K-300K in an education is rarely going to be a bad move. But the housing market collapse showed us that spending 200K-300K on a house could be.
Do you have a mortgage? It seems like you don't because this comment is extremely naive.

Student loan interest currently is 5.31-6.31% depending on federal or grad plus. Mortgage rates with good credit are around 4%. For an investment of $200-300K, 1-2% is massive. Not to mention, what happens if you have to drop out of school? Not because you failed or anything, but because of the random events that happen in life? Student loan debt is the hardest debt to discharge in bankruptcy.

Also, a mortgage is a commodity backed loan. The value of the house may fall, but not to zero. And those affected by the crash were those with variable rate mortgages. If you have a fixed rate, your payments stay the same, just the value of the home is lower. As long as you don't plan on moving, and your job is stable, the only loss is the future profit of the home sale.

So when comparing apples to apples of $200K debt, a mortgage is the safer bet every time. I say this as some with both. In the past year, I've gained $3000 in student loan debt and $5000 in the value of my home.

In the end, it's ALL relative to your goals, financial priorities, and more importantly, how you see life in general i.e. half empty or my preference, half full! ;)
Optimistic people aren't immune from making stupid decisions.

@SHOCKandAWESOME If you have talked to your spouse and kids about this and they support you, that's the most important thing. However, don't be fooled into thinking the grass will be greener. You may end up 9 years from now having more autonomy making not much more than your PA ceiling and drowning in the BS of attending-level bureaucracy. That's not to say that it will, but we often get stars in our eyes about the best possible outcome that we fail to see the other side. Regardless of your decision, good luck and happy hunting.
 
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