Question for Fellow P.A.'s

[Makati2008]

I am currently going to start medical school in a few months, and I am wondering from PA's in medical school the following:
1.)How hard has it been for them.
2.)Any regrets about doing it again?
3.)Has anyone heard anything else about the PA-MD bridge programs.(It will be too late for me but just wondering)

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[deleted6669]

pm pacmatt and bandit. they are both pa's turned physician. both went DO. matt finished up residency a yr ago. he graduated 2nd in his class, aced his boards and got his first choice of residency. I think bandit is an r-3 in em now. both worked several shifts/week as em pa's during medschool. I know several other pa to doc folks outside of sdn. they all worked part time during ms1 and ms2 and did well in school and matched in their specialties of choice.
I haven't taken that route myself but aside from the basic sciences in ms1 how could it not be easier than doing it cold? you've already done most of ms2 and all of ms3 as a pa student and if you worked for a bit you should have some solid experience to make the clinical environment a much more comfortable experience. I looked long and hard at going back(even went back and took genetics, stats, and a yr of physics) but financially it made no sense. my break even point was around the time most folks retire once you factor in lost income, school and other loans, etc
best of luck as you take the next step.
regarding pa to doc bridge. as you may or may not know it is seriously being investigated at the present time. there was a lot of talk about it when the new standards for pa education came out last yr. it will likely be PA to DO and happen 1st at a DO school that already has a pa program. will be 3 yrs; all of ms 1 and parts of ms2 and ms4. I think we will see the first program within 5 years, probably tied to required primary care residencies like the lecom 3 yr program. the current health care legislation makes this even more likely than in yrs past as the current forecast is for a shortage of 40,000 primary care docs. too late for me at this point. now a 2 yr bridge...I might still do that....still haven't completely ruled out doing an MPH, DHSc, or a residency.
see this thread for a discussion of pa to doc bridge that has dragged on for 5 yrs....:
http://forums.studentdoctor.net/showthread.php?t=202203

 

[Makati2008]

I appreciate the answer sir. If I knew that this program would be done in a year or two and I could get into it I would be sitting out of medical school. I totally understand logistically the loss of income by the time I finish medical school I will lose around 1 million dollars. It makes me cringe every time I see the numbers....as well as if I don't finish medical school there is no guarentee that I will find another job that pays me as much for the work I do...

 

[deleted6669]

my figure was > 1 million dollars as well when you factor in loss of income for 7 yrs, even adding back in residents salary

 

[cecilia]

EmedPA,

How do you know the bridge program is seriously being debated? Where do I find info like that? i mean debated by people who can make it happen? or debated by people who wish it could happen?

 

[deleted6669]

the investigation of bridge programs was a top priority of the group that came up with endpoints for pa education last yr. the same group that decided the masters was the appropriate and terminal degree for pa's. if you are thinking about medschool though don't wait for this, just do it the regular way. there are pa's who are deans at medical schools now:
http://www.atsu.edu/soma/faculty_staff/administration.htm
it will happen.
HERE ARE THE HIGH POINTS OF LAST YRS MTG:
The PA Clinical Doctorate Summit was held on March 25-27 in Atlanta, Georgia. The 45 participants represented a diverse group of practicing PAs, PA educators, PA students, physicians from allopathic and osteopathic medicine, workforce experts, and representatives of physical therapy, nursing, and other professions. The summit participants were charged to address the question, "Is the clinical doctorate appropriate to the profession as an entry-level degree, as a postgraduate degree, or not at all?"

The group proceeded from a set of core values for the PA profession, including the overarching importance of patient care, diversity in all aspects of PA education and practice, and the value of the physician/PA team.

The summit participants came to consensus on the following set of preliminary recommendations.

1. The PA profession endorses the master's degree as the single, entry-level, and terminal degree for the profession.

2. The PA profession opposes the entry-level, PA-specific clinical doctorate.

3. The PA profession supports advanced professional development and education, including the option of non-profession-specific postgraduate doctorates.

4. The PA profession should explore with physician education groups the development of a model for advanced standing for PAs who desire to become physicians (sometimes called a "bridge program.")

 

[Dr 14220]

pm pacmatt and bandit. they are both pa's turned physician. both went DO. matt finished up residency a yr ago. he graduated 2nd in his class, aced his boards and got his first choice of residency. I think bandit is an r-3 in em now. both worked several shifts/week as em pa's during medschool. I know several other pa to doc folks outside of sdn. they all worked part time during ms1 and ms2 and did well in school and matched in their specialties of choice.
I haven't taken that route myself but aside from the basic sciences in ms1 how could it not be easier than doing it cold? you've already done most of ms2 and all of ms3 as a pa student and if you worked for a bit you should have some solid experience to make the clinical environment a much more comfortable experience. I looked long and hard at going back(even went back and took genetics, stats, and a yr of physics) but financially it made no sense. my break even point was around the time most folks retire once you factor in lost income, school and other loans, etc
best of luck as you take the next step.
regarding pa to doc bridge. as you may or may not know it is seriously being investigated at the present time. there was a lot of talk about it when the new standards for pa education came out last yr. it will likely be PA to DO and happen 1st at a DO school that already has a pa program. will be 3 yrs; all of ms 1 and parts of ms2 and ms4. I think we will see the first program within 5 years, probably tied to required primary care residencies like the lecom 3 yr program. the current health care legislation makes this even more likely than in yrs past as the current forecast is for a shortage of 40,000 primary care docs. too late for me at this point. now a 2 yr bridge...I might still do that....still haven't completely ruled out doing an MPH, DHSc, or a residency.
see this thread for a discussion of pa to doc bridge that has dragged on for 5 yrs....:
http://forums.studentdoctor.net/showthread.php?t=202203

EMED, u really think you would benefit from a PA residency at this point in your career?? How so?

I'm about 2/3 the way through my 3 year PA program right now, I'm 24 with a wife and daughter, and am having one hell of a time deciding between pursuing medical school or PA EM residency after completing my program. I worry that even if i do the PA residency, the "glass ceiling" will be felt sooner or later. On the other hand, sticking with PA seems the more practical thing to do considering the family situation. Any suggestions/advice??

 

[smarty666]

I was hoping I could get some general and specific information answered by PA's in practice right now.

First off, I've heard the term PA residency thrown around on SDN. What exactly is a PA residency? I thought that after you complete your PA program and passed the certification exam that you went into practice in any specialty of your choosing. Is it harder to get into one specialty then another? Is the residency for PA's only meant for going into certain specialties like surgery?

I know that emedpa is a PA in EM, but I was hoping I could hear from any PA's in primary care FM, IM, or a subspeciality of IM and hear your impressions of being a PA in primary care practice in these fields. I'm mainly interested in this area and have yet to hear from any PAs in these fields so I'm very interested to find out what life is like compare to say EM or surgery for instance.

 

[deleted6669]

see www.appap.org for links to all pa residency programs. they are optional but encouraged.

dr14220- if you are almost done with pa school now I would do an em residency and get a full scope empa job(which probably means rural ) and do that for a yr.
you will be running the whole show as the only provider there. if after a yr you don't like it go back to medschool.
probably should have thought about the md vs pa school before starting pa school but you are far enough in now that you need to ride the pa career for a while and see if it works for you or not.
as far as my situation, a DHSC would allow me to teach and potentially direct a pa program. also I would likely do a focus in global health which ties into my long term goals of doing more disaster medicine(have been to Haiti twice, going again this summer and am on state/federal/international disaster teams).
a residency would fully round out my em experience. there are lots of things I do often but a few things I hardly ever do that I could do regularly in a residency. do I NEED a residency? no. but in a perfect world in which I could take an 80k/yr pay cut I would enjoy doing one for reasons of personal satisfaction. same reason I would go back to medschool if it was free and someone paid all my bills while in school.
if you wait too long to go back it will never happen. once you are making 6 figures it doesn't make financial sense to go back to medschool so if you do it you need to do it before you are making the big bucks. my opportunity cost for med school(cost of school+ lost income for 7 yrs) is well over 1 million dollars not including the loans I would have to take out to pay my current mortgage, etc.

 

[PACMD]

see www.appap.org for links to all pa residency programs. they are optional but encouraged.

dr14220- if you are almost done with pa school now I would do an em residency and get a full scope empa job(which probably means rural ) and do that for a yr.
you will be running the whole show as the only provider there. if after a yr you don't like it go back to medschool.
probably should have thought about the md vs pa school before starting pa school but you are far enough in now that you need to ride the pa career for a while and see if it works for you or not.
as far as my situation, a DHSC would allow me to teach and potentially direct a pa program. also I would likely do a focus in global health which ties into my long term goals of doing more disaster medicine(have been to Haiti twice, going again this summer and am on state/federal/international disaster teams).
a residency would fully round out my em experience. there are lots of things I do often but a few things I hardly ever do that I could do regularly in a residency. do I NEED a residency? no. but in a perfect world in which I could take an 80k/yr pay cut I would enjoy doing one for reasons of personal satisfaction. same reason I would go back to medschool if it was free and someone paid all my bills while in school.
if you wait too long to go back it will never happen. once you are making 6 figures it doesn't make financial sense to go back to medschool so if you do it you need to do it before you are making the big bucks. my opportunity cost for med school(cost of school+ lost income for 7 yrs) is well over 1 million dollars not including the loans I would have to take out to pay my current mortgage, etc.

I'm curious as to how you came up with this figure. If you work at least half-time throughout medical school (which you can easily do), and hope to get a scholarship (which should be possible given that your experience makes you an attractive candidate), I think it might be considerably less.

 

[deleted6669]

medschool cost lets say 200k
lost income 1,050,000 ish

working half time would probably pay my mortgage and related bills(kids college, car insurance, food etc)......so 1,250,000 in the hole at the completion of residency. subtract a bit for residency salary say 150 k and there you have it 1,100,000 dollars in the hole with md in hand ready to work for about a decde before most folks retire. so ten yrs to make up 1 million dollars. if I made 250k/yr for 10 yrs I would break even with where I would be if I never went to medschool. anything beyond 10 yrs and I am ahead 100k/yr(but still paying interest on loans, etc). 250k right out of school is a stretch considering I would want to do rural fp with OB/em(maybe even do a dual residency). and,oh yeah, going to school full time and working 20+ hrs/week I don't see my family for 7 yrs.

 

[PACMD]

medschool cost lets say 200k
lost income 1,050,000 ish

working half time would probably pay my mortgage and related bills(kids college, car insurance, food etc)......so 1,250,000 in the hole at the completion of residency. subtract a bit for residency salary say 150 k and there you have it 1,100,000 dollars in the hole with md in hand ready to work for about a decde before most folks retire. so ten yrs to make up 1 million dollars. if I made 250k/yr for 10 yrs I would break even with where I would be if I never went to medschool. anything beyond 10 yrs and I am ahead 100k/yr(but still paying interest on loans, etc). 250k right out of school is a stretch considering I would want to do rural fp with OB/em(maybe even do a dual residency). and,oh yeah, going to school full time and working 20+ hrs/week I don't see my family for 7 yrs.

a state school would run you 20k/yr on avg if you'r a resident, so that cost would be more like 80K. But where you really lost me was the fact that even with working half time, you somehow lose over a million in income. So you would normally earn over TWO MILLION dollars in a 7 year span? you make $280K a year?

 

[deleted6669]

150K/YR X 7 YRS= 1,050,000
No one gets out of medschool for 80k. my state school tuition only is 26k/yr. then you have to buy books and equipment, pay for transportation to away rotations, etc
additionally I would only be looking at DO schools which cost considerably more than md for the msot part.
working half time I figured I would basically break even on "life expenses" so I don't get the advantage of having that money for investments, etc it's basically treading water.
doing the math your way I am out 525k of income + the cost of medschool. still not chump change considering I would probably make only 180k/yr as a rural doc after residency if I was lucky.

 

[PACMD]

150K/YR X 7 YRS= 1,050,000
No one gets out of medschool for 80k. my state school tuition only is 26k/yr. then you have to buy books and equipment, pay for transportation to away rotations, etc
additionally I would only be looking at DO schools which cost considerably more than md for the msot part.
working half time I figured I would basically break even on "life expenses" so I don't get the advantage of having that money for investments, etc it's basically treading water.
doing the math your way I am out 525k of income + the cost of medschool. still not chump change considering I would probably make only 180k/yr as a rural doc after residency if I was lucky.

I would argue that doing the math my way is a little more realistic because as long as you work half time, then you will only lose half the income. Keep in mind that you get an entire summer between 1st and 2nd year and 5-6 weeks between 2nd and 3rd year, and at least 2 months off during 4th year, so you can work overtime and make up some of those lost earnings. You could realistically average 60-70% of your income throughout the 4 years actually. And if you add 46K/yr for residency, it's actually more like 400K.

And might I ask why DO schools only? Is there a philosophical reason for this? And when it comes to books I guess it depends on the school, but our notes and power point slides were more than sufficient to learn what they wanted us to learn. I only bought one book the entire time, and if I *needed* another text, I either went to the library, or hit up someone from the class ahead of me. The only equipment I ever needed in med school has been my stethescope, and I'm sure you own one of those. And you're ignoring the possibility of getting a scholarship, which is a REAL possibility. With your experience, I would assume you would be a very attractive candidate, especially if you get a decent MCAT score. And much like with everything else in life, being attractive has its privileges.

I know it sounds like I'm trying to convince you to go to med school and I'm not. I just don't want you to make the decision not to go, based on faulty calculations. It sounds like you thought about it rationally and realized that it didn't make economic sense, but if you think about it from the standpoint of your ability to work while in med school, then you would come to a different conclusion I think.

 

[deleted6669]

when I was seriously considering it about 7 yrs ago I had a 2 yr old and didn't want to work 1/2 time as I wanted to be with them more. I figured I would work maybe a shift a week if that. I do have philosophical reasons for wanting DO over md but that is a topic for another thread.