Being a midlevel in surgery is difficult. Not much autonomy to be found. I know plenty of PA/NPs in other areas of medicine that enjoy much more freedom. However, I think competent and aggressive professionals tend to find their niche in any area of medicine. What is your clinical interest? The thought of doing medical school/residency outside of youthful years terrifies me and most people I know that have gone through it have reported major regrets. The time committment is tremendous, and when the infamous MD comes people see what it really entails. Talk to NP and MD's in the area you are interested and get their perspective. Witht hat being said, I am sure whichever you choose it will work for you.