Why are you choosing MD/DO over PA?

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Paralegalities

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The more I've learned about the PA profession, the more I'm confused by why there aren't millions of people flocking to it instead of being pre-med. It seems like basically all of the good parts of being a physician without nearly any of the bad parts. Everyone cites the long training, gigantic debt, and risk of losing your license as the biggest things to consider when applying to med school, but PA's have none of those problems.

Pros:

- 120k starting salary is pretty reasonable, with possibility of hitting like 170k one day due to bonuses or picking up extra shifts etc.

- Only a two year masters degree

- Only like 80k-100k debt

- Able to switch which specialty of medicine you work in almost whenever you want to prevent burnout

- No license to lose, and you'll never get sued

- Substantially easier to get into than medical school based on stats and which classes are required

- Never required to take call

- You can still go to med school anyway a few years later if you want with a much better idea of what it entails, and you really lose nothing except 2 years in school and some easily replaceable money.

Cons:

- Less money (does it even matter when you're making 120k for life starting at 25 years old?)

- Not able to open a private practice

- Less in-depth knowledge

Am I missing something?

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It's becoming a saturated field because NP/PA's are interchangeable and NP schools will accept nurses to the program under the condition that they have a pulse. The big things that push people into a physician career are 1.) pay 2.) prestige 3.) autonomy in patient care 4.) a more competitive field (everyone likes a challenge). These are in no particular order.
 
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I personally am MD/PhD and feel that I will be able to conduct the type of research I am interested in with an MD versus PA. Also like autonomy and possibilities in career avenues.

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I see myself being better enabled (more doors will be opened) as an MD to do things outside of clinical care.

As an extreme example: if Dr. Fauci was a PA or NP, he would not be where he is now.
 
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-Starting salary is generally lower than 120k, but either way, the job market for PA's and NP's is turning into a warzone with the nursing lobby making NP's more employable as far as administration is concerned (and they are graduating an ungodly amount of NP's every year).
- PA's still get sued and lose licenses
- The reasons you stated have not made it substantially easier than medical school to get into, and the average accepted PA student has thousands of hours of prior healthcare employment. So the average PA applicant and medical school applicant are not exactly interchangeable.
- PA's do take call in different practices
- as a PA you will never be the top dog or the "expert." Even as a PA with 20+ years of experience, you can be taking orders from someone fresh out of residency or even still in residency.
 
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The more I've learned about the PA profession, the more I'm confused by why there aren't millions of people flocking to it instead of being pre-med. It seems like basically all of the good parts of being a physician without nearly any of the bad parts. Everyone cites the long training, gigantic debt, and risk of losing your license as the biggest things to consider when applying to med school, but PA's have none of those problems.

Pros:

- 120k starting salary is pretty reasonable, with possibility of hitting like 170k one day due to bonuses or picking up extra shifts etc.

- Only a two year masters degree

- Only like 80k-100k debt

- Able to switch which specialty of medicine you work in almost whenever you want to prevent burnout

- No license to lose, and you'll never get sued

- Substantially easier to get into than medical school based on stats and which classes are required

- Never required to take call

- You can still go to med school anyway a few years later if you want with a much better idea of what it entails, and you really lose nothing except 2 years in school and some easily replaceable money.

Cons:

- Less money (does it even matter when you're making 120k for life starting at 25 years old?)

- Not able to open a private practice

- Less in-depth knowledge

Am I missing something?
As you point out, there are a lot of pluses to being a midlevel. I suspect that in answer to your question, it's because Tiger Parents aren't aware that these professions exist? Or if they do, they're not in the triad of law, engineering or doctoring.

In all truth, seeing what my students have to go through, I wouldn't recommend Medicine (or getting a PhD, for that matter) to my kids. My daughter, in fact, is interested in becoming a nurse. My son wants to be a plumber or electrician.
 
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As you point out, there are a lot of pluses to being a midlevel. I suspect that in answer to your question, it's because Tiger Parents aren't aware that these professions exist? Or if they do, they're not in the triad of law, engineering or doctoring.

In all truth, seeing what my students have to go through, I wouldn't recommend Medicine (or getting a PhD, for that matter) to my kids. My daughter, in fact, is interested in becoming a nurse. My son wants to be a plumber or electrician.
Interesting. Why wouldn’t you recommend medicine?
 
-Starting salary is generally lower than 120k, but either way, the job market for PA's and NP's is turning into a warzone with the nursing lobby making NP's more employable as far as administration is concerned (and they are graduating an ungodly amount of NP's every year).

I'm not sure about that. If you take a job in a big city then yeah, but I've talked with many brand new PA's who said they were getting 110k+ offers literally thrown at them from every direction if they were willing to move outside of a city. ER PA's in particular seem to make bank.

- The reasons you stated have not made it substantially easier than medical school to get into, and the average accepted PA student has thousands of hours of prior healthcare employment. So the average PA applicant and medical school applicant are not exactly interchangeable.

I've never seen a PA program with a requirement higher than 2,000 hours or a median higher than 5,000. That's like 1-2 years of working after the bachelors or just working part time during the bachelors. Pre-med's do that anyway during a gap year half the time. None of their programs I've seen require physics, and a lot don't even require organic chemistry, along with 3.5ish median GPA's, with the GRE instead of the MCAT. That certainly does seem substantially easier than med school requirements.

For example: Requirements: School of Physician Assistant Studies Admissions » Requirements » School of Physician Assistant Studies » College of Medicine » University of Florida

University of Florida, the best PA school in my state and one of the best med schools in the country. All they require is gen chem, anatomy/physiology, statistics, microbiology, and medical terminology. They don't even have a minimum patient care experience at all, and they suggest 2,000 hours. Their median GPA is high (3.85), but then again, it should be when you're not required to take biochem, organic chem, physics, or even bio 1 and 2.
 
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Independence.

I'd like to be a leader in medicine, probably need to be an MD/DO for that. When you have an adcoms saying they wouldn't recommend medicine to their kids, you don't need to wait for the xrays to come back: stuff is broken. If not that then serve on a medical board.
 
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Pigeonholing myself as an assistant.
 
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Being a PA(or NP) is a great job. It’s perfect for people who wanted to become a doctor, but are hesitant for one reason or another.

Honestly, I used to waiver back and forth between becoming a PA or MD/DO. For me, I chose to go for the latter because I knew I would only feel comfortable taking care of patients after having that extra training in medical school and residency. I’m also interested in certain specialties like radiology where I haven’t seen PAs practice.
 
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Full autonomy, independence, and being the (for lack of better words) terminal expert in some clinical discipline.
 
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The more I've learned about the PA profession, the more I'm confused by why there aren't millions of people flocking to it instead of being pre-med. It seems like basically all of the good parts of being a physician without nearly any of the bad parts. Everyone cites the long training, gigantic debt, and risk of losing your license as the biggest things to consider when applying to med school, but PA's have none of those problems.

Pros:

- 120k starting salary is pretty reasonable, with possibility of hitting like 170k one day due to bonuses or picking up extra shifts etc.

- Only a two year masters degree

- Only like 80k-100k debt

- Able to switch which specialty of medicine you work in almost whenever you want to prevent burnout

- No license to lose, and you'll never get sued

- Substantially easier to get into than medical school based on stats and which classes are required

- Never required to take call

- You can still go to med school anyway a few years later if you want with a much better idea of what it entails, and you really lose nothing except 2 years in school and some easily replaceable money.

Cons:

- Less money (does it even matter when you're making 120k for life starting at 25 years old?)

- Not able to open a private practice

- Less in-depth knowledge

Am I missing something?

CRNA is way to go. Average salary of $150k and get to dump responsibility on the attending when the clock hits 4PM
 
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I was pre PA all throughout my undergraduate career. When I was scribing during one late night shift in the ER to gain clinical hours for PA schools, I chatted with the attending physician about whether to go to pa or med school. They told me verbatim "do you want to be part of a team and take orders all day? Or do you want to be the captain of the ship?" It was at that moment I knew I wanted to be a physician. I gave my 2 weeks, registered for a DIY post bacc and the mcat and now I'm set to start med school this fall. It really comes to whether you produce your best work and thrive as a team member or a leader. Some people cant stand taking orders.

Weigh out the pros and cons. If being the leader, the captain, the big fish is worth the time and debt then go med. It's not always about the money.

If the accessibility, lateral mobility (pa buzzword), less debt, family time is more important then midlevel is for you.
 
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I was pre PA all throughout my undergraduate career. When I was scribing during one late night shift in the ER to gain clinical hours for PA schools, I chatted with the attending physician about whether to go to pa or med school. They told me verbatim "do you want to be part of a team and take orders all day? Or do you want to be the captain of the ship?" It was at that moment I knew I wanted to be a physician. I gave my 2 weeks, registered for a DIY post bacc and the mcat and now I'm set to start med school this fall. It really comes to whether you produce your best work and thrive as a team member or a leader. Some people cant stand taking orders.

Weigh out the pros and cons. If being the leader, the captain, the big fish is worth the time and debt then go med. It's not always about the money.

If the accessibility, lateral mobility (pa buzzword), less debt, family time is more important then midlevel is for you.

Meanwhile, every physician I've shadowed has said don't touch medicine with a 100-foot pole if you can see yourself doing ANYTHING else. Supplemented with a long list of cons. I'm happy they're assuring me that I'm making the best decision without walking in blindly for money or prestige.
 
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I'm choosing MD because MD's and PA's see different kinds of patients. Other people might be able to speak differently about their own experiences, but at least in the ER I've spent the most time in, the PA's and doc's are utilized differently. PA's are in the "fast lane" handeling lots of low-acuity/high frequency care: sutures, simple orthopedic injuries, non-complex medicine work-ups, and other less severely injured and ill patients. In fact, our PA's usually work triage.

The docs on the other hand get the more complex, intellectual, challenging cases. ROSC's or CPR in progress, major trauma, CVA's, difficult work-ups, and other acutely ill and injured patients always go to the docs. Sometimes the PA's help out if it hits the fan, but usually another MD from elsewhere in the ER is tapped first. I want to perform at the top of my scope and be able to help ANYBODY who comes into the ER, not just the quick fixes. That's a big reason behind why I decided MD was a better option for me.

Additionally, applicants to each profession take different classes. PA is an allied health profession, therefore they take more survey and abridged science classes. MD/DO applicants take more advanced science as undergrads. PA's take a lot of the same classes as pre-nursing students. Maybe this has changed recently, but this is how it was when I was in undergrad.

Finally, it was already said, but I'm pretty certain that PA's take call if the specialty they work in takes call. (IE, derm PA's may never take call but ortho PA's take a lot of call at my hospital)
 
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Like many have said- autonomy, independence, lack of a professional ceiling, all doors open, love for the science and nitty gritty of it all, etc.

I have friends in PA programs and their lives are hell. I’ve heard the stories of having to cram the entire unit of GI in 3 days or cardio in a week. It’s fast paced, a fire-hose of information with little set up for success, and worryingly fast in order to turn them over to field quicker. Then you spend your entire career catching up and learning on the spot.

In an outpatient clinic I worked in, I watched a 60-something year old, veteran PA who’d been a nurse her entire life in the military still have to ask a doctor 20 years her junior how to handle any patients slightly deviant from the norm. I watched the NP get funneled the same basic type of patients and overridden with grunt quantity of follow-ups while the docs took on maybe a third of that load.

Midlevel doesn’t automatically = easier. There may certainly be some lifestyle advantages and flexibility that going the long road will not afford immediately, but one should choose their healthcare career based on the role and their expectations out of their career.. not assumed shortcuts or better deals as that’ll likely lead to one very long road of expensive and time-consuming disappointment.

People going MD/DO typically have an incessant passion for the field and couldn’t imagine doing anything else. Those in healthcare doing other variations of this typically have other priorities in life/other nuances within medicine that they prefer besides “going all the way”.
 
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The truth is that most physicians are prestige w***ores, whether they want to admit it or not...
 
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As you point out, there are a lot of pluses to being a midlevel. I suspect that in answer to your question, it's because Tiger Parents aren't aware that these professions exist? Or if they do, they're not in the triad of law, engineering or doctoring.

In all truth, seeing what my students have to go through, I wouldn't recommend Medicine (or getting a PhD, for that matter) to my kids. My daughter, in fact, is interested in becoming a nurse. My son wants to be a plumber or electrician.

Don’t you work in admission? Not trying to be inflammatory, but I wouldn’t want to work a job getting people into a school that I thought was poor choice for their students.

A PA has about 28 months of training. I had 7 years. I have an advantage in training and knowledge. I’ll always have a market advantage too.

NP and PA’s income depends on the demand and supply (just like MD’s too). It is a lot easier to pump out NP and PA than MD’s, and I bet you will see a change in compensation for them.

I’ve also had the advantage of working with PAs who were brand new, and they require tons of on-the-job training. I’ve taken transfer calls fro NP’s where were managing patients.

Yes, I made the right choice.
 
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Pigeonholing myself as an assistant.

^^ This exactly. I'm honestly not someone who care much about prestige or getting to be "the boss", but when trying to decide between PA and MD, I decided I think I would hate the cases where I had done all I could as a PA and had to consult the Dr for his/her advice and to ultimately make the decision. At those times I can only imagine I would be regretting that I limited myself by not doing any extra two years of school +residency.

People forget that residency, while it is still training, is still a paid job. You are a doctor practicing medicine, albeit for about 50-60k per year. Still, despite making less than a PA would for 5+ years (2 years of school plus residency), MDs/DOs on average are eventually making about double the salary of PAs, so ultimately a physicians is going to have a much higher life earning. I happen to be interested in peds, so my decision is more based on the above reason than the money reason lol, since I'll honestly not be making that much more than many PAs.
 
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People going MD/DO typically have an incessant passion for the field and couldn’t imagine doing anything else. Those in healthcare doing other variations of this typically have other priorities in life/other nuances within medicine that they prefer besides “going all the way”.

I agree with this as well. There's no shame at all in going NP or PA if your priorities are more lifestyle-oriented, but if you were truly passionate about medicine over all else then MD/DO is the clear best choice.
 
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For me, it largely comes down to me wanting to be at the top of my field. I am an incessantly curious person that wants to know as much about what I’m interested in as possible. I want to become an expert and be able to teach others about the field and really get into the nitty gritty, and want to be a leader in my field in some shape or form. When I shadowed in the ER, I was able to shadow both PAs and MDs, and through that I saw that the PAs were mostly dealing with the bread and butter cases. The MDs had an insane amount of knowledge, and I remember this one particular moment when one of the MDs was able to recall a slightly obscure OB/GYN and ER related test out of thin air. I want to be more like her.

I don’t think I’d be as fulfilled as a PA. If medicine hadn’t worked out I would have more likely chosen another more specific allied health profession (like a genetic counselor or perfusionist) where I have more of an opportunity to be an expert in the specific role I fill.
 
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About a decade's worth of delayed gratification, a hell of a lot of debt, and HMO admins + insurance companies getting in the way of you and the patient.

Don't forget med school admins

Don’t you work in admission? Not trying to be inflammatory, but I wouldn’t want to work a job getting people into a school that I thought was poor choice for their students.

A PA has about 28 months of training. I had 7 years. I have an advantage in training and knowledge. I’ll always have a market advantage too.

NP and PA’s income depends on the demand and supply (just like MD’s too). It is a lot easier to pump out NP and PA than MD’s, and I bet you will see a change in compensation for them.

I’ve also had the advantage of working with PAs who were brand new, and they require tons of on-the-job training. I’ve taken transfer calls fro NP’s where were managing patients.

Yes, I made the right choice.

But your PA's still in training got paid twice as much as you did while you were a resident. Not to mention that they had more time off and a much better work-life balance. They could also leave their jobs a year in and go somewhere else without having to restart their entire training process (or worry about finding a place that would accept them in the first place)

I mean - are we honestly giving pre-meds the best advice when we tell them that our training pathway is worth it? That there are little consequences to giving up a decade of your life during which you're at the bottom of the food chain and essentially a disposable cog in the machine? That it's much harder to conceive as an older attending?
 
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As a resident we have a great PA who helps with one of our subspecialty services. She helps interns with tasks while seniors are in the OR and provide a lot of help as continuity of care as resident/fellow teams change. That being said, as long as she's been there and as long as she will be there, her job in responsibilities are not going to be much more than that of an intern.

Then we have some NPs and PAs who see patients outpatient. They do a great job managing purely uncomplicated patients. But the second there is any slight abnormality, those patients get bumped up to an MD.

So to summarize for me, as another poster said, 1. I didn't want a pigeon hole myself into an assistant. And 2. I wanted to have the ability and confidence to handle and see more complicated patients than purely straightforward uncomplicated ones.
 
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The more I've learned about the PA profession, the more I'm confused by why there aren't millions of people flocking to it instead of being pre-med. It seems like basically all of the good parts of being a physician without nearly any of the bad parts. Everyone cites the long training, gigantic debt, and risk of losing your license as the biggest things to consider when applying to med school, but PA's have none of those problems.

Pros:

- 120k starting salary is pretty reasonable, with possibility of hitting like 170k one day due to bonuses or picking up extra shifts etc.

- Only a two year masters degree

- Only like 80k-100k debt

- Able to switch which specialty of medicine you work in almost whenever you want to prevent burnout

- No license to lose, and you'll never get sued

- Substantially easier to get into than medical school based on stats and which classes are required

- Never required to take call

- You can still go to med school anyway a few years later if you want with a much better idea of what it entails, and you really lose nothing except 2 years in school and some easily replaceable money.

Cons:

- Less money (does it even matter when you're making 120k for life starting at 25 years old?)

- Not able to open a private practice

- Less in-depth knowledge

Am I missing something?
This, I'm switching over to pre-PA from this because personally, I can't take the stress of being pre-med.
 
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PAs can for sure get sued and they have to carry malpractice insurance. A lot of them do take call, depending on the specialty. If you're a hospitalist you can plan on having to take call unless you negotiate not to in your contract.
 
PAs can't practice independently and that's a huge plus of being a physician. Some states are beginning to let PAs practice more independently but unlike NPs, they typically still need supervision (at least nominally). Also, it's only after you get into med school that you realize how many doors having an MD or DO opens. Your scope of practice is huge. I've seen family docs doing lots of things that I never expected them to do. As long as it's not illegal or explicitly prohibited and the patient gives informed consent... Not sure if this holds for PAs/NPs as people probably won't give them as much latitude.
 
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My initial reason was wanting the fuller education, mostly, and more independence. However, after going through residency I appreciate not having to do as much scut work as an attending. I think it is different for outpatient PAs but the inpatient ones I have worked with are basically perpetual residents. I’ve worked with some great PAs but that’s not for me!
 
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I like being a leader, but more than that I want to have the depth of knowledge and experience befitting of a leader. The thought of spending years and years honing this knowledge and gaining this experience appeals to me. The thought of spending slightly fewer years in school to spend my career relying on someone who knows more about medicine and physiology than I do does not. I mean no disrespect towards PAs; they do important work. But after a lot of soul searching (I've always been afraid to say this out loud since I don't want to sound like a prestige-driven a******) I realized that in the long term I will be most content as a leader that has put in the time and work necessary to lead well. I'm still a premed and may never reach medical school. But for the above reasons I know I need to try. Nothing worth it is easy.
 
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To all thread posters:

Please do not allow this to become another turd throwing contest on SDN - so far everyone here has done a good job. The OP has pointed out that there are advantages to being a PA. I agree - one of the first medical practitioners for me to observe was a PA who gave me some useful gems, and I considered becoming one a few years ago, considering I will be in my mid-40s before I become "settled in" as a medical practitioner.

Here are my reasons for wanting to be a physician (doctor of medicine or doctor of osteopathic medicine):

- A deeper knowledge base from which to draw (comparing MD/DO in one specialty vs. PA in the same specialty, not doc in one vs. PA with x,y,or z years in another)
- The opportunity to be a leader (I suppose you can say this is an elaboration on the above) - I suppose this is a selfish reason, but I have always wanted to be the best at what I do since I was a teenager - I am in my mid-30s now.
- Opportunities in academia to pursue esoteric pursuits, such as performing arts medicine and the effects of blindness or visual impairment on music cognition or conversely, the effects of music performance on glaucoma (e.g. trumpet performance). I suppose the new DMSc programs for PAs will even the opportunities out and allow PAs to pursue postdoctoral opportunities, and I sincerely hope that it will, though my goals remain the same.
- Physicians can go almost everywhere due to their unrestricted license - ex. you can find an ophthalmologist in any medium size city or more - I grew up in a city of roughly 10,000 with one (I am interested in ophthalmology, but I am not wedded to it at this point - my medical interests vary, including orthopedics, PM&R, and neurology). I have heard that ophthalmic PAs exist, but I quite truthfully do not know where to find them.
- Finally, my various non-medical interests require that I have training to be a versatile worker so that I can live where I wish in secular terms and fulfill the Divine Physician's will. While private practice is becoming a thing of the past, it is still lawful for MDs/DOs in any U.S. state and is always a fallback option if I am not offered a posting in academia or group practice. I want to be able to support a fairly large family as pleasing to our Lord and King, and to move with them freely.
- One more thing: during the COVID-19 outbreak, many physicians in various specialties volunteered to serve as acting general or emergency physicians. I desire to be able to do the same - being able to serve in time of emergency has been on my mind since 9/11 at the very latest, when I was a senior in high school - irrigating the eyes of rescuers irritated from the debris at NYC ground zero was a very common activity for many non-ophthalmologist physicians, while some non-orthopedic physicians wrapped ankles. Whether or not a PA can volunteer to serve outside his or her supervising physician's office in time of disaster will depend on the laws of each state or territory.
- The age test: while physician's training will take close to a decade for me, I do not see myself being happy as a PA or NP in forty years, knowing that I could have achieved more and have been the best in my field.

I invite those of you who pray to pray that the will of His Majesty the King and Divine Physician be done in my life and that if this is not pleasing to Him, that He will show me the proper path.
 
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Our ED is not too big, 15 rooms. 3 “big”, 10 “medium,” and 2 for fast track. The department is normally staffed by 1-2 physicians and 1 mid level (PA or a APRN). That being said, I want to be a MD/DO because as PA/APRN I’d very rarely see patient triaged as 3 or 2 and most surely never see those triaged 1.
 
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The more I've learned about the PA profession, the more I'm confused by why there aren't millions of people flocking to it instead of being pre-med. It seems like basically all of the good parts of being a physician without nearly any of the bad parts. Everyone cites the long training, gigantic debt, and risk of losing your license as the biggest things to consider when applying to med school, but PA's have none of those problems.

Pros:

- 120k starting salary is pretty reasonable, with possibility of hitting like 170k one day due to bonuses or picking up extra shifts etc.

- Only a two year masters degree

- Only like 80k-100k debt

- Able to switch which specialty of medicine you work in almost whenever you want to prevent burnout

- No license to lose, and you'll never get sued

- Substantially easier to get into than medical school based on stats and which classes are required

- Never required to take call

- You can still go to med school anyway a few years later if you want with a much better idea of what it entails, and you really lose nothing except 2 years in school and some easily replaceable money.

Cons:

- Less money (does it even matter when you're making 120k for life starting at 25 years old?)

- Not able to open a private practice

- Less in-depth knowledge

Am I missing something?

I did MD for a couple reasons:

- the most interesting complex and rewarding cases all go to the doctor even in this day and age. Mid-level practitioners are great for sorting through simple workups, but the big surgeries and the crazy resuscitations are all going to be run by the physician.

- there are so many more avenues you can do. Some have mentioned research, others like myself want to move into high-level administration. Sure, as a doctor you are locked into one field. But you have the ability to move to the very top of that field.

lastly, don't delude yourself in thinking that some of the cons of being a doctor aren't going to trickle down to mid-level providers as they push for more scope. When they ask for independent practitioning, they take all the liability fun that comes along with it. I imagine malpractice attorneys in the future will be very happy to sue mid-level practitioners trying to paint them as playing doctor without a real doctorate.

David D MD - USMLE and MCAT Tutor
Med School Tutors
 
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The more I've learned about the PA profession, the more I'm confused by why there aren't millions of people flocking to it instead of being pre-med. It seems like basically all of the good parts of being a physician without nearly any of the bad parts. Everyone cites the long training, gigantic debt, and risk of losing your license as the biggest things to consider when applying to med school, but PA's have none of those problems.

Pros:

- 120k starting salary is pretty reasonable, with possibility of hitting like 170k one day due to bonuses or picking up extra shifts etc.

- Only a two year masters degree

- Only like 80k-100k debt

- Able to switch which specialty of medicine you work in almost whenever you want to prevent burnout

- No license to lose, and you'll never get sued

- Substantially easier to get into than medical school based on stats and which classes are required

- Never required to take call

- You can still go to med school anyway a few years later if you want with a much better idea of what it entails, and you really lose nothing except 2 years in school and some easily replaceable money.

Cons:

- Less money (does it even matter when you're making 120k for life starting at 25 years old?)

- Not able to open a private practice

- Less in-depth knowledge

Am I missing something?
Past are licensed professionals
 
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