It’s the beginning of the year so career questions are common dilemmas to ponder. The question of PA or MD as a medical career option comes up enough times that I will address it here.

For the purists, I refer to physician with MD and so both MD and DO’s are included. Actually, I recently heard a new term that I really liked, “MDO’s” – pronounced ‘emdohs’ which refers to MD’s and DO’s.

The Clinical Role

The first topic worth addressing is why a person would want to go either route, PA or MD. If it’s to become a clinician and treat common illnesses and heal the sick then either one would suffice.

The topic often goes deeper, however, not just because of our misconceptions about PA’s but also how of a physician’s career is romanticized.

As a clinician you get to delve deep into the personal lives of a patient and you have the ability to perform surgeries and prescribe medications. It’s a huge responsibility but it can be very rewarding.

Treating and Prescribing

The whole point of becoming a clinician is so that you can touch a patient, manipulate their body, perform intervention, and prescribe medications if necessary.

If it’s just patient contact you seek, you can become a medical assistant.

Treating and prescribing is a hallmark of a clinician and without the desire to Tx or Rx, why become a clinician when you can become an RN, Psychologist, or LPN with a lot less money and a lot less risk.

The MD as a Clinician

A competent MD will focus on using their knowledge to minimize interventions and makes their practice an art rather than a flow-chart.

The same autonomy that makes a physician’s job so attractive also creates a lot of stress. After all, the final decision and any bad outcomes will fall back on you.

Because you are at the very top of the food chain, there is no other place to look for help. The analogy I would draw is that I chose to practice Urgent Care medicine instead of Family Medicine or Emergency Medicine because I’m right in the middle – I handle one single acute issue and can refer up or down.

As a physician I can’t refer up – but as a PA, I can.

The PA as a Clinician

The PA is a clinician in every which way an MD is a clinician. They independently see and treat patients.

Rates of malpractice and outcomes are on par with their physician colleagues.

In most medical groups, PA’s are placed in lower acuity settings or are given easier cases. But in other medical groups they will see everything an MD sees. Though there is often a patient self-selection or nurse manager who will triage the more complex patient into the MD’s schedule.

Limitations & Downsides

Each field has its own limitations or downsides. To generalize that one is better than the other is absurd. In the PA or MD discussion the prestige of being a physician often is supposed to trump all other factors.

PA Limitations

PA’s are able to practice independently except for an absurd rule that they are to be “supervised” by MD’s. Obviously MD’s or DO’s don’t actually supervise PA’s – they come to us with as many questions as I take to my work MD buddy, Dr. S.

PA cannot own and operate their own medical practice. This is a minor but mentionable limitation of becoming a PA. If you are the strongly entrepreneurial sort there are still ways of scratching that itching but not as a PA with your own practice.

That said, there are plenty of astute PA’s who have their MD buddies license the medical practice for them and both have a working relationship where the practice is run as though the MD owns and operates it but the PA is the real owner and operator.

Income limitations is another part. I’m sorry, but if a PA is doing the same work as me in the urgent care and getting paid less then that’s scandalous. Perhaps that’s why some medical groups choose to place the PA’s in easier roles, in order to defend the lower wages.

The PA’s in my previous medical group were in a union which is the surest way to limit your income potential. I won’t get into the union debate but if you’re in a union, then of course you shouldn’t earn as much as an MD/DO.

PA’s complain that they don’t get the same respect as MD’s and female doctors complain that they don’t get the same respect as male doctors. Family Doctors complain that they don’t get enough respect from their specialist colleagues and so on.

We’ll address ‘respect’ in a minute.

MD Limitations

MD’s can’t switch residencies as easily as PA’s can. It’s not impossible to go back to a different residency but it’s an incredibly disruptive thing to do later in life.

The main limitations of becoming an MD is that it’s incredibly competitive, it’s very expensive, and takes many years to become a physician.

The doctor culture is another one that I’ll mention. Once you’re part of the MD club, you’re in it for life and it carries a hefty emotional and financial toll.

You will work hard, constantly attempt to appear competent, rarely admit defeat, rarely ask for help, try to live a very luxurious lifestyle, and you’ll be constantly hard on yourself.

Other Fields To Consider

When it comes to being a clinician and practicing in an urgent care or a family medicine office I would recommend being a PA. I cannot see any advantage to being an MD when practicing in such low acuity settings.

If you don’t have to be a clinician but want to be in the healthcare field then the PA or MD decision is moot. I would recommend considering one of the following fields below which have among the highest job satisfaction rates.

Physical Therapist

Have you ever been to a good PT? I don’t mean the one your insurance refers you to – I mean a good one.

These people somehow got their hands on the blueprint of your body. Every single thing you say and do is interpreted by them and helps them get you back to normal or better.

It’s a very rewarding field when you’re good at what you do. It’s one of those things where word of mouth carries a lot of weight.

Psychologist

Our US social stigma aside, a competent clinical psychologist is a very valuable member of the medical team. Just think back to how many of your patients who have psychiatric issues which trump all their other medical problems.

The work isn’t easy, by any stretch of the imagination but it is something that can make a huge impact on people’s lives.

Speech Pathologist

I have never met an unhappy child speech pathologist. Some of the nicest and most competent individuals I know.

They love their work, they obviously make a huge impact on their patients and they do something that a doctor couldn’t do.

The Financial Angle

You do a little college, you apply to PA schools and 2-3 years later you’re a PA. In those 2-3 years you’ll get your didactic and clinical rotations out of the way.

On the high end it might cost you $100k in PA school debt and whatever debt you might have from undergrad.

There are accelerated programs which are popular where you can become a PA and get your bachelors in 4 years. I suspect that could save you a lot of dough if the money matters.

Starting Out With Debt

I think one of the toughest things to overcome financially is a hefty student loan debt.

Assuming you have very little personal finance experience when you first start practicing medicine, it can be tough to get a handle on debt, budgeting, and investing. By the time this knowledge is acquired you’re 5 years into your career and have accumulated more debt.

All things being equal, you get to become a PA faster than becoming an MD, with less debt, and you get to do the same things as an MD.

The Income

A PA can earn $120,000-$150,000 a year.

They usually get good employment benefits as well, quite similar to what doctors get.

But they can’t start their own medical practices which can hinder them from taking true advantage of our tax code.

The average doctor can earn $250k/yr. For the number of years in training and the extra debt, I’m not sure if $250k trumps the PA’s $120k salary.

MD’s can make a lot more than $250k. But those specialists also work their asses off to get to those higher incomes. I didn’t want to have to study harder for board exams, work harder during rotations, do research in medical school, and stand through hours of surgeries to become an orthopedist or CT surgeon.

That said, you can earn $450k or $700k incredibly easily as an MD.

MD-PA Food Chain

How important is your place in the food chain? Does it bother you if someone higher up on the food chain can talk down to you? And are you less bothered by a patient talking down to you?

I’m a Family Medicine doctor and I have and get talked down to by specialists on occasion. Why? Because they know more. Are they trying to talk down to me? I doubt it.

I will get talked down to by managers, by chiefs, by medical board investigators, by specialists, by malpractice lawyers, and by patients.

If you don’t want to be talked down to I would choose neurosurgery as a career. I have seen those MD’s in action and they are sure intimidating.

Competence

For those who aren’t in medicine, let me tell you, when you come across a great clinician it’s wonderful – you can sniff out competence right away. It’s a mix of confidence, openness, good communication skills, and the clinician genuinely caring about their art.

There are a lot of MD’s who do a poor job but can hide behind their MD license.

PA’s stand out because we expect a PA to not be as good as an MD. But I have worked with PA’s whom I would love to have as my PCP and I have worked with MD’s who wouldn’t be allowed to change my light bulb.

If I Could Go Back

I have an MD from a US school. Looking back, this was the right choice for me. I like all the options that I have as an MD, specifically being able to start my own medical practice and not have to have another MD supervise me.

However, looking back, I would have applied to PA schools as a backup if I didn’t get into medical school instead of applying to foreign medical schools.

Sadly I didn’t have anyone who could have mentored me on becoming a PA. But my impression now is that it’s a great career option.