MD or DO vs PA? How Should I Decide Which is Best?

Session 79

A common question among stressed-out premeds is, Which do I choose, physician or PA? In this episode, I’m sharing some insights into the differences between a physician and a PA, as well as how to choose between the two.

[01:18] OldPreMeds Question of the Week:

Just like usual, our question this week comes was taken a post on our Nontraditional Premed Forum:

“I’m a new OPM (old premed), 31-year-old, single, no kids. I took a detour from the traditional path. During my original undergrad, 3.47 GPA in biology, I never took the MCAT because I figured out that I wasn’t ready for medical school and started pursuing other interests outside of health care.”

Before reading on, I’ll just say this: As a nontraditional student, you’re allowed to go pursue other things. If you think you’re not ready, maybe you’re a little burnt out from the premed path (all of us are a little bit), that’s okay. Go and explore some other interests—which is what this person did.

As a nontraditional student, you're allowed to go pursue other things.Click To Tweet

“Nearly a decade later, I am more convinced than ever that becoming a health care provider is the right career for me, but I’m struggling with the decision of MD/DO versus PA. I don’t have the requisite health care experience that would make me competitive for most PA programs, but I’d to have to spend one to two years full-time refreshing postbac coursework and taking the MCAT to go to medical school anyway. So I could just as easily spend that time working full-time as an EMT, CNA, or whatever. The problem is I can’t do both, so I need to figure out which path I want to pursue sooner rather than later.

“I’ve read some compelling statistics about PA that appeal to me—90% job satisfaction, two times the patient interaction time, 42-hour work week, etc. But those tend to come from sources that seem incredibly biased towards PA over MD. Furthermore, I am not 100% sure I’d be happy long term with the relatively diminished status of PA and/or whether I could do the type of international work I want to do as part of my life plan. Any thoughts or feedback from the OPM community, especially from those who have explored this decision for themselves, would be most appreciated.”

Here are my thoughts:

[03:50] Don’t Base It on Job Satisfaction or Work Hours!

When deciding between being a physician and a PA, just comparing work hours and patient interaction time and job satisfaction really means nothing. You can’t choose your career based on job satisfaction or ratings about what works for other people. If that’s how you’re going to choose your career, then you risk not being happy in the long run depending on if you made the right choice for yourself.

[05:15] A Huge Difference Between PA and Physician

It's not talked about enough, but there's a huge difference between being a physician and being a PA.Click To Tweet

Unfortunately, it’s not talked about enough, but there’s a huge difference between being a physician and being a PA. The PA world will tell you there’s not that big of a difference, and the physician world will say there is. I am a little biased, as I’m a physician. But in practice, different states have different laws regarding PA’s, so the work that a PA can do can vary drastically.

I’ve talked to PA’s who want to go on to medical school, and I’ve helped some of them get into medical school. The reason always comes back to not having enough knowledge to treat the patients they want to treat.

The Types of Patients You See as a PA versus as a Physician

There’s a huge difference in the types of patients you’ll see as a PA versus those you’ll see as a physician. PAs have a limited knowledge base and, therefore, a limited scope of practice. The role of the PA was created to fill in more of the mundane, easier things, and hand those patients over to a “mid-level” provider. (There’s a lot of controversy around the term “mid-level provider,” but we’ll just call it that because that’s the term that’s been thrown around for a long time.)

The PA and NP are trained to take care of easier things. You can't go through PA or NP school and have the same depth of knowledge as a physician to treat all the same conditions. You can't.Click To Tweet

PAs will often get more patients with minor issues like sniffles or aches and pains. So it can get repetitive. Medicine in general is repetitive, even for physicians. But if you’re okay with treating some of the lower acuity things then great, go be a PA. If you’re okay with not having a comprehensive knowledge base to take care of whatever patient walks in the door, then be a PA.

[08:17] How Should You Choose Between Physician and PA?

We need PAs, and there are plenty of people out there who want to be PAs. They have the mentality, personality, and goals in life that fit with being a PA. But do not choose physician versus PA based on job satisfaction, patient interaction, and hours per week. Don’t base it on years of schooling. Choose physician or PA based on the scope of practice you want and the level of knowledge you want.

Choose physician or PA based on the scope of practice you want and the level of knowledge you want.Click To Tweet

The only way you’re truly going to find out is by shadowing physicians and PAs. Shadow many physicians in different specialties and areas, and shadow PAs in different specialties and areas. Talk to physicians and PAs, and find out what they like and what they don’t like about their job. This is the best way to go about it.

[09:23] International Work as a PA versus as a Physician

I’m going to assume that a PA degree is not recognized throughout the whole world. If you’re interested in doing international work as a PA, you should look into this.

The DO or osteopathic medicine degree started here in the U.S., and it’s most recognized here in the U.S. But now the American Osteopathic Association is working on getting more countries to recognize the DO degree, and they’re doing well. So now as a DO, you can practice in more and more countries. But there are still some limitations for DOs, whereas MDs can practice everywhere.

If you are truly interested in international work, look into what privileges you would have in other countries as a PA.

[10:36] Final Thoughts

Don’t make your decision based on hours of work, patient interaction, or job satisfaction. Find out what you want based on the depth of knowledge and the skills you will learn as a physician versus a PA. You can only get a full picture by shadowing. That’s how you should choose between becoming a physician or a PA.