MD vs PA! Let’s Talk About It with a PA to Help You Decide

Session 254

Savanna Perry is a PA who helps pre-PA students get into PA school. In this session of The Premed Years we chat to discuss the differences in the fields to help you decide. Savanna runs a podcast, The Pre-PA Club Podcast, and a website called The PA Platform. She’s also going to post this conversation on her podcast this week.

We talk about some of the differences between being a PA and a physician, the differences between being a PA student and a medical student, and finally, the differences between being pre-PA and being premed.

Maybe you’re questioning whether you really want to be a physician or if PA is enough for you. Or maybe you’re a pre-PA right now and wondering if you should switch to premed. We’re going to talk about the traits and characteristics you’re going to need to be a successful PA or physician.

Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

MD vs PA: Quick Questions

Is it harder to get into PA school or med school? Acceptance rates for med school are higher than for PA school. Only 33% of applicants were accepted to PA schools in 2016-17, whereas 41% of applicants were accepted to MD schools in 2018-19 and 35% of applicants were accepted to DO medical schools in 2016-17.

Should I be a PA or MD? The best way to decide between PA and physician is to shadow both. Also, consider the role you want in the healthcare team. If being a physician would fit you better, don’t choose PA just because the training is shorter.

[02:17] A Brief Background on Me and Savanna

We started our conversation with me giving a little description about my journey. I’m a physician by training and somehow stumbled into the premed advising world. I don’t practice anymore as I am now a full-time podcaster, running a network of podcasts for premed and medical students, and helping premed students get into medical school. I help them with advising on personal statements, interviewing, and more, along with teaching a little bit at the local medical school here in Colorado.

Savanna is a physician assistant who practices full time in dermatology. She graduated from PA school three years ago. And just like me, she’s gotten into the coaching world on the PA side of things. With The PA Platform, she helps students get into PA school, learn the ropes, and figure out what’s needed to reach their goals.

She’s also married to an internal medicine resident in his second year. So they’ve seen both side of things: she was going through PA school while her husband was going through medical school.

[04:16] MD vs PA: Should Premeds Consider PA as a Plan B?

PA is different than being a physician. It's still health care and patient care. But if you want to be a physician, be a physicianClick To Tweet

If you’ve shadowed PAs and NPs and you’re happy with that, go ahead and do it. We obviously need PAs and NPs, too.

Being married to a physician and having gone through the process together, Savanna chose the PA route over MD or DO. She and her husband started dating in high school. So they were together through undergrad. They went to the same school, both Biology majors. Even though they’re pursuing different tracks, they took exactly the same classes.

As a freshman, she struggled to decide what she wanted to do with her future. She has always been someone who’s very focused on the future and wanted a plan in place. She considered PA school, med school, dental school, and PT school.

After doing lots of research and much shadowing, following around some PAs and doctors, she tried to see the differences on a daily basis. She also considered the schooling differences because she couldn’t see herself making the commitment that medical school requires. She wanted to start her family and be able to get out there and start working with patients, and she also didn’t know if she could commit to one specialty.

Savanna mentions that lateral mobility is one of the frequently cited advantages of being a PA. She thinks it’s a bit overrated in a sense because in practice most PAs tend to stay in one specialty.

But overall PA just made sense for her. She loves working as part of a team. She likes having a physician to bounce ideas off of, as well as the relationships she saw when shadowing PAs.

[07:30] Her Husband’s Reasons for Becoming a Physician

As for Savanna’s husband, he felt it wasn’t really a decision; he just had the feeling that he needed to go to medical school. What he tells people is that if you know you want to be a doctor, go to medical school. If you’re not sure about it, take some time to figure it out.

Look at PA if you want to be involved in health care but don't necessarily want to go through as much training as a physician.Click To Tweet

It’s tough being in medical school. As a second-year resident, he’s on the tail-end of a month of nights where he works six days a week for twelve plus hours and gets one day off.

Although Savannah is happy with her choice to become a PA, sometimes she feels that she missed out on residency training. Hearing her supervising physicians talk about cool cases they get to see in residency at an academic center made her jealous. She wished she had that intense training. But she does have a great supervising physician who teaches her every day, so she does get that training to some degree.

[09:21] PA vs MD: Residency Training

Some PAs do pursue residencies now. But Savanna explains how different residency is for PAs compared to doctors. PA school is so quick and general. So if you want extra training for certain specialties like general surgery, ICU, or emergency medicine, there are now PA residency options available. They’re usually a year of intense residency-like training in specific areas. There are no formal PA residencies in dermatology yet. But a couple are popping up in specialties like urology and OB/GYN.

Savanna mentions that PA residencies are quite controversial since it’s not how the PA profession was designed. Often you can get the same training on the job and make a higher salary through it. Then you can be trained in the way your supervising physician would prefer instead of going through the residency.

[10:57] Savanna’s Typical “Day in the Life” as a PA

In her role in Dermatology, Savanna sees about 30 patients a day. On a typical day, her supervising physician might see one with her. The physician would pop in really quick to make sure they’re on the same page.

At this point, she is very autonomous. She also describes having a great, trusting relationship with her physician. Savanna is trusted to make wise decisions that are within her scope of practice as a PA. If she feels uncomfortable, she discusses the case with her supervising physician. Her physician also comes to ask Savanna for her opinion sometimes, since she’s able to go to more conferences. Savanna considers her physician a friend.

Overall the role of PA doesn’t feel limiting to Savanna at all. She doesn’t do a ton of surgery right now, but she could if she wanted to. She just finds it more lucrative to see patients.

[13:10] PA vs MD: Autonomy

In terms of having autonomy, what Savanna has found is that it depends on the relationship and understanding between the specific supervising physician and the PA, rather than on the state medical licensing board. In Georgia, where she’s at, they’ve had a few issues with the FDA changing a drug schedule.

As a result, PAs who could once write prescriptions for pain medications can no longer do it. She sees this as a problem for surgical and emergency medicine PAs. It’s an ongoing battle, and she hopes more awareness and better legislation will come into play. But it hasn’t really affected her at this point.

In my job as a flight surgeon for five years and in my clinic, I never worked with PAs. The Air Force has special independent duty medical technicians (IDMTs) that are like super-EMTs. The IDMTs would see some of their own patients and act almost like a PA. Folks like that have an easy transition into PA school since that’s the role they’re used to in terms of how much freedom they have and how much supervision they have.

PAs Deciding to Pursue Medical School

Interestingly, I talk to a lot of PAs who went to PA school but now want to become a doctor. They liked their job for a couple of years and then realized they just don’t know enough and would want to know more. PAs are generally not treating the most acute conditions and the most difficult patients and diseases.

Compared to physicians, PAs are generally not treating the most acute conditions and the most difficult patients and diseases.Click To Tweet

For Savanna, she’s very happy treating things like acne. She loves seeing those patients. If a crazy rash or something out of her league comes in, she is perfectly happy passing that along to her supervising physician. She loves learning about it and be involved in those cases, but she’s also okay with those being over her head.

She admits this may change as she gets further into her practice. She’s known some PAs who decided to go back and try to get into medical school.

On the flip side, there are a lot of physicians who are unhappy with their career choice. However, unhappiness or being unfulfilled with their career choice is not very physician-specific. That’s common in the U.S. in general, so it’s a cultural thing. For some reason, everybody just isn’t happy, which is unfortunate.

[17:45] Getting into PA School versus Medical School

PA schools have a rigorous application process, and it’s getting more and more competitive each year. Even though her husband was applying to medical school, Savanna had more requirements than he did. There are more class requirements like anatomy and physiology. She thinks it’s because PA school is quick, so they want you to have a lot of that under your belt before getting there. They did anatomy and physiology in PA school, but it was more intense than an undergrad-level course. It was actually the same course at their program that the medical students went through.

Additionally, you must have health care experience to apply to PA school. This is also a big difference between PA school and medical school. Savanna mentions that med schools want more research, whereas that’s not too important for PA school. They don’t care if you have research. They want you to interact with patients, and they want to know that you enjoy interacting with patients. Some of these programs require 1000-2000 hours of health care experience.

While it’s true that most PA programs require hundreds or thousands of health care experience hours, it should be noted that med schools want you to have clinical experience, too. And while there is more emphasis on research for premed students, it’s actually not as crucial as some people make it out to be. Clinical experience is more crucial than research for med school applications.

[20:34] The Origin of the PA Profession

Savanna takes us back to the origin of the PA profession. It was originally developed as a second career. People were coming back from Army jobs where they were basically acting as a PA. In civilian life, they didn’t have a place to go. At that point they didn’t want to go to medical school, but they had all this knowledge and experience.

So the PA profession was developed as a second career. Many PAs started as nurses or respiratory therapists or some other health care career. Then they decided they’re ready for more knowledge and responsibility, but not ready to commit to medical school and becoming a physician.

Some PA programs still really seek out those applicants who are coming into it as a second career.Click To Tweet

[21:37] PA School versus Medical School

PA programs range from 24-36 months. The first year is usually didactic. They’re in class every single day from 8am to 5pm. Then they went to clinical rotations for a year. She was watching her husband go through medical school where he was only in classroom from 8am to 12pm and had the afternoons to study. The medical students got their summers off while Savanna went straight through with no breaks except for a week at Christmas and a week in between semesters.

For medical school, the standard is two years of nonclinical, classroom training first. This prepares you for Step 1 of the boards, which you need to pass to continue on in your training. Then you need to do clinical rotations for two years before applying for residency.

For PA school, students take the Physician Assistant National Certifying Exam (PANCE) at the end. Pass that and you’re good to go. Savanna feels that the Step exams are what’s especially intimidating about medical school.

[24:00] MD vs PA: Competitiveness in PA School versus Premed and Medical School

The whole motto of this podcast is “Collaboration, Not Competition.” In the premed world, it’s super cutthroat. It’s super competitive. So part of my mission with this podcast is pushing back against that culture.

Once you’re in medical school, there are still the “gunners” who are out trying to do as best as they can, and sometimes they will cut you down in the process. But I went to New York Medical College, and the vast majority of students are there to help you. They’re there to collaborate and build a community. Some of my best friends are med school classmates.

I think the competitive atmosphere in medical school is nowhere near what it is in the premed world.Click To Tweet

As for her fellow PA students, Savanna refers to them as a family. They all help each other. Since many of the students have different backgrounds in health care, they’re able to learn a lot of things from each other, such as putting in IVs. Three of her best friends are from PA school and they still talk almost every day.

[25:30] Lateral Mobility as a PA vs Residency and Fellowship Training

From the standpoint of moving around in careers, Savanna mentioned earlier that although they have lateral mobility, most PAs still choose a specialty and stay there. Based on talking to PAs, it’s usually within the first few years of graduation that people tend to move around just trying to figure out where they belong.

Coming out of school, she knew she wanted to do either dermatology or surgery. She feels very fortunate to have found an awesome job which has worked out wonderfully. She hopes she never has to give that up. But she also knows that if they had to move for her husband’s fellowship or job, she could find another job as a PA. Because of her dermatology experience, it would make her a hot commodity for a family practice or urgent care.

In medicine, you need to apply for specific residencies, but you can still choose something broad like internal medicine. Then you explore all of the internal medicine fields: endocrinology, pulmonology, cardiology, GI, rheumatology, and the list goes on. Or you could choose general surgery and figure out what you like in the surgical field before going on and specializing in a surgical specialty as well.

Although they have lateral mobility, most PAs still choose a specialty and stay there.Click To Tweet

Savanna stresses that if you want to be a PA, you should want to do it for the everyday roles and responsibilities that you’ll have in the career. That’s where shadowing comes in because it’s going to look so different depending what specialty you’re in. A surgical PA is going to work much more closely with their supervising physician than she would as a dermatology PA. Surgical PAs tend to collaborate with their supervising physician on every single patient.

[29:02] PA and Supervising Physician: How Can Relationships Go Wrong?

Savanna’s supervising physician signs all of her notes, as required by the state of Georgia. So she sees whatever Savanna is doing and if there is any question, she’d bring it up. But part of her trust in her comes from the fact that she trained her. Typically, her supervising physician would say the same thing as Savanna does to any patients coming in. In fact, one of the biggest compliments given to Savanna by her physician is she’s basically her.

But the relationship can go wrong for some; the PA can hate the physician or maybe in general hates being supervised and wants more autonomy. As a PA you need to know what you’re getting into.

As a PA, you need to be okay with someone looking over your shoulder giving their opinions. If you're not okay with that, you shouldn't be a PA.Click To Tweet

Medical Students Need to Get More Exposure to PAs

On the contrary, Savanna doesn’t think medical students get great exposure to PAs, so she’s not sure if they understand it. Her husband didn’t know what she did until she graduated. They’d both be studying, and he would have a cardiology question, and he’d be surprised that Savanna knew the answer. Or she’d come home and say she excised a cyst, and he’d be surprised she did that. So it wasn’t until he got into hospital rotations that he actually understood what PAs do on a daily basis, and that there really are some great PAs and nurse practitioners out there.

Savanna thinks some medical students who have never been exposed to PAs have a misunderstanding of what exactly the role is. She thinks it’s important for medical students, who will become physicians and will work with PAs someday, to understand what the role looks like and what the capabilities of a PA are. Even in her practice, they had a couple of physicians coming to join their practice, and they had never worked with PAs. Then after a few months, one of them came to her and told her how impressed they were by what she does since they didn’t know PAs did that.

[33:05] Does the General Population Understand what PA’s Do?

Do PA’s constantly have to answer questions from patients about what a PA does or why the patient can’t see the doctor instead? Savanna says this happens less and less, particularly because she has her own patients that only see her now. But it still happens.

If a patient sees a bad doctor, they'll find another doctor. If they see a PA, they'll never see a PA again.Click To Tweet

Savanna thinks this saying is true and that she has actually run into this situation a couple of times. It all comes down to earning your patient’s trust and respect by being a good provider no matter what your role is. Make sure you’re as knowledgeable as possible and that you’re really providing that best care you can. Continue to learn and stay up to date on everything.

Savanna also gets asked a lot of questions since patients think she’s not old enough to be a doctor. Then she explains she’s a PA. She also encounters some who ask when she’s going back to become a doctor. So she has to explain to them that she’s already done with schooling and she’s trained by her supervising physician.

[35:50] The PA Mentality and Personality

So again as a PA student, you have to be okay with having a physician looking over your shoulder and be okay with the fact that the patient may want to see the physician sometimes. If you’re not okay with that, then you need to move on to MD or something else.

This is something interviews for PA school are looking for. They don’t want those students who are going to pretend to be a doctor and go rogue and do whatever they want. They want people who understand this is a collaborative role. You’re working as part of a team, technically under a supervising physician. To some people, this could carry a negative connotation, but for Savanna, it’s something she enjoys.

No matter what area of medicine you work in, you see difficult patients with difficult diseases. Savanna loves listening to her physician’s experience. She just refers to herself as a lifelong resident because she feels like she constantly wants to be learning as much as she can. They simply both just want to continue to learn. That said, if you want to be good at anything in life, you have to be a lifelong learner. Keep learning.

I just refer to myself as a lifelong resident because I feel like I constantly want to be learning as much as I can.Click To Tweet

Even if you go the physician route, you will go to colleagues to bounce ideas off of each other, so that kind of collaboration is part of medicine in general. It’s not only for PAs.

[40:37] MD vs PA: Advice for People Trying to Decide

Savanna recommends students to shadow a lot and do some soul searching to decide if they’d be happy in that collaborative role and not as the ultimate decision maker.

My personal recommendation would be 100% shadowing. You have to shadow. Go out and see what a PA does. Interact with the PA. Watch the PA interact with a physician. Listen to how the PA talks about being supervised by a physician. Try to find PAs in different specialties and see what those interactions are like.

Some States are More PA-Friendly Than Others

Find out what the rules are for PAs in the state that you’re living in or shadowing in. Find out how autonomous they can be, and how it varies from state to state. You might go shadow a PA who is very autonomous, so then you go into PA school thinking how awesome it is to be a PA. Then you end up moving to a state that’s not as PA-friendly. And now all of a sudden, it’s not the life you thought it was.

Savanna cites one resource you could use if this something you need to look into. Go to the state medical board and look at their website. Also, just ask PAs who work in that state since they’re going to be your best resource for finding out what it’s really like. Just try to get that first-hand knowledge.

[43:50] The Decision to Become a Physician

Back in high school, I thought I was going to be a physical therapist. Then I dissected a cat, and I wanted to be an orthopedist. I wanted to marry that sports-related PT stuff with cutting. So I joked around that I wanted to be a doctor because I wanted to cut people.

The PA world never crossed my mind. Maybe PA school just wasn’t as popular back when I went to school. I applied to medical school back in 2001.

[44:55] Are PAs Encroaching on Doctors’ Space?

There are physicians out there who don't know how to use a PA and don't know what a PA can add to their practice.Click To Tweet

There are physicians out there who don’t know how to play well with others. You’re going to find those personalities everywhere in life.

If you’re a PA or pre-PA and you start working with a physician who just doesn’t know how to play well with you, just go find another physician. There are good doctors and bad doctors as much as there are good PAs and bad PAs. So it’s not that physicians don’t like PAs, but there are just some physicians out there who don’t know how to work well with others.

[46:15] PAs Make Less Money than Physicians

Savanna adds that if you’re considering being a PA, you also need to be okay with the fact that you’re going to make less money than a doctor. And you’re going to make money for them. For her, she’s fine with that. She sees herself as her physician’s assistant. Maybe she would feel differently if they didn’t have such a great working relationship.

If you're considering being a PA, you need to be okay with the fact that you're going to make less money than a doctor. And you're going to make money for them.Click To Tweet

She knows that she makes money for the practice, but she’s also compensated very fairly for her time. And she doesn’t have to deal with any of the administrative stuff. She comes to work, she sees patients, and she goes home.

As a PA, you have to know your worth to the practice and to the doctors and be okay standing up for that a little bit. But you also can’t expect the same compensation a physician is getting.

One reason why physicians get paid more than PAs is the liability issue. The supervising physician is more liable than you. In addition, the physician is often the one that owns the practice, so in most instances they spend all of the overhead money in marketing and everything else, too.

[48:07] What I Hated about Medical School

I hated the preclinical years of medical school. I had taken three years off between undergrad and medical school, didn’t get in the first year, then took some time to fix my application and finally got in. So I basically forgot how to be a student, and I was miserable studying and learning, except for anatomy which was my favorite. I came in very closed minded, saying I wanted to be an orthopedic surgeon so why did I need to know biochemistry.

Then once I got to the clinical rotations in third and fourth year, I was just happy. I was interacting with patients in the hospital, doing what I wanted to do. But it’s a grinding, long process. This is another thing is you have to know about yourself: Are you going to be able to physically, emotionally, and mentally survive medical school, residency, and fellowship, before you actually become a “real” doctor?

Worrying Whether You’re Smart Enough for Medical School

Another thing I want to stress is how students go and think they’re not smart enough to be a doctor, so they’ll be a PA. This is just silly. As Savanna mentioned earlier, they’re learning the same stuff. They’re just learning a lot less of it for a shorter amount of time.

You don't have to be a genius to do well in medical school. You just have to work hard.Click To Tweet

Savanna thinks the same with PA school. With so much information, it’s so easy to get overwhelmed. But the nice thing is that it’s all relevant information. This is why she enjoyed the didactic year of PA school. But looking back and watching her husband struggle as a medical student, she just thinks medical school is too difficult. The comprehensive exams like Step 1 are particularly intimidating.

[51:24] People with Lower GPAs Switching to PA School

Savanna says her most asked question is, can students with a low GPA get into PA school? And I get the same question from premed students. Many of them have a mindset where if their GPA is not good enough to get into medical school, they’ll go to PA school. Again, I think this is silly.

PA schools shouldn’t be Plan B for somebody who wants to be a physician unless you are okay with everything mentioned here. Being a PA as a Plan B right off the bat just is silly. They’re two different careers, first of all. Secondly, if you have a poor GPA, you can still get into medical school. The path may not be as quick as you want. It make take a couple extra years. You may have to do a couple of extra things. But if you have a low GPA, there are ways to overcome it to show and prove to the admissions committees that you can handle medical school. That’s what they want to know. They don’t want to accept a student who’s going to fail. If they do, it’s a waste of a seat.

Not All GPAs Are Created Equal

GPA and MCAT are important, but they're not the end all be all when it comes to getting into medical school.Click To Tweet

I often tell students that not all GPAs are created equal. If you have a strong upward trend with your GPA (ex. last undergrad years, postbac, or science-heavy master’s program), this will help you overcome a low GPA.

This is the same advice Savanna gives to pre-PA students: If they really want to do it, there are ways to get there. The backup they tend to go to is nurse practitioner. But if you want to do PA and you’re set on it, then that’s what you need to keep working toward.

[55:33] Final Thoughts

Hopefully, this gave you insights into the difference being premed and pre-PA, differences both in the schooling and clinical practice. If you have been walking this line, not sure what you want, and you’ve defaulted to the physician side, hopefully this podcast has helped you understand the differences.

Please share this podcast with your friends as well as your advisors, so we can add to everyone’s understanding of how these career paths differ.