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. We chat to discuss the differences in the career field 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 as well as the differences between a PA student and a medical student, and finally, the differences between being a pre-PA and being a pre-med.

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

[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. I currently have four podcasts with some more coming. I help premed students get into medical school. I help them with advising in terms of personal statements, interviewing, and more. I also teach 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 on his second year. So they’ve seen both side of things as she was going through PA school while her husband was going through medical school.

[04:16] Should You Choose PA as a Plan B?

If you’ve shadowed PAs and NPs and those other career fields and if 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’ve been 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.

For her, freshman year was tough in the sense of trying to decide what she wanted to do with her future. She always been someone who’s very focused on the future and wanted a plan in place. She basically thought about going different routes – 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, which was a huge part of her decision-making process. She couldn’t see herself in school and making the commitment that medical school requires. She wanted to start her family and be able to get out there and start working and working with patients. She didn’t know if she could commit to one specialty.

Savanna also mentions that lateral mobility is the biggest part of being a PA. And she thinks it’s a bit overrated since most PAs can stay in one specialty. But it just made sense for her. Not to mention, the teamwork aspect of it. She likes having someone to bounce ideas off as well as the relationships she was able to observe.

[07:30] Her Husband’s Thought Process Behind Becoming a Physician

As for Savanna’s husband, he felt it wasn’t really a decision but he just had that feeling 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.

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. That said, Savanna is completely happy with her decision at the end of the day.

The biggest thing she wished she had is that feeling of missing out on the residency training. Hearing her supervising physicians talking about cool cases they get to see in residency at an academic center is something that made her feel jealous. She wished she had that intense training. But she has a great supervising physician who teaches her everyday. So she does feel she gets that to some degree, just that she wasn’t able to see those really cool cases, as she describes it.

[09:21] Residencies for PA

Savanna cites how different residency for PA is compared to medical residency. PA school is so quick and general. If you want that extra training for certain specialties like general surgery, ICU, or emergency medicine, there are now options available. They’re usually a year of intense residency-like training program in certain areas. No formal ones in dermatology yet. But a couple are popping up in specialties like urology and OB/GYN. She mentions it’s quite controversial since it’s not how the PA profession was designed. A lot of times, you can get the same training on the job and make a higher salary coming out. Then you can be trained in the way your physician would prefer instead of going through the residency. That said, the benefits have yet to be determined.

[10:57] A Typical Day in the Life of Savanna

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. The she would discuss one other case with her. At this point, she is very autonomous. She also describes having a great relationship with her physician, with a lot of trust. She trusts her to make wise decisions and that are within her scope of practice. And if she feel uncomfortable or out of place, she’s going to come and discuss it with her. On the other hand, the physician may also come to her to ask for her opinion since she’s able to go to more conferences than she does. Sometimes, she’s more aware of the newer things going on. She considers her physician a friend.

Additionally, she doesn’t feel limited in her role in any way. She doesn’t do a ton of surgery right now but she could if she wanted to. But she finds it more lucrative to see patients.

[13:10] PA Autonomy and PAs Deciding to Get into Medical School

In terms of having autonomy relative to the state, what she found for the most part is making it more of a decision between the supervising physician and the PA, instead of the state medical licensing board. She would prefer if they had to move to go to a PA-friendly state where PAs are able to be more autonomous. However, it’s difficult. In Georgia, where she’s at, they’ve had a few issues with the FDA changing a drug schedule. Then the state legislation is not catching up yet. As a result, PAs who could once write for pain medications can no longer do it anymore. She sees this as a problem for surgical and emergency medicine PAs. It’s a continuous battle and she hopes more awareness in more 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 any PAs. The Air Force has special independent duty medical technicians (IDMTs) that are like super-EMTs. He would see some of his own patients and act almost like a PA. This is an easy transition for them into PA school since that’s the role they’re used to in terms to how much freedom they have and how much supervision they have. But in the actual family practice clinic, the provider in charge was a PA. So I’ve worked side by side with PAs but just not in my clinic.

Interestingly, I talk to a lot of PAs who went to PA school. They liked their job for a couple of years and then realized they just don’t know enough and would want to know more. You’re not treating the most acute things and you’re not treating the most difficult patients and diseases.

For Savanna, she’s very happy treating things like acne. She loves seeing those patients. But if a crazy rash comes in or something out of her league, 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. In fact, even now after three years, she feels there are things she’s much more comfortable with. She has also known some PAs who decided to go back and try to get into medical school.

On the flip side, there’s 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. It’s 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. You have to take these again, as well as other courses. 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. Since they’re not going to go over it again. They did anatomy and physiology 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 have to have health care experience. This is also a big difference between PA school and medical school. Savanna mentions that med schools want more research whereas it’s not that 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 a 1000-2000 hours.

However, I want to clarify that the research side isn’t as important as most people think for medical school. Clinical experience is. But true, it’s a huge difference in that most PA programs I’ve seen require a lot of clinical hours. But it’s the same for medicine, where they want you to get clinical experience since they want to make sure you want to be around sick people.

[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. This was when 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 skills. The PA profession was developed as this secondary career. Whether they’ve been nurses or respiratory therapists or some type of strong background in healthcare. Then they’re just ready for that next step where they want more knowledge and more responsibility but not ready to commit to medical school and becoming a physician.

[21:37] The Path to PA School versus Medical School

PA programs range from 24-36 months. This is another difference between PA school and medical school. As for Savanna’s PA program, 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. They got their summers off while Savanna went straight through no breaks except for a week for Christmas and a week in between semesters.

Some medical schools though are already getting rid of that summer break. A big draw is early clinical exposure. So if they cut out that summer and just take classes then you get early clinical exposure. I like that summer though because that’s the last time of free time you get.

For medical school, the standard is two years of nonclinical, classroom training. This prepares you for Step 1 or Level 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, there’s the Physician Assistant National Certifying Exam (PANCE) taken at the end. Savanna describes it as a very general test. Pass that and you’re good to go. Savanna feels those different Step exams in medical school are what’s intimidating.

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

The whole motto with this podcast and with everything is collaboration, not competition. In the premed world, it’s super cutthroat. It’s super competitive. For that reason, this is my big mission in life, because I don’t think it needs to be.

But once you’re in medical school, there are those who are the “gunners” who are out trying to do as best as they can. And they cut you down in the process. 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.

As for PA school, Savanna refers to them as a family. They all help each other. Having different backgrounds, they’re able to learn a lot of things on each other like doing IVs and stuff. Three of her best friends are from PA school and they still talk almost everyday.

[25:30] Lateral Mobility in PA and Residency or Fellowship Training

From the standpoint of moving around in careers, Savanna earlier mentioned that although they have some lateral mobility in terms of specialty, 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. They try to figure out what they’re interested in.

Coming out of school, she knew she wanted to do either dermatology or surgery. She feels very fortunate to find 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 to for fellowship or for her husband’s job, she could find a job. Because of her dermatology experience, it would make her a hot commodity for a family practice or an urgent care in areas they struggle with since she has that background.

As for medicine, you need to apply for residencies but you can do 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.

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 again, because it’s going to look so different depending on what area you’re in. A surgical PA is going to work much more closely with their supervising physician than she would as as a dermatology PA. You’ll be in the operating room with that physician mostly, if not all the time. And you’ll be collaborating on every single patient.

[29:02] Where Does the Relationship 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 supervisor would say the same thing she does to any patients coming in. In fact, one of the biggest compliments given to her by her physician is she’s basically her.

But where does the relationship go wrong? Where the PA hates the physician or maybe in general, hates being supervised and wants to be more autonomous?

Savanna says this as being a big issue on both sides. As a PA, you need to know what you’re getting into.

On the contrary, Savanna doesn’t think medical students get a 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. He would just ask him how she knows that. Or she’d come and say she excised a cyst and he’d be surprised she did that. So it wasn’t until he got into hospital rotations (which she has already graduated at that point) that he actually understood what PAs do on a daily basis. And that there really are some great PAs and nurse practitioners out there.

She thinks some medical students who have never been exposed to PAs have a misunderstanding of what exactly the role is. That said, Savanna thinks it’s important for medical students, who will become physicians and will get to 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 have 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. So this is where education really comes into play.

[33:05] The General Population

As a PA, as to how many times they face patients that question why they’re not with a doctor, this happens less and less. For the most part of that, it’s because she has her own patients that only see her now. But it still happens.

Savanna thinks this saying is true and that she has actually ran into this situation a couple of times. It all comes down to earning your patient’s trust and respect by bring 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. Moreover, she gets asked a lot since they think she’s not old enough to be a doctor. Then she explains she’s a PA. She’s also encounter some who would ask when she’s going back to becoming a doctor. So she has to explain to them that she’s already done with schooling and she’s trained by her supervising physician. It’s a good thing she made sure she was introduced to many of her patients. And because they trust the physician and Savanna, they know her roll. And if they ever want to see Savanna instead of the physician, she would be fine with that and she won’t get offended by that. They just have to let her know upfront when they’re scheduling. But it takes to continue to educate people and slowly earn their trust.

[35:50] The Right PA Mentality and Personality

So again as a PA student, you have to be okay with having a physician looking over your shoulder or be okay 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 be “fake” doctor and go rogue and do whatever they want. They want people who understand this is a collaborative role. It’s something your’e working as part of the team, technically under supervising physician. To some people, this could carry a negative connotation but for Savanna, it’s a benefit she enjoys.

Savanna adds that you can’t go into this if you feel like you can’t be confident in your decisions. For her, it’s about putting their heads together. She likes to get all the information she can being a chronic researcher that she is.

No matter what area of medicine you work in, you have the difficult patients with difficult diseases. She loves listening to her physician’s experience. She refer to herself as just 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.

From a physician standpoint, I’d love to go to my colleagues and we’d bounce ideas off each other, which is common in medicine in general. Not only a specific PA interaction.

[40:37] Advice to People Trying to Decide Between MD and PA

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 that 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.

Find out the rules are for PAs in the state that you’re in or shadowing in. Find out how autonomous they can be. Because you may be living in a state that you’re not going to end up practicing in. Then you go shadow a PA and they’re very autonomous. They don’t interact with a physician all day. So you go into a PA school thinking how awesome it is to be a PA. Then you end up moving to a state that’s not 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 to 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 orthopedic. 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 wasn’t just as popular back when I went to school. I applied to medical school back in 2001.

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

There are just physicians that 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. It would have been otherwise if they didn’t have a great working relationship.

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 to fight for that a little bit. But you also can’t expect the same compensation a physician is getting.

As to why this is, there is the liability issue. The physician is more liable than you. From a practice standpoint, PAs have to be supervised in most states. So the physician is the one that owns the practice. In most instances, they spend all of the overhead money in marketing and everything else.

[48:07] What I Hated about Medical School and Thinking You’re Not Smart Enough

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

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

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 learning a lot less of it for a shorter amount of time.

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 relevant information. This is why she enjoys the didactic year of PA school more. She feels she could have done medical school. Sure, the first year she’d have some doubts. But looking back and watching him struggle, she just think medical school is just too difficult. Part of that is those comprehensive exams which can be intimidating.

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

Savanna says her most asked question is they have a low GPA, can they get into PA school? And I get the same question with premed students. And that next level is this mindset that their GPA is not good enough to get into medical school, so they’ll go to PA school. This is another silly thing.

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. It’s two different careers first of all. Secondly, if you have a poor GPA, you can still get into medical school. It may not be as fast 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 committee 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. It looks back on them and it’s a waste of seat.

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

This is the same advice she gives to pre-PA students is if they really want to do it, there are ways to get there. The backup they tend to go to is nurse practitioner. It’s a different career. They are similar but the paths are different to get there. If you want to do PA and you’re set on it, then that’s what you need to keep working towards.

[55:33] Last Thoughts

Hopefully, this gave you insights into the difference being premed and pre-PA, differences in the schooling, and once you’re in practice. If you have been walking this line but not sure what you want, and you’ve defaulted to the physician side, hopefully this podcast has helped you understand those differences. So when interviewing comes, as well as writing personal statement or secondaries, you don’t mistakenly leave the door open for an interview.

Please share this podcast to your friends, both PA friends and premed friends, as well as to your advisors.


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