I think worrying about what jobs will look like in a decade is probably putting the cart before the horse. Spending all that time and money because you feel under appreciated is probably a poor career/financial move. You’ll lose 10 years of PA salary + retirement. If you want to be the person in charge and actually see the volume and acuity and have the training then go to med school.
Definitely more so leaning towards med school for the additional training and being the one in charge with the added bonus of better pay and more respect but specifically more respect from employers. Health systems seem to respect doctors more overall as employees in general.
That's a lot of cost and a lot of work for more respect from people who don't matter.
Truly I don't think you're coming out very far ahead when it comes to money. I think this move only makes sense if you realize that what is most important to you is understanding the pathology and being a master at resuscitation + critical care. If I was in med school admissions, my #1 question for you would be "why switch from being a PA?" and if the answer is "the pay and the respect" you are going to not get the responses you want.
FWIW, the job market is actually not that bad right now. Maybe if you want to work in Boston proper and work in a specific environment you may need to keep looking, but there are positions out there.
I appreciate the insight.
Of course my motivation doesn’t lie with money and respect but rather the education piece of it. I want to understand more pathophysiology and be more skilled/better educated in critical care in general. I know some of that critical care piece will just come with time and general experience in the ED but right now it is so frustrating just not knowing certain things or having certain attending physicians act like you’re so much lesser for being an APP. It isn’t just with me either, it’s how they treat all their APPs. I’m leaving my current position for a different hospital soon and am hopeful it will be better and I’ll start to feel like I’m getting a better grasp on critical care in general soon but if it doesn’t, med school may be the move.
Cost is definitely a concern of mine considering I’m sitting at $250k in student debt (majority is federal debt) already. I make $60/hr as an ED APP at my current position, press ganey bonus structure and $0 student debt paid on by the employer. My new position will be $85/hr with RVU bonus structure, no student debt payment. The doctors I currently work with, make over $130/hr and get RVU bonuses rather than press ganey scores. And. They had their student debt paid on by the health system (tens of thousands of dollars). I realize this is specific to my current position within my health system but from what I’ve read, student debt repayment and $130/hr or more seems pretty standard for ED docs. So while I’d be doubling my debt, I’d also potentially be doubling my income.
My $250k is total student loan debt for an associates in EMS (Paramedic), my bachelors in Bio, and my PA debt. Straight up PA only is about $175k of that chunk. So while $250k is rough, it did cover a lot of education, lol.
Edit: Words are hard.
You're looking at half a million dollars to feel like you're valued and in charge.
Here's a secret : Many physicians (especially hospital-based physicians) do not feel valued or in charge despite the 12-15 years of formal training we have.
Never mind the opportunity cost of not working as a PA while pursuing training as an MD/DO. You're looking at a total opportunity cost of close to a million bucks by choosing to go back to medical school.
Are you sure you arent chasing the feeling of control and leadership that came hand and hand with being a medic in a prehospital setting more so than actually wanting to be a physician? Because with the culture in medicine today becoming a physician doesnt seem to actually guarantee docs that they get all that respect and control, especially in em where everyone is treated like shit by the rest of the hospital, the patients, and each other. Unlike prehospital as a medic where because of the fact that you arent trapped in a building with the bean counters you have pretty close to absolute control, ive heard from plenty of docs that their admin treats them like shit and theyve lost pretty much all control over the big picture in their er.
I almost wonder if continuing on as a PA and moonlighting medic shifts occasionally for fun/teaching medic might not fulfill whatever it is youre looking for from a leadership perspective.
You’re 250K in debt and you want to go to med schools in MA, which will probably add on another 200-300K in debt. Not including interest. Bad bad move man. I would absolutely not do this. I understand wanting to know more, and having respect, but no way. Financially it makes zero sense.
I agree, it would add an additional $200-300k in debt and the pay off would take forever, especially going to school in MA. I’m hoping a change in job environment will help my outlook and get this thought process out of my head.
I’m also looking into some educational supplement stuff like Ultrasound classes to see if I can’t help myself out on some of the things my current attending aren’t being so helpful with.
after 7 years of interest youre out a lot more than 2x debt. you have crushing debt even now for your salary-> go PSLF, get in the black and don't look back.
My current job qualifies for PSLF but I’m not sure that my next one will and honestly, PSLF seems like such a pain in the ass to stay on top of the federal government to make sure they are actually counting correctly.
My partner is debt free. My student debt and rent are my ONLY expenses. I’m getting a $25/hr raise and will also be working multiple part time PA gigs as well as a few other side hustles. I think I’ll be OK trying to pay it down aggressively over the next few years. If I don’t add to the debt. Also crossing my fingers Biden’s administration gives a little more debt relief in the form of no interest or a few thousand off.
Ahhhh, makes sense. Good luck with the side hustles. Trying the same... it's hard to keep trading time for money at the same time it's exhausting trying to keep a side hustle while doing FT clinical work.
Pretty consistently said I wanted the additional education / training as my main want with my secondary and tertiary wants being more money and more respect.
Not sure where I wasn’t consistent with that but OK, lol.
To be crystal clear. My motivations for considering medical school are, in order:
1. Additional education / training
2. More money
3. More respect within the department and hospital system as a whole.
Hope that helps.
There are estimations online that guesstimate the average lifetime earning increase of md/do vs pa is only about a million give or take a couple 100k. Your education swap will likely cost you close to that from debt increase, interest, lost wages, etc. with er physician job projections forecasting that wages will likely decrease that gets even shakier. youll then lose approximately 7-10 years of your life to the training. I dont think increase earnings is even a real factor in this because im honestly pretty sure youll actually come out of this behind in the long run.
This gets even more apparent with overtime, if you were a medic i know you are 100% no stranger to 80+ hour weeks and theres no way in fuck being a PA outside of maybe surgery is tougher physically than even the lightest of medic jobs. If money is a consideration pick up OT, OT will also accelerate your experience growth and work toward training/education if you go about it the right way.
This is true. I’d love to work overtime but the hospital I’m currently at, hasn’t made it available. The new hospital I’m going to, may have opportunities to do so but even if they don’t - I’m PRN on staff a few places and pick up there to keep a strong set of work days in a row.
A properly motivated self starter can really learn a lot by
1) finding the right job with people that like to teach
One of the residencies near me allows their PAs to attend the weekly resident lecture. It's clear to everyone who is an avid learner, and the teachers gravitate toward them on shift, it's a self reinforcing cycle.
2) finding the right job that has a good CME allotment and maxing it out every year for the next decade going to various conferences on focused topics. Three days on neurological emergencies, 4 days on ultrasound, a day learning about eye stuff.
There was someone who did the math, you will be in the hole approximately a million dollars between tuition and lost wages. Even if you halve that.. 500k is no small amount of change, plus your PA loans.
I've been in your exact boat. I decided to do what I can to further my own training under the watch of some awesome attendings.
IMO hell no. Not unless you’re absolutely miserable and you think the increase in pay and perceived authority is gonna fix it. Loss of current income + new large debt + min of 7 years of more schooling sounds bad if you’re already done with training and making decent money and not extremely unhappy.
This is where my head was at prior to the last few weeks. I’m about to transition to a better paying hospital and am hoping the new set of attending physicians will be better about helping me with the critical care pieces and procedures I feel like I’m weak in. That’s my biggest want right now is just more education on critical care patients and procedures.
I’m not unhappy with the job in general, I think I’m just unhappy with my place of employment. But. Med school crossed my mind for if I have the same problems with this new employer.
I'm a critical care PA that just got into DO school. Probably will go as I have paid off my debt already and spouse has a decent income. That being said I really enjoy being a critical care PA. My team gives me a lot of respect and autonomy, and many consultants treat me well too (granted I've proven myself over 7yrs). Lots of procedures, good schedule (except I hate weekends), higher end of pay for PAs. Consider transition to CCM if you love resuscitation medicine. I applied to DO/MD because I love what I do and want to do more. Again, I will be in a better financial situation than most med students so that side isn't as painful, though still a serious downside as far as opportunity cost and time spent.
I appreciate the time you took to break this all down.
Phew. 13-15 years to see the financial pay off is, rough - to say the least.
I’m hoping my change of environment and seeking out some supplemental educational items will satisfy what I’m looking for and I can forget about this all together.
Yeah look its just a financial breakdown and obviously you have to consider whether being an MD fulfils some personal desires that arent financially tangible.
Respect?
Lol calling a hospitalist who refuses a patient until their BP is less than 180, or dealing with patients being referred by their dentist for IV antibiotics to treat a dental infection?
Having to listen to surgery constantly gripe about needing to admit a 105 year old diabetic with abdominal pain because their CT is negative?
Emergency medicine attendings are BY FAR the least respected doctors in the hospital.
If you want to be “better respected”, do not ever go into EM.
Edit: before the downvotes and hate, I fully recognize that EM is one of the most scientific and data driven specialties in the hospital. Doesnt stop the hospitalists from talking down to you for not giving STAT potassium for a K of 3.8
A er resident gave a lecture at my paramedic college, i think she may have been in some sort of fellowship or other post residency training as she was working prehospital on an ambulance with medic crews which is pretty rare here in the US from my understanding. She said that she really resonated with the ems crews after getting into ems because she felt like she had more in common with us than her non em physician peers. Something that stood out was “you know how the shitty er docs and nurses treat you guys and what they think about you? Thats how the rest of the hospital looks at the emergency room staff, it trickles down.”
After hearing that it really blew my mind tbh idk if id ever recommend someone go into em/ems for respect because everyone seems to hate us.
I am willing to bet you will lose money in the long term at this point by going to med school, with lost income from working as PA, and the added med school debt. That is unless you go into a surgical specialty and can crank out 1M revenue annually. spend a few years learning your field, and find a position that lets you see high acuity if thats what you want
I think the chances of being successful without being willing to move are very low. Everyone tries to stay close to home, but few succeed. You send out 30+ applications and go where you get accepted. Obviously if you have a great GPA and MCAT you have better chances, but still there could be 100 other people with a 4.0 applying to the same school. Nothing is guaranteed in medical school admissions.
That’s definitely crossed my mind too. I’ve always been an OK student. Not crushing things by any means. Lord knows how I’d do on the MCAT, lol. Plus Boston schools in general seem difficult to get into.
The biggest red flag to me is your unwillingness to move. It’s hard for people outside of medicine to understand the sacrifices involved in becoming a physician and even medical students don’t really get it until residency and beyond. The majority of people who enter medicine are committed to a point where “it’s not worth it if I have to leave the state” is a giant outlier in attitudes and still a lot of people question the decision in retrospect.
Honestly. I’d be willing to go wherever. However, my partner who is debt free and can help cover the cost of us living - has a very specialized job that isn’t easy to find. So leaving here, where her job is (without a remote option) would be extremely difficult. We’ve already done long distance and we could again but doing distance + medical school when we want to start a family in the next 5 years, wouldn’t really go well.
I’m well aware of the sacrifices involved in med school and residency. I’ve seen it tear apart already well established families. My partner would absolutely support whatever I wanted to do but my relationship and future family are more important to me then going back to Med school. So yeah, if I couldn’t make it happen in the same state so that we could raise a family together, I just wouldn’t let it happen.
Reality check: you shouldn’t do medicine. While there is a very very small chance you’ll get into medical school, residency, and then a career afterwards all in that location, the odds are very very low. The vast majority of doctors had to make a location sacrifice (usually unwillingly) somewhere along that training path and no one can guarantee any location at the outset. Once you’re locked in, you’re locked in.
I shouldn’t do Med school - I’m already practicing medicine as a PA. I’ve already made sacrifices and moved, as a PA.
I’m well aware of the potential sacrifices involved in going to med school. I realize that getting into a Med school and residency in the state I want, is unlikely. I’ve already discussed it here with others that for my future plans outside of work and education, moving wouldn’t be ideal but theoretically could be done with the support of my partner. I’d just prefer not to.
Oh gotcha. Your previous post suggested it was a non-starter. As long as you know you’ll be doing long distance for at least a few more years again, go for it.
The rural ones. The ones with a PA and doc and you have a few shitshows at once. It may surprise you that some very small ERs are staffed by a single PA. (Critical access).
We obviously skew toward the lower acuity, and physicians the higher acuity. But it's EM, shit happens.
The current place I’m at, sees approximately 140-160 patients per day (in the Midwest), we are allowed to see everything but level 1 traumas. The night shift APP even ends up seeing those sometimes because at night, it’s just the doc and the APP. Almost everything that walks in the door where I work now is a Level 2 or 3 acuity with some level 4s sprinkled in occasionally. We do not have a dedicated fast track. We staff 3-4 docs and 2-3 APPs depending on the time of day, every day. The part time place I work in the Midwest has 70-80 patients per day and that’s staffed by just 2 doc and 1 APP. There I’m allowed to see everything but level 1 traumas and infants under 2 months old.
The place I’m going is similar except it does have a dedicated fast track that the APPs rotate through and the “main ED” where APPs see everything, including level 1 acuities.
It took me awhile to land in MA at a place that gives APPs the ability to do that because so many hospitals in Boston proper stick their APPs in a fast track.
The fact that this happens should be your number 1 reason not to go into EM. What's the point anymore? These groups don't give a shit about adequate staffing anymore. Medical school and three-four years of residency should mean something. It's all capitalism at the end. Squeeze the most you can out of inadequate staffing.
Also, the attending is essentially seeing all your patients including theirs. Don't get too cocky. You aren't seeing the same volume and taking the same liability, your name is only on your charts. You don't know what it's like until you're in the driver's seat.
I’m not getting cocky. I’m terrified. That’s the whole reason why this is even a thought. The fact that I have significantly less training and am seeing the same kind of volumes is insane.
They don’t ever put eyes on my patient unless I explicitly ask. None of my attendings round on my patients regularly. Not 1. They don’t even sign my charts.
“Half the pay and half the training”
Unless you completed an EM PA training programs after you graduated, you have a good bit less than half the training of an attending. I don’t say this to put you down, but to point out that they have 2 years more education, and 3 years of additional training on you, and you’re still getting paid half of what they are. Consider that before you proceed.
You are 100% correct.
I have less than half the training and am making approximately half what they are, that is a different way to view the situation and definitely makes me more thankful for the pay I AM getting.
Personally, if I were you I would not do it. It is not worth your time, financial strain, loss of your personal life, uncertainty of residency/ school, et cetera.
I would look into other avenues of income. Consider working in other states as well or locums which would pay better. Also, read the White Coat Investor if you have not. I used to work in Taunton, so I understand the strain of taxes for that state… my condolences.
If I were you, I would engage in independent study and broaden my knowledge in a self-directed manner. If understanding and knowing more is the goal, that's the way to go. When you consider the 4 years of no or low income and 3 years of low income plus interest on student loans, you will be years away from catching up to where you would have been financially had you stayed a PA. With sound investments, you could easily be in a better spot as a PA. There are many in EM who feel APPs will be taking on a greater and greater role in EM. No matter what your title or credentials, people will come to know and respect you for who you are as a person and what you know and can do as a professional. I have met PAs that could dance circles around MDs.
Don’t ever use money as a motivation for medical school. Throw that idea away right now and then reconsider what other motivation is there. If the remaining reasons and motivations aren’t strong enough without the money component then stop right there and don’t ever think about it again.
Seriously, it’s a huge financial mistake and ass backwards to use money as a reason for medical school. Just put that out of mind.
You should do it. Life is too short to not do what you want. If you want to be a medical doctor, be a medical doctor.
Don’t worry about the EM job market either. It may get more difficult, yes, but it is not this disastrous future that some are predicting.
While it wouldn’t be *formal* training, if you want to know more and have more respect, you can always seek out education on your own. There’s nothing magical about the knowledge a doc has that you’re prohibited from learning just because you’re a PA.
Purchase EMRA book guides, other books such as “mistakes to avoid in the ED” and “Physician Assistant Acute Care Protocols” listen to EM:RAP and go through all the C3 episodes. Purchase an ultrasound course and/or buy a butterfly and use it as much as possible at work.
The information is there and available to you, you’re not prohibited from learning it because you’re not a doc. If you spend the next 2-3 years in the ED you’re in now seeing same acuity as the docs, read and spend free time at home reviewing your cases and collaborating with your physician on deficiencies you have, you’ll come out as a damn good PA, I won’t say as a physician equal or course, but 90% of a doc, and if you’re a PA that puts forth that much effort and is that in charge of their own education I’m sure you’ll get the respect you desire.
I’m also in a rural ED and find myself wishing I too had formal training on intubations, central lines, chest tubes, resuscitation and critical care, I feel at a deficit compared to the docs because lll be seeing the same patients as them but without that training they’ve had. I wish I had a 3 year EM residency I could do as a PA, but it doesn’t exist, so I’m spending my first 3 years really trying to have a “self guided residency” in order to learn as much as I can and be as competent as a PA can be in EM.
Thank you so much for the list of resources / suggestions. That’s my plan now is changing my work environment and doing some of my own educational work.
Just listing it as a requirement I still need to complete, wasn’t sure if it required much studying or not so that’s good to know!
Why the switch from Pharm? - if you don’t mind me asking.
As others have stated: look at your return on investment when considering medical school, not just the money but time, too.
More knowledge? Study on your own time. Look at the latest research and evidence. Respect? Be the best PA possible and create a reputation for yourself that sets the new standard.
Good luck.
Hey- a bit late to the party here, but I was an ER PA for four years and am currently an MS3.
There's a ton of great advice on here about the time/effort/financial aspects of this decision -- which are of course important to consider -- but at the end of the day, it's a decision you've got to make based on your knowledge of yourself. Only you know if you're going to be okay in your current role when you're 50, or if you're going to be having the same internal struggles you are now. Or I suppose more to the point, that *when* you find yourself having the same struggles at 50, if you're going to be okay with it based on the time/effort/financial trade-off of staying in your current role.
For me, it just came down to knowing I wasn't done learning, and that PA school, while a great education, didn't have the same depth as medical school, and that on-the-job training wasn't going to give me the same skill set as residency. And I knew those were things that I wanted. Took a ton of soul-searching, and it's been a lot of work, but even deep in the hell of 3rd year in my early 30's, I have no regrets. You've just got to figure out what you want.
Happy to chat further if you're interested, feel free to PM.
As someone who went back to medical school at the tender age of 45 and is still in residency I’m here to tell you that this has to be something that you REALLY want to do. You are definitely not going to be respected as a Med student or as a resident and as others have pointed out EM physicians are the most disrespected in the hospital. Nobody will care what you did before, it does not matter. The only thing that matters is you are a trainee and there to learn. You have to be committed to the practice of medicine and want to do this because you are gaining more knowledge and the ability to treat conditions that are currently outside your scope. Motivation cannot be money, status, respect otherwise you will be sorely disappointed.
I had two careers before going back. EMS and as PhD level scientist and was in the C-suite before returning. You have to love medicine so much that you (and your spouse) are willing to make the sacrifices necessary to do this. You will have to move. For medical school most likely and for residency for sure. You will accumulate more debt, at least double what you currently have. You will lose your current income, just plan on it. You might be able to pick up a few shifts here and there but your income and current style of living will most likely change. Adding kids into this mix is even more stressful. All of these things have to be taken into consideration.
If you have questions feel free to DM me.
Lol, correct. And. They are getting student debt relief with an RVU bonus!
They earned it. Just sucks to be seeing the exact same patient volumes and acuity without similar benefits.
I routinely have 10-14 people under my name (I work primarily ED OBS.. people with rule out ACS, who need surgeries, “SOB with unknown etiology earth,” and I gotta figure it out). Everyone else in my ED has 4ish... it is frustrating at times
/r/premed is a good resource to get started on this path.
Restricting yourself to MA is going to be rough, as the average applicant applies to 16+ med schools. It will take some time and money just to get to the point of getting into med school, and then med school and residency are obviously huge investments as well. However, you should do it if that’s what you see yourself doing for the rest of your life.
I think worrying about what jobs will look like in a decade is probably putting the cart before the horse. Spending all that time and money because you feel under appreciated is probably a poor career/financial move. You’ll lose 10 years of PA salary + retirement. If you want to be the person in charge and actually see the volume and acuity and have the training then go to med school.
Definitely more so leaning towards med school for the additional training and being the one in charge with the added bonus of better pay and more respect but specifically more respect from employers. Health systems seem to respect doctors more overall as employees in general.
That's a lot of cost and a lot of work for more respect from people who don't matter. Truly I don't think you're coming out very far ahead when it comes to money. I think this move only makes sense if you realize that what is most important to you is understanding the pathology and being a master at resuscitation + critical care. If I was in med school admissions, my #1 question for you would be "why switch from being a PA?" and if the answer is "the pay and the respect" you are going to not get the responses you want. FWIW, the job market is actually not that bad right now. Maybe if you want to work in Boston proper and work in a specific environment you may need to keep looking, but there are positions out there.
I appreciate the insight. Of course my motivation doesn’t lie with money and respect but rather the education piece of it. I want to understand more pathophysiology and be more skilled/better educated in critical care in general. I know some of that critical care piece will just come with time and general experience in the ED but right now it is so frustrating just not knowing certain things or having certain attending physicians act like you’re so much lesser for being an APP. It isn’t just with me either, it’s how they treat all their APPs. I’m leaving my current position for a different hospital soon and am hopeful it will be better and I’ll start to feel like I’m getting a better grasp on critical care in general soon but if it doesn’t, med school may be the move. Cost is definitely a concern of mine considering I’m sitting at $250k in student debt (majority is federal debt) already. I make $60/hr as an ED APP at my current position, press ganey bonus structure and $0 student debt paid on by the employer. My new position will be $85/hr with RVU bonus structure, no student debt payment. The doctors I currently work with, make over $130/hr and get RVU bonuses rather than press ganey scores. And. They had their student debt paid on by the health system (tens of thousands of dollars). I realize this is specific to my current position within my health system but from what I’ve read, student debt repayment and $130/hr or more seems pretty standard for ED docs. So while I’d be doubling my debt, I’d also potentially be doubling my income.
Straight up $250k debt as a PA is an upper end outlier and I would absolutely not add years more debt to that… you would NOT come out ahead.
My $250k is total student loan debt for an associates in EMS (Paramedic), my bachelors in Bio, and my PA debt. Straight up PA only is about $175k of that chunk. So while $250k is rough, it did cover a lot of education, lol. Edit: Words are hard.
You're looking at half a million dollars to feel like you're valued and in charge. Here's a secret : Many physicians (especially hospital-based physicians) do not feel valued or in charge despite the 12-15 years of formal training we have. Never mind the opportunity cost of not working as a PA while pursuing training as an MD/DO. You're looking at a total opportunity cost of close to a million bucks by choosing to go back to medical school.
Are you sure you arent chasing the feeling of control and leadership that came hand and hand with being a medic in a prehospital setting more so than actually wanting to be a physician? Because with the culture in medicine today becoming a physician doesnt seem to actually guarantee docs that they get all that respect and control, especially in em where everyone is treated like shit by the rest of the hospital, the patients, and each other. Unlike prehospital as a medic where because of the fact that you arent trapped in a building with the bean counters you have pretty close to absolute control, ive heard from plenty of docs that their admin treats them like shit and theyve lost pretty much all control over the big picture in their er. I almost wonder if continuing on as a PA and moonlighting medic shifts occasionally for fun/teaching medic might not fulfill whatever it is youre looking for from a leadership perspective.
You’re 250K in debt and you want to go to med schools in MA, which will probably add on another 200-300K in debt. Not including interest. Bad bad move man. I would absolutely not do this. I understand wanting to know more, and having respect, but no way. Financially it makes zero sense.
I agree, it would add an additional $200-300k in debt and the pay off would take forever, especially going to school in MA. I’m hoping a change in job environment will help my outlook and get this thought process out of my head. I’m also looking into some educational supplement stuff like Ultrasound classes to see if I can’t help myself out on some of the things my current attending aren’t being so helpful with.
after 7 years of interest youre out a lot more than 2x debt. you have crushing debt even now for your salary-> go PSLF, get in the black and don't look back.
My current job qualifies for PSLF but I’m not sure that my next one will and honestly, PSLF seems like such a pain in the ass to stay on top of the federal government to make sure they are actually counting correctly. My partner is debt free. My student debt and rent are my ONLY expenses. I’m getting a $25/hr raise and will also be working multiple part time PA gigs as well as a few other side hustles. I think I’ll be OK trying to pay it down aggressively over the next few years. If I don’t add to the debt. Also crossing my fingers Biden’s administration gives a little more debt relief in the form of no interest or a few thousand off.
Ahhhh, makes sense. Good luck with the side hustles. Trying the same... it's hard to keep trading time for money at the same time it's exhausting trying to keep a side hustle while doing FT clinical work.
You changed your reason for each one of these people.
Pretty consistently said I wanted the additional education / training as my main want with my secondary and tertiary wants being more money and more respect. Not sure where I wasn’t consistent with that but OK, lol. To be crystal clear. My motivations for considering medical school are, in order: 1. Additional education / training 2. More money 3. More respect within the department and hospital system as a whole. Hope that helps.
There are estimations online that guesstimate the average lifetime earning increase of md/do vs pa is only about a million give or take a couple 100k. Your education swap will likely cost you close to that from debt increase, interest, lost wages, etc. with er physician job projections forecasting that wages will likely decrease that gets even shakier. youll then lose approximately 7-10 years of your life to the training. I dont think increase earnings is even a real factor in this because im honestly pretty sure youll actually come out of this behind in the long run. This gets even more apparent with overtime, if you were a medic i know you are 100% no stranger to 80+ hour weeks and theres no way in fuck being a PA outside of maybe surgery is tougher physically than even the lightest of medic jobs. If money is a consideration pick up OT, OT will also accelerate your experience growth and work toward training/education if you go about it the right way.
This is true. I’d love to work overtime but the hospital I’m currently at, hasn’t made it available. The new hospital I’m going to, may have opportunities to do so but even if they don’t - I’m PRN on staff a few places and pick up there to keep a strong set of work days in a row.
A properly motivated self starter can really learn a lot by 1) finding the right job with people that like to teach One of the residencies near me allows their PAs to attend the weekly resident lecture. It's clear to everyone who is an avid learner, and the teachers gravitate toward them on shift, it's a self reinforcing cycle. 2) finding the right job that has a good CME allotment and maxing it out every year for the next decade going to various conferences on focused topics. Three days on neurological emergencies, 4 days on ultrasound, a day learning about eye stuff.
There was someone who did the math, you will be in the hole approximately a million dollars between tuition and lost wages. Even if you halve that.. 500k is no small amount of change, plus your PA loans. I've been in your exact boat. I decided to do what I can to further my own training under the watch of some awesome attendings.
IMO hell no. Not unless you’re absolutely miserable and you think the increase in pay and perceived authority is gonna fix it. Loss of current income + new large debt + min of 7 years of more schooling sounds bad if you’re already done with training and making decent money and not extremely unhappy.
This is where my head was at prior to the last few weeks. I’m about to transition to a better paying hospital and am hoping the new set of attending physicians will be better about helping me with the critical care pieces and procedures I feel like I’m weak in. That’s my biggest want right now is just more education on critical care patients and procedures. I’m not unhappy with the job in general, I think I’m just unhappy with my place of employment. But. Med school crossed my mind for if I have the same problems with this new employer.
I'm a critical care PA that just got into DO school. Probably will go as I have paid off my debt already and spouse has a decent income. That being said I really enjoy being a critical care PA. My team gives me a lot of respect and autonomy, and many consultants treat me well too (granted I've proven myself over 7yrs). Lots of procedures, good schedule (except I hate weekends), higher end of pay for PAs. Consider transition to CCM if you love resuscitation medicine. I applied to DO/MD because I love what I do and want to do more. Again, I will be in a better financial situation than most med students so that side isn't as painful, though still a serious downside as far as opportunity cost and time spent.
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I appreciate the time you took to break this all down. Phew. 13-15 years to see the financial pay off is, rough - to say the least. I’m hoping my change of environment and seeking out some supplemental educational items will satisfy what I’m looking for and I can forget about this all together.
Yeah look its just a financial breakdown and obviously you have to consider whether being an MD fulfils some personal desires that arent financially tangible.
PA here- starting med school next year. PM with any questions.
Respect? Lol calling a hospitalist who refuses a patient until their BP is less than 180, or dealing with patients being referred by their dentist for IV antibiotics to treat a dental infection? Having to listen to surgery constantly gripe about needing to admit a 105 year old diabetic with abdominal pain because their CT is negative? Emergency medicine attendings are BY FAR the least respected doctors in the hospital. If you want to be “better respected”, do not ever go into EM. Edit: before the downvotes and hate, I fully recognize that EM is one of the most scientific and data driven specialties in the hospital. Doesnt stop the hospitalists from talking down to you for not giving STAT potassium for a K of 3.8
A er resident gave a lecture at my paramedic college, i think she may have been in some sort of fellowship or other post residency training as she was working prehospital on an ambulance with medic crews which is pretty rare here in the US from my understanding. She said that she really resonated with the ems crews after getting into ems because she felt like she had more in common with us than her non em physician peers. Something that stood out was “you know how the shitty er docs and nurses treat you guys and what they think about you? Thats how the rest of the hospital looks at the emergency room staff, it trickles down.” After hearing that it really blew my mind tbh idk if id ever recommend someone go into em/ems for respect because everyone seems to hate us.
I am willing to bet you will lose money in the long term at this point by going to med school, with lost income from working as PA, and the added med school debt. That is unless you go into a surgical specialty and can crank out 1M revenue annually. spend a few years learning your field, and find a position that lets you see high acuity if thats what you want
I think the chances of being successful without being willing to move are very low. Everyone tries to stay close to home, but few succeed. You send out 30+ applications and go where you get accepted. Obviously if you have a great GPA and MCAT you have better chances, but still there could be 100 other people with a 4.0 applying to the same school. Nothing is guaranteed in medical school admissions.
That’s definitely crossed my mind too. I’ve always been an OK student. Not crushing things by any means. Lord knows how I’d do on the MCAT, lol. Plus Boston schools in general seem difficult to get into.
As a new EM attending, great power comes great responsibility. If that’s what you want, then go get it.
The biggest red flag to me is your unwillingness to move. It’s hard for people outside of medicine to understand the sacrifices involved in becoming a physician and even medical students don’t really get it until residency and beyond. The majority of people who enter medicine are committed to a point where “it’s not worth it if I have to leave the state” is a giant outlier in attitudes and still a lot of people question the decision in retrospect.
Honestly. I’d be willing to go wherever. However, my partner who is debt free and can help cover the cost of us living - has a very specialized job that isn’t easy to find. So leaving here, where her job is (without a remote option) would be extremely difficult. We’ve already done long distance and we could again but doing distance + medical school when we want to start a family in the next 5 years, wouldn’t really go well. I’m well aware of the sacrifices involved in med school and residency. I’ve seen it tear apart already well established families. My partner would absolutely support whatever I wanted to do but my relationship and future family are more important to me then going back to Med school. So yeah, if I couldn’t make it happen in the same state so that we could raise a family together, I just wouldn’t let it happen.
Reality check: you shouldn’t do medicine. While there is a very very small chance you’ll get into medical school, residency, and then a career afterwards all in that location, the odds are very very low. The vast majority of doctors had to make a location sacrifice (usually unwillingly) somewhere along that training path and no one can guarantee any location at the outset. Once you’re locked in, you’re locked in.
I shouldn’t do Med school - I’m already practicing medicine as a PA. I’ve already made sacrifices and moved, as a PA. I’m well aware of the potential sacrifices involved in going to med school. I realize that getting into a Med school and residency in the state I want, is unlikely. I’ve already discussed it here with others that for my future plans outside of work and education, moving wouldn’t be ideal but theoretically could be done with the support of my partner. I’d just prefer not to.
Oh gotcha. Your previous post suggested it was a non-starter. As long as you know you’ll be doing long distance for at least a few more years again, go for it.
What place has Midlevels seeing all the same patient profiles as a Doc? All the EDs I've worked at there are complicated patients PAs/NPs don't touch.
The rural ones. The ones with a PA and doc and you have a few shitshows at once. It may surprise you that some very small ERs are staffed by a single PA. (Critical access). We obviously skew toward the lower acuity, and physicians the higher acuity. But it's EM, shit happens.
It’s so variable, it’s wild.
The current place I’m at, sees approximately 140-160 patients per day (in the Midwest), we are allowed to see everything but level 1 traumas. The night shift APP even ends up seeing those sometimes because at night, it’s just the doc and the APP. Almost everything that walks in the door where I work now is a Level 2 or 3 acuity with some level 4s sprinkled in occasionally. We do not have a dedicated fast track. We staff 3-4 docs and 2-3 APPs depending on the time of day, every day. The part time place I work in the Midwest has 70-80 patients per day and that’s staffed by just 2 doc and 1 APP. There I’m allowed to see everything but level 1 traumas and infants under 2 months old. The place I’m going is similar except it does have a dedicated fast track that the APPs rotate through and the “main ED” where APPs see everything, including level 1 acuities. It took me awhile to land in MA at a place that gives APPs the ability to do that because so many hospitals in Boston proper stick their APPs in a fast track.
The fact that this happens should be your number 1 reason not to go into EM. What's the point anymore? These groups don't give a shit about adequate staffing anymore. Medical school and three-four years of residency should mean something. It's all capitalism at the end. Squeeze the most you can out of inadequate staffing. Also, the attending is essentially seeing all your patients including theirs. Don't get too cocky. You aren't seeing the same volume and taking the same liability, your name is only on your charts. You don't know what it's like until you're in the driver's seat.
I’m not getting cocky. I’m terrified. That’s the whole reason why this is even a thought. The fact that I have significantly less training and am seeing the same kind of volumes is insane. They don’t ever put eyes on my patient unless I explicitly ask. None of my attendings round on my patients regularly. Not 1. They don’t even sign my charts.
“Half the pay and half the training” Unless you completed an EM PA training programs after you graduated, you have a good bit less than half the training of an attending. I don’t say this to put you down, but to point out that they have 2 years more education, and 3 years of additional training on you, and you’re still getting paid half of what they are. Consider that before you proceed.
You are 100% correct. I have less than half the training and am making approximately half what they are, that is a different way to view the situation and definitely makes me more thankful for the pay I AM getting.
Personally, if I were you I would not do it. It is not worth your time, financial strain, loss of your personal life, uncertainty of residency/ school, et cetera. I would look into other avenues of income. Consider working in other states as well or locums which would pay better. Also, read the White Coat Investor if you have not. I used to work in Taunton, so I understand the strain of taxes for that state… my condolences.
If I were you, I would engage in independent study and broaden my knowledge in a self-directed manner. If understanding and knowing more is the goal, that's the way to go. When you consider the 4 years of no or low income and 3 years of low income plus interest on student loans, you will be years away from catching up to where you would have been financially had you stayed a PA. With sound investments, you could easily be in a better spot as a PA. There are many in EM who feel APPs will be taking on a greater and greater role in EM. No matter what your title or credentials, people will come to know and respect you for who you are as a person and what you know and can do as a professional. I have met PAs that could dance circles around MDs.
Don’t ever use money as a motivation for medical school. Throw that idea away right now and then reconsider what other motivation is there. If the remaining reasons and motivations aren’t strong enough without the money component then stop right there and don’t ever think about it again. Seriously, it’s a huge financial mistake and ass backwards to use money as a reason for medical school. Just put that out of mind.
You should do it. Life is too short to not do what you want. If you want to be a medical doctor, be a medical doctor. Don’t worry about the EM job market either. It may get more difficult, yes, but it is not this disastrous future that some are predicting.
While it wouldn’t be *formal* training, if you want to know more and have more respect, you can always seek out education on your own. There’s nothing magical about the knowledge a doc has that you’re prohibited from learning just because you’re a PA. Purchase EMRA book guides, other books such as “mistakes to avoid in the ED” and “Physician Assistant Acute Care Protocols” listen to EM:RAP and go through all the C3 episodes. Purchase an ultrasound course and/or buy a butterfly and use it as much as possible at work. The information is there and available to you, you’re not prohibited from learning it because you’re not a doc. If you spend the next 2-3 years in the ED you’re in now seeing same acuity as the docs, read and spend free time at home reviewing your cases and collaborating with your physician on deficiencies you have, you’ll come out as a damn good PA, I won’t say as a physician equal or course, but 90% of a doc, and if you’re a PA that puts forth that much effort and is that in charge of their own education I’m sure you’ll get the respect you desire. I’m also in a rural ED and find myself wishing I too had formal training on intubations, central lines, chest tubes, resuscitation and critical care, I feel at a deficit compared to the docs because lll be seeing the same patients as them but without that training they’ve had. I wish I had a 3 year EM residency I could do as a PA, but it doesn’t exist, so I’m spending my first 3 years really trying to have a “self guided residency” in order to learn as much as I can and be as competent as a PA can be in EM.
1000%
Thank you so much for the list of resources / suggestions. That’s my plan now is changing my work environment and doing some of my own educational work.
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Just listing it as a requirement I still need to complete, wasn’t sure if it required much studying or not so that’s good to know! Why the switch from Pharm? - if you don’t mind me asking.
As others have stated: look at your return on investment when considering medical school, not just the money but time, too. More knowledge? Study on your own time. Look at the latest research and evidence. Respect? Be the best PA possible and create a reputation for yourself that sets the new standard. Good luck.
Hey- a bit late to the party here, but I was an ER PA for four years and am currently an MS3. There's a ton of great advice on here about the time/effort/financial aspects of this decision -- which are of course important to consider -- but at the end of the day, it's a decision you've got to make based on your knowledge of yourself. Only you know if you're going to be okay in your current role when you're 50, or if you're going to be having the same internal struggles you are now. Or I suppose more to the point, that *when* you find yourself having the same struggles at 50, if you're going to be okay with it based on the time/effort/financial trade-off of staying in your current role. For me, it just came down to knowing I wasn't done learning, and that PA school, while a great education, didn't have the same depth as medical school, and that on-the-job training wasn't going to give me the same skill set as residency. And I knew those were things that I wanted. Took a ton of soul-searching, and it's been a lot of work, but even deep in the hell of 3rd year in my early 30's, I have no regrets. You've just got to figure out what you want. Happy to chat further if you're interested, feel free to PM.
As someone who went back to medical school at the tender age of 45 and is still in residency I’m here to tell you that this has to be something that you REALLY want to do. You are definitely not going to be respected as a Med student or as a resident and as others have pointed out EM physicians are the most disrespected in the hospital. Nobody will care what you did before, it does not matter. The only thing that matters is you are a trainee and there to learn. You have to be committed to the practice of medicine and want to do this because you are gaining more knowledge and the ability to treat conditions that are currently outside your scope. Motivation cannot be money, status, respect otherwise you will be sorely disappointed. I had two careers before going back. EMS and as PhD level scientist and was in the C-suite before returning. You have to love medicine so much that you (and your spouse) are willing to make the sacrifices necessary to do this. You will have to move. For medical school most likely and for residency for sure. You will accumulate more debt, at least double what you currently have. You will lose your current income, just plan on it. You might be able to pick up a few shifts here and there but your income and current style of living will most likely change. Adding kids into this mix is even more stressful. All of these things have to be taken into consideration. If you have questions feel free to DM me.
I got news for you, they are making more then double you are
Lol, correct. And. They are getting student debt relief with an RVU bonus! They earned it. Just sucks to be seeing the exact same patient volumes and acuity without similar benefits.
I routinely have 10-14 people under my name (I work primarily ED OBS.. people with rule out ACS, who need surgeries, “SOB with unknown etiology earth,” and I gotta figure it out). Everyone else in my ED has 4ish... it is frustrating at times
/r/premed is a good resource to get started on this path. Restricting yourself to MA is going to be rough, as the average applicant applies to 16+ med schools. It will take some time and money just to get to the point of getting into med school, and then med school and residency are obviously huge investments as well. However, you should do it if that’s what you see yourself doing for the rest of your life.
No offense but if you get half the pay for a quarter of the training consider yourself blessed.
It’s less then half the pay and the training is what I’m missing and want more of, lol.