5 Reasons a Physician Assistant Career is Wrong for You
Posted By: Paul
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PA Profession
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97 Comments
Look first, or you may regret it
It’s easy to get excited about a physician assistant career. I wrote recently about how to tell if you have the PA personality. But what about the values you hold? Excitement has a way of discouraging us from seeing the little negatives we sometimes need to see. So today’s topic is a little different - 180 degrees, in fact: how to tell if it’s the wrong field for you. Here are five big ones as I see it. If you have one to add, float in a comment below.
5 Reasons a Physician Assistant Career is Wrong for You:
- Your job title is more important to you than what you actually do. I’m not being snide here - for some people (and they usually know who they are), the prestige attached to job titles is crucial. If you’re one of these folks, think twice about a PA career. Why? Even though PAs are gaining acceptance in the eye of the public every day, they have a way to go; many people still don’t really know what a PA is. To be one is to accept that you will be explaining your role to your patients as a normal part of your work. You will occasionally be mistaken for a medical assistant or a doctor. You will be neither, and it’s your job to patiently explain what you are and do.
- Your interest in medicine is more about the science than about caring for patients. Don’t get me wrong - as a PA, you’ll need to know and work with plenty of science. And PAs aren’t the only medical providers who care about their patients. But as a PA, your patients are a larger focus. Your communication with them and your ability to educate and counsel them about their health and treatment are your “magic bullets,” not your specialized knowledge of biochemical pathways or fluid dynamics.
- You need to be at the top of the decision making chain on every decision you make, as opposed to working as a member of a team. PAs are supervised by physicians. They make many decisions independently every day. But sometimes the supervising MD makes the call. If you can’t stomach the idea of not having the final say about everything that happens with every patient, you shouldn’t be a PA.
- You prefer to be the expert on one or two subjects than to be competent in many. One of the recognized strengths of the PA profession is its flexibility. It’s great to be able to work in, say, primary care for a few years, and then switch to a job in emergency. It leaves you open to more employment opportunities, and it’s one reason PAs are so sought after; they are “physician extenders.” But it’s not ideal if you want to be the regional or national expert on a particular illness or procedure.
- You think it’s an easy way to get into medicine. Medicine is hard, in part because it’s complicated, and in part because there’s simply more of it than you could learn in three lifetimes. It takes fewer years to become a PA than a physician, but there isn’t much about it that’s easy, and believe me, you’ll still be learning when you get out of school. It’s loads of work and time to become solid, and a PA’s mistake can kill or harm a patient just easily as a physician’s.
If you have thoughts about these, or have one to add, just leave a comment - we’d love to hear what you think. -P
re: #3
pa’s who work solo em or primary care are at the top of their decision making chain.
any comment an sp makes is often days/weeks/months after the fact and more along the lines of quality review/recommendation as they can’t change what you ahve already done. many states allow for 10% chart review within 1 month which leaves A LOT of room for independent decision making.
Every PA reports to a supervising physician. Yes, for many that means that 10% of their charts must be reviewed by a doc, but that means -wait for it-that you aren’t at last word on all of your patient decisions. In practice, PAs make most of their decisions without any feedback whatsoever, but the good ones know when to consult with their supervising MD. I think I agree with your comment overall, but just to make myself clear, I changed #3 to read “You need to be at the top of the decision-making chain on every decision you make.” Good point, and thanks for the feedback.
I remember reading in one of those article that shows the PA profession as the second best job in the US, that one complain was that there is no opportunity to advance to the highest position (without going to medical school). I guess that is why they call it “mid-level”. So, if you need to be king… But then again, I have heard of PA’s opening their own clinics, running the show, and being the one to hire and fire the providers (including docs), so I guess it depends on what the definition of power is 🙂
Well said, Sundance.
I know a PA who does this very thing: he hired one of my in-laws to be the MD to supervise him and he owns the clinic in which they both work.
I find your implication that physicians are elitist and title-focused offensive, as I do your implication that physicians are not patient-focused. It is a well-known truism that for most of us, the details of biochemistry and physiology are background, and of no immediate application in day-to-day practice. That does not make us science geeks. I teach my residents every single day to treat patients, not lab reports, and I teach them that their patients are people, not diagnoses. You tar an entire profession with far too broad a brush.
Dr. Randy, it seems I wasn’t totally clear. My article was not about physicians, but those who are considering becoming physician assistants. My point was that if titles are more important to you than what you do at work, you probably shouldn’t become a PA. Maybe I should have said that if delving deeply into the scientific underpinnings of medicine is a requirement for you, you might find more satisfaction as an MD. But I purposefully avoid saying things like this so as not to mislead students into thinking that the science in PA training is easy. Since you bring it up, I’ll add my opinion that if the science is all that interests you, you aren’t destined to much of a physician either. I have great respect for physicians and their work. My father was a physician, and though he was a great scientific mind, the human element was always the most important part of his work, and the one in which he took the most joy. I’m glad there are physicians who read this blog - it will keep us honest, and provide perspective.Hopefully I’ve narrowed my brush by a few bristles.
Hey Paul,
After reading your article I was concerned that the PA career path may not be for me. I am currently a freshmen at the university of Michigan and still very un-decisive about my career path. I work as an MA at a gynecology clinic for a well know hospital. I enjoy working there and I enjoy learning new things everyday. I like caring for patients and sometimes go beyond my medical duties to help the patients. I very much dislike being ordered around constantly by the doctors. Also, I don’t tolerate bodily fluids well ( it grosses me out at times). I wanted to go into the PA program because I have much experience in the medical field and enjoy practicing it. The PA program is also a good job with stability which also pays well and it allows me to have a life. ( these were also considered in helping me decide). My question for you is whether or not I should go into the PA Program? I believe that I can really care for patients and become compassionate in what I do. I also cant imagine a job outside the medical field.
This is a tough question and I would tell you that choosing to go to PA school or not is a very personal decision.
PAs are rarely ordered around by anyone. They are supervised by a physician, which USUALLY means that doctor is available if the PA wants to run something by them, and that that doctor cosigns at least 5% of the PAs charts. In practice, PAs - once trained and possessing some experience - practice pretty much independently. I should add that all of this depends on the supervising physician that the PA works with and the relationship between the two. Doctors are human and therefore prone to human weaknesses. If your supervising physician is controlling, micromanaging, temperamental, inappropriate, abusive, or otherwise difficult, they can make your life hell. But this is rarely the case. More often the PA and MD relationship is collegial and cooperative.
As for bodily fluids, you will definitely run across them, particularly while you are in training. Body fluids are a nearly unavoidable part of medicine. On your side, however, is the ability to choose a specialty that keeps them away from you, such as psychiatry, endocrinology, orthopedics, etc. In a very famous book read by medical and PA students (The House of God by Samuel Shem), the main character has this problem and ends up becoming a psychiatrist. They talk about the so-called “no patient care” or NPC specialties, which are psychiatry, radiology, pathology, etc. because they don’t require you to tough patients.
Sounds to me like maybe you should spend some time shadowing a PA - that way you can get familiar with what you will doing and have no illusions about it.
I wish you luck in your decision making process.
Paul
I have to agree with DrRandy.
First let me say I think both fields are great.
But I agree that the authors of this website have made comments that while commending the practice of being a PA, imply that being a doctor means that you dont focus on the patients, don’t enjoy working as a team, and are a science geek.
I know that you are a PA, but try to not be so denigrating in what should be a more objective piece.
Thanks, PA Student. I enjoy a good controversy! As I’ve said, they’re both great fields, but they aren’t both great for very every person - it’s the fit that counts. So I’ll stick with what I’ve written - I think it speaks for itself.
It seems to me that people reading this are taking what is meant to be directed at a targeted audience and going off into directions that stray away from the purpose of this article. I am the targeted audience, I am a certified pharmacy technician and I am currently looking into several healthcare related careers (Nursing, PharmD, PA etc). The very first thing everyone tells me as an aspiring healthcare program student is “if you are interested in applying to this program only because you think you will make a lot of money or your parents are making you do this then don’t do it, you have to WANT to take care of people”. I think that is what the author is trying to convey here. He is warning people that this profession requires passion for patient care and if that isn’t your main intention you really need to do some soul searching before you commit to this kind of career path. I have friends who went to pharmacy school, medical school and PA school solely because their parents forced them to. Now, they hate it because that isn’t what they truly want to do. I told a co-worker who was applying to medical school that I believe she should rethink her decision because she hated every single patient that came through the pharmacy. She made negative comments and made fun of these poor sick people, I just looked at her and said, “are you sure you WANT to take care of these people?” I don’t think she was sure. With that being said, I appreciate this article and all of the people who are giving information to students or generally interested people who may want a career in this field. I honestly hope that the “controversy” between MD’s and PA’s here isn’t a sign of how the relationships between the two really are. Please be aware that it’s discouraging to kids looking for real perspectives and information when people start using these forums as a way to belittle others opinions and take attention away from the point of the discussion. I work hard and don’t want to waste my lunch break researching my future only to find that I just wasted half of it reading people attacking one another instead of providing me with useful info!
[…] About two weeks ago, I got into an interesting debate with a reader of an article I wrote for the medical blog, KevinMD.com (click for the article and comments). In the article, I referred to myself as a medical student. I had several reasons for doing this which I won’t share at this point. Anyway, one of the readers took me to task, saying that I shouldn’t use that title since I was working toward my PA and not my MD. Some of my classmates and I discussed the issue, and I was surprised at how differently some of us felt. I thought I would put it out there and see what you think. Recall my last post, where I argued that PA school may not be right for you if your title is more important to you than what you do at work. […]
Honestly, I think that becoming a PA is of the utmost rewarding profession. I am currently a PA student at Wake Forest University, and I have friends who are in the Medical School Program here. Sometimes we sit down and analyze our assignments holistically, and, in turn, the assignments are essentially requiring the same amount of time, cognitive thought and work levels. Yes, you’re right about having to consult a Physician at times, but I think that’s what makes one a better PA — taking the initiative to ask questions in the event that one is unsure, so that the next time you’re place in a similar situation, you’ll know exactly what to do. Furthermore, I think that a PA should be well-rounded, and not fully focused on one specific practice. Here at Wake, patients have a multitude of illnesses and it feels prodigious when we’re able to detect the illness, and help cure the illness. Moreover, being patient-focused seems like the better route in my book — my professor always says, “patients first, diagnosis whenever they are needed, but not when they are wanted” which merely means that if one is in PA school for the love of Medicine and Science alone, and have no prior adoration for patients — he or she may want to choose an ancillary direction in his or her life. PA’s are here for guidance, advising and we’ll always be there for our patients.
If you become a PA and decide that these things do, in fact, bother you, how easy is it for you to become an MD. Do you have to start all over from the beginning of medical school? Or can you skip a few years? Or are there special tracks for PAs becoming MDs?
I ask because I’m trying to pick between the two. I’m able to do both but I’m just not sure which one will make me happier, so I’m just trying to understand my options.
Thanks so much
cg
Unfortunately, being a PA doesn’t save you any time if you ever want to become a physician. Of course, you probably would have some of prereqs already taken care of (physio, micro, etc.). And although there’s been much talk of the introduction of a PA fastrack to MD program, no such program has ever materialized. I suggest you consider the matter carefully; if you become a PA and want to switch to physician, you start your medical training over from square 1; if you become an MD and decide you want to become a PA, you may get in, but you will be carrying a very heavy burden of debt and you’ll be on a career track that won’t pay it off as easily. If possible, I say choose one and stick with it. Good luck.
Great discussion board. There’s a lot of good topics here, currently I am finishing my didactic year in PA school, I had military, EMT and Sport medicine training and psychology training (undergrad) before starting PA school. Like many people it was tough for me to decide which path was best, but I was accepted to PA school and I decided I had nothing to lose. There are some paths and programs in the works that I have heard of that take one year off of medical school if you so decide to go that route if PA is not satisfying you. But it’s hard to imagine that being the case. You get autonomy, a high level of knowledge, and respect in the work place. You make a good salary and are able to work in any setting imaginable. I talked with a pediatrician the other day about this, and his advice was to get my PA, work and if I didn’t feel satisfied, to apply to medical school and use all that knowledge to my advantage. I can’t imagine that I would need to do that now, since I intend to work in primary care my salary would not be all that much different, and my job would be almost identical with about 200,000 more bucks of college loans, however, it is an option, and I would never call going back to a school a BAD idea. Just something to think about.
I love the medical profession. Let me be clear, I am not a doctor or pa, but I know many good ones in both professions. I have enjoyed the fortuity of having very professional and caring primary care physicians and pas for most of my life (one dr literally saved my life because he was concerned about me and not the consensus diagnosis of several other doctors). I praise God for him.
Anyway I am in a place in my life in which I must make a career change. I have asked myself for over a year what can I possibly be passionate about beside my previous employment. I have struggled with that question for over a year. I mean it has been struggling!
Now as I was at my pain pa the other day, it came to me. I could be passionate about being a pa. I have always had a strong interest in the medical profession. My wife manages 2 clinics at a major children’s hospital in the midwest, and I love to talk to her about the challenges and such that she faces each day. Because of hippa, there are things, she can’t discuss of course, but what she can she does and I love it. Especially the difficult diagnosis and treatment the docs have had to figure.
I have been thinking and researching this now for over a month and I am still excited about the possibility. The question or topic that I offer for your advice is; do you think I have a chance of being accepted into a program, and do you think it is a good choice for someone my age. I am 52 years old. I have a bachelor’s degree in ancient literature and graduated with highest honors (above 3.8 out of 4). I don’t have the prerequisites, but that’s not a problem I am looking into making them up in the next year. I have a great memory. My study habits are excellent and I have above average IQ and very good EQ.
I believe in getting advice and opinion from many sources and yours would be a great help. Be honest with me please and tell me what you truly think.
I will thank you ahead of time. Thank you very much!
Hi, Rdane. I’m not big on answering the very common “what are my odds questions” with actual odds. There are so many variables, the biggest of which being the whims of each admissions committee. But here are my thoughts:
At 52, you won’t be the oldest person to go to PA school, but it will definitely make you one of the older/oldest people in your class. In my class the oldest person was 54 (if I remember correctly). More than anything, it depends on where you apply. I suggest you call around and ask how they feel about older candidates. If they don’t like them, they may say it flat out. If they don’t mind, they’ll say something like “We look for the best candidates, but more than anything want strong students who are a “fit” for our program. To me, this means age isn’t a make-or-break factor.
Should you go for it? It’s a personal decision, but if you feel passionate about it (as you said), I think you should take that feeling very seriously. Strong clinical experiences will help you, so make sure you have or get some good health care experience. We have a section on that at Inside PA Training, so be sure to check that out.
if you think it’s a long shot, maybe hedging your bets would be wise. You could take your prereqs, get a job somewhere in the medical field that interests you, and apply. If you don’t get in or change your mind, you’ll have learned plenty that will come in handy in another “wing” of the medical field.
I urge you to think creatively about this new interest. Being a “nontraditional student” usually means using some “nontraditional” thinking/strategy to make it happen.
I hope this helps - be sure to get active on the forum where you can get the thoughts of others too.
SUCCESS.
Paul
Hey Paul,
I just wanted to back you since I came across this site right now and read all of the comments. In no way did you ever even mention doctors in your #2 reason (your interest in medicine is more about the science than about caring for patients). In fact, you could have been actually pointing out without saying it, that both PAs and doctors and nurses (clinical medical fields) all have a broader focus on a patient. Instead it seems that a few doctors on here took it the opposite direction (argumentative and unproductive) and felt that you were indirectly saying that PAs have a broad focus on patients while doctors do not. That is just ridiculous! It was never even said!! What is wrong with people who always try to see the bad in a great and helpful posting like this? This was a short and sweet and to the point posting, from an obviously educated person who was in no way trying to talk about how MDs don’t care about their patients as much. I commend you for letting your words speak for themselves and others can just read the post over if they cannot critically think and comprehend this simple post.
I tend to agree that there was not a clear implication that MDs are focused on the science and care less about the patient. My dad’s an MD and I love him very much, but there are plenty of docs I’ve been to that have very poor bedside manner.
I work in the software industry and have considered going back for a PA and it did not occur to me that #2 was directed at MDs. I can see their perspective but it seems a little self-centered to assume that someone’s comment is aimed solely at you.
Hello! well I am writing because I have been looking for info about PA for long time but still undecided and I need feedback from those who are the Masters in the field like Paul :). I am between bioengineering or medicine since childhood I wanted to become a surgeon specializing in Pediatrics Cardiologist, then life changed for me I became a Paralegal and wanted go into Law School but realized that law is pretty in books and not so about justice. The thing is that I started engineering but I no like so much math but I love science and research I wish become surgeon but I cant stand vomits lol but I can stand blood. Is weird but that a fact when I see someone vomiting or nausea or even doing those noises with the nose my stomach become totally disaster 😀 what u advise to me is that normal for MD or PA students? Will that go away over the time? or i just simply try to get into another field.
TC and I love this blog
Nice compliments - thanks!
I think if you can make it through your training (in which you will need to have some of those experiences), you will be fine. You can choose a specialty that avoids those things, such as psychiatry, endocrinology, medical cardiology (non-surgical), or one of many others. The not liking math thing could be tough, but I will say there isn’t really any advanced math in the PA field - only basic math and understanding mathematical concepts, such as logarithms.
There are plenty of medical students with similar issues. I recommend for truly fun reading and reassurance about how to handle this that you check out an amazing book called The House of God by Samuel Shem. I did an article on it a while back, which you can get to by clicking the link in this reply. Good luck! P
I am a graduate nurse and can’t wait to enroll as a PA student. Am really enjoying the forum
Thanks for this article. I already work in the health care field as a Registered Dietitian, but I want to do more than just counsel people on diet, food, and weight loss. I am currently praying about a career change: probably either PA or med school or a professor or something. I just love medicine, how the body works, diseases progress, and just KNOWING things. But I can’t decide which one: I like having knowledge and the “delving deeply into the scientific underpinnings of medicine” that being a physician would supply. But you don’t use that information everyday to explain to the patients, so it just slips away. But I also like explaining to people about what is going on inside of their body, so as a PA, I would study the information and be able to do some education.
And I do love people and helping them by solving their problems, but after reading your comment about “Your interest in medicine is more about the science than about caring for patients”… I was a little worried. And this probably sounds cold-hearted but what would be a career in which I just learn all the medical stuff and retain it, not patient-focused? A professor of A&P or Biochemistry or something? An epidemiologist? Thanks for your help.
Yes, I think those are good guesses. Or as a physician in a NPC (non-patient care) specialty, such as radiology, pathology, etc.