To PA or not to PA?
February 26, 2010 7:26 PM   Subscribe

Are you a Physician Assistant? What is awesome about your job? What sucks about it?

If you are not a PA, but for some reason you have intimate knowledge of the profession, feel free to chip in here too.
posted by serazin to Work & Money (7 answers total) 16 users marked this as a favorite
IANAPA, but my mom has been a PA for 20 years. My brother just finished PA school last year, so I have a bunch of second-hand knowledge on this.

PA school costs somewhat less than medical school, and since PAs get to start regular jobs right away instead of doing a relatively low-paid, high-stress residency, they tend to carry less debt than new doctors. The initial time & money investment required were a big factor in both my mom's and my brother's decision to become a PA rather than a doctor.

As far as I can tell, the differences between PAs and doctors are: the length of training you have to go through (doctors have to go through residency while PAs do a year of clinical rotations and then jump in), the amount of power you have to make decisions or work in private practice (in most places PAs need to be practicing under the official supervision of an MD), and the money (obviously doctors make more money, although PA compensation does NOT suck -- in NYC the starting pay for PAs right out of school looked to be 70-90k. Adjust down for other locations, obviously).

That said, there are opportunities for PAs in pretty much any branch of medicine you might be interested, and the job market looks to be very favorable. My brother had several offers pending by the time he finished school. PAs are very frequently the face of direct care in a lot of practices -- they see patients for office visits, do rounds at the hospital, handle trauma cases in the ER, etc. In a lot of practices, patients think of the PA as their regular doctor, because that's who they see.

The biggest issue I've seen for the PAs I know is that a PA is not a doctor and will never be one. My mom, for one, has worked under doctors just out of school, who are authorized to override or ignore her care decisions and recommendations despite the fact that she's probably a better diagnostician, given her experience, than they are. This has been pretty frustrating for her. No matter how much they know, PAs will always be lower in the pecking order.

There has been talk of creating a path for experienced PAs, who have studied and already know most of the material covered in medical school and have already worked in a number of clinical settings, to become MDs, but this would be a threat to the medical establishment, and I don't know if it would ever happen.
posted by mneekadon at 6:07 AM on February 27, 2010

Think of the physician's perspective for a second. Physicians hire physician assistants to do the kind of work that physicians do not want to do. Outside of primary care, PAs are hired to handle administrative work and participate in patient care when it is inconvenient for physicians (for example, seeing patients in clinic while the surgeon is in the OR). If you are fine with handling the mundane stuff, a PA career can be quite rewarding. Also, having worked with a number of PAs I can tell you that the difference between the knowledge of a PA and a physician is breadth. After a few years on the job PAs become quite good at what they do, but unfortunately they lack the breadth and insight from other fields that physicians have. Of course, this statement applies only to the average and there are always outliers (in case someone feels the need to counter this with an anecdote of an outstanding PA or horrible physician).
posted by Brennus at 7:55 AM on February 27, 2010 [1 favorite]

I'll give you a patient's anecdote. When I was active duty, my primary care physician was actually a PA. Unless you look or ask, most times soldiers have no idea who's helping us. Sometimes I was seen by a simple medic. But it took me 4 years active duty before I realized that the only doctor on the floor was in his office doing who-know's-what. I'm not hating on doctors, I know several and respect their profession. I also understand that this Colonel was supervising 20 PAs/Nurses and all of THEIR patients. But now that I'm a reservist and I have to use civilian doctors, I get pissed that I get charged for a 'Doctor's Visit' but never really need to see one. I sit in the lobby for an hour. I often ask for the PA so I can be in and out.

Another story: A year after I got off active duty, I went into a diabetic coma for 3 days. I did 10 days in the hospital after that. I only saw my Doctor 10 times, 3 minutes each time. I doubt he even knew my name, and I'd been at his practice for nearly a year. He came by once a day, every morning to read my blood sugar from the night before. Anyone reading this could have done what he did and it cost me nearly $50k. He put me on a special diet that included orange juice at breakfast and grape juice lunch. I would still be in the hospital now (4 years later) if it weren't for my physician assistant who looked at my diet and realized that my blood sugar was ridiculously high because of all the junk my Doctor ordered. He either checked the wrong box on my meal order or got paid per visit. The PA stepped up and revised my diet and I was out of the hospital 2 days later. Because I had no idea what a PA was at the time, I didn't realize the risk he'd had taken when he contradicted a doctor with 20 years under his belt.

I dumped that doctor and I now specifically ask to see a PA. It's been 4 years, and I haven't needed to see my MD for anything. My wife, also in the service, has only seen a 'DOCTOR' for 2 C-Sections and other lady visits. She's also about to go to school for PA. There's an ARMY scholarship for that program and you only have to accept a 3 year commission afterward.

Do the PA thing. From my nursing friends, I've found that they hate the hospital politics and they hate covering for young doctors. A close friend - PA in pediatric oncology - writes me all the time about how young doctors (residents) make bonehead calls and nearly kill children every day. It doesn't seem to matter to them that these nurses and PAs have decades more experience.
posted by Davaal at 8:35 AM on February 27, 2010

(physician here) After reading what you've written, I can only conclude that you already have a really good understanding of what the positives and negatives are to becoming a PA... I'm not sure what I can add except to say it seems like a great job and one that many residents are quite jealous of. I don't think most specialist attendings are jealous of PAs though, so that probably tells you something (primary care folks probably are though because PAs essentially get to do their work for comparable pay without going through all the pain that you cite). So I think if you want to go into primary care, being a PA could be a great choice! If you want to specialize, there are tons of opportunities for jobs that are really interesting, and I would still recommend it as a career path to anyone, but doing 7 or 8 years of painful med school and residency just might be worth it to be an attending for 30 years. Not sure yet. Ask me after I've been an attending for 30 years :-)

I always recommend trying shadowing in an academic setting to people who tell me they want to go to med school (most prospectives are not smart enough to even consider being a PA, I know I never had a clue about it!). You should try shadowing a bunch of different types of PAs or physicians and see what their life is like. If you really like neurosurgery, it seems like the neurosurgery PAs get to do all kinds of pretty awesome things and they didn't have to do the extremely long and painful neurosurg residency!! For me though, I am in emergency medicine and I wouldn't be happy as a PA because they are relegated mainly to urgent care, whereas I love being in the thick of central lines, intubations, etc. Plus, it sure is nice to be able to introduce yourself and be addressed as doctor, even despite the erosion of trust and respect these days. I get warm fuzzies from it, but maybe that's just my ego trip... I love it when the patient says to me "I want to talk to the doctor!" (I don't look like a doctor, apparently, because I am young) and I kindly but firmly say, "I AM the doctor and this is what the deal is." Or when they say "you are the doctor, I will do whatever you think is right." It's a heady responsibility. I have a healthy fear of it but I enjoy it. You just have to see what it's like and how you feel when you try it.
posted by treehorn+bunny at 8:44 AM on February 27, 2010

p.s. to Davaal - I am just finishing up residency, and yes, physicians in training can get into trouble if they don't listen to experienced nurses or midlevels. In fact, everyone can make mistakes, and that is why the team approach we take in academic medicine works. A lot of residents in fact do ask experienced nurses and midlevels for their thoughts on patient care and follow their suggestions on what to do. Especially in my intern year, I would have been sunk if not for the advice of my nurses. But it is important to recognize that nurses and midlevels can make mistakes too and nearly kill children (key example: when nurses draw up the wrong drug or wrong dose of a drug). We all have to help each other out to recognize mistakes. The biggest issue I've seen is probably that the nurses and midlevels tend to be great in their specific field of experience, but don't have as much knowledge outside that comfort zone. Also, they tend to adhere strictly to protocols for care, and they may know those protocols cold and get things right 90% of the time by using algorithms etc, but it is also important to know when you need to go outside the protocol and do what's right for a particular patient.
posted by treehorn+bunny at 8:55 AM on February 27, 2010

One of my best friends finished PA school about 2 years ago and is working in a prison infirmary now.

Someone upthread said to scale down salary from NYC, but she makes $40/hour now, or 83k/year, and we live in mid-Michigan. I believe her debt from two years of PA school is about $125,000. Because she works in a prison (an underserved population) she is getting loan relief funds that will completely pay off her loans if she stays for, I think, four years.

She likes to have a lot of autonomy, which is one reason she likes working in the prison. When she decided last year to leave the hospital where she was working overnights, she interviewed at a cushy suburban clinic and was tempted, but thought she would chafe at the higher level of supervision. At the prison, she gets to use her own judgment more and do interesting procedures (she's telling me by IM at this very moment about taking out a metal splinter driven through a patients thumbnail into the flesh underneath yesterday).

It was fairly easy for her to find work right out of school, and to change jobs when she decided to. She felt like she had a lot of interesting options, including ER work. She was about 40 when she started PA school, with one kid already and a pregnant wife, and the shorter time frame of PA school to earning money appealed to her for those reasons. She seems generally happy in her job, though at the hospital suffered under bad management practices.
posted by not that girl at 11:16 AM on February 27, 2010

Hmm, well thanks for the thoughtful replies so far. This will all go into the oven of my brain to bake for a while.
posted by serazin at 6:00 PM on February 27, 2010

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