As a college student, deciding which avenue of medicine to pursue can be confusing. Many students struggle to determine if they want to go the MD/DO route or the PA route. Both allow for working with patients and delivering quality care, but there are important differences to consider when deciding which career path is right for you.

Autonomy

Although PAs and physicians are both trained to practice medicine (including examining, diagnosing, and treating patients), a primary differentiating factor is the degree of autonomy with which they practice medicine.

The role of a PA was designed in the 1960s when the primary care physician shortage was recognized. PAs became a brilliant solution to the physician shortage.  Duke University Medical Center created the first PA class made of Navy men who had completed some medical training during their time in the military. The layout of the curriculum prioritized “fast-track” training to enable these PAs to learn what was needed to practice primary care.

PAs practice under the guidance of the physician and will either work alongside the physician or will consult the physician on more complex cases. PAs most commonly work in primary care, conducting physicals, doing general procedures, and treating more common illnesses. State and local laws govern a PA’s autonomy meaning the scope by which they practice varies from state to state, whereas a physician has no oversight and can practice medicine anywhere. A majority of the time, a physician will have to review and sign off on the PA’s patient cases.

Now we see physicians and PAs collaborating to allow for the caseload to be spread among more practitioners.

Education Paths

There are also different academic requirements for each of these careers. To become an MD/DO, you study a premed curriculum in college and are required to sit for the Medical College Admissions Test (MCAT) prior to applying for medical school. Medical school is 4 years long, with the first 2 years consisting mostly of didactics and lectures, and the later 2 years focusing on clinical experience. Over the course of medical school, students must take 3 national medical board exams. After graduating from medical school and earning an MD/DO degree, physicians complete a 3-7 year post-graduate residency training program to practice a specific specialty. During this time, physicians complete additional national medical board exams. Physicians are recognized internationally once receiving their medical licenses.

To become a PA, you must complete a minimum of 2 years of college biological and behavioral sciences. Many undergraduate colleges now have a pre-PA track. Much like applying for medical school, there are pre-requisite undergraduate science courses required, including chemistry, physiology, anatomy, microbiology, and biology. Additionally, you are required to sit for the Graduate Record Examination (GRE) prior to applying for PA school. PA school is a 2-3 year program. The first half of that time is spent in didactics and lectures and the latter half focuses on clinical experience and training. Clinical training emphasizes exposure to primary care fields, such as ambulatory clinics, physician offices, and care facilities. After completing their program and passing their Physician’s Assistant National Certifying Examination (PANCE), PAs get their license to practice in the United States and may begin practicing medicine. Here there’s lots of on-the-job training. Additionally, PAs must maintain their national certification. This is achieved by completing 100 hours of continuing medical education (CME) credits every two years and passing the Physician Assistant National Re-certifying Exam (PANRE), every 10 years.

Both programs require medical shadowing experience, patient contact hours, volunteer hours, and extracurricular activities to be competitive. Traditionally, medical schools require higher GPAs for acceptance than PA schools. The average accepted medical student GPA in 2019 was a 3.7 compared to that of accepted PA students, a 3.5. However, PA schools have other requirements that medical schools do not have. For instance, they often require several hundred hours of patient contact experience. These contacts can be attained through becoming a medical assistant, EMT, phlebotomist, paramedic, RN, CNA, emergency room/surgical technician. As an oversimplification, physicians go through more extensive training and examinations while PAs have a shorter career path.

Specialization

Specialization is another important consideration when deciding between the physician and physician assistant career path. Medical specialties include internal medicine, family medicine, surgery, pediatrics, psychiatry, obstetrics and gynecology, urology, neurology, emergency medicine, etc. After graduating from medical school, physicians complete a 3-7 year residency in a specialty of their choosing. These doctors become board certified in their respective specialties and typically practice them for the remainder of their careers. Naturally, this makes committing to a specialty a stressful decision for most medical students. In contrast, PAs do not have to commit to one specialty for their entire career and can bounce between specialties as they please. This has been theorized as a way to mitigate healthcare professional burn out as it allows for variety and flexibility. They do not complete residencies and do not become board certified in a specialty, which allows them to practice medicine more broadly and transition between specialties.

Cost and Salary

Lastly, there is a difference in the cost of education and salaries of both careers. The median annual salary for physicians in the United States is $200,000-$300,000+ while the median annual salary for a PA is $80,000-$120,000.

The average cost of 4 years of medical school is $200,000-$300,000, while the average cost of  2-3 years of PA school is $70,000-$90,000.

Physician demand is increasing with an 8% expected employment growth by 2028. PA demand is even greater and has a projected 31% growth through 2028.

How to Decide

Both careers are very rewarding and allow for interaction with patients and the medical field. Healthcare providers work as a team to ensure quality care to the community. It is important to consider the differences in the career paths and figure out what fits your personal goals. Additionally, reflect on your own character traits and qualities to help you to determine which field is best for you. Most importantly, gaining exposure to both fields through research and shadowing can help determine which route is for you.