By Elizabeth LaScala, PhD
While PAs and MDs do similar things in their day-to-day work, there are many differences that may make a PA pathway more suited to certain individuals. Of these many differences, I’ve identified four main factors that will help you decide if a PA program may be a better fit than medical school.
Post-Degree Requirements
After completing your PA program, you’ll need a national certification and a state-issued license in order to practice as a PA.
Certification: First, you’ll need to pass the PA National Certifying Examination (PANCE). This is a five-hour test with 300 multiple-choice questions covering medical and surgical material. If you don’t pass, you can retake the exam once in a 90-day period or three times a year (whichever is fewer) for a maximum of six times within six years of graduating.
State licensure: You’ll then need to apply for licensure. Each state has their own requirements. Many states, including California and New Jersey, require you to be co-signed to a physician who will supervise your work.
Maintenance: To maintain certification, PAs must complete 100 hours of continuing medical education every two years. In addition, they must participate in ongoing certification through either the traditional Physician Assistant National Recertifying Examination (PANRE) or the newer longitudinal assessment option (PANRE-LA).
Hands-on experience
The PA path is ideal for those who appreciate hands-on experience. This is true even during the application process—PA applicants are generally expected to have substantial direct patient care experience before applying. While requirements vary by program, successful applicants often apply with hundreds of hours, and top programs are requiring 1,000 and some even 2,000 hours working in healthcare settings. This emphasis on learning through direct patient care continues throughout PA education and practice. If hands-on experience gives you more satisfaction that learning in an academic setting, the PA path may be for you.
Investment and payout
Becoming an MD is a big investment of your time. MDs complete a 4-year Doctor of Medicine followed by three or more years of medical residency. PAs, however, receive their degrees through a master’s program in two to three years. Once this is complete and they have obtained a license, they can practice as PAs without completing a residency.
Becoming an MD is also a significant financial investment. Depending on the institution, medical students often incur educational costs exceeding $250,000 to $400,000, while PA students may face costs ranging from approximately $80,000 to $150,000. However, the resulting salary for these two degrees is similarly disparate. According to the latest US Bureau of Labor Statistics, the median PA salary was approximately $134,000+ while most MDs earn well above $200,000, with many specialties earning substantially more.
For some applicants, the promised payout makes the investment in medical school worthwhile. Others might prefer to join the workforce as soon as possible, regardless of the pay, or they may balk at the idea of accumulating excessive student debt. This tradeoff is important to factor into your decision.
Preferred work/life mode
The most fundamental difference between the nature of working as an MD versus a PA is independence. While physicians practice independently, PAs practice as part of a healthcare team. State laws vary considerably. Some states still require formal physician supervision, while others have adopted collaborative practice models that provide greater autonomy. Here’s a great interactive guide on PA Scope of Practice Law that gives an overview of how variable state-level laws can be. Regardless of the specific legal framework, PAs and physicians typically work closely together in delivering patient care.
How do you feel about being supervised? Is it irritating? Or do you feel more comfortable working closely with someone else to achieve a goal?
Since PAs don’t need to shoulder the burdens associated with independence (like running your private practice), they can opt to work a 40-hour week instead of the 60+ hours many physicians dedicate to their practice. If you place a high value on things outside of your medical career, being a PA is a way to practice medicine with a lower risk of burnout.
Generalist or specialist
MDs and PAs can both work as generalists and specialists. Physicians become specialists by continuing their formal training in a specific medical discipline, like surgery or pediatrics. This usually means completing additional years of training and even completing a specialist residency. These specialties tend to be compensated according to how advanced the skills are and the amount of time taken to train. PAs can also specialize by practicing and training under a specialist. Because this training takes place on the job, PAs are unlikely to see that same jump in compensation. However, since it isn’t as costly or time consuming for a PA to specialize, it’s easier to shift to a new specialty. The amount of time and effort MDs spend on their specialties locks them into their chosen niche more tightly.
See also my article on Planning Your Physician Assistant (PA) Application.
Post-Degree Requirements
After completing your PA program, you’ll need a national certification and a state-issued license in order to practice as a PA.
Certification: First, you’ll need to pass the PA National Certifying Examination (PANCE). This is a five-hour test with 300 multiple-choice questions covering medical and surgical material. If you don’t pass, you can retake the exam once in a 90-day period or three times a year (whichever is fewer) for a maximum of six times within six years of graduating.
State licensure: You’ll then need to apply for licensure. Each state has their own requirements. Many states, including California and New Jersey, require you to be co-signed to a physician who will supervise your work.
Maintenance: To maintain certification, PAs must complete 100 hours of continuing medical education every two years. In addition, they must participate in ongoing certification through either the traditional Physician Assistant National Recertifying Examination (PANRE) or the newer longitudinal assessment option (PANRE-LA).
