Lifestyle choice: PA vs. DO/MD as a Climber!

Dan Evans wrote:

I encountered a similar dilemma last year after initially pursuing a BSN upon leaving the military after 8 years. I was worried because I was starting school at the age of 28 and did not want to waste "the good years." An EM physician from my state messaged me on MP after seeing my post, and actually got me a job as an ED scribe in a level I trauma center here in Phoenix. Since climbing with him and talking with other doctors at my work, I decided to make the switch to medicine and haven't looked back.

From my experience working there though, presumably like yours, the PA's and NP's I've worked with seem happy with their decision, however, they are only able to see 3's and lesser acuity patients. I haven't heard one EM doctor tell me they regret their decision and they make ~400k/year for 30 hrs/week. No on-call. No pagers. The RN's appear to be miserable and I can't say that I blame them. 

Personally, I am pursuing emergency medicine because I genuinely love the field (particularly the trauma aspect) and can't see myself doing anything else. As such, I want the autonomy of an MD with higher acuity patients. That was ultimately the impetus for me to make the switch. I think you need to ask yourself why you are pursuing the field of medicine, and you will likely answer your own question. If you are content seeing and treating lower acuity patients in most healthcare settings (obviously some exceptions to this), then PA is likely a good route for you. I will graduate medical school when I'm 35, and receive my first real paycheck at 39 if all goes according to plan. In the long run though, I will never have the question of "what if" looming over me. Getting a doctorates degree also gives you flexibility later on in life if you want to start teaching. Just think about what you want in life, and then decide. But just make sure you think of the long term and don't let yourself get scared into settling for something less.

Solid advice brother, that I'll certainly take into consideration! From what I keep reading it, it sounds like the midlevels at my location have a somewhat atypical ER role. Every ESI 1 or 2, most 3's that we see is assigned to a midlevel (NP or PA) or resident and an attending (obviously). Some 3's and virtually all 4's and 5's are seen by a PA or NP only. So they're able to help with higher acuity patients in addition to the fast track patients, which appeals to me. As you said though, I don't really think this is the norm.

caesar.salad wrote:

No, this isn't public service loan forgiveness. That's a different program and they are not mutually exclusive. But that is true that you do have to pay taxes on the part of the principle that is forgiven. I'm fine with that. I was the one who chose to attend medical school and take out loans. I don't find that unreasonable.

I never said it was the same program. Just highlighting that people in a somewhat similar situation, who played by the rules, are already being denighed. 

It will be interesting to see how this all plays out over the next couple decades. The subprime mortgage crisis was in the neighborhood of 2 trillion dollars, student loan debt is up around 1.4 with about 1T in federal hands. 

When housing value went tits and foreclosures spread like wild fire, the houses at least had some value still. Student debt doesn't have this collateral.

Daniel Hamilton wrote:

Student debt doesn't have this collateral.

No collateral, but they can claw some it back through a lifetime of servitude.

Dave Kos wrote:

No collateral, but they can claw some it back through a lifetime of servitude.

Makes a guy wonder if that wasn't the plan all along.

Mason Stone wrote:

+1 LL,

Young as you are go MD, you can become a nurse or PA later or reduce your workload to mimic the schedule. You can teach later if you want to do something different and have time to climb. Once you hit 40 it becomes harder to get into a program and have the stamina to finish, it can/has been done but its not easy. Realize climbing will always be something you can do and get better at but an academic education can only be had optimally under certain conditions. What I mean is, attrition is higher with age. How you feel now will be different in a few years.

Always remember, the clock is ticking, choose sooner rather than later and enjoy the time life grants you whatever you take upon yourself to do.

I could not disagree more with almost every sentence in this post.

I'm always amazed at all these healthcare professionals who complain about how miserable they are on the internet, make 120k+ and work less than 50 hours a week. Meanwhile I see lots of incredibly talented engineers only break 6 figures if they consistently log 20+ hours of OT each week. 

Usually those healthcare professionals that complain are the first to list all the reasons why universal healthcare would be terrible.

Sandbagger Vance wrote:

I'm always amazed at all these healthcare professionals who complain about how miserable they are on the internet, make 120k+ and work less than 50 hours a week. Meanwhile I see lots of incredibly talented engineers only break 6 figures if they consistently log 20+ hours of OT each week. 

Usually those healthcare professionals that complain are the first to list all the reasons why universal healthcare would be terrible.

"Healthcare professionals" captures and immense and diverse group of different professions. I suggest you try to be more specific.

Sandbagger Vance wrote:

Meanwhile I see lots of incredibly talented engineers only break 6 figures if they consistently log 20+ hours of OT each week. 

I guess it depends on the engineering field. Certainly in software engineering (insert how software engineering isn't actually engineering), plenty people make 6 figures w/o putting in OT once they've had enough work experience. Regardless, you are comparing people being able to enter the work force w/ a decent salary right out of college to racking tons of debt post college going thru MD+residency before making real money.

caesar.salad wrote:

"Healthcare professionals" captures and immense and diverse group of different professions. I suggest you try to be more specific.

I define it as anyone who receives money from qualified HSA expenditures, "qualified medical expenditures" as defined on IRS form 8889.

Sandbagger Vance wrote:

I'm always amazed at all these healthcare professionals who complain about how miserable they are on the internet, make 120k+ and work less than 50 hours a week. Meanwhile I see lots of incredibly talented engineers only break 6 figures if they consistently log 20+ hours of OT each week. 

Usually those healthcare professionals that complain are the first to list all the reasons why universal healthcare would be terrible.

Because at the end of the day, one career deals with peoples' lives and the other deals with either makin money or spending money for a rich person/corporation... And I don't know where you grew up, but where i grew up, in the suburbs, everyone ever was told to or actually went to university to become an engineer because you're "guaranteed" a great job. 

Most of my engineering friends are miserable, because, go figure, planning your life around a career you don't really enjoy sucks. Making 100k a year doesn't really mean anything if ya hate your existence day in and day out.

Most health care workers I know that hate it, hate working in a massively broken system that requires a pretty great deal of emotional attachment.

Having known a handful of MD's and PA's, and from what I've read here, it sounds like a PA is the better choice (especially if climbing is a high priority). 

-Less school 

-Less loans

-More flexible schedule

-Still a good living 

My mom was a nurse for 30 years and then became an APRN and loved it, also a route to think about.

From my own experience, you'll want to be able to climb while getting a degree and starting your career as well.  Going for the MD may hinder that. 

Anthony Lubetski wrote:

Because at the end of the day, one career deals with peoples' lives and the other deals with either makin money or spending money for a rich person/corporation... 

Ummm most hospital networks nowadays are for profit, you don't see outpatient care centers opening up in Eastern KY or WV.

Sandbagger Vance wrote:

Ummm most hospital networks nowadays are for profit, you don't see outpatient care centers opening up in Eastern KY or WV.

Yes. Absolutely.  Plenty of my medical worker friends hate it for that reason and say that it's getting much worse to be in the healthcare field... That being said, I'd personally still find most nursing jobs far less soul-sucking than most engineering job. (Of course, I've only worked as an engineer. Debated nursing but ended up in the school system. No money but lots of time off!)

Don't go into medicine at all...be a dirt bag.  Coming from a DO who quit medicine at 40 years old.

I was an ER Doc for 25 years,

Despite all the type 2 fun involved, I still think it's the best job in the world. I never really understood why anybody would do anything else.

I climbed regularly during Med school. With all the gyms and training devices now, there's no reason you can't stay fit during those years.

Had a classmate who went to Everest twice.

Same with residency, at least for ER. Maybe not so much for some of the other specialties. 

Our PAs were exceptional, but they were always employees and never got the toughest cases. 

And all the stuff that makes medicine difficult (unpleasant patients, unpleasant Doctors, stress, hours, etc) - PAs aren't immune to any of that.

TBH, having a family will put more of a crimp in your climbing time than a career in Medicine.

Wow guys! Thanks to everyone who put there words in, I really didn't plan to get this much response. I'll certainly take it all into consideration when I make my final decision. I still feel like if I don't go the med route, there will always be that what if I stuck it out. It's really my biggest hesitation. In the end though, I think it'll all be what I make of it anyway. 

I'll shoot some PM's and ask some more questions locally. 

Thanks again fellas!

Interested in what you decide. I am headed down the PA route myself after a mid life direction change. Not in a program yet, and will be in my 40s when I get out.

Longtime PA here.  Having observed the careers and lifestyles of many PAs and MDs I would have to say "it depends".  First, age.  Med school is certainly less appealing if you are older and/or have a family.  Second, money.  If you do the math, despite school debt being about 50% more for med school you will make many millions more over your career.  In emergency medicine you will make more than twice a PA's salary for what is often less work.  This allows you to pay your larger debt much faster than most PAs can if you live at the same level.  My family members who are MDs take more vacations that cost a lot more than I ever could afford.  They own second homes and their children have vastly improved opportunities.  Being a PA is gratifying but it is blue-collar medicine.  Don't let anyone ever tell you that PAs don't practice medicine.  They just got to it a bit faster with less debt.  Consequently they make less than half of much and in the case of emergency medicine they often work more.  Third, respect.  MDs don't admit to it but no PA gets the respect for the title that MDs are accustomed to.  That is a social reality that is okay with me, but it is real.  But none of that is the primary reason to go into medicine rather than becoming a PA.  The main reason to pursue med school is autonomy.  If you prefer to function with greater autonomy you may find being a PA challenging.  Either way you go you will always be beholden to the business of medicine, Press-Ganey surveys, drug-seekers, and all the rest of the bullshit that can cause burnout.  

As far as climbing is concerned, my friends in med school had far more time to play than anyone at my PA school.  And I know many residents who skied 50+ days a season.  But that all depends on your chosen field.  Don't go into surgery expecting to play.  But if you are a radiologist, anesthesiologist, emergency doc, etc you can find a job to live a comfortable life that won't be your excuse for not sending Freerider or your project at your local crag.  

And finally, always remember, whatever you do you will be better off than 99% of the world, and engaging in a sport that seems frivolous, selfish, and absurd to most of the rest of the folks on the planet.  First world problems indeed.

Tim Lutz wrote:

he is trying to decide between being a 200k a year doctor or a 100k a year PA.  either the 1% or the 2%, and basing it on climbing rocks.

should he get the 2018 Tacoma or a Sprinter to celebrate?!   only MP can help him decide!   can't wait to find out!!!

Right.  Since medical school is free and easy to get into and you won't have to work your ass off for several years to get through it.

I got my MD last year and took a year to travel/climb. Definitely I will not do residency in the U.S. It's the only developed nation where people have to lie to themselves to have the courage to go into a field that is otherwise very noble. Luckily I have EU options so after taking enough time to travel I will likely pursue those.

On a side note, a few weeks ago I met a premed and when I asked him why medicine, he said so he could make 200k a year. What a nice system we have and such great personalities the system attracts.