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

Tim Lutz wrote:

there is no 'try'

Love ya, buddy.

Scott O wrote:

Medicine is also incredibly rewarding, and now that I am on the other side of residency, I wouldn't trade what I do for just about anything. I love my job. I personally would not have career satisfaction from being a PA. I just wouldn't. I crave the responsibility for decisions, and at the end of the day I couldn't spend a career answering to someone else for every patient encounter. I wanted to be the best at what I do professionally. 

Scott O completely nails it.  I also feel that the challenge and satisfaction in practicing medicine comes from the decision making.  The desire for autonomy has driven me to practice in very remote and austere environments.  So if you want to be "the decider" then go to med school.  If that sounds like you then your choice is already made.  If that doesn't matter too much I think no other job matches the flexibility of nursing.  If you really just want a more stable dirtbag climbing life nursing is probably the best way to go, and it's faster and cheaper.

I took 5 years off before med school and am halfway through third year right now. I was a ski patroller and am pursuing an emergency medicine residency. Despite the fact that I'm on my surgery clerkship right now and have been covered with poo two mornings in a row, I'm still very stoked about medicine.

I can only speak to med school and not residency, but I've climbed outside at least once a week during med school, usually more often (and I live in Boston--so the climate and geography are not easy). Some of my classmates have found it all-consuming, but if you prioritize work/life balance it's not too much of a challenge. You get lots of vacation. This spring, I went to Yosemite for a week. This winter, I'm going to EPC for a week and then skiing for another. I'll get another trip in April and then a couple of months off during fourth year. Most residency programs give you four weeks of vacation, so although you're worked to the bone, you still get twice as much as the average American. Anesthesiologists can get 8 weeks of vacation a year. Hospitalists often are 2 weeks on/2 weeks off. 

My advice is to take a few years off and make sure it's something you really want to do--and then make the MD/PA/APRN decision. Most people I know who are burned out (either as med students or physicians) went straight through.

Tim Lutz wrote:

there is no 'try'

There is too, "try". For those of us who dream in color.

;-)

caesar.salad wrote:

I was totally into medicine until about half way into medical school.

So did you finish med school and practices medicine right now? Otherwise, this thread is full of survival bias.

I did finish. I have an MD. I didn't go to residency and I don't practice medicine. However, you spend the second two years of medical school in the hospital working as a student doctor. The first two years of medical school are class work and studying. I was fine with that part. I enjoy the study of medicine very much. In fact I work now part time as a researcher and writer. The second two years ... actually took me three and a half years because I hated it and took a few months off and had to repeat some rotations. I finished because I had no exit. I felt really trapped. I didn't want to drop out half way through and be in the hole a ton of money with nothing to show for it. So I finished and now I have an MD and am in the hole a ton of money ×2. But to answer the core of your question, I don't work as a doctor but I spent a TON of time 60 to 80 hours a week working as a practice of doctor and that's my background.

Internal Medicine resident here - the only thing I'd add is that as an MD, your specialty contributes immensely to the the difficulty and length of training, as well as the expected schedule when you finish.  Plenty of free time if you go into psychiatry - basically none if you hope to be a neurosurgeon. Everything else somewhere in the middle.  Advance practice providers generally don't have as much variation between different fields, and more would come down to where you would end up practicing. 

Thanks again guys! I'm digging the feedback. I should add that I am partial to the EP route (although I admittedly lack exposure in other fields). I like the variety of cases and procedures that are run into, and I'm also obviously drawn to the schedule and lifestyle. Although I originally opened the thread vaguely, I feel like I should add that emergency medicine is my most likely route. I currently have little interest in any hyper-specialization or crazy work hours (surgery/trauma).

Is getting an ER gig in a climber friendly area (namely AZ, NV, CO, WA, or the like) actually any more competitive than elsewhere? I'd even be fine with rural, really.

Yes, it is. You fit the EM mold and you certainly won't be the only one applying for positions near the outdoors. 

L L wrote:

Is getting an ER gig in a climber friendly area (namely AZ, NV, CO, WA, or the like) actually any more competitive than elsewhere? I'd even be fine with rural, really.

Yes. There was a time when there were more open ER positions in CO, but that time has passed. 

Just don't get too much student loan debt- or any. You're welcome. Good luck!

My buddy I was telling you about from Phoenix just got hired outside of Denver and is moving his family next year. He didn't mention it being very difficult. I'm sure locking down a residency or acceptance to med school in those areas are more difficult, but once you are an attending I think you can pretty much go wherever for the most part.

you can get a job in a desired location...in general pay may be lower and jobs are more competitive. If you are looking for a particular type of group, hours, specific shifts etc...its harder to negotiate the contract. Jobs in EM are still easy to get.

Hey man, second year DO orthopedic surgery resident here. PA vs physician is a tought choice for sure, upsides and downsides to both. If you're purely looking for climbing lifestyle, PA may be the better choice. I know some ortho PAs who hold retractors in the OR and round on patients four days a week, no call, and make >100k/year, it's pretty nice. 

However, I am 100% happy that I chose the med school route versus PA. I would go insane being in a PA role for the rest of my career, basically doing a lot of the shitty busy work for the surgeons, definitely hitting a ceiling as far as autonomy, knowledge, skill, and income.  There is something to be said for the professional autonomy and knowledge base that comes along with being the doctor. My job is amazing, and I truly love what I do. I don't climb a lot these days, but that's more because I have a family. If I was a single resident, I would probably climb a decent amount. 

Either way, it's not a big deal. My priorities have shifted in life. I love being a dad and a doctor, even thought it means I don't climb a lot. I know that one day when I'm done with residency and the kids are in school, I'll have plenty of time to climb again.  Orthopedic surgery attendings have pretty awesome lifestyles. In the meantime, I still camp with the fam and go hiking and trail running a good bit, so still get some good outdoor time. 

The thing is, learning how to operate is sort of like climbing in that it's a cool, fun, and satisfying skill that you can constantly improve upon. It feels awesome to get better at the technical skills and learn more about how to manage orthopedic conditions, sort of addicting like climbing. On top of that, the things you do genuinely help people, and, with surgery at least, you get instant gratification. For example, last weekend I cut a dude's leg off who was in septic shock due to a gangrenous infection of his leg. He is now out of the ICU, recovering from very close to death, we literally saved his life. It feels pretty neat to do shit like that, and I'm happy to give up climbing time to get to do it! I hammered a nail into someone's shattered femur who was hit by a car the other day, a super fun procedure to do and this person went from totally fucked up and bedbound to walking the next day after surgery! Every day is cool stuff. The fact that I'll make an epic income after residency is an added bonus to it all that I also look forward to. 

Don't get me wrong, medical training is seriously brutal, definitely not for everyone. I'm on my 18th day straight of 16 hour days. It's long hours, lots of stress because you can easily kill someone, there's super high expectations of you, a lot of technical information to know,  sad and disturbing stuff you see everyday, and not a lot of sleep.  It's all good though because I love what I do and I play hard on my free time. Also, there are some more chill times in med school and residency where the schedule is pretty reasonable. 

If you don't want such a brutal residency you can do family med, psych, PM&R, or derm to have a chill residency lifestyle. PA is cool for some, but for me I just would not be satisfied with it and would always wish I just went to med school. 

Even though shit is hard right now, I would not change my choices. Good luck man. 

It is possible to kill it as a PA. 

Counter to some of the comments that PAs just do scutt or shit work is really not entirely true. At some institutions there is a culture that PAs won't get to do much, which I wouldn't work at. I'm not a doc and don't ever claim to be one, but why would any PA stay at a place that has little confidence in my ability to save lives and promote health and wellness? I wouldn't. Those institutions that keep retaining that type of culture will continue to have high turnover.

I actively participate in level 1 to 5 triaged patients (some times mass casualty) either running the medical management or slotting into a first assist. I go between primary care, hospitalist, emed and surgery. I work at an institution that correctly applies a health care as a team model, and can practice at the top of my scope if needed. The PA role is more about finding a great place to work and expand your skillset working with the MD/DO. And, I make bank, great benefits, and can get out and practice remotely in wilderness. 

PA school sucks anywhere. Your life is over for a few years; it's medical school on steroids but without the residency. 

Tim Lutz wrote:

#problemsoftheprivledged

While I do sympathize with a few of your comments from a social justice perspective, your intervention here in this context still reads like a kind of subconscious guilt-ridden projection.

As others mentionned, having the freedom to decide to gear your life mostly from the perspective of a hobby is a first world problem. True that choosing between MD & PA is more first-world than most job in said first world, but you're still part of that. You should probably explore that fact and learn to deal with it....

Hey LL,

I'm a 4th year medical student. I was able to climb the most in the pre-clinical years. The first two years are a lot of cyclical book learning, test-taking, on hyperspeed. The great thing is, is that most campuses have recorded lectures and I would use that to my climbing benefit. This meant I easily got 4-day weekends whenever I wanted, the 3 other days being all day labs (doctoring/anatomy/pathology etc) which I had to be present for. However, there is the constant stress of being responsible for a lot of information, so it took careful pacing of my work allow for an epic trip. This is all easier said than done, but the possibility is there. Climbing kept me sane honestly. I climbed outdoors once a month (many planned trips cancelled due to weather). I was able to make it to the climbing gym 3-4x a week.

Once I started rotations/clinical years/last 2 years, I was on my feet trying to not be an idiot every month where I switched specialties and started with 0 practical skills over and over again. My time was no longer my own, and it was much harder to break away or find the energy to climb. However, "easier" rotations such as outpatient Family Med, Psyc, Peds left me with energy to be a weekend warrior. Boards are another monstrosity. Timing became depressing because summers of my 2nd and 3rd year was pretty much board studying time. I missed a lot of the prime climbing season the last 2 years. My partner would be out climbing the nose and sending epicness and I was atrophying - sitting in the same position studying like my life depended on it for 1-3 mo.

All in all, I could be a stronger climber, I could have had more adventures, but I think I've kept up my climbing/training at a level which I'm happy at through medical school! 

I'm about to start residency next year in Ob/Gyn. I've been told it's going to be the hardest thing I've ever done. I'm praying I'll match within 3hrs of mountains. EM was always on the backburner because I always found them to be "my people" with flexible schedules and NO CALL. Given your background as an EMT and desire to climb throughout the career you choose, I think it makes sense to do EM. If you're traveling, it's also easy to moonlight as an EM doc, esp in underserved rural areas.

Like many other physicians have said, I chose to medical school instead of other mid-level school because I wanted to make the diagnosis, decisions, consultations of my patients at all levels of acuity.  For me, it is extremely rewarding and humbling to take on that ultimate responsibility.

Medical School/Residency asks a lot of you. It'll change you. For your 7-10 years of training, medicine is going to be #1. There will be low points where you'll feel so ground down that you start wondering why you even decided to do this. After training though, find a way to practice that takes into account where you want to invest your time. I know a EM doc who works only half time, the other half at an accordion shop, keeps up climbing and spearfishing. So there's that. Best of luck to you. Feel free to PM me if you have more questions.

L L wrote:

Is getting an ER gig in a climber friendly area (namely AZ, NV, CO, WA, or the like) actually any more competitive than elsewhere? I'd even be fine with rural, really.

Yes and no. I can think of several exceptional climbing regions with good EM groups that are currently hiring. It just depends on the area. Some places are going to be very competitive, but that has less to do with the climbing than the town. Friends of mine had a hard time getting responses in Bend and Boulder, but outside of that you have a ton of opportunities near climbing. I do rural EM in Alaska, and if you're willing to work in a rural hospital, your job opportunities are pretty much endless as an EM-trained physician. Not to mention that as an emergency physician, I'm regularly getting solicited to go work in New Zealand, where I hear there's pretty good climbing. 

Buff Johnson wrote:

it's medical school on steroids  

No it isn't. 

Scott O wrote:

No it isn't.

I'm sure Buff wasn't trying to minimize the academic challenges of med school, only that the classroom semesters in PA school are generally longer days than med school.  8 AM to 5 PM every day five days a week for three or four semesters.  You will develop an iron ass sitting in class all day.  And since classes are smaller there tend to be fewer opportunities for sharing notes or online lectures.  The classes are not harder than med school, but even with excellent time management skills you won't be climbing or skiing as much in PA school as you might in the first couple years of med school.  During clinical years it's a wash and it comes down to how much sleep you require.  But after that, as a PA, you're done.  As an intern/resident, your hardships are just beginning.  

But I don't know any PAs who "make bank" and have a lifestyle that allows any level of climbing fitness.  Those jobs are like unicorns, just more rare.