“For the average person who goes in to see a provider, you’re not going to notice much of a difference whether you’re seeing a physician or a PA”
Affirmed by the president and chair of the Board of Directors of the American Academy of PAs (AAPA), Jonathan Sobel, the statement above illustrates how PAs and MDs play in different positions on the same team. “PAs do the same type of work,” he continues, “it’s very similar to what you’re getting from your physician provider that you can expect to receive from your PA provider.”
However, although they are both highly collaborative roles that have considerable overlap in their duties, they are incredibly distinct.
So, in the debate of PA vs MD, what’s the difference between the two, how do you become one, and which is better?
A physician assistant (PA) is a versatile licensed medical professional educated in the medical model who collaborates with physicians to examine, diagnose, and treat patients.
A Medical Doctor or Doctor of Medicine (MD) is a licensed medical professional who practices allopathic medicine. They receive thorough training in various specialized medical fields, including pediatrics, psychiatry, surgery, and radiology.
PAs, like MDs, are educated in the medical model. Dawn Morton-Rias, president and CEO of the National Commission on Certification of Physician Assistants, states that the “foremost responsibility” of a PA, “like physicians, is to diagnose, treat and manage” patients.
Morton-Rias claims that once licensed, “PAs provide 80 to 90 percent of the services ordinarily provided by physicians.” Indeed, a study conducted by the Annals of Internal Medicine determined that there were no significant variations in the care and treatment of diabetes by PAs and MDs.
However, a distinct difference between the two roles is that PAs are not independent practitioners. Each state regulates the PA scope of practice differently, though all PAs must work under the direct supervision and delegation of an MD.
On the other hand, physicians can perform all of the duties a PAs can, maintain independent medical practices, perform surgeries, and prescribe medications. Unlike PAs, they have full liability over their patients and act as the most responsible provider.
Additionally, when patients have complex cases, other differences between the two careers emerge. Morton-Rias notes that “on the rare occasion where the patient has a very complex or unique situation or condition presenting unusually, then we consult with physicians on care and management of that patient.”
Both MD and PA career routes are incredibly competitive and start with a postgraduate college degree. Good academic grades are essential.
While entry requirements vary between schools, most PA schools desire a 3.5 minimum GPA in non-science classes and a 3.47 minimum GPA in science classes.
Most applicants major in a science-based field as some of the PA school prereqs are fulfilled by the coursework completed within this time. Although not always required for your undergraduate degree, standard classes like physics, statistics, and ethics may be necessary for your preferred PA program.
If these topics aren’t covered in your undergraduate program, additional courses may need to be taken to fulfill these requirements. Thankfully, the dreaded MCAT is optional as most PA schools don’t require it. But, prospective PAs are expected to take the GRE and achieve a minimum score of 310.
One of the unique prerequisites for PA schools is the required 2,000 hours of healthcare experience. Although these hours are not required for some programs, having them makes you an even more competitive applicant. This time spent gaining hands-on experience with patients can be achieved over two to three years of part-time work during your undergraduate degree or one year of full-time employment.
Unfortunately, assisting with ailing family members and shadowing physicians won’t cut it – the school admissions boards are looking for paid healthcare experience. Several fields that are accepted for these 2,000 hours include:
For medical school, more rigorous academic requirements need to be met. A minimum GPA of 3.78 in your non-science classes and 3.64 in your science classes for an overall 3.71 GPA is essential for a competitive application.
Although you can major in any field, certain prereqs need to be met, like some PA programs. The coursework required for many medical schools include:
Though the amount of required healthcare experience for MD school is far lower than the prerequisite for PA school, having as much hands-on exposure to the world of medicine as possible makes you an even more competitive applicant.
In addition to this, while the GRE is optional, prospective MDs have to take the MCAT. Although some medical schools set minimums scores and others don’t, the average MCAT score that most MD applicants achieve is 511.
Though fees depend on the school’s location, the institution itself, and access to in-state tuition, the annual tuition fees of PA programs range from $30,000 to over $120,000.
Medical school, however, costs significantly more, and tuition rates are increasing. Although costs again depend on the school’s location, whether it is a public or private institution, and the availability of in-state tuition, the average tuition fee is $41,000.
PA schooling can take anywhere from twelve months to three years, though most courses range from two to three years to complete. Compared to medical school, PA schooling is more generalized.
The first year aims to provide an individual with a firm grounding in various topics such as medical ethics, clinical medicine, human anatomy, and pharmacology. One advantage of this more generalized curriculum is that studying multiple specialties offers PAs the flexibility to work in more than one specialty during their career.
For MD students, the first two years are spent taking courses such as biochemistry, anatomy, medical ethics, and pharmacology in laboratories and classrooms. Practical skills like examining patients, diagnosing illnesses, and taking medical histories are also gained during this period.
During the later years in both programs, there is a strong focus on clinical rotations completed within hospitals and clinics under experienced medical professionals’ supervision.
PAs spend more than 2,000 hours doing clinical rotations in different areas of medicine, providing them with a broad base of practical knowledge they can take directly into a career. Clinical rotations offer students cross-functional knowledge that can be used when dealing with various emergencies and more general instances in their daily practice.
One secret to thriving during your rotation, says Dr. Bernard Leo Remakes, an MD with 35 years of experience in internal medicine, is to “completely immerse yourself in the rotation as though you planned to specialize in the rotation’s discipline.”
Once PAs have graduated from one of the 267 PA programs accredited by The Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), they can begin their careers. To do so, they must obtain a state license after passing the Physician Assistant National Certifying Exam.
Although there are options to pursue additional training, Ann Marie Strong, a Family Medicine Physician Assistant in Minneapolis, says that “most PAs round out their skills with on-the-job training” instead of undertaking “optional residencies.”
For physicians, however, further education is required. Almost all graduates enter a postgraduate residency training program catering to their preferred specialty, as this is one of the requirements for obtaining a medical license.
These residencies tend to last between three to seven years, depending on the specialty. The National Resident Matching Program’s Main Residency Match, better known as ‘The Match,’ is the most widely used system which allocates medical students a spot in a US residency program.
Once completed, MDs must then pass all three steps of the US Medical Licensing Examination (USMLE) to become board-certified and obtain a state license. Those seeking to pursue a highly specialized area of medicine need to do a fellowship where they closely follow and train with a specialist in their preferred field.
Both professions require periodic recertification and continuing education throughout their careers.
“So you finish medical school, residency, and become a full-fledged practicing doctor. You are ready for a good night’s sleep. Forget about it,” jokes Dr. Alex Roher, a certified anesthetist. “Modern working arrangements,” Roher says, have created “the ‘week of nights,’ where you work four or five and sometimes seven night shifts in a row.”
Although some PAs work more than forty hours per week, they have a relatively balanced work-life balance and somewhat consistent 9-5 work schedule. MDs, on the other hand, often work long, irregular, and overnight hours.
The Physicians Foundation’s Physician Survey found that most physicians work an average of 51.5 hours a week, with almost 1 in 4 working 61-80 hour weeks. Additionally, both professionals can be on-call, meaning they must respond to work queries and emergencies with little notice.
Unfortunately, both careers can be physically and emotionally demanding. Dr. Arun Saini, an assistant professor in the Division of Critical Care Medicine at the University of Tennessee Health Science Center, states that “dissatisfaction, depression, and burnout are common in physicians.” One Medscape survey reported that 42% of a sample of 115,000 physicians in 29 specialties experienced high-stress levels and burnout.
For PAs, this figure stands at a slightly lower 32.6%, according to the AAPA. “Typically, the PA lifestyle — it’s a little less stressful because there’s a little less responsibility involved, less schooling obviously,” says Joshua Johnson, a PA-based in Hawaii who focuses on orthopedic surgery.
PAs are one of the fastest-growing professions in the country; the Bureau of Labor Statistics (BLS) estimates that in the next ten years, the number of PAs is expected to increase from 118,800 to 155,700, approximately 31%.
The demand for PAs is so high that, upon graduation, three-quarters of graduates receive multiple job offers. While not as high as the demand for PAs, the overall need for physicians and surgeons is anticipated to grow by 4% in the next ten years, with certain specialties like psychiatry projected to expand by 12%.
“Once you have your PA license, that basically affords you an opportunity to work in any medical specialty” says Chris Hanifin, academic chair of the department of physician assistant at Seton Hall University.
Having this level of professional mid-career flexibility, Hanifin continues, means that “a physician assistant can go from working in internal medicine to obstetrics and gynecology without getting additional training.” Indeed, data from four decades analyzed by the AAPA indicates that 49% of PAs changed their specialty at least once throughout their time practicing.
However, while physicians have more opportunities to specialize during their training, changing specialties once they begin practicing is challenging.
Few doctors opt for this route as the cost and time of the retraining required and the likelihood of the need to do another specialized residency are enormous. “Once medical school graduates complete residency — and sometimes additional training — in a specialty, switching to another form of medicine could require another few years of training,” Hanifin concludes.
While physicians don’t have the same mid-career flexibility PAs do, their education and postgraduate residency specialization mean that they can work independently and run their businesses.
Salaries for both professions depend on several factors, including their specialization, the location of their practice, and whether they work in a private practice, hospital, or clinic. The BLS reports that PAs earn an average annual salary of $108,610.
On the other hand, MDs generally earn higher wages than PAs; the BLS has stated that the median salary of MDs was more significant than or equal to $208,000. According to the BLS, most MDs are family and general doctors who earn an average wage of $211,780.
The wages of MDs, in particular, are dependent upon their specialization; the average annual salaries for anesthesiologists, surgeons, and psychiatrists are $261,730, $252,040, and $220,430, respectively. However, one annual survey found that plastic surgeons can earn over $500,000 in one year alone.
The main factors that influence a student’s “decision to attend PA school,” Hanifin says, are the ability to begin a career more quickly combined with the length of PA programs and the smaller debt burden.
Echoing this sentiment, Dr. Will Kirby, a dermatologist and the chief medical officer for the LaserAway aesthetic dermatology group, argues that this mid-career flexibility is an advantage of being a PA instead of a MD. If your work-life balance needs a change, Kirby states, “a PA who starts out in a kinetic field in his or her early 20s, like emergency medicine, for example, may decide that they want to start a family and that a slower-paced, more predictable field suits them better in their early 30s and can transition over to dermatology with very little effort.”
On the other hand, becoming an MD has its advantages. If money is a motivating factor, MDs generally receive higher annual wages than PAs, primarily if you pursue a lucrative specialty like plastic surgery.
For Dr. Strong, her love and enjoyment of the “science of medicine” led her to “the more in-depth training of medical school and residency.” Additionally, the varied, dynamic, and autonomous nature of a career as an MD is a handsome prospect. Unlike PAs, who are not independent practitioners, MDs can work independently, run their own practices, and receive a higher degree of financial compensation while doing it.
Dr. Sylvie Stacy, a Bessemer-based Preventive Medicine Physician, also says that MDs have a more comprehensive range of work options. “Especially in medical or healthcare-related, non-clinical jobs, such as working for a pharmaceutical company or health insurance company” and “organizations looking for medical leadership,” she continues, MDs are highly sought after.
Ultimately, those who are deciding between pursuing either career, Sobel suggests, “should consider shadowing both types of healthcare providers” and speak with those who are in each profession.
The combination of asking professional real-time questions and having hands-on experiences with both careers will uncover how “the pros and cons of each profession will resonate differently with every individual,” Sobel concludes.
In short, no. Currently, there are no PA programs that require you to take the MCAT specifically. However, most PA schools do ask you to take the GRE instead.
Like MDs, PAs work in various healthcare settings, including nursing homes, community health centers, medical offices, hospitals, educational facilities, workplace clinics, correctional institutions, and retail clinics. Additionally, PAs work for federal government agencies and services in the military.
Yes, although the road to becoming a licensed MD is a long one, especially after completing your PA training. However, it is not impossible. You’ll need to attend, and fund your way through four years of medical school, a postgraduate residency training program, a fellowship, and then sit the USMLE to become licensed.
Though both occupations work on-call, PAs often have a more structured’ 9-5’ schedule than MDs, who often work long and irregular hours. High stress and burnout are experienced in both, though data shows that a higher percentage of MDs suffer from burnout than PAs. Ultimately, both occupations are extremely physically and emotionally demanding.
Most PA schools require you to have 2,000 hours of hands-on healthcare experience under your belt. Many prospective PA students are former medical assistants, paramedics, and nurses who have accumulated these hours over their respective careers.
Yes, although the MD would have to complete another postgraduate residency training program, procure a fellowship in the relevant specialty, and then sit the USMLE to become licensed in that field.
So, which is better?
Well, if you are looking to perform clinical tasks independently, earn a large sum of money, and run your own practice, become an MD. However, if you are not sure where your medical future lies, consider becoming a PA. The mid-career flexibility combined with the slightly less stressful work/life balance is an attractive prospect.
Ultimately, when deciding between PA vs MD, your decision depends on you, your motivations, and your future ambitions.