What is a PA, or Physician Assistant?
Before comparing PA and MD, we need to take a brief look at what, exactly, a Physician Assistant is and does. A Physician Assistant (PA) is a medical support professional, working under the supervision and delegation of a physician (MD). They participate directly in patient care, taking medical histories, examining and diagnosing patients, developing treatment plans, educating patients and working toward positive patient outcomes as an integral part of the healthcare team. Some of the differences between PA and MD depend on where you’re practicing (state/province/country), but, on the whole, PAs do not perform surgery (they can assist), they do not take on the most complex or acute medical cases, and they may or may not be able to prescribe medications (again, depending on location). There is a good deal of overlap between these two professions, but there are many key differences, as well. This blog will help you more fully understand the differences between becoming a Physician Assistant (PA) and becoming a Medical Doctor (MD), to help you determine which path best suits your own goals, needs, and aspirations.
PA vs. MD: General Summary
Physician Assistants have consistently high levels of job satisfaction, job stability, and work-life balance, while spending less time and money on school and having more opportunities to switch specializations than their MD colleagues. Following an undergraduate degree, most are able to begin practicing after an additional 2-3 years of education and do so with comfortable starting salaries ($75,000-80,000/year). On the other hand, PAs must have more healthcare experience at the beginning of their careers and do complex work for often-comparably long hours at lower wages than MDs. They have less independence and are in some ways dependent on physician oversight, and their profession as a whole is relatively new, compared to physicians, meaning the laws around their practice vary widely depending on state/province/country.
MDs, on the other hand, are some of the most esteemed and well-paid traditional professionals in our society. They have more autonomy than Physician Assistants and can start their own practices, and their profession is one of the most established of all human endeavors. Their high level of education offsets lower amounts of healthcare experience at the beginning of their career (compared to PAs), and the prestige of becoming a physician is undeniable. At the same time, they spend much more time and money on their education, resulting in higher amounts of debt. Following an undergraduate degree, it can take anywhere from 6-12 additional years of education before being able to practice. Once they are practicing, MDs tend to work longer hours than their PA counterparts, are more likely to do on-call work, and have lower job satisfaction and fewer options to change things up if they begin to burn out in their chosen specialty. Physicians who run their own practices must also take on employer and managerial roles on top of practicing medicine, which presents its own set of challenges, and MDs have greater liability all-around than PAs.
PA vs. MD: A Detailed Comparison
Let’s take a look at some of the more specific differences between pursing a PA and an MD. Below, we’ll explore the following:
- PA vs MD: Education and Cost
- PA vs MD: Roles and Duties
- PA vs MD: Specialization
- PA vs MD: Job Satisfaction, Work-Life Balance, and Burnout
- PA vs MD: Compensation
- PA vs MD: Flexibility and Control
Whether aspiring to become a PA or MD, education is crucial, and both paths require strong academic performance. In general, PA programs require strong marks and extensive clinical experience; MD programs require exceptional marks, but less clinical experience at the time of application. During the initial 4-year undergraduate degree, the science pre-requisites and experiences necessary (shadowing, clinical work, etc.) tend to be similar for both, though those on the MD path must take more advanced science courses as prerequisites for medical school.
The average GPA for those pursuing PA programs is 3.5, and the average Science GPA is 3.47. Standardized testing requirements vary between different Physician Assistant programs. Many programs require the GRE (as PA programs are often Master’s degree programs), and the average GRE score for PA program applicants is 310 (note that some programs will accept the MCAT instead of the GRE, but the current prevalence of the GRE means that average MCAT scores for PA programs aren’t available). As well, PA programs often require extensive clinical experience prior to application – to be highly competitive, 2000 hours of hands-on patient care is recommended. This patient care requirement can be met through volunteering (e.g., as an EMT, in patient transport, or in various hospital departments), though many PAs worked in healthcare in some capacity prior to pursuing a PA program – nurses, phlebotomists, paramedics, and medical assistants are frequently applicants to PA programs.
The educational rigors are much more substantial for those who want to pursue an MD. How hard is it to get into medical school? Well, for MD applicants, the average GPA is 3.70, and the average Science GPA is 3.64. The GRE is not required for MD programs, but – of course – the MCAT is, and a good MCAT score is required, if you want to become a physician. The average MCAT score for those pursuing the MD is around 508 (though, of course, some schools have lower and higher individual averages than that). Clinical experience, e.g., through shadowing a doctor or holding paid or volunteer patient care positions, is not always required for those hoping to attend med school, but is definitely adds to the overall competitiveness of one’s application.
Check out this link if you need to know how to ask to shadow a doctor (including a sample request letter), or watch this video:
Generally, to become a Physician Assistant, you must have a bachelor’s degree and complete an accredited PA program. PA programs are usually 2-3 years in length, and the average total cost for a PA program is between $70,000-90,000 (varying based primarily on resident vs non-resident status).
While there are some optional residencies for PAs (in the U.S., and depending on specialty), most get on-the-job training following their education, meaning that the path from school to work is generally much shorter than it is for MDs. PAs do have to obtain licensure and pass a certifying exam (in the U.S., the Physician Assistant National Certifying Exam, or PANCE; in Canada, the Physician Assistant Entry to Practice Examination, or PA Cert Exam), and licensure is usually preceded by a one-year clinical rotation. As well, during your time as a PA, you must complete ongoing training and testing of your expertise, and certification may need to be renewed on a regular basis, depending on state/province/country.
To become an MD, you must complete a bachelor’s degree, followed by 4-years of medical school, followed by 3-7 years of residency, depending on specialization. The average cost of 4 years of medical school ranges from $200,000-300,000 (though this varies considerably, based on the school, whether the school is a public or private institution, whether you’re an in-state/in-province or out-of-state/out-of-province resident, and myriad other factors). Once education is completed, you are able to obtain certification and licensure. As with PA licensure, this often has to be renewed on a regular basis, depending on state/province/country.
Check out this blog if that price tag leaves you asking, “Is medical school worth it?”
Physician Assistants are a crucial part of the healthcare team, and often help increase the number of patients seen in a day, by taking on key clinical responsibilities and allowing MDs the room needed to tend to surgeries and more complex cases. Their core function is as diagnostician, performing physicals and collecting patient histories, imaging, and labs to diagnose conditions and work with patients on a treatment plan. They are able to perform many in-office procedures and assist in (but not perform) surgeries. In the U.S., PAs can prescribe medications in some states, and some can obtain DEA registration to prescribe controlled substances (though not all do); in Canada, PAs can prescribe medications in some provinces, but they are not able to prescribe controlled substances. Ultimately, the procedures any PA can perform depends on the procedures performed by their supervising MD, and the work a PA does is work that has been delegated by that supervising MD.
MDs, obviously, are able to practice without this kind of delegation and direct supervision. They can maintain independent medical practices and do all the things PAs do, as well as prescribing all medications and performing surgeries. That independence in their role as lead medical professional also means that they have ultimate liability, both with regard to their own patients and the patients seen by the PAs they supervise. If a PA is negligent, they are certainly liable, but their supervising MD is liable, as well.
Physician Assistants generally work in primary care and do so in a variety of settings. They tend to conduct physicals, general procedures, and treat more common illnesses and injuries. That said, PAs are able to specialize, and they are able to switch specialties, as well, and some work in two specialties at once. As PAs tend to get more of their experience on-the-job, a change in specialization generally means training as they go, rather than having to start over and getting additional certification after years of training.
MDs have more opportunities to specialize during their education, but don’t have the same opportunities to chance specialties once they are practicing. While this varies, a major change in specialization for a practicing physician would often require completing a residency in that new specialty. With medical school taking far longer than PA programs, few doctors would want to go through another residency after already devoting so much time to their chosen program.
Physician Assistants often have more room to arrange for “typical”, 9-5 workdays and 40-hour workweeks, if they so choose, and – regardless of the hours they work – they can often have a more consistent schedule than MDs. While the work they do isn’t quite as dynamic as an MD, there is still variety in their work. As PAs tend to be educated through a patient-centered approach, they know that each patient requires individualized care and treatment, based on their unique circumstances and the biological, psychological, environmental, and social determinants of health. PAs tend to have very high job satisfaction (especially compared to other medical professions) and high job stability rates. That said, the work is undeniably stressful, and there aren’t many studies that look into burnout among PAs. It is possible that the opportunity to change specialties at any point in their career can help mitigate burnout, allowing them to learn more and take on new perspectives and approaches, should they find themselves in a rut or otherwise dissatisfied with the work they’re currently doing.
MDs often run their own clinics, while also doing rounds in hospitals, performing surgeries, being on-call, etc., so the work is more varied and dynamic. As a result of these multiple roles, MDs frequently work 60+ hours per week (and often even more during residency). In terms of job satisfaction, this varies considerably based on specialization, with family physicians showing greatest satisfaction and just under half of doctors indicating that they would choose the same specialty again, if they had the chance to start over. Nearly 1/3 of doctors, regardless of specialty, say they would not pursue medicine as a career again, if they could turn back the clock. Similarly, rates of burnout are substantially different based on specialization, with the highest rates of burnout being in emergency medicine, internal medicine, and family medicine. Overall, physicians are considerably more likely to experience burnout and dissatisfaction with their work-life balance than the general population.
Salaries for both PAs and MDs vary considerably, based on numerous factors, including the location of their practice, their specialization, whether they work in a hospital, clinic, or private practice, and so on. Across North America, medical doctor is one of the best paying traditional jobs, with the average salary ranging from about $200,000-300,000 per year in both the U.S. and Canada (with even higher salaries for certain specialists, but lower salaries during residency). As well, the need for MDs continues to grow, and this job tends to be in steadily high demand.
The average Physician Assistant salary ranges from around $80,000-120,000 in the U.S., and $75,000-130,000 in Canada. With the higher salaries of MDs come the costs of owning and operating a practice, as well – costs that PAs need not cover, as they do not run their own practices. PAs are also in high demand, as they can tend to less critical (though often more frequent) cases, freeing up physicians to handle surgeries and more specialized or complex procedures for which one needs the MD degree.
Physician Assistants work collaboratively with, and under the guidance of, MDs, and thus don’t have the same level of autonomy. Some PAs do work autonomously, conferring with physicians in more complex cases; others work directly alongside physicians at all times. This difference often depends on various factors, including – but not limited to – the type of practice, the country/state/province in which they are working, and the different standards of each particular practice or specialty.
MDs often run their own practices, and thus also control their own businesses, which has both benefits and drawbacks. As PAs are generally employees, rather than owner/managers of a practice, the business concerns and responsibilities that come with running an independent practice and functioning as employer are beyond their purview (whether this is a benefit or drawback depends on your own position on such things).
As noted above, what PAs lack in autonomy, they make up for in a bit more control over their own schedules and considerably more flexibility in their specializations. As MDs treat more complex cases, perform surgeries, and take on less-common illnesses and injuries, they are more frequently required to be on-call. That’s not to say MDs are unable to set their own schedules; they can – especially in private practices. But physicians are more likely to take on the kinds of hospital positions that require on-call and shift work. PAs certainly can choose positions that include things like being on-call or having overnight shifts, but they often have more choice in the contracts they accept.
Check out this video summary of the information you've learned here:
PA vs. MD: Conclusion
As medicine begins moving more consciously away from a top-down hierarchical model to an intentionally collaborative, team-based approach to healthcare, new dynamics are emerging to (ideally) ensure each patient gets the kind of attention and treatment they need, with various, overlapping professionals providing a web of care, rather than a singular life-line. While, historically, the physician-at-the-top model has been the norm, the growing understanding of patients as diverse, complex, and requiring individualized care necessitates a multiplicity of approaches to assessment, diagnosis, treatment, and management. MDs, PAs, nurses, nurse practitioners and a wealth of other healthcare providers, from highly specialized surgeons to dietitians to medical social workers, all form the larger collaborative framework of patient care that drives early 21st century medical practice.
Both paths – the PA and the MD – bring with them a heavy burden of responsibility, work, and stress, but also rewards that often far surpass the toll of either profession. If you are willing to exchange reduced autonomy for less time and money spent on education and more flexibility in terms of your long-term career trajectory, then you may want to consider the PA path. On the other hand, if autonomy and the ability to work without direct oversight are more important to you than the monetary and time investment needed for education, and you’re willing to take on the longer hours and higher risk of burnout, then the MD might be the better path for you. Both are valuable, interconnected-yet-distinct, components of the wider healthcare team.
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