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Does the PA Profession Have a 2030 Expiration Date?

Physician assistants (PA) are number #1 in healthcare, so getting a job for an experienced PA should be super simple. Right? Maybe not always. My personal awakening to the looming problems in the physician assistant profession came in 2018. I had always enjoyed an easy time finding a position, and with an upcoming out-of-state move, I expected nothing less. I applied, however, to over 50 PA/NP jobs with few responses.

Many of the jobs required a state license to apply, so I had difficulty making it past computer algorithms and human resource screeners. This was because antiquated legislative laws dictated that I have a supervising physician in order to acquire a state license. In essence, it was an endless cycle wherein I could not apply for a job without a state license, but I couldn’t acquire a state license without a job. As I began to wonder what I was going to do for a job, I realized that physicians and NPs did not have this same mandate. It awakened me to the grave realization that the PA profession was not competitive in my new environment. 

Are PAs Being Phased Out?

I eventually decided that if I couldn’t readily get a job as a PA, I would need to maneuver into another profession. Nurse practitioners (NP) and physicians have professions that are flexible enough that they can readily pivot into other professional roles, such as education, research, pharmaceuticals, medical malpractice expert, and medical writer. Although PAs can be found in all of these roles as well, there are relatively few PAs, in both number and percentage, that leave clinical practice in comparison to nurses and physicians.

I personally decided to fall back on teaching at the collegiate level-something I had been doing on the side for the past decade. Even in academia and with my experience, I had difficulty finding an academic placement due to the relative lack of PA schools in my metropolitan area. As I was forced to compete for general biology undergraduate positions, my stiff competition was likely from masters-level high school biology teachers.

Generalizing the Generalist

In general, PAs are excellently trained to provide competent, exceptional care to the most vulnerable and fragile in our society. Healthcare employers, however, have difficulty fully understanding a PA’s capabilities, so it is little surprise that the larger populace has no working construct for the PA. As a result of all this, I came face to face with the challenges of being able to pivot into other roles. I had difficulty transitioning into academics, recruiters for clinical research told me that PAs were too risky for their market clientele, and administration wouldn’t consider my underwhelming administrative working experience and education. My training in clinical medicine was excellent, but it did not equip me for job mobility. Unfortunately, I fear PAs will increasingly try to row this same proverbial boat when clinical PA positions become increasingly scarce.

Roughly half of PAs have been in practice for seven years, meaning that a majority of the profession has substantial student loans and a long career ahead. There is dire news for PAs that fall into this category. Our profession may not last long enough to pay off those substantial loans, much less last the entirety of their professional career. There are a few reasons why our profession may be headed for rough days.

APP Jobs will be dominated by NPs

Consistent with nurse practitioners’ objectives of “meeting the existing and future primary care needs of our nation”, all sectors of healthcare will be dominated, if not completely run, by nurses and nurse practitioners within ten years. As a little background; nurse practitioner numbers were projected to increase a staggering 130% between 2008 and 2024, with a projected NP workforce of 198,000 by 2024. There is projected to be a surplus of primary care nurse practitioners by 2025, with 13 states boasting an oversupply of primary care NPs by 2025. A 2015 Monthly Labor Review article goes on to state that registered nurses and nurse practitioners “are projected to add the newest jobs and grow the fastest” from 2014 to 2024.

The projected nurse practitioner numbers were wrong, as there are already more than 290,000 nurse practitioners in 2020. In comparison, the PA profession is expected to increase by 72% by 2025. The increase in primary care PA supply is also projected to exceed demand by 2025 but to a lesser extent. With full practice authority for NPs, the squeeze for jobs will be much harder felt for PAs than NPs. This is because it is cheaper and easier to hire an unrestricted NP than it is to hire a PA plus a supervising physician. There is then the added administrative work of finding a physician to supervise a PA hire. 

Legislative Restrictions Will Limit PAs

In addition to the NP surplus problem for the PA workforce will be the administrative disparities between NPs and PAs. NPs have full practice authority in 24 states and are legislatively close to achieving it in an additional 16 states.  Much has been said about training and educational comparisons between the three types of providers, but in the end, this is just a distraction from the numerous studies showing the most important issue of outcomes, for which the professions are similar. The truth is that healthcare employers hire nurse practitioners and PAs because of their financial appeal.

Healthcare is a Business

Who is “best” for the job is, and has always been, financially driven. The most cost-effective, least burdensome provider will win. When physicians largely ran medicine, burdens of supervision, malpractice risk, and administrative issues were par for the course, as NPs and PAs provided competent care, increased revenue profits, and had a similar scope of practice. Now that physicians are no longer making a majority of the financial decisions for healthcare, they likely don’t want to be saddled with these burdens. Administrators arguably don’t want the burden either. In essence, PAs maintain financial appeal but are increasingly less desirable than our legislatively unrestricted NPs. The following NP perspective is acutely accurate.  

“PAs are not allowed to practice independently of the physician, but an NP may have authority to diagnose, treat, and prescribe without physician supervision. Thus, when NP [scope of practice] SOP is broader, NP capabilities are closer to those of a physician and PA capabilities are more limited when compared to an NP’s.”

When given a choice, the unrestricted provider will always be a more desirable hire. 

Is the PA Job Market Saturated?

PAs’ footprint in primary care is already shrinking and this shrinkage will likely seep into all specialties over the next ten years. Likely, this is due to two main issues. First, the primary care surplus NP issue likely pushes restricted PAs and expensive physicians out of the primary care marketplace. Second, PAs have legislatively mandated tethers to physicians. Simply stated, even if NP oversupply wasn’t an issue, lack of supervising physicians in primary care inadvertently forces tethered PAs into the specialties where physicians are located.

Once oversupply in primary care becomes problematic for NPs, they will likely work to increase job opportunities for their profession via certifications, legislation, and advocacy. A realistic projection is that once NPs have dominated the primary care sector by 2025 and oversupply becomes a problem, unrestricted NPs will spread into surgical and specialty positions via an RNFA certificate, further reducing the PA footprint. A 2018 study showing that employment of specialty NPs grew at a 13% faster rate than the employment of PAs from 2008 to 2016 leads credence to this. By this, NPs will bleed into specialties and continue to push out PAs from their already marginalized areas of practice, and they will do it with an unrestricted license. This will further decrease the PA footprint in medicine. 

New Frontiers for Physicians

Telemedicine is another nail in the PA professional coffin.  Physicians have an Interstate Medical Licensure Compact system, which makes it significantly easier to obtain licenses in multiple states. Adding this to their unrestricted licenses, physicians are currently seeing a boom in telemedicine jobs. NPs and PAs do not have this compact. However, NPs do have a Nurse Licensure Compact and are working to expand this for their NP counterparts. Without such compacts, the wait time and difficulty in acquiring multiple licenses are costly and time-consuming.

For PAs, the requirement for physician licenses and physician supervision costs must be added to this administrative licensure headache. The logical outcome is that PAs are not desirable candidates for telemedicine. Considering the explosion of telemedicine with the pandemic and its projected exponential growth over the next ten years, the financial incentive to hire an NP, their independence in about half of the states, and the developing NP multistate licensure compact, PAs will have increasing difficulty finding work in telemedicine. 

Physician Assistants vs Assistant Physicians

Perhaps the final blow for the PA profession will be from unmatched international medical school graduates (IMG). Every year, thousands of medical school graduates (mostly foreign) are unable to place in US residencies. These graduates have created a niche license known as the assistant physician (AP). Just as the name is similar to physician assistants, these assistant physicians work in much the same way. APs must have a collaborative agreement with a licensed physician and have varying degrees of physician delegation based on the state and terms with the collaborating physician.

Missouri passed legislation allowing for these IMGs to practice back in 2014. Since then, Arkansas, Kansas, and Utah have allowed some form of license for these graduates despite troubling USMLE scores from this group of poor residency candidates. They are considered physician assistants for reimbursement purposes but don’t need to have passed the Physician Assistant National Certifying Exam (PANCE), need a named collaborating physician, or need to list their practice type. With an average compensation of $48,381 in July of 2019, there are considerable concerns about salary competition with NPs and PAs. 

What Can We Do to Keep Physician Assistants from Dying Off?

Mindset Shift

Fear is a powerful force. My four-year-old daughter has struggled recently with confidence in swimming. She completed infant swim rescue (ISR) training last year and is a capable, albeit inexperienced swimmer. On a recent swimming trip, she would have drowned in a pool for nothing more than her paralyzing fear that she couldn’t do it. PAs are experiencing their own version of drowning. PAs are a proven, capable profession, but many are admittedly afraid physicians will start negative campaigns if PAs ask for legislation that reflects clinical practice. Others are simply afraid of failure.

Most don’t understand that fear is not an inherent problem. However, how individual PAs handle this fear repeatedly will determine our professional fate. Failure to act is still a failure. Failure will occur and is a necessary ingredient for success. The only way to overcome this fear is to develop the winner mindset, with the understanding that failure will occur, can be overcome, is necessary, and is rooted squarely on the path to eventual success.

Make the PA Profession Last

For my daughter, overcoming fear meant returning her to an ISR refresher course. For the PA profession, it likely means submitting legislation that may have negative physician reception or pushing for legislation that may initially fail. Are we ready, as a profession, to embrace our upcoming failures on the road to success? Or, more importantly, have PAs yet decided whether they want the PA profession more than their fear of failure?

The biggest issue with professional advancement, in this author’s opinion, is the mindset of pre-PAs, PA students, and early-career PAs. As a pre-PA, I was delighted to know that someone else would be ultimately in charge of my care decisions, due to personal fears of failure with someone’s life. These ideas were uneducated. For every patient that a PA encounters without a supervising physician physically present, that PA is providing autonomous care.

PAs are held to the same standard–let’s rise above it.

Any experienced PA could explain that PAs are required to be as competent and capable as their physician counterparts and are held to the same legal standards of care as physicians. This is born out of the legal mandate requiring equal standards of care for physicians, PAs, and NPs. Because we are legally required to be equal in our care standards and research studies show equal care outcomes, we need to as a profession embrace and promote our achievements and abilities.

Support Your Professional Organizations

Own this responsibility. Push for legislation to reflect it. Demand our organizations promote it. The profession started out as someone’s assistant, yes, but it quickly evolved from that role. Recent studies reveal that 76% of PAs currently clinically practice autonomously. It is time to start pushing legislation similar to North Dakota, Minnesota, and Maine. Asking for PA legislation to mirror PA clinical practice is nothing more than asking for the legal authority to do what we are already doing.

Should PAs be restricted with mandated physician oversight? In short, no. If for no other reason than to allow patients better access to competent, capable providers, PAs should not be restricted. All providers should be allowed to work at their fullest capability to provide care for our patients. NPs understand it. Physicians fear it. The US government acknowledges it. It is time for PAs to stop our professional infighting and push for legislation to keep a better pace with our training and professional skills.

From this, it becomes evident that we must modernize our professional views relative to physicians. PAs must continue to clinically collaborate with all healthcare entities. We must stop desiring physician agreement with the PA profession. PAs need to acknowledge that they already provide quality care in the absence of a physical physician presence in the patient’s room. PAs need to take leadership positions and push for legislative advancements that reflect current clinical practice. 

A More Accurate Name for Physician Assistants

This leads to the inevitable issue of the PA title. Many PAs, likely due to our historical origin, are just fine with our current title and feel that we simply need to market it better.  This author contends that it is difficult, if not impossible, to market a lie. PAs do not assist physicians in their job duties. PAs perform the same job duties as physicians. The name is an oxymoron that creates confusion due to the fact that in no other profession does a subordinate do the actual job of the senior. Much research has concluded that PAs substitute for the physician in 85% of primary care tasks and produce the same productivity outputs as physicians in outpatient settings. The 15% difference likely has much to do with legislatively mandated restrictions on experienced primary care PAs.

PAs make medical treatment decisions for millions of patients per year. We perform in all levels of healthcare management, including medical director, chief medical officer, clinic owner, and CEO. PAs need to acknowledge our professional abilities, acknowledge that the name hurts advancements, acknowledge our excellent training, and advocate for a name change. PAs need to grasp the seriousness of how the PA title has hindered forward progression in states such as Ohio, Florida, and many others.

Moving Forward

What then is to become of the PA profession? Only time will tell, but the likely outcome is that the PA profession will steadily become less favored in the healthcare marketplace. This may very well lead to the extinction of the PA profession. Will this happen in ten years? Given the above market forces, this is a conceivable outcome. What an interesting path it would be to go from number one to not at all. Changing healthcare preferences for one provider type over another can affect which occupations are employed in an industry. The good news is that PAs have not been pushed out of all job markets yet and several states are making headway with legislation.

There is a real foreseeable danger of being forced out of the profession when employment challenges and professional competition becomes fierce. My job search prior to the pandemic showcases this. The solution of moving to a PA-friendly state or changing medical specialties may not be an option for everyone, as was the case for me. If any of this speaks to you, I suggest joining the effort for reform

Please leave a comment below but keep it professional and constructive or it will be automatically deleted.

Nicole Mason, DMSc, PA-C, Psychiatry CAQ

Dr. Mason graduated from the University of Illinois at Urbana-Champaign with a Chemistry degree and the highest distinction in the curriculum. She then went on to graduate from Midwestern University’s Physician Assistant program where she completed a Master’s project on the concept of international PAs, leading her to receive that year’s Master’s Project Award. Upon completion, she transitioned into primary care medicine and has remained in the primary care field for the last fourteen years. Dr. Mason holds a Doctorate in Medical Science from the University of Lynchburg. She is a member of AAPA and the Oklahoma Academy of Physician Assistants. Dr. Mason is also the co-founder and current president of the Academy of Doctoral PAs. To find out more about this important organization, please check out their website

65 thoughts on “Does the PA Profession Have a 2030 Expiration Date?

  • Rose Williams DMSc, PA-C

    Exquisitely written! I concur. I decided to obtain my Doctorate degree to propel the profession forward. I intend to join forces and will be legislating for the profession on a state level.

    • As a 23+ year, very skilled and experienced clinician, who owns a small start up, has earned an MBA, speaks Spanish, and has had a successful career thus far, I agree the PA profession has a (slightly) better chance of survival if PA programs quickly catch up to most (if not all) the allied health fields to award Doctorate degrees, practicing PA’s earn a “Doctor” degree, AND the profession pivots to follow Yale’s foresight to award their graduates a “Physician Associate” degree and UK medical schools awarding their graduate students a “MSc in Physician Associate studies”. Despite the PA profession resting on an early advantage of didactic and clinical training under the MEDICAL model, the paying patient’s perception (title and use of “Doctor”), individual state medical legislation, and most importantly- fiscal practicality, will usually trump raw intellect, skill, and (I hesitate to say) ….experience.

  • Christopher Bradley

    Excellent read, I highly agree with your perspective. Thank you for this article. A Lot of remote jobs are hyperfocusing on NPs and leaving out PA’s due to the need of supervision. I would love to seen more PA’s come together to grow this profession in the appropriate path needed. Christopher Bradley DMS-c, PA-c, psychiatry

  • Melanie DiProfio

    I agree that we must fight to save our profession. I need to get involved.

  • R sharon Mason

    Dr Nicole Mason is a great Dr. She is capable of all that Physicians do

  • Timothy Lassiter, DMSc, PA-C

    Very well written and could not be more pertinent to what our profession is going through right now. Unfortunately, I do not see anything actually happening in our professional organizations. I support my state PA organization as well as AAPA, and in 15 years almost nothing has been actually accomplished to put us on more even footing with NP’s. They can go to school online, do not have to recertify and can practice independently. A new graduate NP in my state can literally open their own practice where as a PA with years of experience and more comprehensive medical training can never work independent of a physician. I would love advice as to how I can do more to promote our profession, but it is more than a little demoralizing when watching the same arguments and debates for the last 15 years has produced almost no results.

  • Leticia Camacho-Stovern

    Very well written…yet so frightening! I have been a PA for over 25 years and plan to continue practicing for at least another 15-20 years. The thought of our profession becoming a thing of the past is so disheartening. I know this is happening but how can I get involved with the legislature? Besides joining my state PA organizations…what else can I do personally? How can we make this a movement?

    • Great question! While we may need an entire article on the topic, here are a few general suggestions:
      -Join AAPA
      -Join your state chapter
      -Donate to AAPA’s PA PAC
      -Donate to state PA PAC (if available)
      -Be active in these organizations–Volunteer your time and serve
      -Identify and write your state legislators
      -Identify and write your federal legislators
      -Write an editorial or opinion piece for your local or regional newspaper
      -Write for us!
      -Be active on social media and fight misinformation by well-meaning but misguided physician groups
      -Be active on social media to rally your peers
      -Encourage co-workers to join the appropriate organizations
      -Get familiar with your state medical society and be on the lookout for proposed legislation that might impact PAs
      -If you live in an FPA state for NPs, connect with their leadership for guidance and work together if possible.
      -Don’t give up! It’s easy to get burned out or disillusioned, so pace yourself and keep going!

      • Sorry, AAPA, NCCPA and other rigs are useless and they discourage us from doing any unity to save our profession. Been there done that.
        Sorry to add more on to your disappointment.
        I am already sick to my stomach by just wasting my life for a useless professional outcome.

  • Excellent analysis Dr. Mason. We need to grow our profession in scope, influence and numbers to continue to be competitive in the marketplace as a profession.

  • Mousumi Dey

    Thank you Dr. Mason for your excellent analysis regarding the current and the future of the PA profession and how we are facing stiff competition from the NPs. My husband and I are both PAs and practice in GI and ENT respectively. My husband recently resigned from his job though he had been performing exceptionally well because the organization was not able to hire a permanent supervising physician. Instead, they hired a NP who had much less skill and knowledge than him. Fortunately my husband immediately received several offers in and out-of -state but he could no join the out- of -state jobs because of the time it would take for him to obtain the license. We soon realized why he had so many offers – that is because the physicians had tried to train NPs but because of their paucity of knowledge and skill they ultimately realized that it would be beneficial to hire a knowledgeable, experienced and skilled PA over an NP. We are now both in the process of completing the DMSc program from AT Still University and looking forward to joining this fight to making our profession of not only equal but of better standing than the NPs in every way.

  • Excellent read, well presented (the best presented argument in our never-ending industry struggle). Moreover, I highly agree with your perspective personally and professionally. After 32 years as a practicing PA, I kind of foresaw this potential demise of our profession back in 1992 with the PA name game then and ever since. Remain9ing a “Brandless” profession has been costly…if not the final nail in the coffin…hopefully I am wrong. Sadly we’re beyond turf battles…our apathy…the professional misinformation/disinformation based on our PA moniker has become too deeply rooted along with the tone deaf stance from our leaders & organizations may be too much to overcome.

    I tried to raise these concerns of our future trajectory in the marketplace among many colleagues, but time after time I was chastised among my peers by being the prophet of doom and gloom, especially with the proliferation of NP/PA programs. But as my grandmother used to say: no one is a prophet in their own land”! Yet, I remain hopeful that we can overcome this crisis with aggressive educational marketing and finally getting the branding we deserve.

  • Respect for the conversation you are carrying. Let me know if I can help.

  • Amanda

    Thank you. I am seeing this being a new grad, tons of NP jobs and no one will look at a new PA grad. That is why I am going to take action with my state organization here in FL.

  • This is the most informative and contemporary excellent article that I have read on the future of the PA profession. Some words are almost prophetic and we acknowledge from history that many of the hearers of a special message close their ears and are unconcerned. Unless we as PAs open our ears to the realities and open our eyes to what is displayed so vividly, we will fall short of our purported image forever.

  • Jefferson DuHale

    Great article and VERY TRUE.. I’m not a PA, but from the outside looking in, here is my 2 cents:
    1. NP school is easier to get into and manage. NP students can do almost their entire program online and some can be done in 18 months. When will PA schools catch up to that?
    2. Your article cites the fact that studies have shown that the outcomes are the same for NPs, PAs and MDs. So any argument that the standard PA education methodology is better can be readily dismissed. Since strong biochemistry, organic chemistry, and MCAT scores don’t seem to be predictors of patient outcomes why place so much emphasis on them in a PA program. This is another area that NPs are killing PAs, professionally speaking.

    I agree with the name change- I’ve know people who flat out state they don’t want to see ‘an assistant’. I get the history and respect how the PA profession grew, but it has to change.

  • Wayne

    I am a pre-PA student currently accepted and planning on beginning PA school this coming summer. I am 24 and recently completed my undergraduate degree. Reading this article, and some other similar-minded pieces, has got me doubting my decision to pursue a career as a PA. I have not paid tuition yet and would only lose out on my seat reservation deposit. Would you recommend I pursue a different path?

    • This is a precarious time to be pursuing a career as a PA. It depends on what state you’re practicing in and what type of work you want to find yourself doing. NPs are not trained as well but have much more freedom in how they practice. Medical school is still the best way to go if you’re looking for a combination of training and flexibility. If you choose PA, make sure you know what your limitations will be and what’s on the horizon.

      • Terrel Armstrong, pre-PA student

        Can you point us to a hub for specific state laws / hints about whether they will change, or how soon?
        For example, I hope to practice in Oregon.

        • Terrel Armstrong, pre-PA student

          Edit: great news! House Bill 4081 in the State of Oregon is waiting to be passed by the Oregon senate:
          It’s hard to understand exactly what it means, but it looks like more autonomy, more access to a supervising, and more clearly established terms of practice.

          • Bano

            I must say PA profession is itself a great one but the stupidity and insecurity of the physicians have made it miserable.
            AMA and DOs organization have made this profession worthless.
            But once we will be free from the clutches of the physicians co- signature, then we”ll be fully growing and then the sky is the limit.
            Just go for it and also try to evolve this profession with the help of your fellow PAs. Good luck
            Go for it!!!

      • Howard

        Do not do it. 10000000% don’t. Everything in tbis article is correct. Even worse,
        There are so many problems with being a PA. If u love what u do and work with a doc that let’s u practice but is a nomad, U either have to move with them or hope there is someome that will let u perform to that same level. Why? Did my skills magically disappear??? Did my 20 years of experience disappear? Nope, but it did happen to me.

        Even worse than that, What about when you have your own panel of patients and youre thriving. but then your supervising doc has an affair with your girlfriend? U can’t say crap because if u aren’t happy with that, u lose your supervisor and your job. Why do we have to walk on eggshells like that???? Nps can say dont sleep with my SO, piss off and ill see my patients,, stand up for their life. PA-nope, yiu have to say “sorry I was upset you slept with my girlfriend, can I still see patients?” I actuallly stayed because I loved my patients and could practice how I wanted, but i lost all respect for myself. I had to endure that so that guy can occasionally sign some notes. But I needed him, so I shut up. How would that make you feel???? Could that happen to ANY other profession. Where you are great at yiur job, thriving top performer, and because you need a few charts signed, yoir supervising doc can say “Hey, im sleeping with your girlfriend, if you don’t like it, how about I take away yoir ability to perform your job” WTH! I Can’t tell people enough that they should never be a PA.
        That being said, I like working with the new surgeon I’m with , great guy, great surgeon, has a soul. But if something happens, who is to say I don’t get into some terrible situation like that again. I just want to see pts, not worry iif the doc is going to move again, worry they will sleep with my GF so I have to say “thank u sir, may I have another” or look for a new job and maybe have to sell my house and leave the state to find something that fits. How is that fair? If you want to feel like the biggest powerless pathetic loser, Yeah. Sign yourself up for this. This profession has destroyed destroyed my self esteem and any self worth. Yeah, i could change professions, but I love what I do AND THAT ISNT THE PROBLEM NOW IS IT. So don’t become a PA, when this happens, you never get those parts of yoir pride and self worth back. Even though I support a team effort. Their needs to be “independent” practice becaue of Dr’s and situations like that.
        I mean independent as in no signed agreement if you’re working in a facility. The docs are there to consult but you have the normal recourse offered by HR.

        • Yes, PA profession has become the worst profession because of co-signs of some people who are less competent than experienced PAs. These physicians have made this profession the worst and have completely destroyed the beauty of it.
          The only way out is our complete independence.
          Otherwise, PA profession will be extinct soon.
          I regret being PA after 20 plus years of experience, I feel like I wasted all those years… I do not feel proud but lack of self esteem as if I am doing a crime being PA.. the reason is these physicians have taken away my pride.

        • Howard

          Sorry for spelling and spelling. I was extremely tired, no corrective lenses and on my cell.

  • I must admit, I was in your shoes 33 years ago when I when to PA school. Sure things have change a great deal in the marketplace for us since then.
    I also agree with the prior comments 100%—they are right on point. I guess while you could argue many things regarding this decision ( which naturally is not an easy one), I must say try to project the “RETURN OF INVESTMENT” of the decision sort-of-speak.. In other words employ a “SWOT” ( Strenghts /Weaknesses/Opportunities/threats) a model of strategic planning and thinking in the business world, yet certainly applicable for any walk of life when it comes to decision making in anyone’s life…try it. I personally think is very helpful deciding or arriving at any final decision that you will make. Is like taking a phot, you see the big picture while looking at the details simultaneously.

    The other side of the coin is that in the worst case scenario you can always use the PA training/background/skill set to springboard into other alternative careers. For example, teaching, consulting , biomedical writing and so for.. As my retirement horizon approaches, I have already developed these side niches which will help to transition from clinical medicine nicely. Naturally, no one has to wait to retirement to do this ,but what I am getting at is that the possibilities are endless. Many PAs are becoming entepreteneurs in their own right.

    As they say follow your heart even though is a big financial decision. Good luck in your personal and professional endeavors.
    feel free to privately e-mail me if desire to continue this chat @

  • Brian Jacquot

    Great to see your work Nicole. You were always an asset to the medical community in whole when we worked together.

  • Leslie Byrne FNP-C

    I am an NP who has always admired and respected PAs for their wealth of knowledge and competence. I enjoy attending my local PA conference in NC periodically. I had no idea these were issues for PAs! I wish you all success in your endeavors to continue to allow the Healthcare professions and the patients you serve to continue to see your value for decades to come.

  • Ann Wendorf

    I am an NP and was happily onboard with your analysis and stance, until I read the comments and realized this had degraded to the tiring approach of mudslinging regarding which role is better ( better prepared, better educated, etc). There is little value in this and does nothing to propel either profession forward. We should choose not to participate in eroding other professions, to appear taller in our own. *sigh*

    • Thank you for commenting, Ann. We agree with you and go out of our way to make sure we stick to the facts and avoid mudslinging.


        I have been to both medical school and PA school, graduated from the best medical school from another country, then I got 2 years of credit in to PA school.

        I have been an ER PA for the last 20 years with my ER – CAQ board certification plus have my extensive experience of Cardiology including interventional and general cardiology, Hospitalist, Inpatient emergency Medical officer , dermatology, then did my fellowship in nephrology / dialysis and currently I am Assist Physician in nephrology and PA in ER.
        I can assure all PAs and Physicians that there is NO difference between Medical school and PA school curriculum, exactly the mirror image of each other based on evidence based Allopathic Medicine.
        The only difference is when After graduation PAs get their training at the job and the MD graduates get in to residency programs.
        After 2-3 years of job training any PA is equivalent to their MD counterparts.
        Unfortunately MDs due to their insecurities always oppress PAs as a profession which is not Only bad and ugly politics but is a professional dishonesty towards PA profession.
        First of all the name PA must and should be immediately changed bc this name is an insult and derogatory to what PAs actually are capable of. Physicians slap PAs by twisting this name to satisfy their own insecurities and treat PAs ad their personal assistants by suppressing their scope.
        Every physician twists PAs to his/ her own needs which shouldn’t be.
        PAs are trained as Generalists and they should be called Doctor of General Medicine ( DGM) and then those PAs who are in surgery should add surgery after DGM as ( DGMS).
        Doctor is a health care professional who diagnoses and treats the patients and hence called doctor by the society. It has been like that since centuries. PAs were fast paced doctors during WW2.
        PAs should and must be independent without having any co-signature of the physicians.
        PAs should have residency training for 3-4 years after graduation, then boards examinations and they should be full fledge doctors in the health care market as DGM or DGMS without any restrictions just like DOs achieved.
        PAs need to be evolved, enough is enough.
        NPs are just advanced care nurses, they are trained differently. They do few online researches and few scattered out patient office shadowings with physicians in a v unstructured way.
        But PA schools are just like medical schools, highly structured with exactly the similar training and curriculum of Allopathic medicine.
        AAPA should and must promote only PAs, leave NPs alone, they have their own nursing body to protect their rights.
        AAPA should promote PAs, not NPS…
        PA profession and career is as important as MD and DO, to say that PA are not competent enough to carry ER duties and to replace ED PAs with MDs/ DOs only is not only attack on a very refined profession but it is an open violation of PAs right to sabotage an established medical profession and to violate our patients rights to rip them off of the best health care professionals who have proven time and time how well liked they are.

        NPs and MDs harrass PAs with such a barrage of attacks that is considered an open attack on all the PAs.
        I am seriously thinking about suing all those who are violating my profession in such a derogatory way, in such an offensive way, in such a brutal way… I can utter the similar attacks on others profession. My profession is my bread and butter just like your profession is your bread and butter.
        Who are you to choke my great profession.
        I will blame APPA, NCCPA and all PAs to take such insults happily without being United against such attacks.
        If we are all United, no one will even look down on our profession.
        We let them and we don’t respect our profession, how could we expect others will respect us.
        Now, AAPA is lumping PAs and NPs together??? Why?? Stop, NPs are not your responsibility, they have better organized community to protect their profession.
        This is the time to get evolved in to independent profession…this is the time to counterattack by being United and by taking the full responsibility of our patients without involving anyone else as a co-signer.
        Come on we are not stupid, we are more intelligent and competent to stand up on our own…
        Don’t tell me, we are not physicians and that we should go to Medical school… stop this useless illogical notion.
        This is the time to come out and don’t be scared to stand on your own.
        Our profession is the best of all the medical professions… just get evolved.
        Even water gets spoilt by being stagnant, PA profession needs complete evolvement without being stagnant…
        stagnant makes matter rotten, inertia makes matter fresh, active and refined…..
        Come out of this mental block that we are some low level or mid level or some advanced level third rated professionals.
        Take full responsibility of your patients, be independent, change the name and get your profession in your hand before it is too late.
        Wake up before this profession becomes EXTINCT.

      • As a 23 year veteran PA with formal and informal training in General Surgery, Emergency Medicine, Internal Medicine, Physical Medicine, Family Medicine (very different scope of practice compared to IM), and Integrative Medicine, I have realized one important fact: Patient’s judge clinicians very differently than the formal “leaders” of the Allopathic medical community. Though I have criticized by MD’s while working in the ED “I see your pretending to be a doctor again…”, I firmly believe the average patient is not interested in how much the physician/PA/NP knows until they KNOW you care. Even early on in my career in FP, patients gravitated and even migrated to me FROM the MD despite my naivete. Why? Well when the question was posed by the puzzled 2 angry MD why they chose me (“the assistant, who did not go to medical school”) over their long time “real doctor” and why patient called me doctor despite being reprimanded for using an incorrect title, the patient responded “because he solves and explains things to me, treats me well, and always takes good care my family-we want doctor Albert to be OUR doctor!” (tears of fear, hurt, and frustration are visible to the medical assistant who reported this observation—2 weeks prior to my notice of resignation…)

        • What a cool experience, Albert!

          We have had similar experiences. Why does this happen? Why do some patients prefer PAs to MDs? What is it about being a PA that causes us to approach things differently?

          I think you nailed some of the answers… Humility. We know we don’t know it all and that shows. As a result, the PAs I know are often more motivated to find the correct answer instead of downplaying, deferring, or referring. Perhaps some PAs put forth an extra effort to serve and care for the patient, knowing we are starting from somewhat of a disadvantage. Maybe PAs aren’t quite as burned out as MDs given our condensed training times?

          No profession has a corner on compassion but these are not uncommon experiences.

    • Rebecca

      We all knew what we were getting into when we chose PA school. My interviewers drilled me on “why PA school and not med school.” You have to know your reasons why you chose this path and not the path with complete medical autonomy. There are trade offs to being a PA and taking a subordinate role – specialty flexibility, less bureaucratic paperwork and red tape, more time with patients. If you want medicine and full autonomy, go to medical school. Our training is rigorous and extensive, but no matter how long we practice it will not change the fact that we ARE NOT PHYSICIANS. The push for independent practice is misguided and childish, like a child reneging on their interest in a toy just because they see their peer (NPs) having something they hadn’t thought they’d wanted before (independent practice). Accept the role you’ve chosen, keep learning and being the best you can be to maintain your desirability to employers, and if you simply can’t stomach your choices then take the time and make the sacrifices to become a physician.

      • Thanks for commenting, Rebecca. Your comment seems to ignore the fact that many, if not all, experienced PAs already practice autonomously. The quest for “independent practice” is not at all childish but a desire to modernize legislation to reflect the way PAs actually work. We should not be tied to physicians. This can and should be separate from the scope of practice debate–no one is suggesting that PAs should start doing things they were not trained to do. We are trying to do away with antiquated, anti-competitive policies that make it less attractive to employ a PA.

        Secondly, there is no path for experienced PAs to evolve. New grads might be happy managing minor cases but experienced PAs can and do produce outcomes comparable to their physician colleagues yet too many states have yet to recognize this. Utah has the right idea–mentor new PAs until they are capable of safely practicing within the scope of their training then allow them to govern themselves just as every other healthcare provider must do. Suggesting that a PA with 10-20 years of experience go back to medical school is not only economically reckless but is just plain nonsensical.

      • Rebecca
        It is the mindset of people like u we don’t needs cruel dictators. Your post makes me embarrassed about this fact that how could a professional write such a useless and pathetic post with zero insight.
        You are just attacking this PA profession without even trying to read in to it.
        I have been to Medical school and PAs hook both. There is no difference in curriculum.
        The only difference is residency, but PAs become more knowledgeable and competitive after 2-3 years of experience.
        So, you suggest to remain be stunted and oppressed.
        Go figure out history of DOs… they struggled for their independence. We are better trained in allopathic medicine than osteopathic doctors.
        NPs are just the nurses without any structured training and have become independent but why we should suffer and our profession becomes extinct just because we can not be hired because of extreme stupid restrictions.
        I have 20 plus years of ER experience and I trust my experience more competitive than physicians.
        Stop being negligent, start supporting our struggle for existence.
        Thank you!

        • The Skooch

          I am showing up late to the party. Thank you all for the exceptional expression of your experience. Personally I have 20+years working in healthcare, 15 as a PA. Every medical professional, from a cardiac surgeon to the medical assistant have treated negatively by their colleagues. PA’s are in the line of fire from MD’S,NP’s, and the community’s we live in. Or my family or a friend. Perception that I encounter is you’re not a doctor and you’re not a nurse.
          We need to come together, possibly advocating with in our state legislature.
          I have concerns about the national representatives of our profession.
          I do not have a solution. I appreciate PA’s and all my colleagues. I’m not shy or naive. Let’s work on the present because everyone’s future is unknown

  • Marcos A. Vargas, MSHA, PA-C

    For the supporters of our Profession:

    Thank you…is nice to know that our kindred professional colleagues understand our situation.

    Marcos A. Vargas, MSHA, PA-C

  • Passion for your craft and compassion for your fellow man/woman are unfortunately not teachable attributes. Fortunately most PA’s I’ve meet have both, at least early on in their career…..After 24 years of practice, (recent 10 in surgery), the contagious enthusiasm of a recent graduate APRN I’m mentoring, has surprisingly rekindled my dormant passion for practicing medicine!

  • I disagree that it’s “mudslinging” to discuss the differences in training. There are profound differences. I use an analogy of 2 NPs In my workplace. We all are perceived to be able to do the same thing – urgent care, emergencies, sew, intubate, recognize a hot belly or an MI. We biopsy, cut, etc.

    NP 1 became an RN because a brother in law said they make great money more than his plumbing gig offered. This is awesome. But here was his training. He went to a commercial nursing program here in the valley. Not a college- but he did have a generic degree already. Then he went online straight to an np program. Did it online except his 500 hour internship. In his uncles family medicine office is where he did that. All of it. No ER or critical care. No inpatient. No surgical suite and first assistant like PAs do. No urgent care even. Did not know how to even stain an eye to look for corneal abrasions.

    BUT he was hired under the premise he was like us PAs ……emergency and urgent care ready. Able to do procedures etc. he had no skills. Because he never trained. Nps of course like this as it makes their schooling much simpler and they get out, get given independence status and off you go thus you it’s mudslinging

    I am highlighting the absurdity of nps getting independent status all over while PAs …. and we can argue all night who’s better trained ..are felt to be tied down to a doc. And we are losing jobs. If the urgent care doesn’t need a doc on staff then they’ve realized just hire nps.

    Can’t hire PAs unless they have a “ babysitter”. Going off hours PAs are better and more diversely across the disciplines trained

  • Terrel Armstrong, pre-PA student

    Hi there,

    Could you give sources for some uncited things you said?
    E.g.: “A 2018 study showing that employment of specialty NPs grew at a 13% faster…”

    I’m pre-PA and very interested in the direction healthcare is headed. Especially after the pandemic, the work-from-home revolution, telemedicine, potentially more federal standardization of practice laws.

    • Hi PA student
      Just read my post carefully before you proceed. You got to fight for your freedom.. PA profession needs a complete freedom for their independence.
      No babysitting by MDs… thank you


    It has been with great interest that I read this intriguing and informative article by Dr. Mason. And the many comments were also revealing. Although I am not a PA, I can greatly sympathize with the struggles of this profession.
    This might not be the proper forum to comment about NPs and their education, but since it was brought up in the comments, I felt I might chime in. I am a Nurse Practitioner. It is easy to make broad generalizations about either profession based on anecdotal incidents, but these types of generalizations usually lack true validity. However, I need to say that some of us “old school” NPs also are not happy with the direction of current NP training and specifically the DNP degree. You see, I have been a Nurse Practitioner for over 26 years…trained at Wayne State University in the old “brick and mortar” model. I spent over 3 years getting my Masters degree as an Adult Nurse Practitioner, studying side by side with medical students at times. The University’s “over emphasis” on didactic training could only be correlated to the many hours of on-site clinical practice in the likes of Detroit Receiving Hospital.
    I have worked as a Nurse Practitioner for over 26 years and will be retiring in a few months. My jobs have been varied from Cardiology, working in the office and managing ICU patients. I have also worked in a small primary care clinic, and was also the Medical Director for a large detention center with over 900 inmates. Currently, for the last 15 years I have been the hospitalist at a fairly large inpatient psychiatric facility.
    I have worked side by side with PAs and have enjoyed the camaraderie.
    I fear for the “dumbing down” of my profession, and I also fear for my colleagues in the PA profession.
    God Speed.

    • Daniel, thank you for the thoughtful comment. We’ll be the first to say that no degree automatically confers competency and compassion. We’ll also defend the fact that excellent clinicians can and do come out of PA and NP programs alike (no med school required). It sounds like you’ve touched many lives over your long career. Thank you for your service and for your collegiality.

    • Sorry CNP
      Your profession is great but I disagree with the lumping together of NPs And PAs because these two professions are completely different.
      First of all NPs are the trained Nurses and they are not clinicians.
      I love 💕 and have great respect for the nurses which are the soul of of the health care system, without the nurses the health care system will collapse.
      Health care system can withstand the lack of doctors but can not withstand the lack of the nurses.
      Now, the nurses are trained in the nursing ethics, knowledge snd skills which is basically taking orders from the clinicians and then follow those orders in the best interest of the patients. Nurses do not make diagnoses or make decisions regarding the patients health care.
      When the nurses becomes NPs, they attend few online courses of the advanced nursing, shadowing with out patient primary care clinics and Gyn clinics.
      They do not have any structured schooling, plus now a days each nurse wants to become an NP which is not competitive at all, any nurse can become an NP without even going through any hassle.
      Now PAs have to have undergrad with all the prerequisites, then have to have hands on medical experience, hours and shadowing with MDs and PAs , then GRE for 99% PA schools and Mact for some.
      PAs have to have a really good GPAS s as bd then evaluation letters.
      PA Schools are super competitive. As a matter of fact there are many examples of the pre-medical students not being accepted in PA schools but got accepted in DO school.
      PA schools are three years of duration but Pre-PA is 2 years prerequisites.
      The curriculum of PA school is exactly the same as Medical School. It won’t be wrong if I say the PA schools are much more condensed than the medical school with more training than the medical students.
      PAs do all their rotations with the medical students and with the Residents, learning the same way, something and the same allopathic medicine.
      PAs are already doctors and clinicians by their PA school training. They never were the Nurses.
      PAs should be lumped with MDs, not even with DOs bc DOs go to the osteopathic Schools which are quite different than the Medical schools.
      Kindly, do not even try to lump PAs with NPs… they both are different professions…
      Thank you

      • Your ignorance my friend is a bit appalling. You have no idea what med students go through do you? Not a clue. Or the crap and hours a resident puts in. No PAs are NOT already “doctors” by their schooling. We’re not simply cheap doctors. Put down the envy stick and do some study. And no. Absolutely no, are the “DO” schools different then MD schools not in any way anymore. No offense but get a clue

        • Dear friend
          I did my graduation in Medical School abroad from India x 5 years, it was really tough to get in. Worked hard, did my ob gyn x 2 years, came to usa, did attend Kaplan for both step 1 and step 2 usmle.
          I didn’t take the tests but instead my husband advised me to go to PA school which I thought would be v easy but it was very tough and the curriculum was exactly similar to MD schools.
          I didn’t see any difference. It was same allopathic medicine.
          Similar rotations like md students.
          The only difference was in residency training, but pas now are also doing residencies in different specialities.
          After 20 plus years of training in multiple specialties I must say that I am better in knowledge, skills, patients interactions and my procedures skills.
          So, kindly do not come off as condescending with insecurities that MDs usually show while undermining PAs.
          Unfortunately PAs are not here to compete, here to have their bread and butter just like you.
          Nobody is superior or inferior.
          We are all clinicians practicing Allopathic medicine for the community.
          DOs is another story, they have completely different way of training and that is osteopathic medicine deals with the body as whole.
          They started just like PAs and later got their freedom from the clutches of AMA.
          They are doctors focused more on musculoskeletal studies.
          Thank you
          been there done that.
          No difference between PAs and MDs.


    So glad I found this article. I’m a software engineer considering a career change into becoming a physician assistant and the Phoenix metropolitan area where I live and work has 3 PA programs and two universities with BSN and MSN programs to become an NP. As an experiment (remember I’m an engineer), I requested notifications from LinkedIn and Indeed whenever a PA job requisition was posted and noticed the following 1) The job requisition was for either a PA or an NP and 2) There weren’t as many job posted for PAs as NPs. Regardless, I signed up for the Associated in Biochemistry in order to satisfy pre-requisites for the local PA programs if I decide to go that route. I’m also looking to volunteer at one of the local hospitals for unpaid patient-care experience. From reading the articles and casually looking at job requisitions in the Phoenix metro area, it “appears” that this market is saturated.

    • Hi, Carolyn. I love your analytical thinking. I’ve actually thought about becoming a software engineer!

      Up until these last few years, I’ve always said that PAs are typically better trained but NPs have us beat in the legislature. That is slowly changing and you can keep track of recent progress here. Even with legislative advancements, however, you will still likely have more opportunities as an RN/NP/CRNA.

      If I could do it over again, I would have gone to medical school or something else entirely… like coding. 🙂


        Software engineering is a great and lucrative career path, no doubt. I’m inspired by the medical professionals in the oncology clinic where my mom is currently being treated for stage 4 non-small cell lung cancer. Note she is not a smoker and her cancer is caused by a driver gene mutation. It’s been a journey this past year and I’m always thinking what if I can take my love of math (Bachelors in Applied Math), science, and my ability to work with people into a career that can give patients hope during what could be the darkest days of their lives, especially if it’s stage 3 or stage 4 cancer. I’m not sure if the medical professionals see it that way, but I know as a caregiver and watching patients and their families at MD Anderson in Gilbert, AZ, it’s been a privilege to be on this journey with the cancer warriors.

        • I’m sorry to hear about your mom, Carolyn.

          Have you considered health or bioinformatics? It’s a growing field that would seem to build off all of your interests and experiences.

          It certainly is inspiring to see others work on behalf of a loved one and I appreciate your noble intentions. When I’ve struggled with burnout or disillusionment, I try to remember that my true purpose ought to be relieving suffering, which is something I can always work towards and feel proud of.

  • I’d rather be shot in the head twice than become a PA again. I would never ever recommend anyone to go to PA school. The Dr’s lobby against us, nursing lobbies against us, 90% of the PAs out there don’t do a thing to help the profession. To top it off, NP schools won’t let NPs train with a PA anymore, they are trying to make themselves appear on par with physicians, so PAs can’t be good enough to train them (however I Train NPs at work) it’s the most humiliating depressing title in medicine and you’re correct, it will be extinct.. docs won’t relinquish supervision because they get paid, it’s racketeering. I love what I do but it makes me soooooo sad. So so sad

    • The Skooch

      Dumpster fire. It’s getting sadder and soul crushing.

  • Dale Bingham

    A couple years ago I saw the same. NPs are 4:1 to us PAs. I met some who did everything online then some cheesy “doctoral” paper no better than a courseroom essay, and spent all 500 0f their “clinical” hours in an uncles internal medicine practice. Yet here in Utah at the time they did not need “supervision”. So what that meant was at my large rural clinic we had ONLY 2 PAs forever , myself being one, and 6-10 NPs because they could work independent. I had to tell my PA friends don’t even apply. There’s no md babysitter for you.

    I saw the AAPA doing nothing but targeting anyone who spoke up on advancement. Oh the old retired PAs had OTP etc. and it was always be quiet can’t we get along. While the NPs walked all over us and took our jobs.

    So I took to huddle and wrote wrote wrote. Let me say that none of you k ow how badly I was harrassed. One old timer a well know name literally told me to “shut my mouth about independence “ as I didn’t know what I was talking about. I had a phone call from the president and others of the AAPA. Then they juts “banned” me from huddle. Liberals answer to everything.

    Now, suddenly they LIKe the topic. What losers we have in put leadership.

  • I got laid off for a bit and was doing some teaching – I’ve been a PA 20 years now- and decided to go on a writing spree about PA independence. I used the example of how my job had one retired old doc as medical director but he could only supervise 2 PAs in Utah. But my job had 10 NPs because they needed no one and no other PAs could apply. One urgent care a large one in our area only hired NPs so they could avoid hiring and paying a doc.

    So I realized we’re already down 4:1 to these “online” NPs they throw out there and losing jobs. So I hit huddle hard advocating, nicely, we need OUR independence. After all we go longer and have more clinical, and more diverse types of clinicals, than NPs. BUT I got phone calls from the president of the AAPA to “discuss” how wrong I was, I got nasty emails- I saved them- from the “elites” , names from the PA profession you would all know and have read and heard. One guy, a well-known PA name literally told me I needed to “shut up”. They were pushing their baby OTP. But we need more.

    Because I would not see it their way and I persisted for some time they banned me from huddle like liberals do with anyone who won’t agree with their view. So I was banned.

    Now, here in Utah we snuck in during Covid and passed our law giving us total independence- we have a consult doc. But zero supervision. Feels incredible! We need this everywhere

    • Bravo for your moral compass and resilience. I have experienced very same similar circumstances as yours. After 35 years of giving everything to this profession, it is clear we will be indentured servants of the AMA/Physician groups as long as we remain co-dependent partners. Sadly, professional apathy has been our mantra forever. How can we break the chains when the AAPA has fostered a “brandless identity” for nearly 50 years. Our story is akin to the modern version of Cinderella sort of speak.

  • Howard

    I’m sorry if I sounded harsh. I am for indepedence with loose collaboration. My issue is when you need a physician to sign that they are responsible. It eliminates job opportunities. Also, the guy who supervised me or 13+ years was making passes at 2 girlfriend and slept with one. He was my only supervisor and I had no recourse at HR. Basically, despite me still practicing the same, if i tried to pursue it, all he would have to say is “nope not signing a supervison agreement” . He’d probably do it too. Then I have zero recourse, id be wrongfully terminated for the dr sleeping with my significant other and nowhere to legally go. To tell you how bad the profession is, I elected to stay because the other jobs out there did not offer the same freedoms to practice what I know. It’s just not right. So I encourage people to be an NP before a PA. Not that either is better in general (my NP friends say some of the online programs are producing horrifically dangerous providers. Their words, not mine). Like anything,
    There are good and bad PAs, NPs and Docs. PAs don’t have the lobby money or grassroots support. I donate to my state and a couple other states Political action committees and to the AAPA as well. Ive had no luck in getting colleagues to donate. I must say it’s not all bad, I work with a great surgeon now. It’s just that PA opportunities are shrinking. Docs dont even stand up and say I’d like a fair ratio of good PAs and NPs. When they dont keep a mix they are kinda biting off the nose to spite their face. This career has many downfalls and some are unfortunately very unique to this profession.
    Something constructive to end with, donate, as much as you can reasonably afford, to your state organization and be involved with your medical boards. If a bill is on the ballot and you have genuine support by your docs, Let them know the issues and see if they’d be willing to call or forward a message to your congressman. It means alot coming from them.

    • Sorry for the multiple messages
      Are NP’s Independence mandated by the federal government or by each state?
      I look it up. We could follow their lead. Just a thought

  • I don’t “think” I’m a doctor nor implying I am trained like they are but my pre PA career was incredibly intense. We used to use the term “high performance paramedic” which usually referred to the system. I worked and trained in Los Angeles then retired from Tulsa city to go to the a university of Utah. I applied once, to one school and that was that. First in my class to pass the boards. I’m Tulsa we worked alone with a single emt basic partner. No 2 paramedics and Tulsa charter was ONLY paramedic could be in the back. No matter the call. But we ran the megacode. We shocked, started the lines intubated, pushed all meds did ALL t the paperwork everything. It was intense. We had a full time medical director at t he time only one of 3 cities so we would do advanced things back then like cpap, IOs, trachs (rare but done). And so on . So we learned well and did a lot.

    When the docs sometimes treat us like we’re. “Lower” level of human, and many do, as if we can’t learn too, I realized while they sat in a classroom I learned about life and people and patients. Many of you did too. We’re not second rate we just have a different role and in the past PA was our NEXT career now many go right through. But we often get treated like a lower life form.

  • Daniel

    Is the mood still the same? I am deciding if I should go to PA school or MD school. Please someone give me a small update. I am 24 right now.

    • My advice as a PA of 10+ years… Go to medical school.

      You’re young and have your entire life and career ahead of you. There really isn’t much of an advantage to PA school unless you know for certain that you won’t like working in a single specialty your entire career. If you were 34 or 44 with a previous career in medicine, sure, PA would be the better route. The other scenario where PA wins out is if you plan on stepping down to raise a family for any length of time.

      I didn’t start undergrad until I was 21 and I felt like I was already behind in my studies. If I could do it over again, I would have gone to medical school hands down. I think about it every day. But I also have a wife, 2 kids, and a home and I can’t continue to be selfish (we’ve already moved multiple times for my work).

      Go spend some time with both MDs and PAs to get more information. Those shadowing hours and inside perspective will be priceless.

      Whichever route you choose, good luck. You’ll make a comfortable living helping others.

  • This is just in response to some comments…

    I feel upset when someone says “PA education is the same as MD education minus the residency”. As a PA-C, I witness my sister who is a medical student currently studying for STEPI, juggling multiple tasks on the daily from academic to clinical to social tasks (to land a good residency). The curriculum is soooo much more in-depth than the PA curriculum. For once simple instance, they have to learn so much histology, things I have never even heard of during PA school. The biochemistry, pathophysiology, embroyology, pharmacology…all of that is ingrained into their education, and they have to know it ALL! and it’s all IMPORTANT in the field. It’s literally nothing compared to PA school. I say that and I consider myself a go-getter PA who seeks knowledge and reads, yet I don’t match up to her in-depth knowledge. Their clinicals are 2 years, think about how much you learned on your IM rotation as a PA student, a LOT right? Now think about it if there was an additional month of IM rotation, and additional month of EVERY rotation. Then, when they graduate, they get paid inhumanly little during residency, working 80 hours a week, lacking sleep and QOL, and studying on the side, while still clinically doing more than what we do right out of school getting paid 6 figures annually.

    Please have some respect and appreciation for the doctors, some of them literally get paid few thousands less than an NP in some specialties, even after going through all of the above. Be humble as a PA, your education, effort, struggles… are only maybe 25% of theirs.

    This talk is directed towards any DNP that places her/himself as an equal to MD/DO/MBBS.

    • I know you are PA but Please educate yourself first about PA education.

      You have no clue about PA schooling then.

      Let me breakdown.

      I have been to PA and MD school both. I did my MBBS from an excellent medical school.

      PAs are required to have 4 years of undergrad with science good GPAs with biochemistry, psychology, genetics, physiology, anatomy, pharmacy and more then thousands of hands on patient experience, then GRE with good scores( 95% ) require GRE test, MCAT is appreciated but not required.

      Then 2 years pre-clinical sciences of physiology, Anatomy, pharmacy, pathology, biochemistry, psychology (then get in to super competitive 3 years of PA school with a combined application of CASPA).

      1-1/2 didactic years of Anatomy, Physiology, pathology, pharmacology( all advanced) along with surgery, internal medicine, radiology, pediatrics, psychiatry, dermatology, medico-legal/ toxicology/ primary care/ Ob/gyn

      1-2 months sutures/ splint/ ACLS/BLS/PALS/ATLS.

      I studied Guyton( physiology), Grace anatomy and other pharma books for the basic sciences along with pathology.

      PAs also do study Laboratory sciences what to order and how to interpret.

      Plus Physical and occupational therapies along with social worker lectures.

      After taking tests at the end of each subject with the passing score of minimum 75-80, then cumulative test of all the subjects, then PAs enter the clinical rotations with residents and with medical students.

      Internal Medicine, surgery, ob/Gyn, Orthopedic surgery, cardio thoracic surgery, urology, nephrology, GI, hem/onco, cardio, psychiatry( floor/ crisis), medico-legal/ autopsy, emergency medicine, geriatrics and much much more.

      At the end of each rotations PA has to take shelf examination to pass with minimum score of 75 to 80 scores along with case presentations, Aldo rounds and grand rounds, also 1st assist to the surgeons.

      At the end each PA has to deliver one grand Presentation.

      Then cumulative final test followed by NCCPA Certification, which was 5 years re-certification but now it is 10 years, 2 years of 100 CMES with 50 of AMA category 1 required, independent state listened, DEA, CDC,

      Now PAs do residencies in different specialities and are becoming board certified like I did my board certification in Emergency medicine.

      The only difference is the PAs are not required for residency like MDs and DOs but get experienced at work and after 2-3 years of experience they become as good and even superior to their other colleagues.

      With all due respect don’t lump NPs with PAs.

      NPs are advanced nurses trained in a nursing module with a couple of years of scattered shadowing with a couple of primary care doctors offices and scattered few online lectures… highly unstructured.

      PAs are not trained on the nursing module, they are fully trained on the evidence based allopathic medicine just like MDs.

      Thank you

    • Histology slideshow was included in pa curriculum. Actually it is the prerequisite to get admission to PA school, anatomy, psychology, physiology and statistics are prerequisites, genetics, immunology, bacteriology. Parasitology, biochemistry,
      Pathology and forensics, post Mortem examination rotations, toxicology, pharmacology, all in-depth.
      When I was not in PA school I too thought that PA school would be easy leash snd would be piece of cake for me but it was absolutely harder than Medical School.
      3 years of PA school with didactic learning experience from morning till the evening and sometimes night, test daily early 7 am, every subject at the end needed the final test with 70% score to pass.
      Then splinting, sutures, intubation, and many many procedures boot camps…
      Social worker lectures, physical therapy lectures, occupational therapy lectures in depth. H and P ( work shops and boot camps)
      Dermatology classes in depth with slide shows, surgery, medicine, primary care, pediatrics, ob/gyn, emergency medicine, orthopedics, plastics, urology, cardio thoracic rotations, nephrology rotations ( optional), psychiatry ( in patients and in crisis)
      Everything with the medical students and in depths.
      At the end of each rotations , testing and presentations. Grand rounds and rounds.
      I learned so much from PA school which I could not from my medical school.
      If PAs are given a chance to do residency just like medical students then I can bet you that the PA students will excel with brilliant colors.
      You can not undermine PA schools and PA profession.

  • I agree with most of the posting. We as PA’s (and human’s), should always remain humble and grateful.
    I’ve been practicing medicine for 25 years and have just about completed. DMSc education. Throughout my years, the PA and NP presence in the Stamford and Greenwich, CT is low compared to the nearby less affluent areas. I’m guessing the glut of MD’s and the extremely high cost of living are contributing factors. Therefore my “peers” have been MD’s, and only once a phenomenal DO. I’ve spent my career backfilling to gain some of formal medical education missed as a PA.
    Recently I’ve entered into my second year of a from-scratch start up General Medicine / UC practice, serving mostly the spanish speaking and and Brazilian local population. I do not have the luxury of punting every patient to a specialist or ordering many tests to figure things out or to cover my a$$. So when introducing myself as thw PA – owner, I mention I work closely with a physician medical director (with whom I regularly review cases). I then explain I’m extremely good at as a clinician, help many patients. I then add fees reflect the time spent and complexity the medical issue or issues addressed.
    The point ?
    I believe my niche self pay medical model has proven to work and is in need, despite not having the credentials or training as an MD/DO.

    How can this be done when modern medicine is only about hospital systems, their aggressive growth, and acquisitions ?


    first I try to “listen to understand, (prior to attempting to be understood),
    2nd- ask patients / family, “how does the illness impact your life / situation” and repeat the issue or issues they wish to addressed today,
    3rd- get patient “buy in” by helping the patient to understand their issues and explaining “our” plan either figure out the issue or offering “solutions” to their problems.
    4th- reminding the patient they can reach me by text by calling our bilingual answering service, 24 hrs per day,
    5th- enthusiastically expressing our appreciation for their trust and time.

    A bewildered physician, who had recruited me from the ER 20 years ago asked me “Why do patient’s insist on calling you “doctor” and are scheduling follow up visits with you, not me ? I’m their doctor and I’m the one who went to medical school?” “Are you requesting they follow up with you and not me?”

    My (surprisingly calm) response:
    “Nope, I always urge the patient to schedule their next appointment with you, NOT me.
    but “Maybe they want ME to be their “doctor” ?

    The point of this very verbose story?

    I’m not trained as a medical doctor, and despite earning a new “doctorate degree”, I’m not a physician. I did not have the confidence to pursue a med school education…..and that’s ok – because I have my health, wonderful kids, and….

    I love my craft. I (thoroughly) enjoy every night’s reading – reviewing the day’s puzzling, or potentially dangerous case, despite often feeling sleep deprived. I can’t imagine doing anything else and feel a great sense of fulfillment after most patient encounters. No, I’ve no interest in considering retirement in the next 15 years. I’m truly blessed and have never been happier !

    Love others and love what you do. Be passionate, help and protect those who are not as strong, fortunate, educated or intelligent, as we are!

    and don’t just do it for the paycheck.

    Remember feel grateful, every day.

    Please, Give back!


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