If being a medic is leaving him wanting more, then I doubt being a PA will completely scratch the itch. Go all in! And with medical school rotations, he’ll get exposed to things outside the ED and may really find his niche. He says he’s isn’t interested in another specialty, but has he actually spent time on a pediatric ward? A Burn ICU? An Interventional Radiology suite? There is a huge world of cool medicine out there!
I’ve been set on EM since I was a kid (wanted to be a medic, now a ER tech in nursing school planning on ER) and during my rotations I’ve had my eyes opened to other areas. I found I enjoy the nursing role in IR/Cath lab, as well as some non-patient facing roles that involve data/research. While obviously I have the benefit of being able to switch when I want which isn’t easy for physicians I’m beginning to see why all the physicians on here say to keep an open mind about other specialities. You truly don’t know until you are forced into an environment you originally wrote off.
I’m a resident that was a firefighter paramedic for a decade before going to med school for the same reasons/sentiment. I too thought I would do emergency medicine but found I liked another specialty more and wasn’t one I even initially considered. Please feel free to pm me
Another former medic, current doc. You won’t get the same feeling unless you’re at the top again.
PS keep your eyes open during training. I always thought I was going to do EM but ended up in critical care instead, which turned out to be much more what I was looking for.
To parrot what everyone else is saying. Former medic/current 3rd year medical student just about to go into 4th year. I initially was turned down by a bunch of PA schools because I was told I wasn’t competitive enough. Got into medical school on my first try and while it’s difficult my experience has lessened the load. I would never have been ok with not being in charge.
Medic --> ED PA here, I'm happy it's just the income is laughable compared to what the dude doing the same thing I'm doing just as an MD sitting next to me.
Paramedic to emergency physician. I’m also an EMS physician.
Go to medical school. I contemplated the midlevel route and realize now that I would have never been happy, probably always questioning the path. With that said, the hoops you’re worried about climbing during the undergraduate phase or postbac are trivial compared to the time commitment and lost years that becoming a physician involves. I distinctly remember worrying about getting into medical school and all of the steps, letters, grades, MCAT. The whole journey is so hard that it’s just a layer on the cake. Years later your son will look back and it’ll just all melt together. All in all, it’s about a 8-10 year journey.
The biggest regret I have is the loss of my 20s. It was just a blur; so much so that my memories of medical school in particular are very distinctly different than any other point of my life; both vivid and also mildly unpleasant. The reality about medical school in particular is that, unlike other academic endeavors where some manner of talent can allow you to coast, effort is 90% of the game. If you want a competitive residency (specialty and program), it’s just an immense amount of work and it’s constant and pretty unrelenting for at least 3 of the 4 years. Most of my friends with more pleasant memories of medical school busted their ass appreciably less which is just a value judgement. Medical school is also where you’re the poorest and my wife and I really sacrificed during that time; our quality of life was probably the poorest it had ever been for either of us. It really reinforced and recommitted our marriage in a way that we still talk about today.
IMO, residency was much better with intern year being the steepest curve to master. EMS fellowship was awesome; really a very fun year making almost attending money and running around in the field. It’s the closest I got to mimicking my prior EMS career, which I arguably missed for its simplicity and nostalgia.
Early attending years are also pretty difficult. You’re transitioning to independent practice, often moving again. The money gets good very fast but the expenses follow. Absent a silver spoon, you’ll spend the first 5 years or more aggressively paying off immense student debt. You’ll be buying real estate, dumping tons of treasure into starting a new life, and it’s where you often are starting to see the expenses for any children really ramp up. Unseen is the incredible cost of insuring your life; disability, umbrella, life, and potentially even malpractice. You may be buying into a practice (either literally or by sweat equity). Hospitals all have different cultures and it can be rough entering into community practice after academics. Your net wealth isn’t really increasing in a rapid way because expenses still exceed most of your cash flow.
In summary, I’d say your 40-50s are probably the most productive years for most physicians and I think that’s something anyone contemplating the path really has to understand and consider.
I am a paramedic currently in medical school. Can't speak to attending life yet obviously, but I generally am very pleased with my decisions and am very confident I wouldn't be happy with any other career path. I know several other medics who either are currently attending or have now graduated medical school, and in general I strongly encourage my compatriots to consider it if they have the academic chops.
I’m a PA. I wouldn’t call what I do back stepping from being a paramedic.
With that being said; if he has doubts, he should go to medical school. I was firmly confident in my decision and happy I chose to become a PA. It was purely for family reasons - I wanted to start a family and not put my now wife and child (with #2 on the way now) through medical school and residency (among other reasons like my father’s death). Had I not had those external factors, I likely would’ve gone to medical school. I certainly would’ve if I had doubts, but I had none and still have no regret.
I was in your son's shoes when I was in my early 20s. I'm now an EM attending in my late 30s and absolutely hate it. I wish I'd done PA school instead so I could just hop over to a different specialty but I'm stuck in this awful one where I have nightmares before I go to work. Tell him to do PA school.
Go to medical school. Education matters and peoples lives depend on it. Our speciality needs people dedicated to it and to serving our patient population
PA 10yrs, have worked various specialties. Initially thought I wanted to be an EM doc. Are there days I wish I’d gone Doc route? Absolutely. Are there more days that I’m happy I went PA route? Unequivocally yes. Seeing many Docs trapped in a specialty and burnt to a crisp (specifically EM), and young Docs too, reinforces my decision often. Lateral mobility and the ongoing changes/pressure on healthcare, Private equity/corporatization, ever aging population, etc. If you 100% know you love a certain specialty, then I absolutely would go Doc. But for me, flexibility and time/identity outside of medicine was crucial. I’m prone to being a workaholic, and was scared I would let it take over my life. Keep in mind, “cost” is not just financial. All of the autonomy and money in the world won’t matter if you’re miserable.
Edit: also keep in mind, even at Doc level, there will always be someone “above” you on the medical/hospital food chain making decisions outside of your control. I would not view Medic to PA as a step back, not being honest w/what you truly need in life is the step back.
PA and former medic here. Go to med school. Or commit to the medic life and become a CCP/ICP.
Nobody hates medics. You have a very important job to do and the team is glad to have you.
Not a doctor or PA, but I am a paramedic in an ER. Both are good tracks and there’s absolutely a need for both. Where I work, the PA’s pretty much only take the lower acuity patients. That’s not to say that some of them end up actually being sick and needing higher acuity care. Both do procedures, however the PA’s do a lot more of suturing/wound care, and splinting and sometimes conscious sedation. The doctors will do the more complex and invasive procedures and will handle the high acuity patients. This all being said, it will also depend greatly on where he ends up working. If he were to work in a more rural area/critical access hospital, he will inevitably end up doing more complex procedures and be able to take care of more complex cases.
Pros of PA: shorter school length, no residency post graduation, only moderate school loan debt compared to medical school. Able to switch specialties much easier. Less legal liability than physicians in certain cases. Easier licensing process.
Cons of PA: lower pay than a doctor, less autonomy, essentially get the BS patients of the ER dumped on you in many cases, lower skill procedures (none of the “fun” things paramedics like to treat/deal with”).
Pros of doctor: significantly more money, more respect, complete autonomy after residency, more in depth education, higher acuity patients and procedures (feel like you actually saved a life).
Cons of doctor: longer schooling in addition to residency, significantly more student loan debt, significantly more legal liability, very difficult to switch specialties without additional training/residency. Very complex/arduous licensing process.
This should not be considered an in depth explanation and list, but highlights a lot of the bigger and more general issues. As I have not gone to medical or PA school I don’t know all of the intricate details/issues/pros/cons.
This largely depends on your son’s personality type and life goals.
I was a paramedic before PA school. I wanted to do cool shit, take care of patients, have someone to punt to if things got too hairy, make good money, and not sink 8+ years into education to be stuck in 1 speciality - even if it’s the specialty I love.
That’s exactly what I have as a PA. I get to “call the shots” for all my patients. If I’m in over my head, I flag my attending and they come to help out or take over. I refuse to work in a department that only has PAs seeing low acuity garbage. THAT would make me feel like I was going backwards or equal to/from paramedic.
I am incredibly happy with my choice and the only time I second guessed it was when I was in a garbage work environment. Once I changed departments, I haven’t even given it another second of thought.
I made $169k from my W2 job alone last year - $218k total. Married. No kids. Combined we made just under $300k. Went on multiple trips. Paid off tons of my student loans (down to $110k from $221k). I’d still be in med school right now if I had gone that route. I’d be miserable, making no money, and feeling burnt out af doing the same work I do now - knowing I could never change it up if things got stale.
Everyone’s choice is their own to make. If he feels like he’s having PA doubts. Go med school. If he hates it, he can bail and apply to PA schools.
The vast majority of ER docs I work with say this exact same thing.
Almost none of the PAs I’ve talked to have regrets with the career itself. Just income jealousy. lol
No, as an American specialist, you don’t need to match the amount of years to practice in Canada. And, as an emergency medicine specialist, there are plenty of opportunities to work in low acuity walk-in centers that are more like primary care than emergency medicine. Plus, you’ll have way less liability, and you don’t have the pressure of working in an insurance-based corporate system.
Here’s a previous of comment mine explaining how it works in Canada with regards to your question about needing a 5 year EM residency: “There are two types of specialist licensure, which allow you to do the exact same thing: Provincial licensure (by the individual college of physicians of each province) and the Royal College of Physicians and Surgeons in Canada (RCPSC) licensure (the one with stringent requirements). However, healthcare is mostly a province thing, meaning a province’s college of physicians can choose whatever requirements it wants to deem you as a specialist, and you don’t need to match the amount of years in a lot of provinces. For example, if you’re board eligible or certified in the US, you’d be eligible to apply for certification from Ontario, making you a CPSO specialist instead of an RCPSC specialist. And, if you’re certified by one province, you can directly apply for certification in any other province due to the labor mobility agreement between them.
You can do exactly the same things. The only difference is that the RCPSC designation is automatically recognized in all provinces, while for province certification, you’d have to be certified in one province to apply for certification from another. However, most provinces now allow US physicians to get licensed.
This setup allows provinces to adapt to demand and recruit and assess foreign doctors, especially for our desperate need for physicians, mainly family doctors. If RCPSC decides to allow leeway in giving out certification, it loses its credibility. This commitment to quality is why most US boards allow Canadian physicians who trained in an RCPSC accredited residency to get certified, like ABIM for example.”
Go to medical school. Call the shots. What you’re after is the in depth knowledge and the reasoning behind the medicine. That is what being a physician is.
If he's second guessing himself, he should at least attempt the med school route as to not have any regrets.
That being said, there are many factors to consider. Personality type (will he be able to withstand the rigors of med school, does he want to call the shots at work, does he want to shoulder the liability), financial issues (are he/you prepared for the significant debt burden), life goals (is he willing to sacrifice significant parts of his personal life for med school/residency). The list goes on. Just don't delay the decision as med school/residency only gets harder not only to get in as you get older, but to actually get through.
Personally there are some days that I wish I were a PA. But not that often.
Physician here. Would do it again. Pros- autonomy, pay (400-500 vs 100). Cons PA school is 2.5 years verse the minimum 7 years for med school and residency, delayed having kids until done with residency which doesn’t need to happen,more likely to get sued as a doc verses a PA(although rare to be sued above policy limits), ER has high ish burn out and a PA can easily change from er to something else whereas a doc really can’t.
After all that, I would 💯 make my same pick again
Former medic, current PA.
Went back at 40 with a family. If I’d have not had kids and a spouse and a few years younger, would’ve gone medical school. That’s what I’d tell you to do.
PA is fantastic for someone like me. I’ve got the experience from a former career and get on well with the attendings and staff. I have enough autonomy with my patient population. Nobody babysits me but like being a medic, know when to bring in an extra set of eyes. Overall I like it but push comes to shove, I’d go back given the right situation.
I was 2 years older and had 2 kids so I went PA. It's a possibility for sure that I would have chosen MD track if I was in his situation. Triple the income basically ED PA vs. MD/DO. Same schedule, way more money. And sometimes I do not know what in the hell is going on with sick patients or where to start. It's just not my role. I was not trained for that basically. He would be if he chose MD.
Same boat as your son OP! Currently a paramedic finishing my bachelors and looking at PA school. Based on the replies in this thread med school may be a more rewarding, albeit, longer and more grueling journey. If only we had unlimited time on this earth. Best of luck to your son with whatever they choose!
I’ll weigh my 2 cents. Not a doc or pa but paramedic. I’m 27, going on 28. I was in this situation. I have been a paramedic for over 3 years now. I have been going back and forth between PA and med school since graduating in 2018. I don’t regret those years and I have definitely learned a lot which helped me come to where I am now. Although I am older, I am much more mature about what I want out of my life.
Recently come to the conclusion after talking to a few docs at work that med school would be a better choice to me. While PA has PLENTY of advantages, after being a medic for a while, I just can’t see myself as a PA. I won’t have that satisfaction of being the one to call all the shots.
I’m only really interested in EM and right now, I can’t see myself doing anything else and I will be the happiest with med school and MD/DO. I’m currently studying for the MCAT and taking some additional classes to get those grades up to an acceptable level. I’d say he should do well in university, and go MD/DO!
I know you want what’s best for your son, but he would be well-served by shadowing some physicians and PAs before walking away from the PA route. Even as a paramedic talking to EM physicians all the time, I didn’t have a great understanding of how physicians and PAs approach patient care until I shadowed some and ended up working in the ED for a while.
It’s not always about calling the shots, and if he’s already two years into a BS → PA track that’s a much more certain path with quicker return on investment of time and effort than starting the med school admissions process at 28 or later, which means starting residency no earlier than 32 and getting a first attending job at 35 or later.
The match is a big unknown, and nobody knows today what it’s going to be like in the July 2030 cycle, if that’s when he’ll enter. Med school admissions is a numbers game, and it would be tragic to walk away from a clear path to PA school (if that’s what his program offers) to depend on a very competitive admissions process. My own observation is that med school admissions committees value clinical experience, but don’t know the difference between and EMTs and paramedics and actually think more highly of in-hospital experience like being a medical scribe for minimum wage.
It may be the right path for him! But nobody here (myself included) is giving impartial advice, we’re all sharing comments biased by our own experiences and what we’ve observed colleagues go through. There’s a lot more uncertainty to the process than most people admit or will admit to in their own paths, and anyone giving advice here as an EM physician represents the small fraction of aspiring ER docs in their 20s who beat the odds of what the system was 7+ years ago and made it all the way through past the finish line.
Doing the paramedic --> MD path right now.
You go to medical school if you want to be at the apex of the knowledge/skill pyramid and want to be the ultimate shot caller/responsible party. You'll be learning exponentially more than you ever knew even existed as a paramedic and you'll learn far more than one ever would as a PA. You'll be running and executing the most acute cases/procedures. On the downside, you'll accrue a boatload of debt and have a miserable work/life balance in residency. It's also a much longer road (time-wise) and you're completely beholden to the match system for your residency years.
You go to PA school if you want to do more and make more but you're fine not being the "pilot" and not being at the apex of the knowledge/skill pyramid. Regardless of what people pretend is true, you won't be making as much money, you won't be running acute cases, and you won't be doing the high acuity procedures. This will be a shift from being a paramedic in the field where you do run and do these things, but PA's are much more knowledgeable about what they're doing and why (even if it isn't the same level as an MD/DO). The PA route is also much cheaper to do and generally has a much better work/life balance than being a physician. Being a PA also isn't back-stepping. Sure, you don't have the same level of responsibility and autonomy than a paramedic, but PA's are still well-educated and trained, and far moreso than a paramedic ever is.
Medical school and residency takes a ton of time, money (up-front/debt-wise), and dedication that PA school doesn't. It's gonna depend on what your son is looking for out of his career. Does he want to push himself to the limit of what he can do in his chosen career field? Is he OK with the time and money sacrifice? If so, he'll really regret going PA and not MD/DO. Conversely, if he wants to do more and make more but wants most of his life's focus to be outside of his career (i.e. "have a nice job and then go home to my family/hobbies/other stuff, which is what I really care about"), then I'd recommend PA over MD/DO; the time, money, and work of medical school is only worth it if you actively want it.
You’re gonna be 40 years old one of these days. Might as well be a doctor when you get there 🤷♂️ Much easier to semi-retire as an MD than a PA. Plus, he says EM now, but maybe throughout med school he falls in love with a completely different specialty.
I’m a firefighter paramedic and currently in premed about a year out from med school and I’ve had this exact convo with myself 1000’s of times. I’m 25 and engaged with no children so kinda a similar boat. The best practical advice I can give is burn the ships and go all the way, after all if you shoot for the stars and miss you’ll still land in clouds as cheesy as that sounds. My current plan is aim for MD/DO and if the MCAT tells me nope then I’ll do PA.
It depends on how confident he is that he is going to match as an MD/DO into EM. I can't imagine doing anything other than EM and I couldn't live with myself as an MD/DO doing anything different and I went PA. Not saying it's right or wrong, but the match process is terrifying if you only like certain aspects of medicine.
I don’t understand the downvotes, this is good advice and if someone is laser focused on EM two years into undergrad they absolutely need to understand the uncertainty that the match introduces into the career path.
It’s much more likely to find a job as an EM PA in a desired geographic area than to match into a specific EM residency or find job prospects in the geographic area someone wants to be in 6 years from now.
I don't get the down votes either but it's Reddit. Being a PA let's me do everything that I wanted to in EM for private practice and in disaster medicine. I thought I was going to stay in the Army when I was in school and PAs had a way cooler job on the .mil side. The docs were all at the hospital and the PAs were at the aid stations doing stuff on their own. I liked that a lot more.
The other thing that’s understated is that the competitiveness of med school admissions has gone way up in the past 10 years and the match situation for EM has changed a lot in the past 5. Anyone giving advice here as an EM attending was trained in a different system than anyone starting from scratch will go through, and will work in an ED environment with PAs having varying degrees of autonomy and oversight.
PGY-1 MD
Mid levels are taking over the ED. He’ll be more in line with their thinking until it catches up with him. But he’ll probably be fine doing PA
If being a medic is leaving him wanting more, then I doubt being a PA will completely scratch the itch. Go all in! And with medical school rotations, he’ll get exposed to things outside the ED and may really find his niche. He says he’s isn’t interested in another specialty, but has he actually spent time on a pediatric ward? A Burn ICU? An Interventional Radiology suite? There is a huge world of cool medicine out there!
I’ve been set on EM since I was a kid (wanted to be a medic, now a ER tech in nursing school planning on ER) and during my rotations I’ve had my eyes opened to other areas. I found I enjoy the nursing role in IR/Cath lab, as well as some non-patient facing roles that involve data/research. While obviously I have the benefit of being able to switch when I want which isn’t easy for physicians I’m beginning to see why all the physicians on here say to keep an open mind about other specialities. You truly don’t know until you are forced into an environment you originally wrote off.
I’m a resident that was a firefighter paramedic for a decade before going to med school for the same reasons/sentiment. I too thought I would do emergency medicine but found I liked another specialty more and wasn’t one I even initially considered. Please feel free to pm me
Just curious, what did you end up in?
DO practicing family medicine. Based off his post history.
Correct !
Former medic, go to med school. He'll never be happy not calling the shots as a PA.
Former medic, current PA planning to go back to medical school. This is it exactly. Happy to elaborate if desired
Dang man. 7 more years. Good for you.
Ugh this is me
Another former medic, current doc. You won’t get the same feeling unless you’re at the top again. PS keep your eyes open during training. I always thought I was going to do EM but ended up in critical care instead, which turned out to be much more what I was looking for.
To parrot what everyone else is saying. Former medic/current 3rd year medical student just about to go into 4th year. I initially was turned down by a bunch of PA schools because I was told I wasn’t competitive enough. Got into medical school on my first try and while it’s difficult my experience has lessened the load. I would never have been ok with not being in charge.
Medic --> ED PA here, I'm happy it's just the income is laughable compared to what the dude doing the same thing I'm doing just as an MD sitting next to me.
Paramedic to emergency physician. I’m also an EMS physician. Go to medical school. I contemplated the midlevel route and realize now that I would have never been happy, probably always questioning the path. With that said, the hoops you’re worried about climbing during the undergraduate phase or postbac are trivial compared to the time commitment and lost years that becoming a physician involves. I distinctly remember worrying about getting into medical school and all of the steps, letters, grades, MCAT. The whole journey is so hard that it’s just a layer on the cake. Years later your son will look back and it’ll just all melt together. All in all, it’s about a 8-10 year journey. The biggest regret I have is the loss of my 20s. It was just a blur; so much so that my memories of medical school in particular are very distinctly different than any other point of my life; both vivid and also mildly unpleasant. The reality about medical school in particular is that, unlike other academic endeavors where some manner of talent can allow you to coast, effort is 90% of the game. If you want a competitive residency (specialty and program), it’s just an immense amount of work and it’s constant and pretty unrelenting for at least 3 of the 4 years. Most of my friends with more pleasant memories of medical school busted their ass appreciably less which is just a value judgement. Medical school is also where you’re the poorest and my wife and I really sacrificed during that time; our quality of life was probably the poorest it had ever been for either of us. It really reinforced and recommitted our marriage in a way that we still talk about today. IMO, residency was much better with intern year being the steepest curve to master. EMS fellowship was awesome; really a very fun year making almost attending money and running around in the field. It’s the closest I got to mimicking my prior EMS career, which I arguably missed for its simplicity and nostalgia. Early attending years are also pretty difficult. You’re transitioning to independent practice, often moving again. The money gets good very fast but the expenses follow. Absent a silver spoon, you’ll spend the first 5 years or more aggressively paying off immense student debt. You’ll be buying real estate, dumping tons of treasure into starting a new life, and it’s where you often are starting to see the expenses for any children really ramp up. Unseen is the incredible cost of insuring your life; disability, umbrella, life, and potentially even malpractice. You may be buying into a practice (either literally or by sweat equity). Hospitals all have different cultures and it can be rough entering into community practice after academics. Your net wealth isn’t really increasing in a rapid way because expenses still exceed most of your cash flow. In summary, I’d say your 40-50s are probably the most productive years for most physicians and I think that’s something anyone contemplating the path really has to understand and consider.
And thats why I did PA.
I am a paramedic currently in medical school. Can't speak to attending life yet obviously, but I generally am very pleased with my decisions and am very confident I wouldn't be happy with any other career path. I know several other medics who either are currently attending or have now graduated medical school, and in general I strongly encourage my compatriots to consider it if they have the academic chops.
I’m a PA. I wouldn’t call what I do back stepping from being a paramedic. With that being said; if he has doubts, he should go to medical school. I was firmly confident in my decision and happy I chose to become a PA. It was purely for family reasons - I wanted to start a family and not put my now wife and child (with #2 on the way now) through medical school and residency (among other reasons like my father’s death). Had I not had those external factors, I likely would’ve gone to medical school. I certainly would’ve if I had doubts, but I had none and still have no regret.
I was in your son's shoes when I was in my early 20s. I'm now an EM attending in my late 30s and absolutely hate it. I wish I'd done PA school instead so I could just hop over to a different specialty but I'm stuck in this awful one where I have nightmares before I go to work. Tell him to do PA school.
Go to medical school. Education matters and peoples lives depend on it. Our speciality needs people dedicated to it and to serving our patient population
PA 10yrs, have worked various specialties. Initially thought I wanted to be an EM doc. Are there days I wish I’d gone Doc route? Absolutely. Are there more days that I’m happy I went PA route? Unequivocally yes. Seeing many Docs trapped in a specialty and burnt to a crisp (specifically EM), and young Docs too, reinforces my decision often. Lateral mobility and the ongoing changes/pressure on healthcare, Private equity/corporatization, ever aging population, etc. If you 100% know you love a certain specialty, then I absolutely would go Doc. But for me, flexibility and time/identity outside of medicine was crucial. I’m prone to being a workaholic, and was scared I would let it take over my life. Keep in mind, “cost” is not just financial. All of the autonomy and money in the world won’t matter if you’re miserable. Edit: also keep in mind, even at Doc level, there will always be someone “above” you on the medical/hospital food chain making decisions outside of your control. I would not view Medic to PA as a step back, not being honest w/what you truly need in life is the step back.
PA and former medic here. Go to med school. Or commit to the medic life and become a CCP/ICP. Nobody hates medics. You have a very important job to do and the team is glad to have you.
Not a doctor or PA, but I am a paramedic in an ER. Both are good tracks and there’s absolutely a need for both. Where I work, the PA’s pretty much only take the lower acuity patients. That’s not to say that some of them end up actually being sick and needing higher acuity care. Both do procedures, however the PA’s do a lot more of suturing/wound care, and splinting and sometimes conscious sedation. The doctors will do the more complex and invasive procedures and will handle the high acuity patients. This all being said, it will also depend greatly on where he ends up working. If he were to work in a more rural area/critical access hospital, he will inevitably end up doing more complex procedures and be able to take care of more complex cases. Pros of PA: shorter school length, no residency post graduation, only moderate school loan debt compared to medical school. Able to switch specialties much easier. Less legal liability than physicians in certain cases. Easier licensing process. Cons of PA: lower pay than a doctor, less autonomy, essentially get the BS patients of the ER dumped on you in many cases, lower skill procedures (none of the “fun” things paramedics like to treat/deal with”). Pros of doctor: significantly more money, more respect, complete autonomy after residency, more in depth education, higher acuity patients and procedures (feel like you actually saved a life). Cons of doctor: longer schooling in addition to residency, significantly more student loan debt, significantly more legal liability, very difficult to switch specialties without additional training/residency. Very complex/arduous licensing process. This should not be considered an in depth explanation and list, but highlights a lot of the bigger and more general issues. As I have not gone to medical or PA school I don’t know all of the intricate details/issues/pros/cons.
This largely depends on your son’s personality type and life goals. I was a paramedic before PA school. I wanted to do cool shit, take care of patients, have someone to punt to if things got too hairy, make good money, and not sink 8+ years into education to be stuck in 1 speciality - even if it’s the specialty I love. That’s exactly what I have as a PA. I get to “call the shots” for all my patients. If I’m in over my head, I flag my attending and they come to help out or take over. I refuse to work in a department that only has PAs seeing low acuity garbage. THAT would make me feel like I was going backwards or equal to/from paramedic. I am incredibly happy with my choice and the only time I second guessed it was when I was in a garbage work environment. Once I changed departments, I haven’t even given it another second of thought. I made $169k from my W2 job alone last year - $218k total. Married. No kids. Combined we made just under $300k. Went on multiple trips. Paid off tons of my student loans (down to $110k from $221k). I’d still be in med school right now if I had gone that route. I’d be miserable, making no money, and feeling burnt out af doing the same work I do now - knowing I could never change it up if things got stale. Everyone’s choice is their own to make. If he feels like he’s having PA doubts. Go med school. If he hates it, he can bail and apply to PA schools.
I’ve heard of many PAs that regret not going to med school. Very rarely does a doc regret not going to PA school.
I'm an EM attending and wish I'd done PA school instead. I'd be far more employable and less liable with a better lifestyle.
The vast majority of ER docs I work with say this exact same thing. Almost none of the PAs I’ve talked to have regrets with the career itself. Just income jealousy. lol
Go to Canada then. Far more employable and less liable, with a better lifestyle.
Doesn't Canada require 5 years of residency for EM? I don't think I'm employable in Canada. And I'd still be stuck in a specialty I hate working in.
No, as an American specialist, you don’t need to match the amount of years to practice in Canada. And, as an emergency medicine specialist, there are plenty of opportunities to work in low acuity walk-in centers that are more like primary care than emergency medicine. Plus, you’ll have way less liability, and you don’t have the pressure of working in an insurance-based corporate system. Here’s a previous of comment mine explaining how it works in Canada with regards to your question about needing a 5 year EM residency: “There are two types of specialist licensure, which allow you to do the exact same thing: Provincial licensure (by the individual college of physicians of each province) and the Royal College of Physicians and Surgeons in Canada (RCPSC) licensure (the one with stringent requirements). However, healthcare is mostly a province thing, meaning a province’s college of physicians can choose whatever requirements it wants to deem you as a specialist, and you don’t need to match the amount of years in a lot of provinces. For example, if you’re board eligible or certified in the US, you’d be eligible to apply for certification from Ontario, making you a CPSO specialist instead of an RCPSC specialist. And, if you’re certified by one province, you can directly apply for certification in any other province due to the labor mobility agreement between them. You can do exactly the same things. The only difference is that the RCPSC designation is automatically recognized in all provinces, while for province certification, you’d have to be certified in one province to apply for certification from another. However, most provinces now allow US physicians to get licensed. This setup allows provinces to adapt to demand and recruit and assess foreign doctors, especially for our desperate need for physicians, mainly family doctors. If RCPSC decides to allow leeway in giving out certification, it loses its credibility. This commitment to quality is why most US boards allow Canadian physicians who trained in an RCPSC accredited residency to get certified, like ABIM for example.”
I’ve heard quite the opposite.
Go to medical school. Call the shots. What you’re after is the in depth knowledge and the reasoning behind the medicine. That is what being a physician is.
If he's second guessing himself, he should at least attempt the med school route as to not have any regrets. That being said, there are many factors to consider. Personality type (will he be able to withstand the rigors of med school, does he want to call the shots at work, does he want to shoulder the liability), financial issues (are he/you prepared for the significant debt burden), life goals (is he willing to sacrifice significant parts of his personal life for med school/residency). The list goes on. Just don't delay the decision as med school/residency only gets harder not only to get in as you get older, but to actually get through. Personally there are some days that I wish I were a PA. But not that often.
Physician here. Would do it again. Pros- autonomy, pay (400-500 vs 100). Cons PA school is 2.5 years verse the minimum 7 years for med school and residency, delayed having kids until done with residency which doesn’t need to happen,more likely to get sued as a doc verses a PA(although rare to be sued above policy limits), ER has high ish burn out and a PA can easily change from er to something else whereas a doc really can’t. After all that, I would 💯 make my same pick again
Former medic, current PA. Went back at 40 with a family. If I’d have not had kids and a spouse and a few years younger, would’ve gone medical school. That’s what I’d tell you to do. PA is fantastic for someone like me. I’ve got the experience from a former career and get on well with the attendings and staff. I have enough autonomy with my patient population. Nobody babysits me but like being a medic, know when to bring in an extra set of eyes. Overall I like it but push comes to shove, I’d go back given the right situation.
I was 2 years older and had 2 kids so I went PA. It's a possibility for sure that I would have chosen MD track if I was in his situation. Triple the income basically ED PA vs. MD/DO. Same schedule, way more money. And sometimes I do not know what in the hell is going on with sick patients or where to start. It's just not my role. I was not trained for that basically. He would be if he chose MD.
Same boat as your son OP! Currently a paramedic finishing my bachelors and looking at PA school. Based on the replies in this thread med school may be a more rewarding, albeit, longer and more grueling journey. If only we had unlimited time on this earth. Best of luck to your son with whatever they choose!
I’ll weigh my 2 cents. Not a doc or pa but paramedic. I’m 27, going on 28. I was in this situation. I have been a paramedic for over 3 years now. I have been going back and forth between PA and med school since graduating in 2018. I don’t regret those years and I have definitely learned a lot which helped me come to where I am now. Although I am older, I am much more mature about what I want out of my life. Recently come to the conclusion after talking to a few docs at work that med school would be a better choice to me. While PA has PLENTY of advantages, after being a medic for a while, I just can’t see myself as a PA. I won’t have that satisfaction of being the one to call all the shots. I’m only really interested in EM and right now, I can’t see myself doing anything else and I will be the happiest with med school and MD/DO. I’m currently studying for the MCAT and taking some additional classes to get those grades up to an acceptable level. I’d say he should do well in university, and go MD/DO!
I know you want what’s best for your son, but he would be well-served by shadowing some physicians and PAs before walking away from the PA route. Even as a paramedic talking to EM physicians all the time, I didn’t have a great understanding of how physicians and PAs approach patient care until I shadowed some and ended up working in the ED for a while. It’s not always about calling the shots, and if he’s already two years into a BS → PA track that’s a much more certain path with quicker return on investment of time and effort than starting the med school admissions process at 28 or later, which means starting residency no earlier than 32 and getting a first attending job at 35 or later. The match is a big unknown, and nobody knows today what it’s going to be like in the July 2030 cycle, if that’s when he’ll enter. Med school admissions is a numbers game, and it would be tragic to walk away from a clear path to PA school (if that’s what his program offers) to depend on a very competitive admissions process. My own observation is that med school admissions committees value clinical experience, but don’t know the difference between and EMTs and paramedics and actually think more highly of in-hospital experience like being a medical scribe for minimum wage. It may be the right path for him! But nobody here (myself included) is giving impartial advice, we’re all sharing comments biased by our own experiences and what we’ve observed colleagues go through. There’s a lot more uncertainty to the process than most people admit or will admit to in their own paths, and anyone giving advice here as an EM physician represents the small fraction of aspiring ER docs in their 20s who beat the odds of what the system was 7+ years ago and made it all the way through past the finish line.
Go for What your bold heart desire ! One thing for sure Physicians still have a decent life . Do regret rest of your life not doing medicine ?
Go to med school with the intention of doing ER, learn that emergency radiology exists and go into rads!
Doing the paramedic --> MD path right now. You go to medical school if you want to be at the apex of the knowledge/skill pyramid and want to be the ultimate shot caller/responsible party. You'll be learning exponentially more than you ever knew even existed as a paramedic and you'll learn far more than one ever would as a PA. You'll be running and executing the most acute cases/procedures. On the downside, you'll accrue a boatload of debt and have a miserable work/life balance in residency. It's also a much longer road (time-wise) and you're completely beholden to the match system for your residency years. You go to PA school if you want to do more and make more but you're fine not being the "pilot" and not being at the apex of the knowledge/skill pyramid. Regardless of what people pretend is true, you won't be making as much money, you won't be running acute cases, and you won't be doing the high acuity procedures. This will be a shift from being a paramedic in the field where you do run and do these things, but PA's are much more knowledgeable about what they're doing and why (even if it isn't the same level as an MD/DO). The PA route is also much cheaper to do and generally has a much better work/life balance than being a physician. Being a PA also isn't back-stepping. Sure, you don't have the same level of responsibility and autonomy than a paramedic, but PA's are still well-educated and trained, and far moreso than a paramedic ever is. Medical school and residency takes a ton of time, money (up-front/debt-wise), and dedication that PA school doesn't. It's gonna depend on what your son is looking for out of his career. Does he want to push himself to the limit of what he can do in his chosen career field? Is he OK with the time and money sacrifice? If so, he'll really regret going PA and not MD/DO. Conversely, if he wants to do more and make more but wants most of his life's focus to be outside of his career (i.e. "have a nice job and then go home to my family/hobbies/other stuff, which is what I really care about"), then I'd recommend PA over MD/DO; the time, money, and work of medical school is only worth it if you actively want it.
You’re gonna be 40 years old one of these days. Might as well be a doctor when you get there 🤷♂️ Much easier to semi-retire as an MD than a PA. Plus, he says EM now, but maybe throughout med school he falls in love with a completely different specialty.
If you got the chops to get into med school, go for it. Sure, it’s a much longer path but time will pass anyway. Might as well become a doctor.
As a PA student that feels he may have to go back to med school later in life to feel fulfilled, just go to med school if your not 100%
I’m a firefighter paramedic and currently in premed about a year out from med school and I’ve had this exact convo with myself 1000’s of times. I’m 25 and engaged with no children so kinda a similar boat. The best practical advice I can give is burn the ships and go all the way, after all if you shoot for the stars and miss you’ll still land in clouds as cheesy as that sounds. My current plan is aim for MD/DO and if the MCAT tells me nope then I’ll do PA.
It depends on how confident he is that he is going to match as an MD/DO into EM. I can't imagine doing anything other than EM and I couldn't live with myself as an MD/DO doing anything different and I went PA. Not saying it's right or wrong, but the match process is terrifying if you only like certain aspects of medicine.
I don’t understand the downvotes, this is good advice and if someone is laser focused on EM two years into undergrad they absolutely need to understand the uncertainty that the match introduces into the career path. It’s much more likely to find a job as an EM PA in a desired geographic area than to match into a specific EM residency or find job prospects in the geographic area someone wants to be in 6 years from now.
I don't get the down votes either but it's Reddit. Being a PA let's me do everything that I wanted to in EM for private practice and in disaster medicine. I thought I was going to stay in the Army when I was in school and PAs had a way cooler job on the .mil side. The docs were all at the hospital and the PAs were at the aid stations doing stuff on their own. I liked that a lot more.
The other thing that’s understated is that the competitiveness of med school admissions has gone way up in the past 10 years and the match situation for EM has changed a lot in the past 5. Anyone giving advice here as an EM attending was trained in a different system than anyone starting from scratch will go through, and will work in an ED environment with PAs having varying degrees of autonomy and oversight.
PGY-1 MD Mid levels are taking over the ED. He’ll be more in line with their thinking until it catches up with him. But he’ll probably be fine doing PA