College students who are interested in health care and who excel in science often see one path open to them: medical school. However, becoming a licensed and board-certified physician typically requires four years at either an M.D. or a D.O. program, plus three to five years in a residency focused on a medical specialty like psychiatry or surgery.
Aspiring doctors who want to sub-specialize in a very specific area of medicine, such as addiction psychiatry or pediatric surgery, may elect to pursue a fellowship in that field, which means that their medical training will last about a decade.
In contrast to the many years of post-undergraduate training required for a career as a doctor, completing a physician assistant graduate program takes about 27 months.
Becoming a physician assistant allows someone to provide health care without the lengthy and strenuous education that is mandatory for a doctor. Physician assistants can examine patients, prescribe medicine, order diagnostic tests and perform a host of other duties that doctors also do, experts say. And this path may become more popular — the Bureau of Labor Statistics projects 37% growth in the number of physician assistants between 2016 and 2026. By comparison, physicians and surgeons are only expected to see 13% employment growth.
Physician assistants often take home a hefty salary. According to the Bureau of Labor Statistics, the median salary for U.S. physician assistants in 2018 was $108,610.
But this compensation is still meager when compared to a doctor’s salary. In 2018, family care and general medical practititoners had an average salary of $211,780, while anesthesiologists were paid $267,020 on average, according to the Bureau of Labor Statistics.
Choosing between becoming a doctor or a physician assistant may likely require students to weigh more than just their potential salary. John McGinnity, a past president of the American Academy of Physician Assistants, says he didn’t want to lead or run a medical practice by himself. “I like the team environment,” he says.
Jonathan E. Sobel, the current president of the AAPA and the chair of its board of directors, adds that PAs have the option of not only serving as health care providers but also as health care administrators. “In addition to practicing clinically, PAs are increasingly in leadership roles within hospitals and health systems, helping them meet quality metrics and improve care,” he wrote in an email.
Tony Stajduhar, the president of Jackson Physician Search — a health care recruiting firm based in Georgia that places doctors, nurse practitioners and physician assistants into jobs — says one key distinction between physicians and physician assistants is their level of autonomy. Specifically, physician assistants must work under a physician and cannot open a separate practice, even though they can both see patients and perform similar treatments, he says.
Joshua Johnson, a Hawaii-based physician assistant who focuses on orthopedic surgery, says one of the perks of being a physician assistant as opposed to a physician is that a PA tends to have more reasonable hours and better work-life balance.
“Typically, the PA lifestyle — it’s a little less stressful, because there’s a little less responsibility involved, less schooling obviously,” Johnson says. “The M.D., to commit to that is to make quite a long commitment, as compared to the P.A. program.” Though the jobs of physician assistants and doctors vary, there are some important similarities, he adds. Physician assistants can read X-rays and lab reports, perform medical procedures and provide assistance to surgeons in medical operating rooms, he explains.
Dr. Steve Howe, an associate professor and medical director of the physician assistant program at Marietta College in Ohio, suggests that physician assistants may “fill a void for the health care industry” by increasing the number of health care providers and ameliorating doctor shortages.
While a physician assistant’s day-to-day duties may closely resemble those of a doctor’s, there are some differences between the two professions.
Dr. Christin Giordano, a former physician assistant who decided to become a physician and obtained her medical degree from the University of Central Florida, says working as either a physician assistant or a doctor can be fulfilling, and those interested in medicine should pursue the health care career that they prefer.
“Both are great options, and you really can’t go wrong with either,” she says. “However, if your heart’s desire is to become a physician, and your deterrent is time commitment, financial commitment, difficulty of training (or) wanting a family … but your true desire is to become a physician, if you go to PA school, likely you’ll have happen to you what happened to me, which is you’ll end up wanting to go back to medical school.”
However, she says people who are “not completely sold on becoming a physician” but who like the idea of providing health care and working relatively normal hours may enjoy a career as a physician assistant.
Prospective health care providers who are deciding between a career as a physician assistant or doctor should consider shadowing both types of health care providers, Sobel says. “The pros and cons of each profession will resonate differently with every individual,” Sobel wrote in an email. “Speaking to those who are in the profession and asking real time questions is also helpful.”
Prospective graduate students who are considering becoming physician assistants should consider the following aspects of this field.
Schooling and Training
Most physician assistant programs take two or three years to complete, says Chris Hanifin, academic chair of the department of physician assistant at Seton Hall University in New Jersey. “There tends to be a year or more of basic science training,” he says. During this period, students may study subjects such as pharmacology, anatomy and physiology. Medical students, he says, study basic sciences for two years.
“For some students, the length of PA programs, the smaller debt burden, and the ability to begin a career more quickly influence their decision to attend PA school,” Sobel says. “There tends to be a year of more of basic science training,” he says. During this period students may study subjects such as pharmacology, anatomy and physiology. Medical students, he says, study basic sciences for two years.
Once the basic classroom work is complete, physician assistant students then have clinical rotations, just as medical students would. Rotations can last one or two months, Hanifin says. Students are immersed in a medical specialty, such as pediatrics or emergency medicine, and interact with patients. After graduation, students become nationally certified and obtain a license that permits them to work.
Doctors usually have more options when deciding how many people they’d like as co-workers. “A physician can basically work independently,” Hanifin says. “A physician assistant will always work in a collaborative relationship with a physician.”
What this relationship entails can vary from state to state, depending on state regulations.
“It doesn’t mean that your physician is there in the room with you,” McGinnity says. In some instances, a physician may check in once a week with the physician assistant, he adds.
Physician assistants may have limited independence, but it’s easier for them to make a change within their career, experts say.
“Once you have your PA license, that basically affords you an opportunity to work in any medical specialty,” Hanifin says. For example, a physician assistant can go from working in internal medicine to obstetrics and gynecology without getting additional training.
But once medical school graduates complete residency — and sometimes additional training — in a specialty, switching to another form of medicine could require another few years of training.
Physician assistants may also have more flexible work days, Howe says. “They just pretty much work in the office, and then go home.”
Howe says physicians are more likely to be on-call after hours and deal with the managerial side of a medical practice than PAs.
Dr. Will Kirby — a dermatologist and the chief medical officer for the LaserAway aesthetic dermatology group, which employs many physician assistants — says one advantage of being a PA as opposed to a physician is the freedom to shift between medical specialties as your work-life balance needs change.
“If you are a physician with board certification in general surgery who thrives on the excitement and late nights in your 30s but decide that you are drawn to radiology in your 40s, you unfortunately have no simple recourse to switch areas of specialization and will remain a surgeon,” he wrote in an email. “Physician assistants however have much more flexibility when it comes to areas of specialization and a PA who starts out in a kinetic field in his or her early 20s, like emergency medicine for example, may decide that they want to start a family and that a slower-paced, more predictable field suits them better in their early 30s and can transition over to dermatology with very little effort.”
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Update 05/13/19: This article was originally published on Aug. 25, 2014, and has been updated to include new information.