A physician assistant (PA) is a healthcare collaborator who can diagnose, treat, and manage patients as part of a healthcare team. With the unmet need for health care providers in the United States, PAs are set to play a valuable role in the healthcare system. As such, PA school is a popular alternative for people seeking alternative paths to medical school. In this article, we delve into the similarities and differences between medical school and PA school. We discuss similarities and differences in admissions and education. We will also discuss the difference in scope of practice and career prospects.
Table of Contents
Medical School Versus Physician Assistant School Comparison Chart
| Med School | PA School | |
|---|---|---|
| Admission Test | MCAT | GRE |
| Direct Patient Experience Prior to Matriculating | No | Yes |
| Average GPA Of Admitted Student | 3.73 | 3.56 |
| Average Test Score Percentile of Admitted Student | 511 MCAT (85%) | 153.7 (GRE Verbal) (61%), 153.1 (GRE Quantitative) (51%), 4.1 (Analytical Writing) (60%) |
| Years of Schooling | 4 | 2 |
| Years of Training (Residency) | At least 3 | Not required |
| Board Exam | USMLE/COMLEX | PANCE |
| Average School Debt | $196,520 | $100,656 |
| Typical Salary Range | $237,000 – $341,000 | $90,150 – $127,220 |
| Average Hours Worked | Avg = 51.4 hours, Range = 40-60 hours | 40 hours |
| BLS Growth rate from 2018 to 2028 | 7% | 31% |
| Can Practice Independently | Yes | No (except for New Mexico) |
| Average Annual Malpractice Insurance Premiums | $12,000 (PCP) $21,000 (Specialists) |
$2,000 to $6,000 |
| Employer Covers Majority of Malpractice Insurance? | Usually yes | Usually yes |
| Job Satisfaction | 82% | 95% |
Admissions Requirements
The following section delves into the admission requirements for these two specialized tracks.
Undergraduate Coursework
The pathway for pre-PA students and premed students overlap significantly. Although the exact requirements may vary slightly from school to school, the vast majority of medical school (including both DO and MD schools) and PA school programs require students to finish prerequisite courses in biology, chemistry, psychology, and statistics.
Medical schools also require coursework in additional sciences such as physics, biochemistry, upper-level biology courses, and mathematics. The upper-level biology courses are usually not specified and can be in a variety of subjects such as neuroscience, genetics, cell biology, anatomy, or microbiology. In contrast, most PA schools require students to take coursework specifically in anatomy, physiology, and microbiology.
However, this can also vary by school. For example, some PA schools require students to take coursework in biochemistry and/or psychology before matriculation.
Clinical Hours
A key difference between the two schools is that PA schools require applicants to accumulate a significant number of clinical hours before matriculation. Many of the top PA schools require between 1000-4000 hours of healthcare experience. However, many competitive students will exceed this minimum. According to the 2018 PAEA report, the average number of patient contact experience of the matriculating class was 3,021 hours.
In addition to the total hours that need to be accumulated, another important distinction from medical school is that PA schools require “direct patient healthcare experience.” This is defined as a position where a student works in a hands-on manner with patients. Examples of such positions include emergency medical technicians, phlebotomists, physical therapy aide, nursing aide, EKG technicians, or medical assistants.
It is important to note that this list often excludes scribes, which is a popular way to get clinical experience for premedical students. Scribing does not usually require hands-on patient experience as scribes shadow healthcare providers and document interactions, but do not typically work with the patients themselves.
Although medical schools also require clinical experience, they accept indirect clinical experiences and do not necessitate as many hours as PA schools do. The general objective of this prerequisite for medical schools is that students understand what life as a practicing physician looks like. On the other hand, PA schools expect students to already know how to work with patients.
Entrance Examinations
The Medical College Admissions Test (MCAT) is required for entrance into medical school, while PA schools require students to take the GRE.
The level of competitiveness for PA schools is similar to that of medical schools. Matriculants in 2018 had an average undergraduate science GPA of 3.5 and an average total undergraduate GPA of 3.6. The average GRE score breakdown for these matriculants was 153.7 in verbal reasoning (61st percentile), 153.1 in quantitative reasoning (51st percentile), and 4.1 (60th percentile) in analytical writing.
According to the 2018 AACOMAS Applicant and Matriculant Profile, 20,981 students applied for DO school and 7,415 (35.3%) matriculated into an osteopathic program. Matriculants had an average undergraduate science GPA of 3.43 and an average total undergraduate GPA of 3.54. The average MCAT score for matriculants was 503 (61%).
In 2018, 52,777 students applied to MD schools and 21,622 (40.9 %) matriculated into a U.S. allopathic program. Matriculants had an average undergraduate science GPA of 3.65 and an average total undergraduate GPA of 3.72. The average MCAT for MD matriculants was 511 (80%).
Is Med School Or PA School Harder?
Although there is some overlap between the training that doctors and physician assistants must undergo, there are some significant differences as well.
One of the biggest differences is the duration of training. Most PA programs last between 20-36 months, with the average program length being close to 27 months. Students can then complete their certification and start practicing. This option makes PA school an attractive option for people who do not wish to spend a significant amount of time in school.
Doctors must undergo 4 years of medical school, followed by 3-7 years of residency training. Some even pursue further fellowship training in specific subspecialties.
Coursework
The actual preclinical coursework is very similar for both schools. Both PA and medical students study topics such as anatomy, physiology, biochemistry, pathophysiology, immunology, and microbiology. For PA students, this coursework is compressed within 1-1.5 years (depending on the program).
While PA school cover the same subjects, they may not go as in-depth as medical school.. However, it should be noted that many medical schools are also implementing 1.5-year didactic curriculums, which will be more focused and thus maybe quite similar to PA school didactic curriculums.
Throughout the first year, PA schools tend to emphasize clinical skills more than medical schools do as students will be thrust into clinical roles sooner.
Other factors to consider are the implementation of pass-fail and class schedules. Although this varies, many medical schools are trending towards more student-friendly policies such as pass/fail grade systems and minimizing the number of mandatory events/classes. In contrast, a significant number of PA schools still utilize traditional grading schemes and are structured so that students are required to attend class from 8 am – 5 pm.
Clinical Training
Another difference between the two is the duration of clinical training. Medical students spend an additional year in clinical training and then go onto complete residencies.
Board Examinations
Another key difference is the board exams. Medical students are required to take a series of board exams, either the USMLE for MD students or the COMLEX for DO students. Both sets of exams are taken in three parts, two of which are completed during medical school, and the third completed during residency.
PAs only take one exam, the Physician Assistant National Certifying Exam (PANCE). This exam consists of 300 total questions and is taken after graduating from PA school.
Which is More Difficult?
As far as which route is harder, a case can be argued for both. The actual PA school coursework may be more difficult due to how both preclinical and clinical education is compressed within a 23-27 month span. Mandatory class sessions and curriculum pace may make the PA school didactic year more challenging than the medical school one, where students are usually afforded more freedom and time in studying the material.
However, medical school requires students to know more information overall and simultaneously study for board exams which play a significant role in determining their future residency options. These two factors can make the 2nd and 3rd year of medical schools an extremely stressful time.
Training: PA School Versus Med School
Unlike doctors, physician assistants are not required to complete residencies in order to practice. However, it is an option for PAs who are interested. The main advantage of residency training for PAs is that they will undergo intense protected training in specialties, allowing them to accrue experience in a field which may have taken several years to gain otherwise. This can help with confidence and may also open doors for employment.
The list of postgraduate PA programs is very diverse. There are programs offered in specialties such as cardiothoracic surgery, orthopedic surgery, and urology. These residencies are around 12-13 months long.
In contrast, residencies for doctors are required to practice and are much longer. Medical residencies range in length from 3-7 years. The longer specialties typically tend to be surgical residencies such as neurosurgery (7 years) and vascular surgery (7 years).
Primary care specialties such as pediatrics, internal medicine, and family medicine all are 3 years long. However, these doctors can subspecialize, thus extending their training. For example, a cardiologist must first complete three years of internal medicine training and then complete a cardiology fellowship afterward.
Debt, Salary, and Job Satisfaction
Debt and compensation are also important factors to consider. The average medical school debt in 2018 was $196,520 and the median was $200,000. The average compensation ranges depending on specialty. On average, it was $237,000 for primary care providers and $341,000 for specialists.
However, the average medical resident makes $61,200 annually. This is important as it highlights how medical students accumulate significantly more school debt but also receive significantly less compensation. It will take years before they make physician salaries, during which the interest on their loan will continue to accrue.
PA students are only required to pay for two years of schooling. Thus, their debt is roughly half that of medical students upon graduating at an average of $100,656. The typical starting salary of PAs range from $90,150-$127,220. Due to the higher compensation and lower loan amount, PA students are better equipped to pay off their loans sooner.
Difference in Scope of Practice
Perhaps the most important difference to note between doctors and physician assistants is the difference in their role on the healthcare team. Doctors act as autonomous health care providers who can start and run their own practices. In most states, PAs are required to work under a specific physician to practice medicine.
Individual states also choose whether to define the PA/doctor relationship as supervisory or collaborative and further define specific requirements, such as frequency of communication and availability of the doctor for the PA. Doctors are also responsible for training the PA and familiarizing the PA with their expectations for patient care.
The scope of practice is then decided by the individual supervising physician. This can vary depending on the doctor’s assessment of the PAs and the needs of the institution or clinical practice. PAs can typically assess, diagnose, and treat the majority of the clinic’s patients. However, for unusual or complicated cases, they typically are expected to work closely with the physician.
Recently, there has been a push to increase the autonomy of PAs. In some states, physicians are no longer needed to be physically present while PAs perform their clinical services. New Mexico allows primary care PAs with three years of experience to move to a collaboratory role with a physician where the legal responsibility for care is solely on the PA. Florida and Rhode Island are also considering legislation that will allow PAs to practice independently.
There are also several PAs who have opened up their own practice. The exact method to do this varies from state to state. However, it typically requires PAs to find a physician who is willing to collaborate in return for partial compensation.
Liability and Malpractice Insurance
As far as liability, the doctor has complete responsibility of every patient in the clinic. PAs share partial responsibility with their supervising physicians. Both are required to have malpractice insurance. For PAs, malpractice premiums can range from $2000-6000 per year. This cost can be partially or fully covered by the PA’s employer, although in some cases, the PA may be required to pay for it on their own.
For physicians, the two most important factors in malpractice premiums costs are specialty and location. The average for primary care physicians is $12,000 and $21,000 for specialists. The specific cost varies per specialty as exemplified in the table below.
| Malpractice Premiums (Obtained from the Medscape Malpractice Premium Report 2019) | |
|---|---|
| Ob/Gyn and Women’s Health | $46,000 |
| Specialized surgery | $34,000 |
| Radiology | $21,000 |
| Anesthesiology | $15,000 |
| Internal Medicine | $14,000 |
| Family Medicine | $10,000 |
| Psychiatry | $5,000 |
Another important factor to consider is location. According to a 2018 AMA report, OB/GYNs in California paid a manual premium of $49,804 in some areas of California while those in Suffolk county in New York paid $214,999.
The majority of physicians do not pay for their own malpractice insurance and it is typically covered by the employer. However, physicians who practice solo must pay for their own.
Career Outlook
There is an unmet healthcare need in the United States, especially with the increasing proportion of the aged population and unmet primary care provider need. PAs are well situated to satisfy this demand due to their relatively short training time and flexibility. According to the U.S. Bureau of Labor Statistics, the job outlook for physician assistants is expected to grow by 31% from 2018 to 2028.
This projected growth is fueled by many factors. PAs have lower salaries compared to doctors and may be viewed as more cost-effective by certain healthcare facilities.
The growth for physicians is expected to be slower at 7%.
Job Satisfaction, Work-life Balance, and Flexibility
The PA career is notable for its high levels of job satisfaction and flexibility. In a recent 2017 study, PAs reported higher levels of career satisfaction (95%) than physicians (82%).
One of the most highly valued aspects of the PA career is the career flexibility. Unlike doctors, who must specialize via residency training, PAs can move between specialties without requiring additional training. According to the National Academy of Medicine, career mobility may provide relief from burnout and result in higher career satisfaction for PAs.
Doctors often spend more time at work, performing additional duties such as rounds, administrative tasks, and research. Doctors often end up working at least 60 hours per week. The hours can be long and occur at irregular hours, especially if they are on call. In a 2014 AMA report, nearly one-quarter of physicians work between 61 to 80 hours a week.
In contrast, PAs typically have less responsibility and are more likely to establish a typical 40-hour workweek.
Conclusion
Both PA and medical school lead to extremely rewarding careers in the healthcare field. Although there are some similarities in the functional role of these healthcare providers, they have some significant differences in schooling, finances, duration of training, and scope of practice. Ultimately, when deciding between both, the decision should come down to what you think is best for you in terms of duration of training, autonomy, loan burden, and career flexibility.
References
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