Opportunity Costs: PA Or A Physician?


By:  The Musing Medic (@TheMusingMedic)



Blast From The Past


During my sophomore year of undergraduate school, I was required to take an economics course. Now, I don’t remember much from that class, but I do remember one particular concept: opportunity cost. It’s a simple idea really. Assuming the best choice is made, the opportunity cost is the lost benefit–it’s the benefit(s) you would have had if you chose the other option.


For example, pretend you can only eat at one restaurant on one particular night. By choosing Restaurant A, you cannot have the food from Restaurant B. The cost of choosing A, then, includes missing out on the food from Restaurant B…which may or may not be better than the food at Restaurant A.


Choosing PA School Over Medical School?


Let’s apply this idea to choosing an occupation within the field of Medicine.


Let’s say a student has been accepted to both medical school and a physician assistant program. Choosing to attend medical school means at least 7-10 years of formal didactic and clinical education. It means incurring extensive amounts of debt from student loans. There is also delayed gratification in buying a house, new car, or having a family. By choosing this route, your “cost” includes what the PA program/profession offers such as shorter training, less debt, and lateral mobility within the profession.


Of course, choosing the PA route also has its own set of “costs”. Choosing PA means less autonomy, simpler cases, lower income, and initial limitations in medical knowledge. You may be a competent provider that works similarly to a physician but you will never be the expert. And, the truth is, one day you will be a twenty year veteran PA who will be supervised by a newly minted attending who is younger than your own children. Talk about a kick in the ego!


A Call To Action:  Tell Me What You Think!


Why do I bring this up?  It’s because I am currently in this position. If I had to choose right now, it would be medical school hands down. But if we examine the current climate of medicine as well as the future, the PA role may be a more economical and conservative one to embrace. As Medicine continues to grow as a multi-billion dollar business, there will be more impetus on hospitals and health care companies to lower costs. This puts the PA in prime position to move up the professional ladder and have continued employment opportunities across all specialties. That is not saying physicians will be without opportunity, as they will always have the top position in the medical hierarchy. (At least that’s how it looks right now.) But I can see their roles progressing to a more supervisory position over physician assistants who carry out a majority of the tasks. Perhaps, in a busy ED, you will see one or two physicians overseeing three to five physician assistants.


Now this is all speculation…but I’m not alone in thinking this way. In Doctored: The Disillusionment of an American Physician, Sandeep Juhar (an interventional cardiologist) comments extensively on the state of Medicine in America and its depressing trend of moving away from doing what is best for the patient and more towards customer satisfaction. He illuminates studies done over the past decade that indicate a number of physicians regret their career choice at the present moment and would steer their children and those interested away from the field. Such a depressing thought.


The opportunity costs riding on my decision really are very high no matter which direction I choose. I desire the autonomy and knowledge but at almost thirty years old, with ten years as a medic under my belt, the prospect of another decade of school is daunting. Throw in the overwhelming number of studies highlighting the unhappiness of American physicians in the 21st century and the conservation decision seems more and more clear. Still, potential regrets exist and the only thing I can do is attempt to minimize them.


…so, what do you think?  Are you a PA or physician?  Let me know what you decided and why!  Would you do the same nowadays?