PA vs. MD: How to Decide Your Best Next Step

Are you trying to decide whether to become a doctor (MD) or a physician associate (PA)? The most commonly cited pros and cons about both degrees focus on the amount of required training, the scope of practice and salaries versus debt after graduation. But according to higher education experts who train future practitioners, the real decision comes down to long-term life goals and work-life realities. If you are at a crossroads in your undergraduate degree, this guide breaks down the lifestyle differences between PA school and medical school, sharing a clearer picture of what each program is like and which might be right for you.

Real-life choices: a paramedic’s decision between PA and MD

In Clinical Assistant Professor Brian Collins’ personal experience, the question came down to the best decision for his family. He had completed an undergraduate degree in philosophy but had gone back to school to become a paramedic. With this new experience under his belt, he wanted to pursue more medical training.

At the time, he had two choices. He could continue taking additional undergraduate prerequisite science classes required for PA school, or he could apply to medical school, where many of the same science courses are built into the first year.

“The number of undergraduate prerequisites is how PA programs compress their training timeline,” explains Collins. “There is a strong science expectation for incoming students. For me, the decision came down to whether I should take more undergraduate sciences and choose the compressed PA program or go for four years of medical school with three plus years of residency. We chose the shorter timeline.”

Collins explains that his story mirrors the historical origins of PA programs. The shortage of primary care physicians precipitated the first PA program in the late 1960s, which included Navy Hospital Corpsmen, EMTs, paramedics, army medics and athletic trainers often pursue more medical training as a second career.

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Having a nursing program in the same building at Berry College, Collins says they commonly receive questions about the difference between PA programs and nurse practitioner (NP) programs, which function in similar ways to PA in practice. He explains that these programs grew out of registered nurses (RNs) seeking further education and medical training and nursing education is a significantly different model than that of a practitioner. NP programs also allow traditional nurses to continue working whereas PA programs are full‑time, immersive and structured.

Today, however, the most common decision for an undergraduate interested in being a health care provider is between a PA program and medical school. And despite its history as a second-destination career, students are now frequently choosing PA programs as their first stop post-graduation. The decision factor has become more focused around deciding whether to pursue a career as a generalist with lateral career mobility straight out of undergraduate (the PA model) versus a career as a specialized MD over seven plus years.

How PA and MD training compare

Flexibility: the advantage of the PA profession

Beyond a desire for a compressed education timeline, Collins says he bought into the flexibility as foundational for PA programs in comparison to other options.

“The beauty of the PA build is the generalist education and the lateral mobility within medicine,” says Collins. “We have a very similar timeline to recertification as a physician, too. But I could walk into a different specialty tomorrow without going back to school. That’s the power of PA training. One day, I could be a hospitalist, but if I got tired of that, I could work as a dermatologist. Flexibility is the defining feature of the profession, flexibility in location, in specialty and in life.”

In contrast, MDs are tied to medical school for four years, followed by placement in a location-based residency prior to joining a practice or pursuing a fellowship. They typically focus on one specialty and stay focused on that area for the entirety of their career.

Responsibility: what PAs can and can’t do

So, what can’t PAs do with their training? Collins says if you are interested in surgery, then a PA program might not be right for you. PAs can assist in surgery but are not licensed to act as the primary surgeon in any specialty. But in other areas, PAs function with a similar amount of responsibility as a physician, independently performing physical exams, determining diagnoses, building treatment plans, etc.

“PA training has moved toward ‘optimal team practice,’ a phrase describing recent policy changes where PAs are no longer required to have a specified overseeing physician in every state,” explains Collins. “Today, PAs are set up to step into the role of practitioner immediately. The exact composition of the team and specific relationships with physicians are determined by local practices. Still, the mentality of PA training is team-based. It focuses on how healthcare teams can best care for the most patients. And especially in rural medicine settings, if you raise your hand to be in leadership, you’re going to have the chance whether you are a physician or a PA.”

Collaboration over competition makes a successful PA

Polly Evans-Thomas, program manager for the Berry College PA program admission, also expresses that a student’s ability to be collaborative is a defining characteristic of the most successful PA students.

“I think some believe becoming a PA is an easier route, but the reality is that it is like drinking from five fire hydrants at once and trying to decide which one to focus on,” she says. “What you did academically in your undergraduate degree likely won’t work here. Students who succeed in this environment need to be great at asking for help and leaning on one another as a team.”

Collins adds, “Healthcare is not a competition. It’s a team sport, and that’s something we are frequently having to teach high-achieving undergraduates entering the program since many of them have been aiming to be the best for years.”

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When comparing PA school and medical school, many students assume one path is “easier” to get into, but the reality is more nuanced. Both programs are highly competitive in different ways.

Admissions comparisons

When looking at the place you might be the most successful, admission is a major part of the decision. Which programs are the most likely to accept you? PA programs typically receive tons of applications for relatively small cohorts. They also require or strongly prefer 500–2,000 hours of clinical work, which can be a major barrier for traditional undergraduates. Because PA programs have a shorter timeline, they expect strong performance in prerequisite sciences, showing that students can handle an intense academic load.

In comparison, medical schools evaluate applicants on a broader academic and testing profile, including the MCAT, GPA, research experience and letters of recommendation. While medical schools do not require as many hands-on patient-care hours, they expect a strong academic record and a commitment to medicine demonstrated through shadowing, volunteering or research.

Ultimately, PA school is not necessarily easier to get into than medical school. Instead, students are evaluated through a different set of metrics. PA programs emphasize the sciences, clinical hours and prior experience, while medical schools emphasize academic depth. Choosing the right direction depends on your strengths and experiences.

PA vs. MD: finding your path

Summing up the advice of a program manager and clinical PA professor, there are several areas worth reflecting on when choosing the best program fit beyond admissions.

Professional goals: Are you highly interested in the depth of a particular specialty, or does the flexibility of a generalist appeal to you?
Learning style: Based on your learning and education history, what type of program setup would best suit your learning needs? Do you prefer longer, more in-depth program or the compressed program style of a PA program?
Financial realities: What grants are available to you in both spaces? How are you paying for PA school or medical school?

Job outlook and salary

Whichever you choose, healthcare needs both MDs and PAs. The job outlook for both career paths is strong, but it is a bit stronger for PAs. According to the U.S. Bureau of Labor Statistics, PA jobs are projected to grow 20% from 2024 to 2034, much higher than average, while job growth for physicians stands at 3%. The latest median pay for PAs is $133,260 per year, while physicians’ median pay is $239,200 or higher, depending on specialty.

Collins encourages students to meet with PAs to talk through lifestyle, work-life balance, specialties and experiences. Another option? Talk with admissions counselors like Polly Evans-Thomas, who can help you navigate whether you are prepared to apply.

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Want to learn more about the Berry College PA program? Check out these links to find out all the program details and requirements of Northwest Georgia’s first PA program.