Hello,
Nice forum.
Here’s a question. Assuming retirement at 65, which would be best (financially responsible, feasible, etc) choice…starting MD school or PA school at 40? All prerequisites and medical experience are in place, as well as LORS, shadowing, etc.
Family includes 2 young children. No debts, but would have to take out student loans for either decision.
Please note, this is not a PA vs MD/DO question regarding profession or independence, as both can be rewarding. This is more about which would be best financially at this point in life, as I am the sole provider for my family, looking to save for retirement and college tuition for kids. How to pay back school debt and save between 40 and 65.
PA - finish at 42. Less debt, less income, more income years.
MD - finish somewhere between 47 - 50 depending on specialty. More debt, more income, less income years.
Hope to retire with decent savings by 65. Assume I would not go into a specialty that is rigorous, such as ER or Surgery, but would stick to family practice, peds, derm, etc.
Any thoughts?
According to the Occupational Outlook Handbook put out by the DOL (http://www.bls.gov/oco/ocos074.htm), the median primary care physician income in 2008 was $186,000 per year. For PAs, the average was $81,230.
As a PA, you would start earning your salary at age 43, giving you 23 years of income. Not accounting for annual raises, COLA adjustments, living expenses, and the like, that would give you a total income of $1,868,000. Against this, you would have to repay two years of school and expenses and a year of internship. Net lifetime earnings (before living expenses and such): Around $1.75 million.
As a physician, you would start earning a salary as a resident at a rate of around $50,000 per year for four years. Starting your independent career at 48, you would then have about 18 years of income, for a total income of $3,548,000. You would still have to repay four years of school and expenses, at a much higher rate as a DO. Still, your lifetime net earnings will clock in at over $3 million. If you specialize, this figure will increase significantly.
From a purely financial perspective and not considering any complicating factors, being a physician obviously pays a lot more, even for a 40-year-old non-trad. But life consists of a whole lot more than earning money, so at best this is a poor indicator of the right path to choose.
I was going to ask when you took your prereqs? The PA schools I have talked to want all prereqs within the last 5 to 10 years.
Spoxjox, thanks for the number crunching. You’re awesome!
I agree that money, alone, is a poor indicator of which path to follow. My biggest concern was which direction would provide financial stability starting at 40. It seems that both would do this. So, now other things can also be considered. I was worried that starting medical school this late in the journey would keep my finances in the red up until retirement. Of course, now I see it wouldn’t have to. (That would be how we decide to live after graduation and residency).
BaileyPup, that may be the case regarding prereqs. However, I’ve had some really good feedback from adcoms due to strong LORs and my work in the medical field.
- spoxjox Said:
Word!
I personally don't plan to retire until I'm physically unable to work. So, I'm thinking that will probably be around age 90 or so!
- Riboflavin Said:
I agree that money, alone, is a poor indicator of which path to follow. My biggest concern was which direction would provide financial stability starting at 40. It seems that both would do this. So, now other things can also be considered. I was worried that starting medical school this late in the journey would keep my finances in the red up until retirement. Of course, now I see it wouldn't have to. (That would be how we decide to live after graduation and residency).
BaileyPup, that may be the case regarding prereqs. However, I've had some really good feedback from adcoms due to strong LORs and my work in the medical field.
Using the Occupational Handbook average for physician salary may miss the wide variation per specialty. The average lifetime earning of 3 million plus is likely double or triple for some specialization where as primary care may be only half of that.
Link to Specialist vs Primary Care income
It would be useful to the specialization, length of training, and debt to lifetime earnings ratio, and compare that to a PA. I would also consider the training time to degree ratio. The time away from family with young children is a huge consideration
You would also need to factor the income you are loosing. If you are making for instance 100K … you will be loosing that income for: 2 yr post-bacc, 1 year glide, 4 years med-school: and then the difference of 100K and residency/fellowship income ~ 900K (assuming first attempt at med school is successful). If you want to factor in annual increase etc as well ~ 1000K.
But then again, money is not the only reason to work … it is ONE of the reasons for sure unless someone is paying your bills, which does not seems to be the case!
Hopefully this information is helpful and not discouraging in finding the right answer for you.
Hello Riboflavin and welcome. Spoxjox’s number crunching is on target. The years you spend in med school may be a little dicey, but you can catch up quickly. I was in med school age 43-47 and lived on my husband’s income, which required a lot of scaling back after I quit working. During residency we were able to start saving again and have a little more disposable income. Since then we’ve realized that we really don’t want to change our lifestyle that much, other than do some more traveling and charitable things that we couldn’t do during the lean years. I’ve been able to catch up quickly via 401(k), IRA, and 403(b) plans which shelter income and lower the tax burden. Of course there’s risk there too but we’ve tried to diversify as much as possible. The gist: if you really want to be a doc, don’t let the retirement stability question scare you off. The years that you won’t be earning/saving will be minimal compared to your potential after you finish. Nobody goes into this profession to get wealthy, but your skills will always be in demand, and you will be able to make a comfortable living.
What is your background? Do you have anything medical there to start? The reason I ask is that PA programs tend to like to build on existing medical experience. MD/DO programs not so much so. Also be aware that PA programs really want people who wnat to be PA’s. They don’t want people who really want to be MD/DO’s and are applying as a Back-up or second choice.
When I applied I was rejected by the UNE PA program. I think they checked and saw I applied to the DO program and rejected me because they felt they were my 2nd choice.
I’ll second what swy55 said about PA school. When I looked in to going, most programs had a rather large hour requirement (usually equivalent to at least 1 year of full-time experience) for previous healthcare experience. I also found that many of the PA programs had virtually the same pre-requisites as medical school. In the long run, I decided that if I was going to have to take virtually the same courses for PA school that I would need for med school, I might as well go for the whole enchilada.
- Emergency! Said:
Same here. Not to mention the fact that, IMHO, it's actually harder to get into PA schools than med school.
I really appreciate all your comments! You guys are very inspiring, and your input is greatly appreciated.
I’ve read (in another forum) that for the first 15 years, it’s actually better economically to go the PA route. But then after that, the MD route is financially much better. If I only had 15 years left to work, then the PA direction would probably be best. However, I do still have much more time to keep a long term goal in mind, especially since I would like to keep working past 65, if possible. (I used that retirement age to gain a conservative perspective).
jmdmd, thanks for your perspective. I will be in a similar situation, so it’s good to see that it could work.
I have already been in the health care work for over 10 years and love it. But the only way I can grow professionally is to go the administrative route. I would rather get more involved clinically. Both PA and MD would be an excellent way to remain clinical, however, like many here have indicated, I would like to be right on the leading edge of patient care and have the knowledge base that can only be gained through medical school.
I’m glad to see it can be done at my old age! 
Interesting follow up. I’ve been accepted to med school to begin in the fall. Excited about that. But just last week, my hospital offered to fund my tuition plus a stipend if I go to PA school in-state. What to do???
You are in a great position, two viable choices. Now the big question is what would you prefer to be? Then go with the choice that you believe will be more fulfiling to you.
The kind of work you do is quite different. A PA is not performing the kind of evidence-based diagnostics and treatment plans that we are. By necessity, given the training gap, the care practice is going to be more cookbook, less your own intellectual design.
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This holds water, except most of my friends are more on the frugal side and knock out the bulk of their student debt earlier. (Almost all attendings, even beginners, earn a better salary than the average PA so the differential lies in debt service). As a rule of thumb, yours is I believe pessimistic for MDs.
Make no mistake, though, a new PA school grad far outearns a first-year resident. Instant gratification or deferred? 
Another important issue is where do you want to work and for whom? This is limited by degree, and also this affects income.
If you want to work in the U.S. at an urban hospital, the income figures are probably relevant for both PA and MD. If you want to work in a rural area, then the differential in pay is not as large.
On the other hand, working for a non-profit pays much less. And if you want to work outside the U.S., say in rural area of Africa, India, or South America, then the PA degree is insufficient, since it is not recognized outside the U.S. Yes, you can do short-term medical missions to foreign countries, but you cannot work there long-term (longer than your Visa, say), even if you can work there as a volunteer. Most foreign medical societies don’t recognize the practice rights of PAs. A better option is to go nursing or nurse practitioner, although, like PA, the NP degree is not universally recognized outside the U.S.
Thank you, so much, for your replies and encouragement. It really is a blessing to be able to draw on the experience and wisdom of this community.
I am really leaning toward med school for reasons stated above. The only issue I’m trying to resolve is will I be able to spend time with my children every day? At least through med school? I know residency will be challenging, depending on the rotation I’m on, but by then they will be in school, and we’ll have family support at that time (live-in mother-in-law). I have the advantage of working with a lot of physicians who were non-traditional students with children. Most of them were able to balance student life with family life quite well and encourage me that it can be done. However, there are two physicians I work with who indicated that their family life suffered and, if they could repeat the past, would have gone into PA school instead. This tells me that it really is up to the person to actively make sure a balance is maintained. Am I correct in this assumption? What do you guys think, especially those of you who have gone through the process with a family?
Riboflavin,
Just to muddy the waters for you, I would suggest you also look into the podiatry route. I am also a 40 year old returning to school with two small kids. This route allows you to practice in a variety of manner (from having your own practice/patnership/worki ng for a group) and has a 3 year surgical residency. You would be a specialized physician dealing with foot and ankle issue only, however. The pay is just as good and the hours are better as you have little to no on-call. That would free up more time with the kids. Its an option that I think many older pre-meds would be advised to consider. See my other posts for more info. Thanks
I think you should go with the one that fits your personality and skills best. When I was shadowing in the ER, I was still thinking about PA, MD, BSN/NP, and even respiratory therapy. Seeing all of those professions working together in one place helped me to figure it out. I believe it’s like different instruments in the symphony; one just fits you better than the others. You’re going to spend so many hours of the rest of your life in your career, that I think you should go with your heart. Kansas has some full med school scholarships with stipends for primary care. Does your MD program have something like that?