Should You Be a PA Instead of a Doctor?

PA school is short. The American Academy of Physician Associates (AAPA) puts PA programs at about 27 months, roughly three academic years, against about 38 months for medical school. That includes at least 2,000 hours of supervised clinical practice, with rotations in family medicine, internal medicine, general surgery, pediatrics, obstetrics and gynecology, emergency medicine and psychiatry.

When you graduate, you take one certification exam and can start working. No residency is required.

The physician path is longer at every stage. The Bureau of Labor Statistics lists 4 years of medical school, then a residency of 3 to 9 years depending on the specialty, plus 1 to 3 years of fellowship for subspecialists. The shortest route is 7 years after college: 4 of school and a 3-year residency like internal medicine or pediatrics. How long it takes to become a doctor breaks down every stage by specialty.

So a PA who starts school right after college can be working by the end of their third year out. A future internist starting at the same time is still in medical school, with 4 more years of training ahead.

Both paths start with a bachelor's degree. After that, the two applications reward different things.

For PA school, the BLS says applicants "typically hold a bachelor's degree and have patient-care experience." The University of Georgia's pre-PA advising office says competitive applicants "generally have over 1000 hours" of direct patient care, plus a little over 100 hours of shadowing in at least two settings. It lists average matriculant GPAs of 3.50 overall and in science, and an average GRE of 310. PA applications go through CASPA, which opens in late April.

Medical schools ask for the MCAT^® instead, and the premed requirements guide covers the courses they expect. If you're undecided, compare that list with the prerequisites of two or three PA programs you'd apply to, so your schedule keeps both doors open as long as possible.

PA school costs less in tuition, at both public and private programs. Northwestern University's health professions advising office reproduces PAEA tuition averages for a full program of about 27 months:

The MD column is an estimate: the AAMC's 2025-26 median yearly tuition and fees ($43,648 at public schools for in-state students and $74,661 at private schools), as listed on the same Northwestern page, multiplied by 4. Neither column includes rent and living costs, which run for 27 months on one path and 48 on the other. With living costs added, Northwestern lists the AAMC's median 4-year cost of attendance at $297,745 for public medical schools and $408,150 for private ones.

At the median, a physician earns about twice what a PA does. The BLS reports a May 2025 median of $135,880 for PAs, or $65.33 an hour, and $275,930 for physicians and surgeons. For PAs, the lowest-paid 10 percent earned less than $99,380 and the top 10 percent more than $190,280. How much doctors make shows the physician spread by specialty.

Where PAs work changes the number. The BLS lists a median of $153,500 in outpatient care centers, $141,150 in hospitals and $132,000 in physicians' offices, which employ 53 percent of PAs.

The PA job market is growing faster. The BLS projects 21 percent growth in PA jobs from 2025 to 2035, to 204,600, with about 11,500 openings a year. For physicians, it projects 4 percent growth over the same decade.

A doctor's higher pay starts late, and a PA starts earning years earlier. The figure estimates pre-tax earnings across the first 10 years after college for three people who start school right after they graduate.

The resident pay comes from the AAMC's 2025 stipend survey, as reported by the AMA: $68,166 for PGY-1, $70,499 for PGY-2, $73,301 for PGY-3, $77,593 for PGY-4 and $81,807 for PGY-5. What a resident doctor does explains the PGY years and the 80-hour cap behind those numbers.

By year 10, the PA and the doctor with a 3-year residency are close: $1,053,070 against $1,039,756. From then on, the doctor out-earns the PA by $140,050 a year at the median. The doctor on a 5-year residency is about $406,000 behind at year 10 and makes up that gap in roughly 3 years at the same difference.

The estimate leaves out a lot. It ignores taxes, interest on loans, raises and the higher tuition on the physician path, and it uses one median for every specialty. Treat it as a sketch of timing, not a forecast of what you'll earn.

PAs examine, diagnose and treat patients, and the BLS notes that the amount of collaboration with physicians "differs by state." Most states require an agreement with a supervising physician, though in most of them that physician doesn't need to be on site at all times. In some rural and underserved areas, the BLS says, a physician may be present only 1 or 2 days a week.

Physicians are the other side of that agreement, since a PA's practice in most states depends on one. If you want to be the person who makes the last decision, that's the clearest difference between the jobs.

PAs get flexibility in return. A physician's specialty is set by the residency they complete. PAs train as generalists and can move between fields: in the NCCPA's 2025 statistical profile, 52.7 percent of board-certified PAs said they'd changed specialties at least once. The largest groups worked in surgical subspecialties (18.3 percent), family medicine (15.9 percent) and emergency medicine (10.4 percent).

New PAs take the PANCE, the national certification exam run by the NCCPA. In 2025, 91.5 percent of 13,145 first-time takers passed, and the first-time pass rate has stayed between 91.5 and 93.2 percent since 2021. To stay certified, the AAPA says PAs complete 100 hours of continuing medical education every 2 years and pass a recertification exam every 10 years.

The NCCPA counted 201,038 board-certified PAs at the end of 2025, up 5.9 percent from 2024, and 72.1 percent were women. You may also see the title "physician associate." The AAPA's House of Delegates voted for that name on May 24, 2021, and said the new title shouldn't be used until laws and regulations adopt it.

• Choose PA if you want to be seeing patients by your mid-20s, want to keep tuition near 2 years' worth, or expect to try more than one specialty.
• Choose physician if you want final responsibility for patients, a specific specialty like surgery or cardiology, or the higher pay that builds after residency.
• Shadow both. Ask a PA and a physician on the same team who makes which decisions, then compare it with what you pictured.
• Compare prerequisite lists early. Check a few PA programs and medical schools before you plan junior year, so one schedule can cover both.

If you're leaning toward medicine, the MCAT^® is your next gate, and the MD vs DO comparison explains the two degrees it leads to. The PurpleCAT concept library breaks the exam's science into short topics you can study one at a time.

Last verified October 31, 2026, against the BLS Occupational Outlook Handbook (May 2025 pay and 2025 to 2035 projections), the NCCPA's 2025 statistical profile and PANCE pass rates, and the AAMC's 2025 stipend survey as reported by the AMA. PA tuition averages are PAEA figures as reproduced by Northwestern University; check individual programs for current costs.