Hi everyone my name is ollie i'm a final year medical student at the university of warwick due to graduate as a doctor in a couple of weeks now just a word of warning today is gonna be a long one and potentially a slightly contentious one but i think it's really important and i wouldn't have made this video.

Although i didn't think twice about it if i didn't think it wasn't worth discussing but it is it's important it affects a lot of people what am i talking about well it's coming round to application season again we are fast approaching the various ucat deadlines they'll be.

Honors before we know it and i am being bombarded with questions both in my email inbox and in my instagram inbox particularly with ollie i want to work with people i want to do science should i go to medical school or should i go to pa physician associate school what's the best choice for me do you.

Have any advice and before we jump into the video proper my take would be do not apply for both pick one do not apply for both but before we go into why i must ask you to like and subscribe to the channel and don't forget to hit the little bell icon to make sure you don't miss.

Any video the youtube algorithm is not being kind to many creators at the moment and we need all the help we can get especially as smaller creators so let's go this topic is contentious and i want to make clear before we start that this is not just the ramblings of me ollie as a medical.

Student this video is based on a substantial amount of research and conversations with both doctors physician associates physician associates students and crucially people who have studied both in practice this is people who have been physician associates in the past.

And are now studying or have studied medicine and gone on to become doctors and this is kind of a summary of all of the wisdom that i've gained from speaking to these people and it is also worth noting that i am talking specifically about the uk here um physician assistants as they are.

Known in the us although i believe the title may be due to change soon and physician associates in the uk although the names are the same they have slightly different roles the application processes are slightly different and there are a lot of differences when.

It comes to licensing and things like that so specifically i'm talking about the uk england scotland wales and northern ireland with all of that preamble done let's start by defining the roles of a doctor and a pa and then we can work from there in more detail as this might help you begin.

To frame the situation and make more of an informed choice so let's start with a doctor because that's what most people are more familiar with a doctor or a physician is a medical professional who is responsible for seeing examining diagnosing and ultimately managing patients who come into hospital or in.

The community as is the case for a gp they attend medical school which usually lasts five to six years which is followed by at least two years of postgraduate what's called foundation training where they rotate around a range of specialties for two years and then typically somewhere between three and eight.

Further years of postgraduate specialty training where they embark on the pathway to either become a general practitioner a gp or a hospital consultant by contrast although not really a pa or physician associate is once again a medical professional.

Responsible for seeing examining diagnosing treating patients they instead attend pa school which is a two-year program that is most commonly taken as a postgraduate course following a life sciences or a sciences degree they then have to pass all of their pa school exams and the national pa.

Exams and then they can begin work as a physician associate fully qualified in a specialty that they choose so it might be general practice cardiology neurosurgery whatever you like now broadly speaking obviously these two roles sound incredibly similar and that's because ultimately they are which is what makes this choice slightly more.

Complicated so how are you as a confused applicant wondering what direction to point your life in how are you gonna choose which of these programs is best for you ultimately i think it's most sensible to break this down into the different core areas of discussion and compare the two as we go.

And before we carry on i think it's worth noting as well that most of these differences that we're about to highlight do not actually come into practice until several years after graduation and it's only then that both of these professionals would would really begin.

To notice the substantive differences but we'll get to that when it comes and that's also why i think it's important to apply for these courses knowing about these changes because if you complete the course and get a couple of years into practice and then notice the differences it's a little bit too late at that point.

It's not ideal so let's start with getting into the course at the moment as of 2021 it is by and large much more difficult to get into a medical program than it is a physician associate program i think it's important to understand that this is incredibly complicated and.

Multifactorial it is not the case as you might jump to the conclusion that one has higher standards than the other that's not really what's going on here pa is a relatively much newer course that has less support up and down the country and it doesn't have the historicity.

Associated with it that medicine does it's almost exclusively postgraduate as i said before although there are undergraduate options beginning to open up we also need to be really clear about the fact in our heads that most candidates who are suitable for one would also be perfectly suitable.

For the other because there's such substantial overlap in the course material any medical student would probably do very well on a pa program equally any pa student would probably do very well in medical school the main problem with medical school is it's massively over subscribed there is huge demand for it from all across.

The country and because of this it necessitates the need for a very strong academic record whether that's a levels or a first degree needing at least two one entrance exams and a very rigorous interview process because of this there are around nine.

Applicants per place for undergraduate medical school and anywhere up to 25 applicants per place for graduate entry medicine the entry requirements for getting onto a pa program at the moment are not as substantial as getting into medical school but again.

This is more likely to reflect demand for places rather than academic integrity of applicants i think we need to be really clear about that so neither are easy but as of 2021 if you are only able for whatever reason or willing to endure one or two application cycles then pa school might be the better.

Choice for you it's statistically more likely that you'll get in first try and you will likely have a bit more control over where in the country you end up whereas with medicine you are completely at the mercy of the application system and it can take people many many attempts to get in as many as five or.

Six in some cases most applicants will get in within a couple of cycles but that's not always the program and it is a much more convoluted and difficult process to deal with so secondly let's talk about the course differences so pa school as i've said is a two-year very intense accelerated.

Program with very few breaks if any the first year being more theory based in nature more of the academic textbook learning and then your second year being more clinical based on the hospital awards learning how things work in the real world medical school by contrast is between four and six years to earn the mbbs.

But with more breaks during that time the pace is not quite that of pa school although there is some similarity with four-year accelerated graduate entry medicine programs where you don't get the breaks either with a standard five-year program it's usually the case that the first two years are what we call pre-clinical.

Again more lecture-based academic textbook learning and your final three years being the clinical years spent rotating around various specialties in hospitals and in the community now the really key major difference as far as the course structures are.

Concerned is that pa school focuses on what's called the matrix of core conditions and i'll show this on the screen now and they use this matrix system to decide what is really important for pas to know and what is within their scope of practice.

So essentially what things they need to pay more attention to than others in order to pass the course whereas medical score by contrast is essentially everything you can be examined on virtually any topic or condition in medicine if the examiners feel like it.

Obviously this means that there's going to be substantial overlap in many areas for example we all need to be able to do the basic clinical exams we all need to be able to clark a patient things like acute coronary syndromes strokes vascular disease there will be.

Significant overlap in these areas but the difference is as ever if we were to draw a bell curve the two would overlap very closely in the middle but the differences between the courses will start to appear at the extremes of each area in medicine so speaking very broadly.

If what you want is to start practicing on the ward as a confident competent practitioner quickly start earning and knowing what you need to know in order to see treat and diagnose patients then pa school might be the better choice for you all of that possible scope of knowledge.

But are willing to exchange it for much longer training relatively and more sets of exams obviously that come every single year then medical school might be the better choice if you can tolerate it this then brings us on to graduation from the course and actually working and again there is basically one key.

Difference to pay attention to doctors as with people like nurses and pharmacists are what we call independent practitioners they are autonomous decision makers who are responsible for their own decisions for most of their career physician associates pas on the other hand.

Are what are called dependent practitioners which means that their plans and management must ultimately be checked by a supervising senior doctor who is usually going to be a gp or a consultant who then is ultimately responsible for that patient's management of course.

For the first few years after graduation when you have a junior doctor and a newly qualified pa they're basically both in this situation because most things are ultimately going to be checked by the consultant in charge of the unit or the ward or wherever you're working there is another crucial difference as.

Of june 2021 as i'm making this video pas are currently unable to prescribe independently and they cannot request ionizing radiation such as chest x-rays and ct scans as far as prescribing medicines goes i think the broad consensus is that this is likely to change at some point.

However it's not clear exactly when this change is going to come because the profession is still going through its regulatory processes and if that change does come it's not clear as to which medications they will be able to prescribe which will almost certainly need something like a non-medical.

Prescribers course to be completed once they graduate if we compare them to doctors for example doctors are not constrained in this way and can prescribe independently and order ionizing radiation as soon as they graduate although again this is more likely to reflect regulatory.

Legal frameworks than academic competence for example and again we shouldn't confuse those two things and now let's quickly talk about finances because once they graduate pas will actually out earn junior doctors as soon as they graduate starting on a salary of around 38 000.

Pounds a year which is a band 7 role within the nhs whereas a newly qualified f1 the role that i'm about to start in august starts on a basic salary of 28 000. and while both roles obviously will accrue pay within the nhs as they get more and more experienced and are responsible for treating more difficult patients this.

Does actually reverse so as doctors become more and more senior and approach becoming a senior registrar and a consultant then they will out-earn pas at that extreme of the scale so now we are post-graduation and working and this.

Is where some of the more significant differences start to appear so just again to reiterate the training pathway doctors will graduate after medical school complete two years of postgraduate foundation training f1 and f2 they may choose to take a year out here and do what's called an f3 year.

And usually then we'll enter specialty training into a specialty of their choice become a medical registrar or a surgical registrar depending on specialty and after a fixed period of time we'll become a consultant because doctors are constantly shifting.

Around in this way they're either rotating during their foundation years or they're constantly kind of moving through the training pathway and that often means moving hospitals this left a big gap in mid-level care and this is essentially my understanding as to why pas were brought into the nhs because.

Pas once they begin working in a specialty do not have to rotate in the same way for the purposes of continuing training they are much better for providing a continuous fixed level of care so seniors can train them basically and they won't go anywhere which means that.

Long term they're a very valuable asset to the ward and someone that can be relied on doctors physicians are expected eventually to move beyond the mid level and become senior autonomous practitioners in and of themselves and as i say we see this at the senior registrar level and beyond.

During this time they will complete what are known as the collegiate exams the member of the royal college of physicians say or surgeons and then eventually they will become fellows of the relevant college for their specialty once they've passed these exams they are deemed to be more or less.

Experts in the field and able to fully practice independently doctors are also expected to do on-calls nights and so on throughout their careers for all these years of training as well as completing a portfolio every year that they're in work demonstrating that they are continuing.

To develop and hit their competencies on time coming back to pas by contrast obviously they are equally expected to demonstrate continuing professional development and have to revalidate every six years by taking their exams again at the moment they do not become autonomous.

Practitioners they remain dependent on a senior doctor now it may of course be the case that eventually we see new roles come into play that allow pas to become independent autonomous practitioners however i would not personally consider it a good idea to.

Train now as a pa before those roles are formally defined in the hopes that they appear at some point we already have doctors obviously who are responsible for these senior decisions as well as the advent of roles like nurse practitioners who are brought in to supplement that autonomous decision making and like i.

Say it may well be the case that we see a similar transformative role appear for pas but that's not the case at the moment doctors also become specialists in one particular area of medicine so you will become a gp a cardiologist a neurologist a surgeon and so on whereas pas are trained more as.

Generalists and will usually remain so even after working in a specialty for a long time of course in the case that a pa is working on say a cardiology ward for a long period of time of course they will build a vast wealth of specialist knowledge but like i say the the point as such is.

For pas to provide that mid-level care manage those core conditions and refer any case or condition that falls outside of their scope of practice to a doctor a physician of course pas can train in many medical procedures that a doctor would do we see many pas for example training to.

Do gastroscopy lists or lumbar punctures on neurological units or being first assistant in surgical theatres all of these things are common and pas will also find it much easier than medics will to move laterally between specialties once a doctor has committed to training in a specialty.

It's very difficult for them to switch again once they're on the training pathway whereas a pa can simply apply for another job and move with relatively little issue now here is the rub where i think we're going to get down to the final elements of this choice i would really not try and equate the.

Two in your head as they are different roles with different responsibilities and career scopes the thing i hear disturbingly often is apply for medical school and if you don't make it have pa school as a backup this is not only enormously.

Disrespectful to our pa colleagues who are excellent at what they do excellent clinicians and made the choice to go to pa school rather than medical school because that was what they wanted but it also won't make you happy if what you actually want is to be a doctor equally the other way if you want to be a pa don't train as a.

Doctor if you want to be a doctor don't train as a pa there's no point if i had to condense the conversations that i've had especially with the pas that are retraining or retrained as doctors the key bit of experience from them is this which is that pas have a very defined ceiling of practice.

And at the moment will not be autonomous decision makers the reason with every single pa that's retrained in medicine that i've spoken to is that ultimately they wanted to go beyond that ceiling of practice and become a specialist calling the shots and if that's what you want and you're willing to take all of the.

Extra years of training admin bureaucracy life hassle that that comes with then that's your choice i've tried to boil it down to two examples which i've read in various places and i think make the summary quite well at least as far as i understand it if you have to organize a sock drawer.

In your house if it absolutely has to be you that organizes the socks the way you want then go to medical school if you ultimately don't really care how the socks are organized as long as they are organized and you're willing to let someone else tell you how to do it then pa school might be an option for.

You and the other example i quite liked is that we are reading from the same book ultimately which is medicine if you want an abridged copy of the book which gives you everything you need to go and be a competent practitioner then again pa school might be the option for you.

If you want the full version of the book which has everything in it 90 of which you're not going to use but is just there then medical school is probably the better choice and not to mention that both professions medical doctors and pas have access to.

Alternative career choices like lecturing research medical leadership all of those things are completely open to both clinicians and ultimately if you're confused to leave you with a final message if you really don't know what to do then the best thing you can possibly do.

Is speak to both and try and shadow both if you can if you're anywhere near a gp or a hospital see what both of them actually do day-to-day and note the differences and similarities because the key thing i think is making an informed decision whichever pathway you choose it's many.

Years of your life that you're going to be dedicating so it's important to make the right choice with understanding from the outset so that's all wrap this video guys thank you so much for watching please be sure to hit that like button for me leave a comment subscribe i'd be really really interested to know your thoughts on this.

One and let me know what you think do you want to be a pa tell me why do you want to be a doctor tell me why this is a community on here and many of the people that watch these videos are going to either medical school or pa school or thinking about both.

So let's do our best to help each other and answer people's questions in the comments take care guys thanks so much and i'll see you next time