Have you ever had a professor or another medical provider tell you that you should start in primary care for your first physician assistant job? If the answer is yes, then you and I are in the same boat. I was told if I didn’t start in general medicine I would lose all of my medical knowledge. The decision between primary care and starting in the specialty I truly wanted to work in (dermatology) was constantly on my mind throughout physician assistant school.
It wasn’t until a classmate asked a question that I finally was able to get over my indecisiveness. She asked, if you know for sure you want to end up in dermatology then why wait? Why would you purposefully put yourself “behind” in learning the specialty you ultimately would want to retire in? The idea stuck with me as I applied for jobs during my last semester of PA school. This idea that I should absolutely start in primary care and then transition to my specialty of choice no longer made any sense.
If you are reading this then you likely are also contemplating this career decision. In this article, I want to share the factors I contemplated prior to my classmate asking the question “why wait?” There are many things to consider. When in doubt I always find that a pro and con list can be very beneficial in helping decide what you really want. Also, don’t forget… if you end up in a specialty that you later decide you don’t like, you can always switch to another one. That is one of the best perks of becoming a physician assistant.
Related: The Pros and Cons of Working in Dermatology
Primary Care
Pros of working in primary care for your first physician assistant job
One obvious pro is you will maintain your knowledge of general medicine. They say that the period following your PANCE is when you’ll have the most knowledge that you will ever have in your career. Okay… maybe not everyone says that, but it sort of makes sense, right? You have studied every specialty and learned as much as you possibly could. Once you stop studying then you will slowly forget any knowledge that you are not currently using.
Primary care allows you to dabble in many different specialties. Working in primary care requires a basic understanding of all specialties. It is not just managing hypertension and hypercholesteremia. You have to know derm, ortho, ENT, red flags for malignancies, etc. You will become a jack of all trades.
If you don’t know the answer you can always refer to a specialty. If you are trying to treat a patient and the patient isn’t responding, then there is typically a specialist you can send them to. This is different than working in a medical specialty where you are the specialist. You are expected to know everything regarding that specific specialty.
Primary care can be very rewarding. There is a great need for good primary care providers. You will be able to establish meaningful relationships with your patients. The primary care physician that I did my clinical rotation with treated families across multiple generations. She started treating one couple, and then she treated their children, and then their children’s children. There really aren’t many other medical specialties that can claim that privilege.
Cons of working in primary care for your first physician assistant job
Primary care providers can be underpaid. This obviously doesn’t hold true for every primary care provider and will depend on a magnitude of factors, especially location. But it is widely known that specialty practices pay more than general medicine.
Primary care providers are overworked. Due to the national shortage of primary care providers, you can bet a lot of them are overworked. They are trying hard to make up for the lack of other qualified practitioners. When you create a combination of being overworked and underpaid that’s when things can get hard.
You will never be considered “the expert” at one thing. Some people may not care about this, but personally, I preferred the idea of learning everything I could about one topic versus learning a little about a lot of different topics. This will likely depend on your personality.
Starting in primary care with the plan to switch to a more sought-after specialty may not be as easy as you think. There is always a learning curve whenever you start a new career path. If you only work in primary care for 1 or 2 years then it may not be as bad. If you instead find yourself working 5-10 years then you may get too comfortable. It is possible you may decide it’s no longer worth it to start all over.
Medical Specialty
Pros of working in a medical specialty for your first physician assistant job
Higher pay. As I mentioned previously, depending on the medical specialty and other factors you may have the potential for collecting a much higher income than if you worked in primary care. For example, my specialty commonly offers bonuses on a monthly basis. This benefits not only me but my employer as it incentivizes me to work harder.
You are regarded as an expert. Again, a lot of the “pros” of working in a medical specialty will be the opposite of the “cons” of working in primary care. Being able to become an expert in something allows for a sense of fulfillment. At least in my opinion. Once you really have a grasp on your specialty then you just need to stay up to date with the latest changes in medications and new clinical studies surrounding your chosen specialty. You can also focus on fine-tuning skills related to your specialty.
Once your foot is in the door you are golden. Once you have experience in a specialty then you should have minimal to no problem finding another job in the same specialty. If you have a PA job offer from a medical specialty you think you are interested in working in long term then think very hard before you pass it up. It can be difficult to get your foot in the door for some specialties especially depending on where you live.
Cons of working in a medical specialty for your first physician assistant job
Yes, you will forget a lot of general medical knowledge. Maybe if you did a few years in primary care first you might remember it better 10 years down the road. It comes back to whether you would rather know a lot about a few topics or a little about a lot of topics. I know what I prefer, but that doesn’t mean everyone else thinks the same way as me.
If you don’t know the answer and can’t help the patient then it can be tough on you mentally. If your job is to know and understand one specific specialty and then you have trouble figuring a case out it can feel like you failed. Fortunately, in the case of PAs, we can always have our supervising physician see the patient if we can’t figure it out, but it is still frustrating when that happens.
Depending on your chosen specialty you may only have the opportunity to work with a select population of patients. This may not matter to some but this is something I cared about when choosing a medical specialty. I didn’t want to work with just children or just the elderly. I wanted to work with people of all ages and backgrounds. My specialty does allow me this privilege but not all will.
Final Thoughts
I made the decision that was best for me by writing out these pros and cons and really considering each factor. I was very fortunate enough to have my first physician assistant job offer happen to be in my specialty of choice (even though I applied to many different specialties). My fear used to be that I would regret my decision of starting off in a specialized field of medicine but I can frankly say that I do not. I will occasionally come across medical questions outside of my chosen specialty that I remember once studying, where I no longer recall the specifics. That was my price to pay for all of the other pros that came with my chosen path.
If you are unsure of what you want to do then it probably does make sense to start in primary care. It will allow you a taste of many different medical specialties, and then you can decide if one subject excites you more than others. If on the flip side, you truly know where you ultimately want to end up then I ask you this question, why wait?
If you are struggling with this decision and have other factors you are considering please share them in the comments below!
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