PA School vs. Real World

If you are currently in PA school or are just about to start your career as a full blown physician assistant, then you’re probably wondering how PA school compares to the real world of medicine. The good news is that unlike almost every other job, PA students undergo a very special focused training that makes them uniquely prepared for day one of their first job. Some of the differences between PA school and the real world actually make real world practice much easier than you would imagine in PA school, and of course there are some that make it more challenging.

There’s a specialist for that

In PA school, sometimes you think you need to know EVERYTHING, but in the real world, you will realize that is not the case. Of course the more you know, the easier your job will be and your patients will appreciate you, but you don’t need to know it ALL because there are lots of specialists out there. In PA school, you fail the test if you don’t have the answers. In the real world, you have people to help you. If you don’t have the answer, you can refer your patient to someone who does. There is no shame in this either. Patients appreciate getting answers and getting started on appropriate treatment sooner than playing around with your trial and error. It also saves you some liability issues. You are the specialist? No worries, you can ask your supervising physician or another colleague for advice. If you’re still coming up dry, try a subspecialist.

Am I having deja vu?

Almost every field has some diagnoses that make up the “bread and butter” of their work. For example, if you’re in psychiatry, most of your patients will have some depression, anxiety, bipolar or schizophrenia. You may get that odd ball diagnosis every now and then, but usually you will see things that are familiar to you. One of the doctors I worked with told me, you learn 80% of what you will do in the first 3 months and you spend the rest of your career learning the other 20%. So after a few months, you will be able to handle the majority of what walks into your office. The exception to this rule is your generalists and emergency medicine specialists. There you are a jack of all trades, but in time you will inevitably see some common themes.

Resources galore

In school, you are kind of expected to have an entire medical database in your head and be able to speak on any topic at any time. That’s not fair. In the real world, you will frequently not have the answer so you will consult your supervising physician, your books and your internet without any judgment. In fact, looking up the answer is encouraged!

Less crazy equations

Thank the lord! If you hated memorizing equations and trying to plug in crazy numbers then you’ll be as happy about this as I am. Throw out that fluid rate calculator and just use your instincts. Old lady frail lady with acute kidney injury, eh, will give you 80 mls/hr. Healthy young guy who is dehydrated, eh will give you 125 mls/hr. Why? Because it works and I can adjust if I need to. You’ll find that some things do still need to be calculated, except that doesn’t mean you need to do it! Sometimes, your computer calculates numbers like GFR and creatnine clearance. Medication dosing? Use epocrates or call up the pharmacy. There are much less long hand calculations in the real world than PA school. Amen.

Money prob$

So you’ve evaluated your patient, you’ve diagnosed them and you’ve even figured out which medicine they will need. Yahoo! Then all of a sudden you realize the medication will cost the patient $500. Buzz kill… Ugh. In the PA school world, you can order all of the tests and medications that you want. In the real world medication, procedures and office visits will cost money that sometimes your patients won’t have. This is the part of medicine they don’t teach you in school. You’ll need to work around limitations in insurance and finances.


In PA school, a patient presents with one disease, you treat them with one medication and then they are better. In the real world, patients have comorbidities that complicate things. Sometimes a patient will even have two problems in direct opposition with one another, like kidney failure and acute heart failure. You cannot always give the medications you want to give because another organ system could be affected.

Those resistant patients

I mean resistance in two ways. Some people are not compliant and some people don’t get any better despite perfect medication use. When it comes to poor compliance, you will learn that there are some battles you cannot win. When it comes to patient resistance, you will call upon other specialists or sub specialists if you can. Bottom line, all you can do is your best.

Social Nightmares

No, I don’t mean that nightmare where you forgot to wear pants on your first day of PA school. I mean those crazy social issues your patients have. In PA school you get exposed to child abuse, domestic abuse, elder abuse etc. However, there is more to social issues than just these types of abuse. Depending on the area you work and your specialty, you will get different flavors of social issues. Elderly patients fall or cannot care for themselves. Sometimes you encounter patients that do not have running water in their homes, patients who cannot read and patients who cannot administer their own medication because they’re blind, paralyzed, or do not have the cognitive ability. Sometimes despite your best efforts patients refuse placement, cannot afford it or do not qualify for it. I’d love to share with you some of the crazy social nightmares I’ve seen, but HIPPA would have my head. You’ll just have to trust me, social issues can be a nightmare. Here you have to think outside the box and use your resources. Thank goodness for social workers to help you jump these hurdles.

Over all, there are definitely some differences between PA school and the real world, but nothing you can’t handle!

One thought on “PA School vs. Real World

  1. Walter says:

    It’s HIPAA and you’re able to share information/anecdotes for training purposes, so long as you don’t tie it to a name/PII.

Leave a Reply

Your email address will not be published. Required fields are marked *