There are a couple of students in my program who are considering PA (physician assistant) school instead of medical school. For anyone interested in primary care and, oh I don’t know, having a life outside of work this is a pretty practical option. The requirements to get into school are slightly different (no physics, for example, which right now sounds like a magical possibility where candy grows on trees and unicorns carry your books to class for you) and, unlike the physician path, the time/money commitment is not as intense. All in all I see the appeal.

Yet for some reason the option of PA school makes me profoundly uncomfortable. I think this is because it’s forcing me to confront the reasons why I’m not choosing to go that route.

I’m an intensely logical person. I’d like to think that is a good trait in someone planning to be a doctor, yet somehow I keep coming back to the unsettling fact that becoming a doctor is not a logical process. The system is archaic; there’s been little change to medical school and residency structure since medical schools first became standardized. The time commitment for training is unreal; even if I condensed all of my future schooling into the shortest time period possible I won’t be a practicing physician until I’m thirty-two. Not to mention the financial commitment is extremely long term and I can probably expect to be paying off student loans most of my foreseeable future.

Why then, I keep asking myself, would any logical person put themselves through all of this when there are dozens of other health service positions that require less time, effort and money?

In an earlier post I mentioned that in biology, the function of most molecules follows from their structure. If you look at the structure of the medical training system, it’s not hard to see why we have a dearth of primary care physicians. It’s not that the interest isn’t there; I think the problem has far more to do with cost benefit analysis. When you sit down and weigh your pros and cons, I imagine a lot of students wonder if maybe they wouldn’t like time to have family someday or start earning a decent living before they hit thirty. I can’t blame them.

So once again I ask myself, why am I not going that route? And uncomfortably I have to answer that some of it just comes down to pride. For a long time I didn’t believe myself capable of being a doctor; medical school was something that really smart people did, not people like me. Even now that I’ve had a taste, there’s a little part of me that just doesn’t believe I could ever be worthy of the Dr. title and I desperately want to prove that part of me wrong.

Is that a good enough reason to eschew the practical path and to subject myself to a second glorious semester of physics problems and MCAT prep? Well, on its own, no, probably not. I do want to help people, and I do crave knowledge for knowledge’s sake. And for all that the prospect of facing a semester and a half of bewildering physics equations fills me with a very special kind of dread, I welcome the thought of immersing myself in the practice of medicine in the coming years. I never want to look back and wonder if maybe I could have done it.

Perhaps addressing my own doubts, naming them as an old psychology professor used to say, is a good thing. No, I’m not going to go to PA or nursing school, and not because I think it’s an impractical choice. Rather, it’s a little too practical for me right now. Just because I’ve put my dreams of living big as the next great American novelist on hold doesn’t mean I’ve stopped dreaming. And if that dream involves a long white coat and more student loans than any sane person should accumulate, then it’s worth it. Logical or not.

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