Better financial payoff for women who become PAs instead doctors

by Grace

The average female primary-care physician would have been financially better off becoming a physician assistant.

When a net-present-value (NPV) calculation was applied to cases where women chose to become physician assistants (PA) and compared to those who chose to become primary-care doctors, the average economic outcome was found to be superior for those who chose the PA career path.  The upfront costs, deferred earnings during training, hourly earnings, and lower PA salaries are all factors in this equation.  One factor that appears to make the biggest difference in outcomes for women is the lower number of hours they work compared to men.

… Male doctor earns more per hour relative to the male PA than the female doctor earns relative to the female PA. However, a big part of the difference comes from an hours gap. The vast majority of male doctors under the age of 55 work substantially more than the standard 40 hour work week. In contrast, most female doctors work between 2 to 10 hours fewer than this per week.

Even though both male and female doctors both earn higher wages than their PA counterparts, most female doctors don’t work enough hours at those wages to financially justify the costs of becoming a doctor.

The medical profession is one that lends itself to women (or men) scaling down to part-time schedule, an option preferred by most working mothers.  So it is should not be surprising that women doctors rarely drop out of the work force.

… there is evidence that women doctors actually “drop out” less frequently than women lawyers and (especially) women MBAs. For example, a 2010 study by Herr and Wolfram find that in a sample of Harvard graduates, 94 percent of mothers with MDs remain working in their late 30s, compared to only 79 percent of JDs and 72 percent of MBAs. One of the attractive features of primary care medicine is the possibility to scale up or scale down the workload — flexibility often not feasible for an executive or investment banker. If one scales down enough, though, the upfront investment of becoming a doctor isn’t recouped.

The fact that most female doctors work “between 2 to 10 hours fewer” than a standard 40-hour work week in contrast to male doctors who work substantially more hours helps explain why many female doctors I’ve encountered tend to keep shorter office hours and are less available after hours.

… in 1976 women constituted only 24 percent of first year medical students. By 2006, that number which doubled to 48 percent.

The rising trend in female doctors who will continue to work fewer hours may exacerbate the shortage of doctors, which is expected to worsen as the result of demographic changes and the implementation of Obamacare.

Considering these trends, what are some possible future scenarios?

  1. Women doctors will begin to work longer hours as more fathers take on the role of primary child care.
  2. Fewer women will choose medical school and instead opt for the PA career route.
  3. More of our medical care will be handled by PAs instead of doctors.
  4. All of the above

Some background on the PA profession

… Physician assistants (PAs) are medical professionals who diagnose and treat illness under the supervision of a physician and who may, in all 50 states and the District of Columbia, write prescriptions. The first PA program started in 1965 at Duke University, and was initially designed to provide civilian medical training to field medics returning from Vietnam.

Interestingly, while the PA field started out all male, the majority of graduates today are female. The PA training program is generally 2 years, shorter than that for doctors. Unsurprisingly, subsequent hourly earnings of PAs are lower than subsequent hourly earnings of doctors.

The 2010 median pay for PAs was $86,410 per year.  It might not be a bad career choice for either men or women.


12 Comments to “Better financial payoff for women who become PAs instead doctors”

  1. Here’s a sexist thought I saw elsewhere: for a woman, going to medical school means getting a better shot at marrying another doctor. (Of course, the gender balance is evening out in medical school these days, so it’s not as much like shooting fish in a barrel as being a female engineering student.)


  2. I had to look up the difference between a nurse practioner and a physician assistant since I was kinda lumping them together in my mind. They are very similar, but one noticeable difference according to what I read is that a PA must always work under the supervision of a doctor but a NP can work independently, as nurses often do. PA earnings are generally higher than those of NPs.

    It appears that the nurse certification process is in the process of significant changes, so there is uncertainty as to how things will shake out. I recently read that in New York a bachelor degree will be required for most nurses.


  3. Whether doctors tend to marry other doctors or other professionals, the trend of assortive mating by educational level is still going strong.


  4. NPs can write prescriptions, which is a very big deal.


  5. “… there is evidence that women doctors actually “drop out” less frequently than women lawyers and (especially) women MBAs”

    That’s interesting. I bet it has a lot to do with how much control 30-something lawyers, MBAs and doctors have over their respective working hours and environment.


  6. “The reality for many years has been that nurses need bachelors degrees.”

    Apparently there are still many 2-year nursing programs turning out graduates who are able to find work, maybe because of a still-existent nursing shortage.

    “Currently, most registered nurses have two-year associate’s degrees. No state requires a four-year degree for initial licensing or afterward, though New Jersey and Rhode Island have considered proposals similar to New York’s over the past several years….”

    “Surveys show that most hospitals prefer to hire nurses with bachelor’s degrees, though they often cannot find enough. Lawmakers in several states, including New York, have introduced bills that would require at least some hospital staff nurses to have bachelor’s degrees within 10 years, though none have become law.”


  7. Both nursing and medicine are two careers where mothers can easily cut back on working hours and then ramp back up. In so many other fields this is difficult.


  8. Very interesting. I wonder if this is a sign of trouble ahead for new nursing graduates with four-year degrees?


  9. Yes, the writing is on the wall for nurse credentialing to move to require a 4-year degree.

    That Forbes article predicted that more nursing opportunities would move from a hospital setting to a home setting.

    “Mancino argues that growth in outpatient, or ambulatory, care does not necessarily help employment prospects for young nurses, cautioning that those treatments are less reliant on nurses than inpatient procedures.”

    Somehow the idea of working as a nurse in a home is less appealing.than working in a hospital or doctor’s office, (Not that working as a nurse is appealing to me in the first place.)


  10. The whole health care jobs outlook feels fuzzy to me. On one hand we know we’ll need more providers, but on the other hand the positions and pay may look very different in the future. Will we have more nurses working in private homes, “traveling nurses”, than in hospitals?

    I just spoke with a college student who is studying speech pathology. After she gets her BS next year she has to go for her masters in order to be competitive for any job. She said the job outlook is good, and I checked the numbers to confirm this. But what I found interesting was that the need for speech pathologists was tied to an aging population. Stroke victims, for example.


  11. “The whole health care jobs outlook feels fuzzy to me.”

    Yeah, in an environment where the government 1) controls the purse strings and 2) is determined to rein in healthcare costs, I think it would be very unwise to go into medical fields for money or security. With the current economic troubles, there’s been a stampede into nursing, which looks like a safe haven to many. I don’t really know what else to suggest, though.


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