Updated
PA vs MD: Training, Cost, Pay and Scope Compared (2026)
A PA trains for about 27 months after college and practices in a team with physicians. An MD or DO trains for 4 years of medical school plus 3 to 9 years of residency, practices independently and earns more. The BLS lists May 2025 median pay of $135,880 for physician assistants and $275,930 for physicians and surgeons.
Below: training time, admissions side by side, cost and pay, what each can do and how to choose.
What is the difference between a PA and an MD?
A physician assistant (also called a physician associate) holds a master's degree. “PAs are trained to practice medicine using a curriculum modeled on medical school education.” A physician holds an MD or DO and completes residency in a specialty. “Currently, most state laws require PAs to have an agreement with a specific physician in order to practice.”, per AAPA. There were 201,038 board certified PAs at the end of 2025, per NCCPA. If you are weighing the two physician degrees too, see our DO school interview questions.
How long does each path take?
“PA programs are approximately 27 months (three academic years), and include classroom instruction and more than 2,000 hours of clinical rotations.” For physicians, medical school takes 4 years. “Depending on their specialty, they also need 3 to 9 years in internship and residency programs.” “Subspecialization includes additional training in a fellowship of 1 to 3 years.”, per the BLS. Here is the gap by residency length:
| Residency length | Physician trained after | PA practicing by then for |
|---|---|---|
| 3 years | 7 years | 4.75 years |
| 5 years | 9 years | 6.75 years |
| 7 years | 11 years | 8.75 years |
| 9 years | 13 years | 10.75 years |
Residents are paid, so the physician is earning during residency, at a resident's salary. The PA head start is in years of full practice, not in years of any income.
How do PA and medical school admissions compare?
PA programs lean on hands-on patient care. “Incoming PA students bring with them an average of more than 3,000 hours of direct patient contact experience”, per AAPA. For medical school, “Applicants usually must submit transcripts, scores from the Medical College Admission Test (MCAT), and letters of recommendation.” GPAs overlap more than people think. Matriculating PA students averaged a 3.6 overall GPA in PAEA's 2021 survey, Program Report 36, and MD matriculants average about a 3.8, per AAMC FACTS. See our average GPA for PA school.
| PA | MD or DO | |
|---|---|---|
| Degree | Master's, about 27 months | MD or DO, 4 years, then residency |
| Typical courses | Basic and behavioral sciences, often anatomy and physiology | Biology, chemistry, physics, biochemistry |
| Experience | Hands-on patient care hours, often thousands | Clinical exposure, shadowing, service, often research |
| Entrance test | GRE, PA-CAT or none, by program | MCAT |
| Application | CASPA | AMCAS, AACOMAS or TMDSAS |
| Certification | PANCE, then CME and recertification | USMLE or COMLEX, then a specialty board exam |
Applying: CASPA, AMCAS and the tests
PA applicants use CASPA, covered in our CASPA guide. On fees, “Each fee waiver covers the cost of the first two programs ($185 and $65, for a total of $250).” per PAEA. Some programs want the GRE or the PA-CAT. For medical school, “The 2027 application fee is $180 for the first school and $48 for each additional school.” and “The initial registration fee for the MCAT ® exam is $345”, per the AAMC. Our guide on how many medical schools to apply to helps you size that list.
What do PA school and medical school cost, and what do they pay?
PAEA's Program Report 36 (2021 survey) put average total PA tuition at $57,955 for residents at public programs and $100,212 at private ones, defined as the “estimated current total tuition that each student will incur for the entire length of the graduate, professional phase of the PA program, excluding fees.” Medical school runs nearly twice as long, so it usually costs more, and each school posts its own cost of attendance on its financial aid page. Among working PAs, 43.3% report no educational debt, per NCCPA.
On pay, the BLS says “The median annual wage for physicians and surgeons was $275,930 in May 2025.” The BLS median for physician assistants was $135,880, and NCCPA reports a 2025 mean PA income of $134,010. Physician pay varies widely by specialty. The BLS lists general pediatricians at $210,040, among the lower-paid specialties. For PAs, “three quarters of PAs receive multiple job offers upon graduation.”
Both fields are growing. The BLS says “Overall employment of physicians and surgeons is projected to grow 4 percent from 2025 to 2035”. For PAs, AAPA writes that “The Bureau of Labor Statistics projects the profession to grow by 28% between 2023-2033”, a different period, so the two figures are not a direct comparison. On hours, most physicians work full time. “Some work more than 40 hours per week. Many physicians and surgeons work long shifts, which may include irregular and overnight hours or being on call.” For PAs, the NCCPA 2025 profile gives the mean hours a week in a PA's main job as “39.2 (median is 40).”
What can a PA do compared with a doctor?
Much of the daily work overlaps: histories, exams, tests, diagnoses and prescriptions. “94.2% of clinically practicing PAs prescribe pharmacologic agents for patients.” And “35.7% (over 50,000) of clinically practicing PAs indicated they have a patient panel for which they are the primary provider.” The differences are final responsibility, independent practice and the operating room. The BLS says “Surgeons operate on patients to treat injuries”, while PAs assist in surgery and perform procedures. How much a PA may do without a physician depends on the state. AAPA calls its policy Optimal Team Practice and argues for dropping the required physician agreement: “By removing the legal tether requiring a PA to be supervised by a physician, healthcare employers have great flexibility in building their provider teams.”
Certification and licensing for each
PAs take the PANCE after graduating. “During that six-year period, PANCE may be taken a total of six times.”, per NCCPA. “All U.S. states, the District of Columbia and the U.S. territories have decided to rely on NCCPA certification as one of the criteria for initial licensure or regulation of PAs.” PAs then keep certification with CME and recertification exams. Physicians pass the USMLE or COMLEX, finish residency and usually take a specialty board exam. “5.8% of PAs indicated they completed a PA postgraduate program (PA residency or fellowship) after graduating from their PA program.”
Can a PA switch specialties more easily?
Yes, and many do. “52.7% of PAs indicated they have changed specialties at least once during their career as a PA.” “Most PAs (86.1%) say the ability to change specialties throughout their careers is important”. Asked how long it took to feel proficient after a switch, “The median was 6 months and the mean was 8.5 months.” Physicians choose a specialty through residency, and changing later usually means another residency. Today, “primary care remains the leading practice area at 21.4%, followed by surgery subspecialties at 18.3%.”
How do you choose between PA and MD?
Our guide, not an official rule:
PA may fit if
You want to treat patients within about two and a quarter years of starting, you value moving between specialties, and team practice with physicians suits you.
MD or DO may fit if
You want to lead care and carry final responsibility, operate as a surgeon or go deep in one field, and the longer training is worth it to you.
Either way
Shadow both a PA and a physician for a full day before you decide. Your answer to why this path will come from what you saw.
Browse real program numbers on our PA program pages.
How do you explain your choice in an interview?
Both sides ask. PA programs ask why not medicine, which our why PA and not MD guide covers, and medical schools ask the reverse. More in our PA interview questions and medical school interview questions.
“Why do you want to be a physician and not a PA?”
Medical school interviewers ask this to see that you know what each role does. Respect the PA role, then name what you want that only physician training gives.
Our example answer (we wrote it, not a real applicant)
I worked two years as a scribe in an emergency department with both PAs and physicians, and the PAs I worked with were excellent. I am not choosing medicine because I think it is the better job.
I am choosing it because of what I want to carry. I watched our attending take the hardest calls, like the septic patient whose labs did not fit any pattern, and decide with incomplete information. I want to train long enough to make those calls and teach others to make them.
I also want to go deep in one field, likely critical care, and residency is how I get there.
Sources: AAPA, NCCPA 2025 Statistical Profile, NCCPA on PANCE, BLS physicians and surgeons, BLS physician assistants, AAMC FACTS, PAEA Program Report 36, PAEA on CASPA and the AAMC cost of applying. All checked October 30, 2026.
Frequently asked questions
How long is PA school compared to medical school?
PA programs take about 27 months, per AAPA. Physicians spend 4 years in medical school and then 3 to 9 years in residency, per the BLS, so 7 to 13 years after college before any fellowship.
How much do PAs make compared to doctors?
The BLS lists a May 2025 median of $135,880 for physician assistants and $275,930 for physicians and surgeons. Physician pay varies widely by specialty, and NCCPA reports a 2025 mean PA income of $134,010.
What can a doctor do that a PA cannot?
Both take histories, examine, order tests, diagnose and prescribe. Physicians practice independently once licensed and surgeons operate, while most states require a PA to have an agreement with a specific physician. The details depend on the state.
Do PAs have to do a residency?
No. PAs can practice after passing the PANCE and getting a state license. Postgraduate PA residencies and fellowships exist, and NCCPA says 5.8% of PAs completed one.
Can a PA switch specialties?
Yes, without a new residency. In NCCPA's 2025 profile, 52.7% of PAs had changed specialties at least once, and the median time to feel proficient in the new one was 6 months.
Is PA school easier to get into than medical school?
Not easier, just different. PA programs weigh patient care hours heavily, and incoming PA students average more than 3,000 hours, per AAPA. Medical schools weigh the MCAT, research and clinical exposure. Both are competitive.
Can a PA go to medical school later?
Yes. A PA applies like anyone else, with the MCAT, prerequisites and AMCAS or AACOMAS, then completes all four years and residency. PA clinical experience is a strong part of that application.
How do I explain why I chose PA over MD?
Name what you saw PAs do, what about the role fits you, such as team practice or moving between specialties, and never call it a backup. Our why PA and not MD guide walks through it.
More PA program guides
Applying to more PA programs? These guides cover how other programs interview: