The Few Disadvantages of Being a PA (Honest Take)

By: Savanna Perry, PA-C

TL;DR

Being a PA is consistently rated one of the best careers, but it does come with real tradeoffs worth knowing before you commit. The main downsides are planning your time off well in advance, working within an office hierarchy, demanding continuing education requirements, and earning less than your supervising physician.

Last Updated: June 12, 2026

Your Pre-PA Bestie Blog - everything you need to know to become a PA in one place.

What are the scheduling and hierarchy tradeoffs of being a PA?

If you work in a clinic with scheduled patients, you have to get really good at planning ahead, and you have to convince your family to do the same. Schedulers do not love being asked to move 60 patients so you can take a trip. It is not the end of the world to reschedule, but it is courteous to patients and staff to avoid it when you can.

There is also the office hierarchy. In a private practice, you may be at the bottom of the totem pole at times. That does not mean you are not respected or valued, but unless you own the practice, you do not call all the shots. You might take shifts you would not prefer or pick up extra responsibilities, and you will always answer to a supervising physician. If you could not be okay without the final say, that is worth thinking about now.

In this post:

What about pay and the people who do not get the PA role?

PAs do great on compensation in my opinion, especially considering the schooling involved, but you will not earn the same salary as your supervising physician. A physician hires a PA to add capacity and flexibility, so yes, they profit from your work. That can feel discouraging when you are being productive, but if you negotiate well and build a fair contract, you can do very well financially.

Then there are the people who just do not get what a PA does. Some patients, physicians, or family members will not fully trust or understand your training no matter how often you explain it. I get questions like "PAs can actually do that?" all the time, often from medical students. I try to treat those moments as chances to educate people about the profession, and I hope they become better colleagues for it.

In Our Experience

In our experience coaching pre-PAs, the applicants who think honestly about the tradeoffs end up happier and interview better than those who only rehearse the perks. I always encourage people to sit with the downsides, like the hierarchy and the CME load, and decide they can live with them before committing.

How demanding is continuing education for PAs?

Continuing education for PAs is intense. The requirement is 100 hours every 2 years, plus a recertification exam every 10 years covering everything [VERIFY]. If you specialize, staying current across all of medicine for that exam can be tough, since you may rarely touch some topics in daily practice.

The upside is that you have no choice but to stay up to date, which keeps your knowledge sharp. None of these downsides were dealbreakers for me, and I love my job and would not trade it for anything. But if you are on the fence, knowing the real tradeoffs helps you make an informed decision rather than a starry eyed one. Going in with eyes open is the best way to be happy long term.

Every Pre-PA Should Know...

PA recertification requires 100 CME hours every 2 years and a comprehensive recert exam every 10 years [VERIFY], which is a heavier lifelong learning load than many people expect.

Free Application Timeline → https://www.thepaplatform.com/services/free-application-timeline/

Listen: When a Patient Wants to See the Doctor Instead of the PA

Abby asked what to do when a patient says they'd rather see the doctor.

Episode show notes & key takeaways

Abby asked what to do when a patient says they'd rather see the doctor.

It's going to happen. It happened to me plenty. And the instinct is to get defensive, because it feels like a judgment on whether you're good enough. It usually isn't. Most of the time the patient genuinely doesn't know what a PA is or what we're trained to do.

So answer the question they're actually asking. Explain your training, explain how you work with your supervising physician, explain what you can handle. Then let them decide. Most people relax once they understand.

This also comes up in interviews, by the way. "How would you explain the PA role to a patient who wants a physician?" is a real question that gets asked, so it's worth having an answer ready before you're standing in a room.

What I cover

What to say when a patient asks for the physician
Explaining PA training without getting defensive
How the PA-physician relationship actually works
Educating patients as part of the job
Why this question shows up in PA school interviews
Getting comfortable describing your own role

Resources

Follow The Pre-PA Club: Apple Podcasts · Spotify · All episodes

Need to Know:

You often plan vacations and time off far in advance around patient schedules
In private practice you usually answer to a supervising physician
PAs earn well but typically less than their supervising physician
Some patients and colleagues may not fully understand the PA role
Continuing education requirements are demanding, including a recert exam
None of these are dealbreakers for most PAs, but they are worth weighing

FAQ

What are the main disadvantages of being a PA?

The most common ones are planning time off well in advance, working within an office hierarchy, earning less than your supervising physician, and keeping up with demanding continuing education requirements.

Do PAs make less than physicians?

Generally yes. PAs are compensated well for the schooling involved, but you will typically earn less than your supervising physician, who profits from the capacity you add.

How hard are PA continuing education requirements?

They are significant, commonly 100 CME hours every 2 years plus a recertification exam every 10 years, so plan to be a lifelong learner.

Do PAs have to answer to a physician?

In most settings, yes. Unless you own the practice, you work with a supervising physician and may not always have the final say in office decisions.

Do people misunderstand what PAs do?

Sometimes. Patients, family, and even some physicians may not fully grasp PA training, which is why educating others about the role is part of the job.

Are these downsides dealbreakers?

For most PAs, no. They are tradeoffs worth weighing honestly before you commit, but many PAs love the career and would not trade it.

CLOSING

Being a PA is a rewarding career, and these tradeoffs are exactly that, tradeoffs rather than dealbreakers for most people who love the work. Going in informed helps you choose the path with confidence. If you are weighing whether the PA route is right for you, we would love to talk it through with you.

Pre-PA Counseling → https://www.thepaplatform.com/services/pre-pa-counseling/

The Few Disadvantages of Being a PA (Honest Take)