Except the PA has had 10-15 year head start on investing that money and is probably in a lower tax bracket than the MDs bigger salary so ultimately it’s probably still not that big. If treating simple, bread and butter primary care cases is your thing, PA is definitely a smarter financial move than MD. They thing is, as a PA, you will NEVER work on anything more than simple, bread and butter primary care cases - if a career in medicine means anything beyond that then a PA is not worth it.