Med school, internship year, residency, fellowship is definitely a long, arduous process. The process has unfortunately become a tradition and right of passage. Wish some universities could think outside the box and create an alternate pathway for established PAs to take additional courses, sit for boards and apply for residency.

As a PA myself, I'd have to go back and renew old undergrad courses to be eligible to apply for med school with all the youngins. 10-12 years later I'd potentially be through the process and earning a full paycheck again. At this point, a decade of missed income with new debt is prohibitive to any thought of trying to advance my career in medicine to the physician level.