I would caution you to try to figure out what the average PA does. Whenever people start talking about being a PA versus MD some PA always shows up who says "I run a neuro ICU all by myself with no doctors on site" or "I work in an ER and never talk about any of my patient any MD and see everything that comes in the door."
Great. But that's not what the average PA is doing right now. The average PA at a level one trauma center is seeing level 4 and 5 cases pretty much alone (UTIs, stitches, med refills, URI etc etc). At smaller hospitals they may be seeing level 3s, usually with some interaction with an attending.
The truth is you have to ask yourself what you want to do. If you really love the super sick cases in the ER, the strokes, the septic shock patients who need a central line, being an MD will be much more of that.
You should also think about if you are the kind of person who changes what they want to do every couple of years. A PA has the option to do 10 years of ER, then start working in orthopedics, or nuerosurgery or whatever. Once you finish residency as a doctor is is much harder to make radical changes in career.
As far as time goes, it depends how far away you are from applying. If I were 28, personally it would be a very different equation for me if I would be ready to apply next year, versus still having 2 years of pre-requs to go and then another year of applying, which means I wouldn't start med school until 31 or 32.
excellent post.
regarding em pa's, the fact of the matter is that only 5% have a "see anything, do anything, work alone" scope of practice and that group is almost entirely made up of senior pa's >10 yrs into their careers who were former paramedics, nurses, RT's or military corpsmen/medics. having been active in em for almost 25 yrs, I probably know most of the places that staff that way(and most are very rural) and most of these folks personally from conferences and professional societies. it's a small club. 8000 pa's work in em. 50 of every thousand work to this level so we are talking about 400 jobs nationwide, not even remotely close to evenly distributed. most of these jobs are in very rural states(ME, VT, NH, AK, NC, WY, MT, GA, WA probably account for 50% of these jobs).
that being said, if you are set on a career as a pa there are a few things one can do to try to tip the odds in your favor:
do a postgrad pa residency in em or trauma. see
www.appap.org
be willing to leave your current job for new jobs with a better scope of practice even if you will take a huge salary hit or work worse hours(been there, done that-twice).
be willing to leave jobs for better educational opportunities(supportive docs who teach well, etc) despite a big pay hit(also been there, done that).
get all the extra education you can; acls, atls, pals, apls, fccs, difficult airway, also, nals/nrp, u/s, etc
join sempa:
www.sempa.org essentially all the high level pa's in the country are members of this group and attend their conferences.