If I am not mistaken the prerequisites for med school and for getting into a PA program are pretty similar. Both have no major requirements but do require shadowing and exemplary grades and test scores. A 31 ACT is nothing to scoff at and given her GPA and success in HS school I wouldn’t give up her goal of becoming a doctor. If she chooses the right school and works to her potential she can be a successful student. Because grades and MCAT scores are VERY important in consideration for med school she can broaden her search for schools and look for schools with a reputation for preparing students for health fields and where she would potentially be a strong student. If she realizes that she wants to change course in college she should be able to do so within a couple of years. It would largely require a change in where she shadows and volunteers. If she struggles in her prerequisite courses she may need to consider a different track. If she struggles with the MCAT there are other career options available though they will likely require another advanced degree and that she take the GRE.