Before I spend time writing up blogs on various topics in medicine, I want to address something that seems to be ignored by the general public: the amount of education it requires to become a physician. I am not doing this to flaunt my own efforts, but my own family has had difficulty grasping the path to becoming a practicing physician. It's a long process, and a lot of people feel that physicians make too much--but really, for the majority of physicians, the debt we accrue is sufficiently high that we need a high salary to make up for it. Furthermore, I want to emphasize that we are continually tested, so that the practices that we do weren't just picked out of thin air.
So, without further ado, the path to becoming a physician:
1. College
You need a bachelor's degree prior to entering medical school in the US. There are a few, rare exceptions, but we're talking 1-2 people out of the thousands of medical students each year. It doesn't particularly matter what you major in, just that you fulfill some basic requirements. The requirements are actually changing a bit from when I applied 4 years ago, but generally include 4 years (8 semesters) of science courses, including Biology, Chemistry, Organic Chemistry, and Physics, with labs; some sort of English or writing course; some sort of math (generally Statistics and/or Calculus); some sort of humanities course (Psychology, Sociology, etc); and occasionally some upper level science courses such as Biochemistry.
Prior to applying to medical school, you need to take the Medical College Admissions Test (MCAT). It's similar to the ACT or the SAT, except that it focuses on reading comprehension and basic understanding of science concepts. It is scored on a scale of 3-45, with most people scoring somewhere between 25 and 35.
Medical school applications are a beast, but include filling out a central application with every college course you've ever taken, sending your MCAT score, and sending in letters of recommendation from professors, supervisors, etc. The application cycle lasts roughly 1 year; the application opens for submission in June for matriculation the following August. Each school requires a secondary application (and associated fee) with a variable number of essays. You are then selected to interview and must travel to the school to interview.
2. Medical School
Assuming you get through the admissions process, the next step is medical school. It is 4 years, though some schools are piloting 3 year programs, broken up into 2 parts: basic science, and clinical work.
The basic science part is classroom based, and includes courses on everything you need to know about the human body, from anatomy and physiology, to pathology and radiology. Generally, students are also learning the basics about interviewing and examining patients during this time as well. This portion is generally 2 years long, though some schools have made it as short as 1 year and many schools have moved to 18 month curriculums.
For most students, after you complete the basic science instruction, you take the first part of the United States Medical Licensing Exam (USMLE), affectionately referred to as 'Step 1'. This is an 8-hour test that covers all the material you learn during this first portion of medical school. It is scored on a 3-point scale, with a passing score of around 190. In theory, there is no highest score you can achieve, but it is exceedingly rare to find someone scoring more than 270. The national average is currently around 223. This score can determine which specialty you ultimately practice, as lower scores can preclude competitive specialties such as Dermatology or Radiology.
Then, students enter the clinical portion of medical school. Here, they work in a hospital or outpatient clinic with supervising physicians. They interview patients, try to figure out what is wrong with them, and follow them through their hospital stay. This is generally broken into 'clerkships' of the major specialties: Internal Medicine, Pediatrics, Surgery, OB/GYN, Psychiatry, etc. Following this year, students take Step 2 of the USMLE, which is broken into a 9-hour written exam focused on the treatment of a variety of diseases and conditions, and a 8-hour practical exam, which is focused on the ability to communicate with patients (using actors mimicking a variety of medical illnesses).
Finally, students have the opportunity to explore other interests in medicine through electives during their fourth and final year in medical school. Electives are generally broad, and can include travelling overseas, or working in specialties not typically experienced during third year (Radiology, Dermatology, Subspecialties of Internal Medicine and Pediatrics, etc). During this time, students make a decision for what they want to pursue for their career, and apply for residency positions. Similar to medical school applications, residency applications require letters of recommendation, course grades, and interviews.
The residency interview season culminates in Match Day. Applicants rank all the programs they interviewed at and are interested in, and programs do the same with the students they interviewed. A computer goes through both sets of lists, and comes up with a 'match' based on those rankings. Students find out where they will be spending the next portion of their training on Match Day, which is traditionally the third Friday in March. Following Match Day, students finish graduation requirements, and graduate with their degrees in May.
3. Residency
Even having an MD (Medical Doctorate) or DO (Doctorate of Osteopathic Medicine) does not qualify you to practice medicine. In order to get a license to practice, you must complete at least 1 year of residency; even then, most insurance companies won't pay you if you have not completed at least 3. Residencies range in length; general Internal Medicine, Pediatrics, and Family Medicine are 3 years, while General Surgery is at least 5 years. They focus on skills needed to be a competent physician, and include both inpatient and outpatient care. These individuals typically work 60-80 hours per week (that's 1.5-2 full time jobs), and make about $50,000 for their salary (it increases slightly each year). That's $13-$17 per hour, saving lives.
During your residency, generally in the first 1-2 years, you take Step 3 of the USMLE. Passing this makes you eligible for a license to practice. Upon the conclusion of residency, you take another exam to become Board Certified in your specialty.
4. Fellowship
In the event someone doesn't want to do general medicine within their field, they can choose to undergo further training through fellowship. For instance, those who specialize in Pediatric Gastroenterology first underwent a residency in General Pediatrics, then did a fellowship in Pediatric Gastroenterology. Those in fellowship are paid on the same graduated scale as residents, which means they typically only make $5,000-$10,000 more per year than a first year resident.
In summary, a general family medicine, pediatric, or internal medicine physician (those who provide primary care), spend 4 years in college, 4 years in medical school, and 3 years in residency, minimum. The trend lately is to take time off between college and medical school, which means these people are easily into their 30s when they are finally permitted to practice. And given that medical school alone comes with an average debt around $150,000, they certainly put in the effort to make the salary they do.
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