A couple months ago I found myself at large, relaxed Shabbat lunch filled with about 15 people, half of whom were new to me. I eventually wandered my way into a conversation with two young women where we spoke about our careers, their dating lives, and my marriage. One of them had recently started dating a medical student and was trying to wrap her head around his education, so I began explaining the detailed process of becoming a doctor - not just getting the MD with your medical school diploma, but the training that follows. After what ended up being a rather long explanation, she said with eyes wide: "Wow, I bet your husband wouldn't be able to describe your career training so well!" I laughed and said she was probably right, but only because the process of becoming a music teacher is decidedly more simple and straightforward, without nearly as many hoops or cross-country moves. Becoming a doctor, by contrast, is far more complicated. Having rehearsed the speech numerous times to friends and family who, like me, were not raised in a family of doctors, I'd like to present an overview of the five primary stages of training that are part of becoming a fully-formed doctor.* Stage 1: Undergrad (Pre-Med) The path to becoming a doctor begins well before medical school. Although it may begin as early as your first doctor playset and costume as a child, the real work begins in earnest in college. Those who decide early in their undergraduate career to pursue medicine are premed, regardless of the actual degree conferred. A premed student doesn't necessarily have to get a degree in the natural sciences, but most medical schools will require a minimum of a year each in biology, physics, and English, plus two years in chemistry. In addition to a spectacular GPA and well-rounded coursework, students need to get a solid score on the Medical College Admission Test (MCAT) and demonstrate inquiry, success, and perseverance through activities like volunteering and research. A good application with great test scores and grades can lead to more medical school interviews and better chances at admission overall. With the rates of applicants rising and the subsequent medical school admissions rates falling, finding ways to make a medical school application - and applicant - stand out is more important than ever. Stage 2: Medical School With bachelor's degree in hand, the first real step to becoming a doctor is getting into and graduating from medical school. Obtaining a medical degree (as opposed to an MD-PhD, for example) is typically a four-year process and includes a combination of classroom study and clinical experience alongside doctors in hospitals and medical clinics. Getting into medical school is no easy task: U.S. News and World Report announced an average acceptance rate for the 2017-18 school year at only 7% percent. However once you're in, there's an 80% chance you'll graduate in four years and a 97% likelihood you'll get your M.D. in eight years. Those are some good odds considering that most U.S. medical school students can expect to pay upwards of $300,000 for that M.D. Throughout medical school, students also take two of the three tests comprising the U.S. Medical Licensing Examination (USMLE); Step 1 during the 2nd year and Step 2 during the 4th year. Step 1 is particularly stressful because its scores can have a massive impact on a medical student's prospects for residency. In J's experience, he spent much of the first two years (known as M1 and M2) doing classroom-based coursework. The last two years of medical school (M3 and M4) were his opportunities to work in the hospital rotating through a variety of teams and specialties. It was through this experience that his interest in surgery solidified. Stage 3: Residency Graduation from medical school means you are officially a doctor, but not yet able to practice. Following graduation from medical school in May or June, most newly minted doctors head to Residency, a three-to-seven year job where doctors develop the skills specific to their preferred area of medicine or surgery. (I won't get into the actual process of getting into residency here. That deserves an entire post of its own.) Residents are salaried employees of the hospital, but their pay is still far below what they can expect to make after training. The average resident salary in 2017 was $57,200, although salaries vary based on the specialty and the cost of living. Salaries also increase with each additional year, starting with post-graduate year (PGY 1) and continuing until all of training is completed. Residency is a job, but it is also an educational program. Residencies in the U.S. are governed by the Accreditation Council for Graduate Medical Education (ACGME) which sets the guidelines for curriculum, patient care and safety, work hour restrictions, and other facets of the program. Young doctors also take the USMLE Step 3 test during residency, usually within the first couple years. Finally, after residency, doctors take The Boards (either a single test or a combination of exams based on the specialty) to become certified in their field. J's general surgery residency is a five-year program and residents are referred to by their class within the program: Interns (first year residents), Second Years, Third Years, Fourth Years, and Chiefs. J and a few of his colleagues have also taken a year off between the second and third to do research, which both looks great on a resume and was a wonderful break from the arduous demands of residency. Each month, residents are assigned to a particular surgical team in the hospital, known also as a rotation. In J's hospital some of the rotations include general surgery teams, emergency general surgery, pediatric surgery, and thoracic. Much like the clinical clerkships in the third and fourth years of medical school, these rotations help training surgeons identify whether they will want to specialize after residency and, if so, in what area. When J graduates from his residency (only 11 months to go!) and takes the General Surgery Boards, he will finally be able to call himself a surgeon. Stage 4: Fellowship (optional) Completing a general surgery residency (or internal medicine, or pediatric, or. . .) is all well and good and no small accomplishment, but as with many fields your employment prospects, potential salary, and job satisfaction can improve with specialization. For physicians, this means Fellowship. Fellowship doesn't have to immediately follow residency and some doctors will choose to work within their general field for a year or more before pursuing one, but if J's program is any indication then going straight into fellowship from residency is the norm. Sub-specialization is particularly valuable if you want to end up in an urban area with a greater concentration of medical professionals and hospitals. J decided early on that he wanted to go into surgical critical care/trauma surgery. They aren't quite the same thing, but they overlap substantially. Additionally, while trauma is not yet its own accredited field, most accredited surgical critical care fellowships dedicate a portion of the time to trauma surgery. Like residency, the length of the fellowship program depends on the specialty. In many cases, the shorter the residency the longer the fellowship, but most fellowships cap at three years. Surgical critical care is, thankfully, a one-year program (although some offer an optional second year in acute care surgery or research). Fellowship salaries are an extension of the residency salary pay scale. When J starts Fellowship he will be PGY-7 and will make whatever a PGY-7 makes in whatever hospital we end up at. There is no negotiating this number, and it has no basis on what you made during residency, so if you move from a high cost of living area to a low one, the fellowship salary may drop accordingly. At the completion of fellowship, doctors can become Board certified in their sub-specialty through another set of tests. Unlike the more generalized USMLE tests, Board certification must be renewed every 10 years, and physicians can maintain their certification in multiple specialties. For J, this will mean dual certification in both general surgery and surgical critical care throughout his career. Stage 5: You're a Real Doctor! After undergrad (4 years), medical school (4 years), residency (3-7 years), fellowship (1-3 years), passing the Boards, and applying for licensure, a person can finally practice as a fully-formed doctor, also known as an attending physician. Side note for a funny story: Early on when J and I started dating during his M3 year, he texted me and said something about his "attending." Not having any prior experience with the world of medical education, training, or nomenclature, I thought this was a typo and asked "Don't you mean 'attendant'?" "No, attending," he responded. Oops! The learning curve is real, folks. The learning doesn't end, of course, for either of us. In the process of writing this post I had to clarify a lot of things with J and learned more about the process of Board certification. For example, I learned that a doctor can practice without being Board certified, but with a higher liability and with less likelihood of being hired by a hospital or practice. Meanwhile, J will continue education beyond fellowship as he stays on top of the advances in his field and maintains his certification throughout his career. It's a tough journey, to be sure, and one that doesn't really begin to reap rewards until a doctor is in their mid-30s. The hours are long, the expenses are high, and moving multiple times throughout the process is often unavoidable. It's hard sometimes not to feel like J is being pulled along on an 15-year-long riptide, with me holding on for dear life, but we have less than two years left until the waters calm and we can finally lower the anchor and breathe a bit easier. *Pursuing an M.D. isn't the only way to practice medicine, nor is this particular series the only way it's done. There are also osteopathic programs whose graduates become D.O.s, MD-PhD programs in medical schools, and of course plenty of people who start, stop, switch, go back, and otherwise take a more circuitous route to licensure. This post focuses on the simplified and straightforward path of an M.D. and uses J's experiences as a surgical resident as a framework.
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AuthorNashira is a music teacher and proud Small-Town Jew who, after surthriving six years in Brooklyn for her husband's surgical residency, is finally back in Wisconsin where she belongs! At least until the end of the two-year surgical fellowship, that is. It's a wild ride, and she's ready to tell you all about it! Archives
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