the (crazy, long) path to become a doctor: 9 steps to become a physician

 

“The very first step towards success in any occupation is to become interested in it.” - Sir William Osler

 

The path to become a physician is long, highly competitive, and very expensive, but if you're doing it for the right reasons, the journey is fun. I didn't know any physicians growing up, so I learned the process as I reached each step. I’ve listed the general steps below in an attempt to make the process a little less mysterious. For those of you in undergrad, you may also find how to be a strong medical school applicant and components of your medical school application useful. I’m happy to go into detail about any particular phase at a later time if there’s interest!

 

 The crazy, long path to become a doctor - the 9 steps to become a physician

[ 1 ] elementary, middle, and high school education: 13 years

“The best preparation for tomorrow is to do today's work superbly well.” - Sir William Osler

 

The first step to becoming a doctor is successful completion of high school. I highly recommend working hard in high school to obtain an academic or sports scholarship. Scholarships look good on your resume and can potentially save you hundreds of thousands of dollars!

College admission requirements vary across the country. I think it’s a smart idea to have a dream school in mind and know that school’s requirements well. This will help you focus and work hard.

I also highly recommend participating in extracurriculars and/or developing a hobby during high school. My high school didn’t allow much time for non-school activities and I do think it hindered me somewhat socially in college. Also, in every interview you ever go on - someone will ask you about your hobbies.

 


[ 2 ] undergraduate education: 3 – 5 years

“Live neither in the past nor in the future, but let each day’s work absorb your entire energies, and satisfy your widest ambition.” - Sir William Osler

 

Traditionally, an undergraduate degree (Bachelor of Science or Bachelor of Arts) takes 4 years to complete, but it can vary between 3-5 years depending on your major and how many AP classes you took in high school.

The majority of medical students around the country were biology majors because most pre-med students find the course load interesting and pre-medical requirements overlap heavily with the requirements for a biology degree. However, there is no required major for medical school acceptance. You can major in whatever you want. Business, architecture, dance, and nutrition are a few of the non-biology majors from my medical school class. There are, however, a handful of required courses for medical school admission, including, but not limited to, general chemistry I and II, organic chemistry, physics I and II, and general biology I and II.  Most places want math & english as well. Okay, a little more than a handful.

Medical school admission is highly competitive, so it’s important to do well in all courses, extracurricular activities, the MCAT*, and volunteering. More on how to be a strong medical school applicant here.

*The MCAT is a national, standardized test that is required for all medical school applicants. Standardization allows easy comparison of students from different institutions. Early medical school acceptance programs grant joint undergraduate and medical school acceptance to high school seniors. These students do not have to take the MCAT (although, some programs are non-binding and allow applicants to take the MCAT and apply to other medical schools if desired), but they are still required to obtain an undergraduate degree.

 


[ 3 ] time off - optional: 1-10+ years

While medicine is to be your vocation, or calling, see to it that you have also an avocation – some intellectual pastime which may serve to keep you in touch with the world of art, of science, or of letters.”– Sir William Osler

 

“Non traditional applicants” are medical school applicants who have taken time off between undergrad and applying to medical school. Non-traditional applicants are slowly becoming the more traditional medical student. In fact ⅔ of my medical school class took “time off” after undergraduate education before applying to medical school. All of the students spent the time differently. For example, Zed worked on Wall Street for a number of years, a few worked in healthcare consulting, and Donni worked as a music professor in Alaska for 10 years.

 


[ 4 ] post-bach – optional: 1-2 years

“In science the credit goes to the man who convinces the world, not to the man to whom the idea first occurs.” - Sir William Osler

 

Some students complete a post baccalaureate degree after completing college. before medical school acceptance. These degrees are helpful for students who decided on a career in medicine after graduation and need to complete the required courses for medical school admission. It can also be completed by students who did not excel in their core academics during undergrad and want to boost their GPA.

Typically, these programs are very fast paced.

 


[ 5 ] medical school: 4 – 6 years

“What is the student but a lover courting a fickle mistress who ever eludes his grasp?” - Sir William Osler

 

There are two types of medical schools – allopathic medical schools (MD) and osteopathic medical schools (DO). Read about the difference between the two in Fran’s career profile.

Typically, medical school is completed in 4 years, but 5-6 year paths are common now.  Most medical schools associated with a larger University offer the option for students to obtain a masters level degree in 5-6 years. Options for additional degrees include MD/MPH (Master of Public Health), MD/MBA (Master of Business Administration), and MD/MSc (Master of Science). Students applying to competitive specialties may take a “year off” from their medical school curriculum to do clinical or basic science research to boost their residency application without seeking an additional agree.

The first two years of medical schools are spent in a classroom setting learning the basic science "foundations of medicine" - such as microbiology, immunology, and pharmacology. The second two years are spent in the hospital on various rotations - including internal medicine, general surgery, ob/gyn, etc. After experiencing a variety of specialties, students apply to a residency program in their chosen specialty during the fourth year of medical school.

In order to graduate from medical school, medical students must pass the first two steps of the national board licensing exam (commonly referred to as step 1 and step 2). Medical students become doctors at the end of medical school graduation, however, they can not practice medicine or apply for a license until they complete internship and step 3. Medical school teaches the foundations of medicine and allows students to obtain exposure to most medical fields. Internship and residency, however, are where specialty specific learning occurs.

More detail on the medical school process in the future.

 


[ 6 ] internship: 1 year

“To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.” - Sir William Osler

 

For most specialties, internship is just the first year of residency. For some specialties, internship is completely separate from the rest of their training and may be completed at a different program from the advanced residency program. Internship is only one year.

At the end of internship, the doctors in training can apply for their medical license if they have completed all 3 steps of the national board medical exam.

However, they are not yet board certified. Speciality board certfication exams cannot be taken until the completion of an accredited residency.

 


[ 7 ] residency: 2 – 6 years

“One finger in the throat and one in the rectum makes a good diagnostician.” - Sir William Osler

 

During residency, doctors in training see patients and are paid a resident salary. Residents are responsible for all patient care - including admitting patients to the hospital, ordering all patient orders, performing procedures and surgeries, and communicating with insurance companies on behalf of their patient. Attending physicians oversee resident orders for safety control. Attending physicians are also responsible for teaching residents. In addition to on the job teaching, most residency programs have didactic sessions a few hours a week that are similar to medical school lectures.

Residency is a very stressful time in life. Residents typically work long hours (think 24-36 hours at a time), leaving little time for life outside of medicine. In addition, residency is a time of tremendous learning and growth - things that in reality are, very painful to experience. Most residents also experience financial strain due to stagnant residency salaries and ballooning medical school debt.

At the end of residency, doctors in training and able to sit for the board exam in their profession. For example, at the end of my dermatology residency, I will be able to take the dermatology board exam. If I pass, I will then be a board-certified dermatologist. I cannot, however, sit for the pediatrics board exam without completing a pediatrics residency.

Most doctors complete one residency program, but some complete more than one. Unlike the physician assistant path, changing specialties for a physician requires repeat residency training in the new desired specialty.  Do you want to include that multiple residencies are not medicare funded? Do you want to add a line about where resident funding comes from? - no . but happy to include it if you want to write it

 


[ 8 ] fellowship – optional: 1 – 3 years

“Observe, record, tabulate, communicate. Use your five senses. Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone you can become expert.” - Sir William Osler

 

Fellowship is additional, optional training after residency that allows physicians to become more specialized within their field. Most fellows enter fellowship immediately after residency, but it is also allowable to work as a physician before going back to fellowship. Fellowship, like residency, has a set, non-negotiable, salary.

Fellowships are typically 1-3 years in length and fellowship eligibility is limited by residency program. For example, medicine residents can apply to gastroenterology, hematology and oncology, and cardiology fellowships but they cannot apply to a dermatologic surgery residency fellowship.

 


[ 9 ] attending physician: for life

“The teacher's life should have three periods, study until twenty-five, investigation until forty, profession until sixty, at which age I would have him retired on a double allowance.” - Sir William Osler

 

The light at the end of the tunnel.

Attending physicians can evaluate and treat patients on their own without approval of another physician. Attending physicians can also supervise and teach residents in a hospital setting or clinic. The, attending physician is ultimately responsible for all care delivered by residents and physician assistants under their name. This includes bearing the majority, if not all, liability for the patient encounter.

Board certified physicians are able to work in a variety of clinical settings including, but not limited to, in-hospital care and clinic-based care. Physician owned practices are becoming rare in our current economy but do still exist. It is now common for a physician to be employed by a large hospital system.

Attending physician salaries are negotiable and are generally at least 3 times that of resident salaries. This may sound amazing, but most physicians are at least 30 years of age when they finish residency. Most have considerable student loans to pay back, some have growing families, and few have adequately funded retirement funds for their age, so there is a lot of financial catch-up to be played before retirement.  

 

“I desire no other epitaph… than the statement that I taught medical students in the wards, as I regard this as by far the most useful and important work I have been called upon to do.” – Sir William Osler

 

“The search for static security – in the law and elsewhere – is misguided. The fact is security can only be achieved through constant change, adapting old ideas that have outlived their usefulness to current facts.” Sir William Osler