Becoming a Physician: Not for the Faint of Heart

by Ravi V. Shamaiengar, M.D.

This article was first published in the September 2005 issue of the Williamsburg Health Journal.

It’s back to school time again and many incoming college students have begun the coursework that will lead them to their chosen professions. They all have likely been asked the question “What do you plan to do when you grow up” from a very early age (unfortunately, some adults are still asked this question!). Many young students haven’t a clue, which is just fine. But some of these students will have their sights set on a career as a medical doctor. For those considering the medical profession, it would be helpful to have an idea of what they’re getting into. This information may also be of interest to others who may not know exactly what it takes to achieve this goal. As most people know, a career in medicine is not for everyone and certainly not for the faint of heart. However, those who choose this path are guaranteed many exciting challenges and rewards.

Preparation for medical school may actually begin in high school. During those years a student should establish solid study habits and hone the ability to learn many different subjects. A high school student will likely discover whether he or she enjoys the sciences. The physical and biological sciences provide the foundation for medical science. In addition, a high school student considering medical school should also acquire a wealth of knowledge in other areas such as language arts, which are essential for good communication skills. Extracurricular activities may help a student develop traits such as leadership, compassion and empathy, which are not taught in the classroom per se, but will be expected by future patients and colleagues.

The lessons from high school are then carried to the student’s college of choice. Choosing the right college provides advantages when applying to medical school; graduating from a prestigious college with excellent pre-medical curricula gives the medical school candidate a “leg up.” While attending college, the student will likely endure the question “What’s your major?” ad nauseam. Those who respond “pre-med” will often encounter reactions ranging from a sarcastic “Yeah, right!” to a sympathetic “You poor soul!” and everything in between.

The “you poor soul!” response is not far off. The coursework required to complete college and then medical school typically takes eight years. During college a pre-med student must take the following prerequisite courses: one year each of biology, chemistry, physics and organic chemistry, along with their corresponding laboratory classes, plus a year of English and an advanced math such as calculus or statistics.

Contrary to popular belief, pre-meds do not have to be biology or chemistry majors (although many are because the prerequisite classes listed above are also ones often required for those majors). Pre-med students can major in English, economics, engineering, journalism, etc., as long as they take the courses listed above.

The med school prerequisites are intended to prepare prospective students for the infamous MCAT (Medical College Admission Test). Usually taken during the junior and senior college years, this grueling test lasts nearly six hours and includes four sections: physical sciences, biological sciences, verbal reasoning and essay questions.

Although a pre-med student will be immersed in academics during college, most medical schools also expect the student to engage in extracurricular experiences within the medical profession. For example, I gained valuable experience volunteering with a rescue squad and at a clinic providing free care to inner-city patients.

Not all new medical students take the traditional path from college straight to medical school. For some, medicine is a second career. As long as a student takes the course prerequisites, has excellent grades and a four-year college degree, scores well on the MCAT and has gained experience in the medical field, he or she has a shot at entering medical school.

Unfortunately, not all who start down this path reach their destination (here is where the “yeah, right!” reactions from their college days come in). For some, the prerequisite curriculum proves too difficult or not what they find interesting. For others the MCAT may be their pitfall. According to the AAMC (American Association of Medical Colleges), in 2004 there were 35,735 applicants to medical school with an average GPA of 3.47. Of those, 16,648 were accepted with an average GPA of 3.62. In other words, less than half of those who applied last year are entering medical school this fall.

For those who do enter medical school, the first two years include many late nights of bookwork as well as laboratory courses requiring microscopic analysis and anatomical dissection (the latter requiring a strong stomach). These classes prepare the student for part one of the USMLE, the United States Medical Licensing Examination. The third year of medical school is devoted to hospital rotations in which the students apply their knowledge to different areas of medicine (i.e., internal medicine, pediatrics, surgery, obstetrics and gynecology, psychiatry, etc.). After the third year, the students take the second part of the medical boards (USMLE part 2). The fourth year is usually a mix of additional hospital rotations and electives depending on the school.

During the senior year students must apply for a residency, a program of on-the-job training in the specialty they prefer. Their board scores, course scores and professor recommendations all influence which residency program the student may be eligible for. Usually around the “Ides of March” (March 15) comes Match Day, that pivotal, emotional day on which most senior medical students around the country learn where they will spend the next several years. At my medical school, our entire class anxiously gathered in one room, and one at a time, we each received an envelope containing our match. As each match was announced, some students erupted in cheers and high-fives, while others struggled to hold back tears.

After graduation, when students receive an M.D. or D.O. (doctor of osteopathic medicine) degree, they begin their residency, which may last from three years (i.e., family practice, pediatrics) to seven years or more (i.e., cardiac surgery). The first year of residency is often referred to as an internship, and after completing the intern year, the new physician must complete part three of the USMLE.

During these years the residents are paid, but their salaries are often close to what some of their friends started earning upon college graduation four years earlier. This brings up the subject of the costs and debts incurred during medical education.

Medical school tuition alone averages $28,000 per year for out-of-state residents or those attending private medical schools, while in-state students may pay a minimum of $10,000 per year. These figures exclude the cost of housing, books, food, etc. In 2003, approximately 68 percent of medical school graduates reported educational debt of at least $50,000, while five percent reported debt topping $200,000.

After successfully completing a residency program (and often one to three additional years of training known as a fellowship), each doctor will take the board examination in their chosen specialty. However, once board-certified, some physicians must recertify every 10 years (this varies among specialties). In addition, the physician must stay educated about medicine in general and their chosen specialty, as advances in medicine are almost a daily occurrence. Continuing medical education is required to maintain licensure.

So, as you can see, the path to become a medical doctor is certainly not for the faint of heart. However, if a person enjoys the sciences, aspires to a lifetime of continual education, obtains gratification from helping others and is willing to endure significant academic challenges, lost sleep and delayed financial rewards, then the profession of medicine may just be the right prescription.

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