Get articles in your inbox! What Does it Take to Practice Medicine? May 19, 2015May 19, 2015 Andrea D'Eramo Featured, For Patients Ever wonder how many years of school it took your doctor to get where they are now? Most people know doctors go through a lot of training to be able to practice medicine – but what that training is (and how long it takes) is a bit more obscure to most people. Doctors are often labeled ‘Board-Certified,’ ‘Fully licensed,’ ‘Specialist’ and ‘Subspecialist’ – but what do those actually mean when it comes to a physician’s education? It can be really confusing; and because we know experience and level of training are important decision factors for people choosing a doctor, we’ve created a simple flow chart and detailed article to help you understand your doctor’s medical training. The Basics Depending on their specialty and certifications, doctors typically have between 11 and 18 years of education after high school. That includes: – 4 years of College (BA or BS) – 4 years of Medical School (MD or DO) – 3-7 years of Residency Training (length depends on specialty) – 1-3 *Optional* years of Fellowship Training (to subspecialize) Those are the bones of a physician’s medical education and training. To break it down more and get a better picture of what they’re learning at any given point, have a look at the different steps below: 4 Years of College Most medical schools require applicants to have a Bachelor’s degree to begin their medical education. There are exceptions to this as some medical schools now offer combined BA/MD programs that span 6-8 years and start when a student graduates from high school. Undergraduate students intent on pursuing a career in medicine are termed “pre-med”. At most colleges, there is no formal pre-med major. Instead, pre-med implies a student is taking a suite of courses including 1-year courses in biology, chemistry, organic chemistry, physics, and math necessary before medical school. Pre-med students can major in anything from Business to the Arts, however completing the prerequisite courses in the sciences is more difficult for non-related majors so most students major in related fields like Biochemistry. During their four years of college, pre-med students must prepare for admission to medical school. They must hone their GPA, study for the MCAT (Medical College Admission Test), shadow physicians, volunteer in some capacity on a regular basis, have some sort of clinical exposure (such as working as a medical assistant or EMT), participate in research, hold leadership positions and prove they are capable of multitasking–all this on top of everything else required for a Bachelor’s degree. Pre-med students intent on starting Medical School immediately after completing their undergraduate degree take the MCAT the summer after their junior year. Part of their application and acceptance decisions relies on intensive interviews at most medical schools. If they apply to medical schools at the beginning of their senior year and are accepted, they start the fall after graduation. Gap or Bridge Years Because starting Medical School is tantamount to starting down a new 7 year (minimum) path of education and training, many aspiring doctors choose to take a year or two off between their undergraduate degree and Medical School – these are often termed “gap” or “bridge” years. Many pursue research interests, travel, participate in the Peace Corps or other similar programs, or work to get more clinical experience while applying. Bridge years can also give students who completed their bachelor’s degree without all the necessary courses a chance to take the required courses all at once, study for the MCAT and apply to school. There are many paths into medicine, and even more once someone is on track to become a physician. Each doctor has their own training history, thus a different background from their peers. In medicine there is no one ‘right’ path – some are simply more direct. 4 Years of Medical School There are two types of medical schools in the United States. Those where students graduate with a Doctor of Medicine (M.D.) and those where students receive a Doctor of Osteopathic Medicine (D.O.) degree; both are 4-year degrees. Medical schools are generally broken up into two parts: the first two years, and the second two years. In the first two years, medical students spend time in classrooms and labs learning the basics of medicine including things like anatomy and physiology. After their first two years of didactic learning, medical students take the either the USMLE (United States Medical Licensing Exam) Step 1 Exam if they’re pursuing an M.D. or the NBOME (National Board of Osteopathic Medicine Examiners) COMLEX-USA Level 1 Exam (Comprehensive Osteopathic Medical Licensing Examination) if they’re pursuing a D.O. The second two years of medical school includes clinical rotations (or “clerkships”) in doctor’s offices or hospitals. Students rotate between specialties like internal medicine, surgery, pediatrics, family medicine, obstetrics and gynecology, neurology and psychiatry. Toward the end of their two clinical education years, students take Step 2 or Level 2 of their licensing exams. Instead of one exam, it’s broken down into two parts: Clinical Knowledge and Clinical Skills. Medical School Graduates still aren’t full-fledged physicians even after passing both Step 2 exams. When students graduate from Medical School they get their medical degree – either an MD or DO. They still have to match with a residency program where they will continue their clinical learning. Since there are many foreign doctors practicing in the United States, it’s worth mentioning that they don’t typically do the United States’ standard 4 years of college and 4 years of medical school. Rather, students coming from abroad generally obtain those 8 years of education in a combined 6 years straight out of high school. If they intended to practice in the United States, they must complete all USMLE exams. 3-7 years of Residency Training (“Graduate Medical Education” or GME) The year following a doctor’s graduation from medical school is often termed their “intern” year. At that point, doctors have a medical degree, but not the ability to practice medicine unsupervised. After their first year of residency (PGY1 or Post-Graduate Year 1), they take the USMLE Step 3 or COMLEX-USA Level 3 exam. When they pass Step/Level 3, they are permitted to practice medicine unsupervised, but are still in their residency setting on track toward getting their license, full privileges and board-certification if they want it. Residency program length differs depending on what type of medicine a doctor is trying to practice. For example, family medicine is typically a three year program while plastic surgery is six, emergency medicine is four, and neurosurgery is seven. Doctors tend to begin applying for their medical licenses in the final year of their residencies. Unlike board-certifications, medical licenses are necessary to practice medicine. A physician must obtain a license in any state they practice. After completing a residency program, doctors are considered to be “Board Eligible” (or B.E.) – that is they have the option to become Board-Certified in a specific specialty like family medicine or general surgery. Board certification is not necessary for a doctor to practice medicine, and many doctors choose not to become so. Many doctors cannot take their board-certification exams until they have been practicing medicine for a year or two, so oftentimes the transition from residency, to licensed physician to board-certified licensed physician can span a few years. Fellowships Fellowships are optional education opportunities for physicians seeking to subspecialize beyond their first residency (they’re basically a second, more-specific residency). Fellowships are only necessary for physicians looking to become experts in very specific fields. For example, after completing a 3-year internal medicine residency, a doctor could choose to pursue a fellowship in Gastroenterology or a doctor who has already completed a 3-year residency in Pediatrics could choose to pursue a fellowship in pediatric cardiology and become a Pediatric Cardiologist. At each subspecialty level, a doctor becomes eligible to take more specific Board Certification exams. (So our sample Pediatric Cardiologist could be Board-Certified in both Pediatrics and Pediatric Cardiology.) Again, fellowships are completely optional for physicians since all doctors can have full privileges after successfully completing a residency program. Continuing Education All doctors must complete continuing education units to keep their licenses current. The rules and requirements vary widely by state, but as an example, some states require 100 hours of Continuing Medical Education (CME) credits every 2 years. They need these credits or units to apply for license renewal. Doctors can achieve these credits by attending medical conferences, lectures or by taking online courses. Board-Certified doctors voluntarily commit to doing even more within their specialty since they must keep both their licenses and board-certifications renewed and up to date. Depending on the specialty, board-certified doctors renew their board-certifications every 7-10 years in addition to keeping their medical licenses up to date. Combined Degrees Some doctors have other degrees – Master’s in Public Health, Law Degrees, PhD’s, MBA’s, Engineering degrees, the possibilities are almost endless. Every person goes about getting their degrees in different ways. Some schools offer combined programs (MD/PhD, MPH/MD, MD/JD, or MBA/MD), but most break up the academic timeline differently. If you’re curious about your doctor’s specific training regarding a second or dual degree, it’s best to search for the school’s webpage and find out how they do it specifically. The one semi-structured anomaly is for MD/PhDs. For these dual-degree programs, students generally complete their first two years of foundational medicine courses with other MD/DO students. They then complete half of their third year of general medical school (for the USMLE Step 2 Clinical Knowledge exam), and then ‘leave’ to complete their PhD program in the middle of their medical training before re-joining and completing the last 18 months of clinical rotations. After 7-9 years, they graduate with an PhD and MD or DO. Practicing Medicine The road to practicing medicine is a long one. Indeed, most doctors are in their early to late thirties (and often in a lot of debt) by the time they can fully practice medicine. It’s definitely not a profession for the faint-hearted or the weak of will. Take a look at some physicians below, the titles they go by, and how they got to where they are now: Sample Physicians: Dr. Michelle Gordon, D.O., FACOS, FACS Undergraduate: Harvey Mudd College (B.S.) Medical School: Western University of Health Sciences, (D.O.) Intern Year: St. James Hospital, Olympia Fields, IL Residency: St. John’s Episcopal Hospital, Far Rockaway, NY Titles: Board-Certified Acute Care and Emergency Surgeon Board-Certified General Surgeon website: http://drmichellegordon.com Dr. Christine Lee, MD Undergraduate: University of Michigan, Honors College (B.S.) Medical School: Michigan Medical School (M.D.) Residency: University of Virginia, Ophthalmology Titles: Board-Certified Comprehensive Ophthalmologist Specializing in Cataract and Refractive Surgery Board-Certified Ophthalmologist website: http://eyeinstitutenc.com/about-us/christine-e-lee-md/ Dr. Akram Alashari, MD Undergraduate & Medical School: October 6 University, Faculty of Medicine, Egypt & New York Medical College’s Fifth Pathway Program Intern Year: Spartanburg Regional Healthcare System, South Carolina Residency: University of Connecticut Integrated Surgery Program Fellowship: University of Florida Surgical Critical Care Fellowship Titles: Board-Certified Trauma Surgeon and Surgical Intensivist Trauma Surgeon and Critical Care Physician Website: http://www.thepowerofpeakstate.com/ Many thanks to the physicians above who graciously helped craft this article and provided insight into the path to practicing medicine. Special thanks to Los Angeles plastic surgeon Dr. Elliot Hirsch, MD, for his contributions as well (http://www.hirschplasticsurgery.com/). Image Sources // freepik // ClipArtPanda // Webweaver // Sylwia Bartyzel Get articles in your inbox! Andrea D'Eramo Hi! I'm Andrea. I create content at BetterDoctor. I came to BetterDoctor with a background in investigative journalism and a love for health policy. When I'm not playing with Medicare data, I like exploring new cities and finding great restaurants.