Becoming a doctor in the United States is not easy. The first step is to get into medical school. There are more than 120 American schools that offer programmes for those wanting to become doctors.
There are many resources from which people can get advice about medical schools. One of these is the Princeton Review. This publication provides information about colleges, courses and job opportunities.
According to The Princeton Review, competition to enter medical school is fierce. American medical schools have only around sixteen thousand places for students. However, more than twice this number of people apply for a place. Many of those seeking admission are women.
Most applicants contact more than one medical school. Some applicants contact many. An important part of the application process is usually the Medical College Admission Test (MCAT). The Association of American Medical Colleges provides this computerised test. It is offered in the United States and other countries.
Applicants are rated on their reasoning skills, knowledge of the physical and biological sciences, and writing ability. Applicants for medical school need to perform well in the MCAT. They also need to have performed well in their undergraduate studies.
Those who wish to become doctors often study biology, chemistry and other sciences in depth. Some students gain work experience in a medical or research role for a year or two before attempting to enter medical school.
Direct meetings, or interviews, are also usually required for entry to medical school. This involves talking to a school representative. The interviewer wants to ascertain whether the applicant understands the demands of life as a medical student and doctor in training. They also want to know about the person’s goals for a career in medicine.
A medical education can be very expensive. One year at a private medical college can cost over forty thousand dollars. The average cost of a place at a public medical school is over fifteen thousand dollars. Most students need loans to fund their studies. Many finish their education heavily in debt.
Some Americans become doctors by joining the United States Army, Navy, Air Force or Public Health Service. They study at the F. Edward Hebert School of Medicine at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. These students study for free. In return, they commit to seven years of government service.
Doctors are among the highest-paid people in the United States. Those who work in specialties such as eye care in big cities usually earn the most money. However, some other doctors earn far less. This is particularly true in poor communities.
Most medical students spend their first two years mainly studying in the classroom. They learn about the body and all its systems. They also begin studying how to recognise and treat diseases.
By the third year, they begin working with patients in hospitals. Experienced doctors who have treated many patients guide them as they work. As they learn, students consider the medical skills they will require to work as doctors.
During the fourth year, students start contacting hospital programmes to arrange additional training after medical school. Competition for places at top hospitals can be fierce.
Doctors in training in hospitals are known as interns or residents. They are usually called interns during their first year. After that, they are known as residents. Trainees treat patients under the guidance of medical professors and other experts.
All fifty states require doctors-in-training educated at medical schools in the United States to complete at least one year of hospital work. Graduates of study programmes at most foreign medical schools may have to complete two or three years of residency training, although there are exceptions.
To be accepted onto a residency programme, a person must meet the requirements of the Educational Commission for Foreign Medical Graduates. This process involves taking several tests before a visa to stay in the United States for the training period can be obtained.
Those who have completed study programmes at foreign medical schools may be required to return to their home country for at least two years after their training ends. However, due to shortages of doctors or other needs, some have been able to obtain visas without the required two-year stay in their home country.
Doctors-in-training gain experience in various areas of care. Interns, for example, may work with children for one month. The following month, they may assist at births. The length of a residency depends on the chosen area of medicine.
There are many medical specialties. Some people become cardiologists and specialise in heart care. Others become oncologists and treat cancer patients. Some become paediatricians and care for children. Some doctors go into medical research, either at a university or with a private company.
But whatever they choose, they first need experience. Some doctors spend a long time working in hospitals before they are fully trained in a speciality. Some spend six years or more as residents before starting their own practice.
A doctor in Illinois recalls that, prior to his internship, he aspired to work in crisis medicine in the emergency room. However, he later opted for surgery because it allows him more time to decide how to treat his patients.
In 1999, the Institute of Medicine of the National Academies (the IOM) released a report on mistakes in American hospitals. The report stated that preventable errors resulted in at least 44,000 deaths each year.
Five years ago, the New England Journal of Medicine published two government-funded studies of serious errors. These studies found that the rate of mistakes in two intensive care areas decreased when interns worked fewer hours.
The Accreditation Council for Graduate Medical Education oversees medical education. In 2003, the Council reduced the number of hours that residents could work. Residents were limited to no more than thirty hours of continuous duty. Hospitals were not supposed to require more than eighty hours of duty per week. However, some residents were spending over one hundred hours a week at their hospitals.
Last year, the United States Congress commissioned the IOM to review the situation. The IOM reported that the shorter working week had not helped residents. They were getting far less sleep than they should have been.
The report stated that residents were attempting to complete the same amount of work in a shorter timeframe as they had when working longer hours. Therefore, the I.O.M. recommended that residents be required to take five consecutive hours of rest for every sixteen hours on duty. They also recommended that residents be given fewer duties and more supervision.
However, some American researchers have questioned the value of the I.O.M.’s proposals. They claim that the proposed changes could cost American hospitals approximately one billion six hundred million dollars per year.
The researchers are employed by the RAND Corporation and the University of California, Los Angeles. Their report was published in The New England Journal of Medicine last month.
The report also stated that few medical errors result in injury. It also said that changing work rules could lead to other types of errors. For example, if resident doctors work shorter hours, mistakes could happen when one resident takes over a patient’s care from another.
The New England Journal of Medicine published an editorial alongside the report. The authors of the editorial expressed concern that the proposed changes would place too much importance on the number of hours worked. They said that residents would have to consider ethical issues around making others responsible for patients just because their working hours were ending. The editorial also questioned whether reduced working hours would provide residents with the necessary training to become doctors.