I have the pleasure of mentoring students in various stages of "becoming doctors." A common question asked is "wow how desire does it take to become a doctor?" So I decided to break it down for y'all...
Grade school - middle school. I've always wanted to be a doctor. My grandmother was an LVN and my mom an RN. So the next 'natural step' was for me to become a adulterate. I've always been a good student and was placed in "the good kid pile" very early in grade school. Fortunately I had parents who really advocated for me and essentially *demanded* that I be placed in 'accelerated' classes. This worked to my benefit.. and put me on the 'advanced' pathway to college prep. In high-school. I was very active. I played varsity sports.. and essentially had a major afterschool activity every season. Fall sport winter sport spring sport and pass activities.. including band-camp. My mother was able to guide me to good/practical health related 'volunteer opportunities.' I did all of my homework and never missed an (entire) day of school.. since starting educate. I took experience in my school work.. and was paranoid about a negative smudge on my 9th grade "permanent record". I had a social life via sports and school activities boyfriends etc. I was somewhat of a teacher's pet.. always. Took some honors classes.. avoided AP classes because I wanted my GPA to be as high as possible. And at our school honors classes were also graded on a 5.0 scale without the evince of an AP test in the move. Took the PSAT. SAT and ACT. Applied to tons of colleges. Got into each one I followed thru on. Decided to go 'away from home' to school some 3000 miles across the country. I also had a few sports scholarship offers.. but decided I wasn't really that interested in sports and had only participated in sports to undergo a social life. In college. I had a full academic scholarship.. meaning I had to work my ass off to maintain eligibility. One C grade (in any class) would be me my scholarship. In college I did the 'nerd' thing. Vice president of the chemistry unify.. tutoring.. recognise societies. But. I also pledged a sorority.. and become increasingly popular and involved with Sorority Life. All the while doing my homework and going to class. I certainly hadn't moved 3000 miles to fuck around and flunk school.
I did investigate.. published a paper in toxicology. I volunteered. I became a Girl Scout march Leader. I honestly didn't do much in the way of healthcare related activities while in school however when I came home for pass/summer I'd do a bit of healthcare volunteering.
I was invited to bear on to a local medical school early and was accepted. This was awesome and meant that I would save a tremendous be of money by subsequently only applying to medical schools I'd like to attend. The deciding factor was location.. and ultimately I didn't take the early acceptance and came approve home to be school close to my family.
Despite having taken the required classes and even having a chemistry degree with a biology minor.. the classes were very.. detail oriented. Everything that's taught in undergraduate science is covered in the first 3 lectures in medical educate.. everything!! On day 4 everyone is on compete ground. I actually don't think the undergraduate classes helped at all.. because in medical school they teach you everything they want you to experience.
My medical educate was a very laid back school. Of course there were the gunners but overall everyone helped everyone else (beware - this varies widely from school to school). It was important to do well on all tests - especially the first 2 years. And the testing plan was mid-term and final twice a year. Not many opportunities for quizzes or extra-credit.
- If you didn't pass an exam (despite the curve) you had retake the course during the summer.. and retake that exam thereafter. If you didn't pass the course in the summer didn't take the cover in the summer or didn't pass the exam you failed previously after completion of the cover...
There are about 9 classes in year-1. Gross Anatomy (plus lab) physiology microbiology/histology (plus lab) pharmacology introduction to clinical care for preventative medicine (statistics - which was hard as hell) biochemistry (which was so difficult change surface our PhD *biochemsit* had difficulty) nutrition primary care/family care for (their lame attempt to try and persuade us to believe a career of horrible lifestyle and inadequate compensation).... In year 2 and the end of year 1 the subjects were organized into organ systems. First year more normal stuff.. and second year learning how/why things go wrong. So you see it's quite easy to fail an exam...
Before you can do your clinical rotations in 3rd year you have to take and pass the USMLE Step 1. You get one chance before you fall behind. If you fail a rotation in 3rd year you have to tell that rotation. And if you fail the exam at the conclusion of the rotation you have to retake the exam.. possibly repeat the rotation. (The 3rd-4th years of medical school are much easier than the first 2).
In 4th year you take USMLE Step 2. Some schools require you pass this exam before they grant a degree. Ours did not require passage only that you sit for it. During years 3-4 you're doing rotations that interest you and trying to pin down great letters of recommendation. You're trying to meet people in your handle of interest by going to mixers and department meetings/gatherings. You're trying to honor the rotation (by doing everything asked of you being very humble and taking the do by). Perhaps if the specialty is competitive you're also participating in relevant research that ordain lead to publications with prominent cater. You may be working to qualify for consideration for an invitation into AOA (Alpha Omega Alpha) the medial honor society that's recognized nationally. The evaluation comments written by your professors/attendings is content for the Dean's earn (the letter that the medical school will send to the residency programs when you apply.. kinda like a final report card).
There's the very cumbersome process of residency application via ERAS. Very expensive interview travel. My specialty choice largely depended on what was locally available as I had no desire to move out of my house much less to another city or state. In SoCal everything is available. I matched locally.. didn't have to move.. and started internship.
-this causes programs here to lose a handful of residents depending on the competitiveness of the specialty. Unfortunately primary care spots have a high proportion of FMGs and consist of more 'borderline' students who may not evaluate well.. hence their inability to secure a more competitive residency. So many of the FM peds. IM and psych residencies lose residents as they fail Step 3.
In addition to the desire hours and scut work.. there are monthly 'progress' exams in preparation for the inservice exam. The inservice is a board-like exam.. and some programs will use this exam to cause whether to allow you to graduate from the program. Also the residency programs have to give you *permission* to sit for your boards after you've completed the program. If you do poorly on the inservice they may not allow you to sit for the board exam. While a resident you may decide to work hard for chief resident consideration. This will give you a tremendous edge on fellowship applications or on specialty job applications.
Many specialties only offer the exam once a year and may consist of 2 or more parts. Written oral practical etc. So certification may take 2-3 years. And some board exams have an exceptionally low pass evaluate.. so multiple attempts are expected. (All the EM jobs alter very little distinction between board eligible and board certified in their hiring practices or priveleges granted.. however some places will pay more once you become certified.)
For Emergency Medicine there is an ABEM written exam in November. If you go it you then apply for a spot to act the Oral component. You are randomly assigned to move or Fall. - a diplomat of the American Board of Emergency Medicine. After becoming board certified and meeting other 'experience criteria' you are allowed to add and/or after your "MD" to indicate that you are a residency trained board certified practicing competent. ER doc...(which we all know may or may not be true).
Great summary. Congratulations. Don't forgot every couple of years after your national boards you need at least 50 or so hours of education which cost money and every 10 years you must recertify your board exams with a very expensive evaluate just so insurance companies can pay you pennies on the dollar of your going fee and patients can complain that you won't see them without their copay (I know that doesn't REALLY apply in ED medicine). Being a doctor is an art not a book. To the commentor of becoming a PA or NP. I refer you to my comments on my blog. I Am an Artist.
No you don't stay motivated and encouraged the entire time. At first you're on 'auto-pilot'.. going to school and just doing your work. Your parents are expecting you to go to college and you're expecting that of yourself. No be what you end up doing college is your first step. Then in college it's very easy to get caught up in the "I'm a pre-med" thing. Everyone is gunning for a medical school sight.. and this 'group therapy' is your motivation. In medical school.. you're so psyched to be there. That adrenaline just carries you…... for about 3 months. Then... then..... you start to conclude a bit frustrated and tired. You start to feel the force of ‘missing out’ on your life. Your ‘friends’ stop inviting you places. Your significant other…doesn’t understand. You desire Thanksgiving dinner. You feel alone at times…and the days of your life are ‘passing you by’. Studying is hazardous to your personal life…and you feel the *full force* of that as a medical student. Then you find better study techniques and combine more 'personal time' into your life away from school (even if that means just watching a TV show instead of studying one hour a week!!). Things get better as you make friends chew over *smarter* pass some exams and balance your time better. This all make it more doable. And you tell yourself. "Let me just graduate medical school.. and then I'll reconsider. I don't undergo to do care for with my MD.. but I need to just finish this degree.” You think to yourself. “I'll inform kindergarten.. or work at Starbucks with my MD!!" So many days I'd peer into the windows of Starbucks.. actually *jealous* of the baristas because they got to go home at night.. and didn't have to stay cooped up in the library for 12+ hours a day. Everyone on the street seemed to have this awesome life consisting of ample free time and cool jobs that allowed them to see (at least see) the sunshine…. But by the time you realize how fucked up medicine can be.. and question your choice (whether or not your free is/would be worth it).. you're completely trapped. You're a junior/senior medical student and you already owe tons of money to various banks/schools.. and you don't think you'll ever pay it all approve doing anything but medicine. So you (sometimes reluctantly) keep stepping. Internship resurge of energy occurs.. for about a week!! As a resident things get better. And before you can really get depressed (again) about how stupid you were to choose medicine.. you only have "1 more year." You just can't quit now. And so it goes..... there are certainly times I regretted.. not so much choosing medicine.. but rather *not* choosing something else. But then I complain to the wrong (or rather 'right') people/person.. and they "inform me" that I actually have a cool job. They’ll tell me how most people hate their jobs more than I ever could. They’ll tell me that 9a-5p *sucks*!! They remind me of the (many) great things about being a doctor…and how (despite my tales of woe) I don’t really have it that bad!! Besides what else would I have done instead? And I am happy once again!!
if you don't specialize.. and opt to be what we call a command practitioner theoretically you can fasten a shingle or work as a generalist. But practically since almost everyone does an entire residency you're competing with come in eligible/certifed docs.. and will likely find yourself struggling to sight a job. Not to mention the liability issues of not *really* knowing anything about anything.... But simply one year of internship is required to acquire a California license and with this you can do medicine. To specialize you have to complete a residency. This usually includes the intern year.. and is 3+ years (intern year included). Hope that clarifies a bit....
Although medical school debt is a motivation to continue in medicine it needs to be kept in perspective. A small business owner has a similar debt without expectation of a guaranteed 6 evaluate salary the first year out. Although doctors work long hours so do most small business owners. The working poor often work longer and harder without a near-certain future of good earnings. I know; I've been all three. Doctors don't undergo it so bad.
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Related article:
http://emphysician.blogspot.com/2007/11/processhow-long-does-it-take.html
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