So You Want to Be a Doctor...

This is another of the "articles" from my "Stethoscopes to the Streets" series.  It's a little long, but if you were curious what is involved in becomming an MD, it's here in detail!  Enjoy!! (PS, can I complain for a second that I start my stretch of 6 nights tonight? Ok that's enough, thanks!)

Have you ever sat in your doctor’s office and wondered how he or she got there?  I mean, what does it really involve to become an MD?  I get asked this question a lot, and as a current fourth year medical student, I feel that I have acquired enough information to answer.  For today’s Stethoscopes to the Streets article, let’s take a look at what needs to happen to get from point A (college) to point B (a board certified doctor of something).  I was a “traditional” student in that I didn’t stop between college and medical school; I took no time off.  I have classmates who took almost 10 years between undergrad and medical school, with full careers in between.  There are a lot of ways to do this, but I’ll be telling you how to go straight through.

            First of all, let me preface by saying that I NEVER try to be discouraging when I’m talking to people who want to become a doctor.  Yes, it’s a long road.  Yes, it requires more than average “smarts” to be able to handle the book load.  Yes, it will cut into a fair amount of “normal life” stuff.  But there is nothing in the world I would trade for what I almost have; an MD.  When I was in the process of applying to medical school and the road seemed long and dark, my dad asked me, “How do you eat an elephant?  One bite at a time.”  This is true of many things in life, but especially true of the journey of becoming a physician.  At times everything seems super daunting but somehow it all just happens.  Let’s look at how.

            The first thing you’ll need is an undergraduate degree.  It could be in anything, really, but there are several prerequisite classes you’ll need to take, which include a full year of biology, general chemistry, organic chemistry (the bane of my existence), and physics.  Because that’s four years of science-type classes, most people find it easiest to take a degree in some sort of science field (biology, chemistry, etc) or even declare themselves “pre-medicine”, which would require you to take those classes and possibly more.  The first two years of medical school are super duper intense, and the better preparation you have going into those years, the better.  For example, I was able to take a full year of anatomy and physiology, complete with a cadaver lab.  Also, I selected electives like genetics, biochemistry, immunology, and microbiology, all of which I was thankful for in the long run.  Although this makes for a really full schedule, I also continued on with my love of the Spanish language and got a major in that, and took pottery classes, too. 

            While you’re slaving away during undergrad, you’ll also need to take the MCAT: the Medical College Admissions Test.  Most people take it during their junior year, because applications to medical school begin early senior year, and all schools require this test.  It’s pretty daunting and consists of 5 hours of computer based, multiple-choice sections on physical science, verbal reasoning, biological science, and a writing sample.  Your score on this will make or break your application, period.  I won’t get into how it is scored or what different scores mean, but it’s pretty important to score competitively in order to be granted an interview (more on that later).  I thankfully only took it one time, and if I remember correctly, drowned my headache and sorrows in chocolate gelato at a nearby mall after I was finished.  Yes, I digress.

            Besides a ‘smokin’ GPA and MCAT score, you’ll need to show medical schools that you are serious and didn’t just wake up one day and decide to be a doctor.  This means ample volunteer work in anything healthcare-related if you could swing it.  Also, working as a nursing assistant (I did this!) or emergency medical technician (EMT) helps to show that you have experienced the healthcare field, for better or worse, and that’s really where you want to be.  Research is good too, since medicine is really nothing without all the new scientific advances and clinical trials (I didn’t do any research because I don’t care for it, but some people really get into it).  In addition, medical school admission committees love to see applicants who stand out in any area.  If you are a college football player, professional musician, gymnast, or ballet dancer, the programs will likely look on your commitment and dedication as a very unique quality.  Sometimes, people who so obviously dedicated much of their time to their activity are admitted to medical school, even if their GPA or MCAT score isn’t as high as other applicants. 

            So let’s pretend you have a good GPA (around 3.8, give or take) and did well on the MCAT, and it’s the summer before your senior year of college.  Let’s apply to medical school!  The application process is a lengthy one.  First, there is the preliminary application, which is a standardized computer application that goes out to all the medical schools you choose.  How many you choose depends on where you are willing to go and how competitive you are.  For example, my husband  (boyfriend at the time) wanted to go to optometry school, so we both applied to all the cities where we could go together.  We both got into schools in the Chicago area (pretty much the biggest stroke of luck in our lives) and voila!  We got married and are becoming doctors. 

            After the preliminary applications, schools will usually make cutoffs based on GPA and MCAT scores alone (the numbers game).  After that, they send out secondary applications, which usually involve a few essays and other information.  If they like all of this about you, they will invite you to interview.  Interview season is usually from September to February (ish?), and this is when you go get yourself a suit, and to prepare, talk as many people as you can who know how to conduct interviews (business people or PR people are best…go find some of those).  My father and father-in-law are successful businessmen who know a lot about hiring people and interviewing.  We did mock interviews, and I basically had them give me their worst, and they gave me tips.  After interviews are over, medical schools will either accept, waitlist, or decline you.  I was accepted to two schools (Milwaukee and the Chicago Medical School) and obviously chose to be in Chicago to be near my husband. 

            Before we continue, what percentage of people who apply to medical school get accepted?  This is usually where people freak out…the numbers aren’t great.  Obviously the more competitive you are (GPA, MCAT, extracurriculars), your odds increase, but to get to brass tacks, there’s about a 3% acceptance rate average to US MD programs.  Yikes.  However, it’s important to realize that there are 130 medical schools in the US, and the average applicant applies to about 25 schools.  Schools usually offer more acceptances than they end up matriculating because applicants may get accepted to more than one program, and obviously they can only go to one medical school.  In other words, don’t be discouraged.  If your GPA and MCAT scores are fairly decent, it’s definitely worth a shot to apply! 

            Another side note; the cost.  College is becoming expensive.  Application to medical school is expensive.  And medical school itself?  Well…it’s super expensive.  Obviously you’ll have no income during this time (you’re paying to go to school, and there is NO time for a side job.  Trust me).  I don’t believe in evasiveness so I’ll tell you exactly what expensive means.  The tuition for my school is around $47,000 per year.  Some schools (state schools where you are a resident, for example) are cheaper, but many medical schools are private and will have price tags like this one.  It’s something to keep in mind, but not something to deter you.  Physicians on the whole make great money.  The loans might take a while to pay off, but it will be OK. 

            After all of that, you manage to get in!  Great for you!  Now buckle up.  On my first day of medical school orientation, one of the professors said to us, “High school material comes at you like a bubbler.  Totally manageable to drink from.  College is more like a high pressure garden hose.  Med school?  Well, we have a hose attached to a fire hydrant, and it won’t stop until the day you graduate.”  I’ve never heard anything more true in my entire life.  What makes medical school so much different than all the other education you went through?  Volume, sheer volume.  In the first two years, basically all we do is “book stuff.”  In order to be able to work with real patients and help them, a medical student needs to know so much.  The first year’s classes in anatomy, physiology, biochemistry, and genetics (just to name a few) are all backbones for second year’s line up of pathophysiology, pharmacology, immunology, microbiology, etc.  Another challenging aspect of second year is the daunting task of preparing for Step 1 of the USMLE (US Medical Licencing Examination), our big “boards.”  It’s more than a matter of pass/fail; your score on Step 1 will largely dictate what specialty you can apply to as a resident.  Oh yes, there is a hierarchy of the medical specialties, and we’ll get into that.  For example, orthopedic surgery is one of the most competitive specialties.  Family practice (though extremely, extremely important) is not.  So, someone with an average USMLE Step 1 score will be much less likely to match into orthopedic surgery, but would have a great shot at family practice.

            If you survived the first two years and Step 1, you are more than ready for third year, or as I like to call it, the “petting zoo.”  As a third year, you rotate through all the core specialties, essentially assimilating yourself to a field and all it’s people for six to eight weeks, then you head on to the next rotation.  The core rotations at my school are: psychiatry, OB/GYN, pediatrics, family practice, emergency medicine, neurology, surgery, and internal medicine.  Why is it a petting zoo, you ask?  On the wards you find all the things you’ve learned about in one spot:  the gory, the gushy, the rare, the interesting, the classic, the mundane.  It’s one thing to read about a baby giraffe, and it’s quite another to pet it and feed it a couple of crackers.  That’s what I felt about third year.  For example, I had the opportunity to personally deliver a baby, intubate (place an airway tube in the trachea), help evaluate psychotic people, perform CPR on a dying person, draw blood, start IV’s, and see hundreds of patients.  Oh and by the way, you have just this year to figure out what you want to do with the rest of your life.  Sure, you’re going to be a doctor, but now is the time to commit to exactly what kind of doctor, because more applications are coming up!

            Fourth year of medical school: I don’t have a whole lot to say on this topic considering that I’ve just started it, but it seems like it will be a blast, and considerably less tiring than third year.  We get to choose our electives, and most people do as many electives in their chosen field as possible.  In addition, students take Step 2 of that USMLE exam (the score on this one becomes “less important” than before-but you must pass it!) as well as apply for residency.  What is residency, exactly?

            So when you graduate from medical school (after your fourth year), you will be an MD, a medical doctor.  However, you will not be certified or licensed to treat anyone with anything.  You need to complete a residency, which is 3-7 years of additional training in a field of your choice.  Just for a few examples: three-year residencies include pediatrics, family practice, internal medicine, and psychiatry.  OB/GYN is a four-year residency.  Most of the surgeons do a five-year residency (general, orthopedic, urology, etc).  The seven-year residencies are reserved for the neurosurgeons, and they are crazy.  Residency is a paid position (thank goodness), but like the name implies, you will be a “resident” of the hospital.  Work rules have changed considerably, but residents work long hours.  They go through rotations in their chosen field, but this time they are responsible for patient care, writing orders, and making big “doctorly” decisions.  First-year residents feel like they are thrown in the deep end (but really they have a life jacket and several arm flotation devices, if you will, like senior residents and attending physicians who keep them out of trouble).  As a resident goes up the ranks, there is more and more responsibility.  At the other end, you’ll come out a real doctor.

            You could stop at this point and be a general pediatrician, for example.  This is what I plan to do and I’m very happy with that prospect.  But some residents go on to apply for fellowship positions.  A fellowship is an ADDITIONAL 1-3 years of training to make you super specialized.  For example, in pediatrics, there are many three year fellowships in neonatology, gastroenterology, endocrinology, intensive care, and pulmonology, just to name a few.  Just when you thought it was over…

            So there you have it; college through fellowship, a high velocity run-down on what it takes to become a doctor.  Sounds impressive and daunting but remember, this all happens over the course of a decade or so.  It takes time, and that’s OK.  Real life happens around this seemingly chaotic mess.  I’ve managed to maintain a marriage, adopt a dog, make friends, stay in shape, bake, cook dinner most nights, and write articles like this.  If you or anyone you know are considering becoming a physician, I can honestly tell you without a doubt in my mind that I would do it all over again.  After all, I’ll have the coolest job in the world.