How To Become a Doctor (Without Even Trying)

First, the hierarchy, from bottom to top:

Pre-Med (Undergraduate Student)
Medical Student
Sub-intern (4th year medical student on certain rotations)
Intern (the 1st year of Residency)
Resident
Fellow
Attending

Most kids get their undergraduate degree (approximately 4 years long) and then apply to medical school. Medical school admission is dependent upon your GPA, MCAT scores, letters of recommendation, research, etc.

Medical school is 4 years long. The first 2 years are mostly book work and the last 2 years are clinical.

As a caveat, some kids choose an alternative path, which is available at some medical schools. This is an integrated program in which you complete your undergraduate degree and M.D. at the same time. You are accepted directly out of high school and then go year-round, for a total of 6 years (hint, hint) instead of 8. These people are deranged and should not be trusted.

In medical school you learn a lot about the basics of disease and health and you get a broad introduction to all of the medical specialties. You have a lot of supervision and very little true responsibility. For the most part, the emphasis education.

In your 3rd year of medical school, you complete 1-2 months of each of the major medical specialties (internal medicine, general surgery, pediatrics, OB/GYN, etc.).

In your 4th and final year of medical school, you must begin to decide which of the general medical specialties interests you most. You can then choose electives to further pursue this interest. For example, if you enjoyed delivering babies on your OB rotation, you might also want to take an elective in High Risk Obstetrics to further your knowledge of that specialty.

As a side note, I think one thing that many people do not understand is that some medical sub-specialties are branches of a larger, general specialty (Example: Endocrinology is a sub-specialty of Internal Medicine). Furthermore, there is often only one pathway to get there. Take for example, Pediatric Radiology. Let’s say you took this elective in medical school and fell in love. To become a Pediatric Radiologist, you must complete a Radiology residency first, then further sub-specialize in Pediatric Radiology. It is not possible, however, to do it the other way around. For example, you cannot do a Pediatric residency then do a fellowship in Pediatric Radiology. This makes choosing a medical specialty a little bit more complicated.

Most kids decide on their chosen medical specialty around by the fall of their 4th year. Then it is time to apply to residency programs.

You see, just graduating medical school does not a doctor make. You just have an M.D., now you have to learn how to use it.

These days, almost every single medical school graduate enters a residency program. Residency is further education in your chosen specialty, but this time the emphasis is on patient care. You are the primary doctor responsible for your patients. You still have supervision by more senior residents as well as attending physicians. And most importantly, you get paid :) The average starting salary for a resident is $44,000/year. It usually increases about $1,000 per year. Residency ranges from 3 years (for primary care specialties such as Pediatrics and Internal Medicine) to up to 7 years for more specialized residencies such as Neurosurgery.

To make matters more complicated, in certain specialties, the intern year (1st year out of medical school) is seen as a separate entity. For example, in Anesthesiology, you much complete one year of internship before beginning your Anesthesia residency. This year of internship is often in Internal Medicine, but could also be in Pediatrics or General Surgery or even what is called a “Transitional Year” where you do a little bit of everything. Some residency programs only offer advanced positions and ask you to find your own intern year, while others offer categorical positions, in which, for example, the Anesthesia department pays your salary while you complete an Internal Medicine internship at the same hospital. Thus, if you are matching for Anesthesia or other advanced residencies such as Physical Medicine and Rehabilitation, Radiology, Ophthalmology, etc, you must apply for both an internship (“preliminary year”) and the advanced spot in your chosen specialty.

Have I lost you yet….?

Once you figure out the game, then you apply to residency programs, interview and submit a rank list of your preference as to where you will end up. The programs you interview at will also rank their applicants. This year, our rank list is due February 27th. We submit our lists electronically to the NRMP. Then, through the magic of an algorithm with a sprinkle of binary code, a computer program matches the applicants rank list to the rank list submitted by each residency program. If an applicant ranks a residency program as #1 and that program has placed that applicant on their rank list, that applicant will match to that program. If, however, that program had not ranked said applicant, the computer program will move to the applicant's second choice and see if the second program ranked the applicant. This standardized procedure is a fairly new development and allow for fairness in the Match process, replacing the 'good 'ole boys club' of days gone by.

On March 20th, at 1pm Eastern time, medical students from all over the country will open their envelopes and see which program they have matched to.

Graduation occurs in May.

The first day of residency is July 1st.

If you can avoid it, try to stay out of the hospital during the first week of July.

Questions?