Becoming a physician is a long and confusing process! I have answered a lot of questions about the process since starting medical school, so I thought some readers may have questions too. I hope this is helpful for those interested in becoming a physician or just curious about the how it all works.
There are many steps to becoming a licensed, practicing physician and it’s unlike any other profession. From premedical coursework, to all of the classes and clerkships in medical school, to more on-the-job training after you’re already a physician, to continuing education credits… the learning really never ends!
Note: There is a lot of variation between different medical schools and different residency programs, so I will do my best to explain the basics and most common steps. I didn’t include every detail, but please let me know in the comments or via email if there is a glaring error or omission! This information applies for U.S. medical schools only.
How Medical School Works
There is no specific college major required for applying to medical school, however there are required courses to take. These vary across schools, but the minimum is usually one year of biology, one year of chemistry, one year of physics, one year of organic chemistry and one year of English. Some schools require extras such as biochemistry and behavioral sciences, especially now that the MCAT has changed. It varies for each school, so check it out (usually on the school’s website or using the AAMC website) to make sure! You can also learn what types of courses are accepted, such as AP classes, online classes, etc.
Other suggestions for pre-medical students includes volunteering, shadowing physicians, research. Many medical school applicants have great skills and talents outside the field of medicine. These are usually looked upon highly and add to the well-roundedness of the applicant.
There are rare exceptions that don’t require applicants to take the MCAT (Medical College Admissions Test), but nearly everyone that applies to medical school will take the MCAT. The MCAT was updated in 2015 and now includes four sections: biology and biochemical foundations of living systems, chemical and physical foundations of biological systems, psychological, social and biological foundations of behavior, and critical analysis and reasoning skills.
The MCAT Is offered 25+ times a year at various Prometric testing centers across the country. It is 7.5 hours long (HOLY MOLY! It as only 4 when I took it!) It is entirely multiple choice. MCAT scores play a very important role in the admissions process.
3. APPLICATION AND INTERVIEWS
You apply to medical school using AMCAS (American Medical College Application Service) and is entirely done online with one initial application submission, with the exception of Texas public schools that use a program called TMDSAS. AMCAS also allows you to submit recommendation letters, send your test scores, and to get your background check through them. The average number of schools applied to is 14.
Your AMCAS application can be started in in May and submitted in early June for admission to start the following year. Once your initial applications are received, the secondary round begins. Most schools send secondary applications to all applicants automatically, though some schools do an evaluation and select only certain students for secondaries. Secondaries vary school to school, but often require more essays or short answer questions and some additional forms to fill out.
After secondaries, a smaller group of applicants will be selected for interviews. Interviews generally happen from September through March. Applicants will travel to the school and have a presentation from the admissions team, a tour of the campus, lunch, and a few interviews. The type of interviews vary from very casual and conversational to more intense or a multiple-mini-interviews that involves problem solving or mock-situations.
Most medical schools have rolling admission, so you could find out their decision just a few weeks after your interview. This is why applying early is advised. However, students are still accepted through the spring, so don’t rule yourself out if you don’t interview in the fall!
4. MEDICAL SCHOOL
Going to medical school means you are attending either an M.D. (allopathic) or a D.O, (osteopathic) school. Both degrees make you a physician, but there are slight differences in curriculum, licensing exams, and sometimes residencies. This will focus on the allopathic M.D. curriculum as it is what I am currently enrolled in and most familiar with.
Medical school is four years long, though some schools are testing out new three year programs for people going into primary care only. Curriculum schematics vary depending on the medical school, as some have incorporated clinical work into the first two years and some have totally flipped classrooms with entirely problem based learning. But generally:
Years 1 and 2: Classroom work. This includes basics like anatomy and physiology, microbiology, histology, immunology, pharmacology and pathology, as well as all organ systems (renal, neurology, gastroenterology, cardiology, respiratory, endocrinology, skin/bone/joint.) These years also often include some bedside diagnosis work, clinical skills, electives and other add-ons unique to each school.
Year 3: Clerkships. Students rotate through different specialties, spending 4-8 weeks generally on each. Again, things can vary school to school, but most require the fundamental specialties of family medicine, pediatrics, internal medicine, OB/GYN, surgery, and neurology/psychiatry. There are elective weeks throughout and at some point in third or fourth year there are usually required emergency medicine, radiology and intensive care experiences. Most medical schools conclude each third year rotation with a “shelf exam” from the NBME on the information important to that specialty. These rotations are key for not only learning, but determining which specialty you are interested in and forming important relationships with physicians on those services.
Year 4: More rotations, but this time most are elective based on your interest. There are required “sub-Is” or “sub-internships” where you have the role of an intern (first year resident.) These are usually pursued in the student’s chosen field of interest. Some of these rotations can be done at hospitals other than at your home medical school, particularly at hospitals where you may want to do your residency so that you can form relationships with the team there.
Residency applications open in September of the 4th year and use a system called ERAS (Electronic Residency Application System.) The residency application includes essays, recommendations from physicians and deans, test scores and more. Interviews happen through fall and winter, depending on the specialty. Since residency applications don’t happen until fourth year, medical students have three + years of medical school to decide “what kind of doctor” they’re going to be! Sometimes people know earlier, or at least have in idea, but these ideas are often not confirmed until rotations during third year.
5. USMLE (BOARDS EXAMS):
USMLE stands for United States Medical Licensing Examination and is a three-step process in becoming a licensed physician.
Step One: A one day, 8 hour exam that tests science basics and principles of health, daises and treatments. It is usually taken after the second year of medical school, after all the classroom work is complete. As with everything in medical education, that is not always the case and some schools do things differently! Step One scores are hugely important for competitiveness in residency applications.
Step Two: A two part test taken at some point during 3rd or 4th year. Step Two CK is a one day exam focusing more on clinical knowledge, diagnostic skills and treatment plans, while Step Two CS is a practice clinical encounter using standardized patients. Step Two CS is only offered
Step Three: The final two-day test focuses on patient management and ensures the physician is ready for unsupervised patient care. This is taken at some point during residency, but timing varies. Most states allow 7 years from the time of step one to complete step three.
Once you have passed all three steps you can apply for your medical license!
The match system (National Resident Matching Program) is very unique and often seems outrageous to people unfamiliar with it. Matching into a residency uses an algorithm that places applicants at one of the hospitals they applied to. After interviews, applicants rank their choices, and each residency program also ranks the applicants they’ve interviewed. The algorithm is able to use these rankings and place applicants at their highest possible choice (“applicant proposing”), depending on how they were ranked by the schools at which they interviewed.
This video does a good job of explaining how it works.
Match is often an extremely stressful process since applicants don’t know where they will match, or if they will match at all. There is an option to match as a couple as well as a process for military matching. Students get an email letting them know whether or not they have matched on Monday in mid March, and on Friday there is usually a ceremony at the medical school where students find out where they matched. There is a scrambling process to find unfilled spots for those that find out they didn’t match. A match is binding — there are no negotiations!
Right now the number of medical school graduates is increasing at a faster rate than the number of residency training spots, so not matching is becoming a bigger concern for students.
Once your graduate medical school, you have an “M.D” or “D.O” and are a physician, but there is post-graduate medical education still ahead. Medical school graduates match into a 3 to 7 year residency, depending on the specialty. The education continues (greatly!) in residency, where you are working as a physician underneath the attending physicians that have already completely their residency. Residency is hard work and entails a ton of on-the-job learning. Hour restrictions were recently put in place, limiting residents to working no more than 80 hours a week, no more than 30 hours in a row, and at least 10 hours off between shifts.
Residencies are required to become board certified in a medical specialty, which is a voluntary process but very common and often a job requirement.You begin getting paid in your residency, as you are a working physician, but it is a much smaller amount than a standard physician’s salary (someone that has already completed their residency.)
After your residency you can be finished! You are now free to apply for jobs or start your own practice. There are continuing medical education credits and board re-certiciation requirements throughout a physician’s career, but we won’t go into those here.
This sub-specialty training is option and for those that decide they want to specialize even further in their residency field. For example, one could complete a residency in internal medicine where they are then able to practice as an internal medicine physician, but then decide to further specialize and do a fellowship in gastroenterology. Or an OB/GYN could decide to do a fellowship in gynecologic oncology. Getting into a fellowship is another matching process and involves more years of post-graduate medical training.
And that’s it! The long, complicated, but oh-so-fascinating and incredible experience of becoming a physician in the United States. Let me know if you have any questions!