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Find
more about individual specialties by visiting these
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What
does it take to become a Doctor?
Becoming
a Medical Doctor requires many years of preparation. A Medical
Doctor is often called a "Doctor".There are other
professions that award doctorate degrees including Dentistry
and various Ph.D. graduate programs. The terms MD and physician
specifically refer to a Medical Doctor.
In the
United States a physician (MD) will need the equivalent of
a four year college degree to get accepted into medical school.
Entry into medical school is quite competitive. The successful
applicant will require excellent grades, solid scores on medical
school entrance exams (MCAT test), recommendations from college
professors or other professionals giving testimony to the
likelihood that the applicant will make a good physician.
Medical
school training generally lasts four years. Canadian programs
are three years. The first two years of medical school
focus mainly on the basic sciences. The third and fourth years
focus much more on clinical medicine (seeing patients in a
supervised setting).
Upon graduating
from medical school the student receives a Doctorate of Medicine
Degree. He/she is now an MD.
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Does
a Doctor need more training after Medical School?
The answer
is usually yes. Medical school has laid a foundation
of both basic science and clinical knowledge for the new Doctor.
However, this alone is not adequate for the new graduate to
"Hang out his/her Shingle" and go into private practice.
A license to practice medicine must first be obtained. Although
Medical Licensure is granted by individual states most of
the requirements are similar. Almost all states require at
least one year of additional training in an accredited training
program and passage of a Nationwide medical exam (Medical
Boards) prior to granting a physician a license to practice
medicine.
Although
completion of one year of postgraduate training and passage
of the Medical Boards enable a physician to practice medicine
without supervision this amount of minimal postgraduate training
(an Internship year) is generally not enough given the explosion
of medical information and expectations placed on practitioners
of medicine today. Almost all Medical School graduates will
pursue further training in a medical residency program.
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What
is a Residency?
A residency
is a specialty training program three to seven years long
that is completed after medical school. These programs offer
supervised and specific training for the resident in their
chosen specialty. Specialties include Family Practice, Internal
Medicine, Pediatrics, Emergency Medicine, Obstetrics/Gynecology,
and Surgery to name a few. There are currently 24 specialty
boards recognized by the American Board of Medical Specialties
(ABMS). Most of these boards have residency pathways. Each
specialty board decides the extent/scope of training and requirements
for its own specialty.
Upon completing
a residency and passing special exams the physician may now
practice as a recognized specialist in his/her chosen field.
For most medical specialties completion of a residency is
currently the only way to be recognized as a member of a particular
specialty board. In the past physicians who had not completed
a Residency program were eligible to take specialty boards
based on many years of practice experience. This was done
as newer specialties, such as Family Practice and Emergency
Medicine, were established after many physicians had completed
their internship year. Such "grandfathering" into
a medical specialty is no longer available to physicians based
on years of practice alone.
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What
is a Subspecialty?
Some specialties
offer additional training after a Doctor completes his/ her
Residency. These post residency training programs are called
fellowships. Fellowships focus more narrowly on a specific
area of medicine within a specialty area. For example, Gastroenterology
(focus on digestive system) and Cardiology (focus on the heart
and blood vessels) are subspecialties within internal medicine.
Becoming a subspecialist can take from 1 to 4 additional years
of training after residency is completed. It is required to
both complete the selected fellowship and pass subspecialty
board. A subspecialist has a great deal of knowledge in his/her
chosen area of practice. Likewise, general medical knowledge
may diminish in areas not related to a sub-specialists area
of practice.
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Does
a Doctor need to do a residency to be Board Certified in a Specialty?
The
answer is no. Many currently practicing physicians "Grandfathered"
into their medical specialty. That is they did not complete
a residency but were permitted to take certification exams
by their respective medical boards. Reasons for permitting
this were that many Doctors in practice had already completed
their medical training when the specialty was introduced.
This was true for Family Practice in 1968 and Emergency
Medicine in 1978. These specialties gave practicing physicians
approximately 10 years after these dates to take their respective
examinations.
Currently
almost all specialties (those belonging to the ABMS) require
residency training in their own specialty to become board
certified. Although
boards recognized by the ABMS are considered to be the board
for a given specialty some specialties have more than one
certification board. There are various reasons for alternate
boards:
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Some
boards have been in existence for a long time (Osteopathic
organizations) and maintained their own identity.
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Boards
were formed in some specialties by groups of physicians
practicing in a specialty who were not able to take Board
Certification exams in that specialty because they either
did not complete a residency in the specialty they wished
to certify in or they did not "grandfather"
in the specialty while that option was available.
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Examples of the first group include physicians who
have completed a Residency in one specialty but are
now practicing (or have practiced for many years)
in a different specialty. Those most effected are
physicians trained in Family Practice (FP), Internal
Medicine (IM), and Emergency Medicine (EM). Although
not identical, these specialties have many similarities
in the type and scope of training a resident receives.
The most common situation is that physicians trained
in FP and IM are practicing EM. Approximately 40-50%
of currently practicing EM physicians have either
an FP or IM training background. To a lesser extent
EM trained physicians are practicing Primary Care,
an area traditionally handled by FP and IM trained
physicians.
There
are several reasons a physician may want to be recognized
as "Board Certified":
-
Certificate
acknowledges that a physician is recognized by his peers
as a specialist in his chosen field. Many physicians take
pride in this accomplishment.
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There
is a perception by the general public that being board certified
means the physician is competent.
-
An
extremely important reason in recent years is that physicians
may need to be board certified in order to practice (make
a living) in their chosen specialty. Many medical/physician
groups, hospitals, and insurance companies have arbitrarily
used board certification as the main criteria to decide
issues such whether or not a physician can work at a given
facility and how he/she will be reimbursed.
What
does Board Certification mean?
Being
"Board Certified" means that the physician has met
the requirements of the specialty board he is certified in.
For the specialties belonging to the ABMS this means having
completed a residency in a specific specialty (Family Practice
for example) then passing an examination. Depending on the
specialty this examination may either be a written test or
a combination of a written and oral test. Each specialty decides
what its criteria for passing will be.
The test
is an attempt to determine whether or not the physician has
the prerequisite knowledge base for that specialty. The oral
test (in some specialties) is a further attempt to evaluate
physician judgment/ decision making abilities. A physician
who completes a residency will not be recognized as board
certified unless he/ she passes the board examination.
Alternate
Boards of Certification include those offered by the American
Association of Physician Specialists (AAPS) in a variety of
specialties. Criteria used by this organization include having
a certain number of years of practice experience after having
completed a residency program in a similar but not identical
medical specialty that the physician seeks board certification
in. Board examinations are very similar to those used by ABMS
recognized boards.
Board
Certification, regardless of the certifying board, does not
guarantee that the physician practices caring and safe medicine.
Likewise, lack of Board Certification does not mean a physician
is not competent or caring. Certification should not be the
only criteria to use when selecting a doctor.
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Doctors
Corner INternet Group, Inc. 1997-2004
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