Going from premedical student to attending physician is a process that requires more than a decade of test-taking and clinical training. To become a physician, you will overcome many hurdles. Here is an overview of each of the phases of the education and training you need to complete to become a practicing physician.
Premedical school years
The first step to becoming a doctor is to attend college to complete the prerequisite coursework required for entry to medical school and to attain your bachelor’s degree. Medical schools require a series of core science courses that provide the foundation in biology, chemistry, physics, and other disciplines that allow you to dive into a full load of more-advanced science courses in medical school.
During your premedical years, you’ll also explore medicine through physician shadowing and clinical volunteering, as well as participating in activities in areas such as community service, research, and leadership. The premedical years call on your time management and organization skills to juggle everything you need to accomplish. Then, if all goes well, you move on to the next step: medical school.
Medical school: preclinical years
The first two years of medical school, known as the preclinical years, are similar to college in many ways: Learning takes place mostly in the classroom and teaching labs, and you have plenty of studying and test-taking to do. However, unlike in college, your education is much more focused on subjects such as anatomy, physiology, biochemistry, genetics, neuroscience, and pharmacology.
At most schools now, students get at least some patient contact in the first two years. This trend toward early clinical exposure is a welcome development for med students eager to get some hands-on experience with patients.
Medical school: clinical years
The third and fourth years of medical school, traditionally referred to as the clinical years, are when you find yourself truly feeling like a doctor-in-training. During this time, you complete a series of clinical rotations (also known as clerkships) at hospitals and outpatient facilities in all the major specialties of medicine, including surgery, pediatrics, internal medicine, psychiatry, family medicine, and obstetrics and gynecology.
You also have the chance to supplement your required third-year rotations with fourth-year electives to explore additional specialties or more deeply investigate disciplines you’re considering pursuing for your career.
As a member of the medical team on the wards and clinics, you follow your own patients under the supervision of the resident and attending physicians. You also participate in rounds (where you see patients and discuss the diagnosis and treatment plan with the team), take overnight call, and help with admitting and discharging patients.
By the end of medical school, you’ve acquired the tools you need to head into the next phase of your training as a first-year resident.
Medical school: residency
Although you earn the title of doctor upon graduation from medical school, residency is where you learn the nitty-gritty of patient care. After med school graduation, newly-minted doctors have a brief break before beginning their respective residency programs in July.
The first year of residency, commonly called internship, is a time of very intense learning. Although interns are supervised by more-senior residents as well as attending physicians, the level of responsibility is much greater for an intern than for a medical student.
Despite recent reforms in resident duty hours, the schedule is still grueling. Work weeks are 80 hours per week averaged over four weeks for most specialties, with first-year residents now limited to “only” 16 hours per day on duty. From the second year of residency on, you may be taking overnight call every third or fourth night, spending more than 24 hours straight in the hospital.
With each year of residency, you gain more autonomy; as a senior resident, you have a significant amount of responsibility for the patients on your unit and help to supervise junior residents and medical students. This system of increasing responsibility prepares you for the day when your training is complete and you’re ready to practice on your own.
For both residency and fellowship, you receive a stipend that starts around $50,000 for a first-year resident, with modest increases for each year of training — much less than an attending salary but still enough to be considered a real paycheck.
Opt to continue on to a fellowship
Following residency, some physicians opt to continue on to a fellowship in order to enter a field that requires more highly specialized training. For example, if you plan to become a cardiologist, you first do a three-year residency in internal medicine or pediatrics and then go on to subspecialize in cardiology by completing a three-year fellowship, for a total of six years of post-graduate training.
Similar to residency, as a fellow you spend your time in hospitals and outpatient settings, learning your craft through hands-on experiences. However, your training is even more focused on a particular branch of medicine.
Some fellowships, and even some residencies, have a research component to them and are an especially good fit for those who aspire to a career in academia.
Become an attending physician
Eventually, you reach the last day of your training and are ready to go out and practice your specialty as an attending physician. Physicians work in a variety of clinical environments — diagnosing and treating patients, performing surgery, managing chronic conditions, and providing preventive care — as well as in nonclinical roles in research, teaching, and administration.
Formal training is behind you, but you’re always learning, even as an attending. In a field advancing as rapidly as medicine, to stop learning means you risk falling behind and becoming unable to provide the highest quality care to patients. Practicing physicians keep up with changes in their fields by reading medical journals, attending conferences, and taking continuing medical education (CME) courses to meet requirements for licensure renewal.
