Other Health Professions / Medicine

Medicine

D.O.s are more likely to be primary care providers than M.D.s, although they can be found in all specialties. Over half of D.O.s practice general or family medicine, general internal medicine, or general pediatrics. Common specialties for D.O.s include emergency medicine, anesthesiology, obstetrics and gynecology, psychiatry, and surgery

Working Conditions

Many physicians work long, irregular hours. More than one-third of all full-time physicians worked 60 hours or more a week in 1998. They must travel frequently between office and hospital to care for their patients. Increasingly, physicians practice in groups or health care organizations that provide back-up coverage and allow for more time off. These physicians often work as part of a team coordinating care for a population of patients; they are less independent than solo practitioners of the past. Physicians who are on-call deal with many patients’ concerns over the phone, and may make emergency visits to hospitals or nursing homes.

Employment

Physicians (M.D.s and D.O.s) held about 577,000 jobs in 1998. About 7 out of 10 were in office-based practice, including clinics and Health Maintenance Organizations (HMOs); about 2 out of 10 were employed by hospitals. Others practiced in the Federal Government, most in Department of Veterans Affairs hospitals and clinics or in the Public Health Service of the Department of Health and Human Services.

A growing number of physicians are partners or salaried employees of group practices. Organized as clinics or as groups of physicians, medical groups can afford expensive medical equipment and realize other business advantages. Also, hospitals are integrating physician practices into health care networks that provide a continuum of care both inside and outside the hospital setting.

The New England and Middle Atlantic States have the highest ratio of physicians to population; the South Central States, the lowest. D.O.s are more likely than M.D.s to practice in small cities and towns and in rural areas. M.D.s tend to locate in urban areas, close to hospital and educational centers.

Training, Other Qualifications, and Advancement

It takes many years of education and training to become a physician: 4 years of undergraduate school, 4 years of medical school, and 3 to 8 years of internship and residency, depending on the specialty selected. A few medical schools offer a combined undergraduate and medical school program that lasts 6 years instead of the customary 8 years.

Premedical students must complete undergraduate work in physics, biology, mathematics, English, and inorganic and organic chemistry. Students also take courses in the humanities and the social sciences. Some students also volunteer at local hospitals or clinics to gain practical experience in the health professions.

The minimum educational requirement for entry to a medical or osteopathic school is 3 years of college; most applicants, however, have at least a bachelor’s degree, and many have advanced degrees. There are 144 medical schools in the United States—125 teach allopathic medicine and award a Doctor of Medicine (M.D.) degree; 19 teach osteopathic medicine and award the Doctor of Osteopathic Medicine (D.O.) degree. Acceptance to medical school is very competitive. Applicants must submit transcripts, scores from the Medical College Admission Test, and letters of recommendation. Schools also consider character, personality, leadership qualities, and participation in extracurricular activities. Most schools require an interview with members of the admissions committee.

Students spend most of the first 2 years of medical school in laboratories and classrooms taking courses such as anatomy, biochemistry, physiology, pharmacology, psychology, microbiology, pathology, medical ethics, and laws governing medicine. They also learn to take medical histories, examine patients, and diagnose illness. During the last 2 years, students work with patients under the supervision of experienced physicians in hospitals and clinics to learn acute, chronic, preventive, and rehabilitative care. Through rotations in internal medicine, family practice, obstetrics and gynecology, pediatrics, psychiatry, and surgery, they gain experience in the diagnosis and treatment of illness.

Following medical school, almost all M.D.s enter a residency—graduate medical education in a specialty that takes the form of paid on-the-job training, usually in a hospital. Most D.O.s serve a 12-month rotating internship after graduation before entering a residency which may last 2 to 6 years. Physicians may benefit from residencies in managed care settings by gaining experience with this increasingly common type of medical practice.

All States, the District of Columbia, and U.S. territories license physicians. To be licensed, physicians must graduate from an accredited medical school, pass a licensing examination, and complete 1 to 7 years of graduate medical education. Although physicians licensed in one State can usually get a license to practice in another without further examination, some States limit reciprocity. Graduates of foreign medical schools can usually qualify for licensure after passing an examination and completing a U.S. residency.

M.D.s and D.O.s seeking board certification in a specialty may spend up to 7 years—depending on the specialty—in residency training. A final examination immediately after residency, or after 1 or 2 years of practice, is also necessary for board certification by the American Board of Medical Specialists (ABMS) or the American Osteopathic Association (AOA). There are 24 specialty boards, ranging from allergy and immunology to urology. For certification in a subspecialty, physicians usually need another 1 to 2 years of residency.

A physician’s training is costly, and whereas education costs have increased, student financial assistance has not. Over 80 percent of medical students borrow money to cover their expenses.

People who wish to become physicians must have a desire to serve patients, be self-motivated, and be able to survive the pressures and long hours of medical education and practice. Physicians must also have a good bedside manner, emotional stability, and the ability to make decisions in emergencies. Prospective physicians must be willing to study throughout their career to keep up with medical advances. They will also need to be flexible to respond to the changing demands of a rapidly evolving health care system.

Employment of physicians will grow faster than the average for all occupations through the year 2008 due to continued expansion of the health care industries. The growing and aging population will drive overall growth in the demand for physician services. In addition, new technologies permit more intensive care: Physicians can do more tests, perform more procedures, and treat conditions previously regarded as untreatable.

Although job prospects may be better for primary care physicians such as general and family practitioners, general pediatricians, and general internists, a substantial number of jobs for specialists will also be created in response to patient demand for access to specialty care.

The number of physicians in training has leveled off and is likely to decrease over the next few years, alleviating the effects of any physician oversupply. However, future physicians may be more likely to work fewer hours, retire earlier, have lower earnings, or have to practice in underserved areas. Opportunities should be good in some rural and low income areas, because some physicians find these areas unattractive due to lower earnings potential, isolation from medical colleagues, or other reasons.

Unlike their predecessors, newly trained physicians face radically different choices of where and how to practice. New physicians are much less likely to enter solo practice and more likely to take salaried jobs in group medical practices, clinics, and health care networks.

Earnings

Physicians have among the highest earnings of any occupation. According to the American Medical Association, median income, after expenses, for allopathic physicians was about $164,000 in 1997. The middle 50 percent earned between $120,000 and $250,000 a year. Self-employed physicians—those who own or are part owners of their medical practice—had higher median incomes than salaried physicians. Earnings vary according to number of years in practice; geographic region; hours worked; and skill, personality, and professional reputation. As shown in table 2, median income of allopathic physicians, after expenses, also varies by specialty.

Average salaries of medical residents ranged from about $34,100 in 1998-99 for those in their first year of residency to about $42,100 for those in their sixth year, according to the Association of American Medical Colleges.

Related Occupations

Physicians work to prevent, diagnose, and treat diseases, disorders, and injuries. Professionals in other occupations requiring similar skills and critical judgment include acupuncturists, audiologists, chiropractors, dentists, nurse practitioners, optometrists, physician assistants, podiatrists, speech pathologists, and veterinarians.

Sources of Additional Information

For a list of allopathic medical schools and residency programs, as well as general information on premedical education, financial aid, and medicine as a career, contact:

• Association of American Medical Colleges, Section for Student Services, 2450 N St. NW., Washington, DC 20037-1131. Internet: http://www.aamc.org

For a list of osteopathic medical schools, as well as general information on premedical education, financial aid, and medicine as a career, contact:

• American Association of Colleges of Osteopathic Medicine, 5550 Friendship Blvd., Suite 310, Chevy Chase, MD 20815-7321. Internet: http://www.aacom.org

For general information on physicians, contact:

• American Medical Association, Department of Communications and Public Relations, 515 N. State St., Chicago, IL 60610. Internet: http://www.ama-assn.org

• American Osteopathic Association, Department of Public Relations, 142 East Ontario St., Chicago, IL 60611. Internet: http://www.aoa-net.org

Information on Federal scholarships and loans is available from the directors of student financial aid at schools of allopathic and osteopathic medicine.

Information on licensing is available from State boards of examiners.