If you know anyone who has studied to become a doctor, or if you watch TV shows that take place in medical settings, you’ve probably heard terms like "intern," "resident" or "attending." While they are all considered to be doctors, they have not all completed their medical training. Knowing the differences among them will help you determine their experience level, and whether they truly have enough experience to help you.
Here, an overview of the steps that need to be taken in order to become a doctor -- and a "cheat sheet" to who's who.
Medical SchoolIn order to become a doctor, a person must first complete a bachelor's degree. Then, he or she must attend and complete four years of medical school.
The first two years of medical school are comprised mostly of classroom work, learning the basics of anatomy, diseases and body functions. The second half of medical school is comprised of clinical, hands-on-patient work, usually in a teaching hospital or academic medical center.
Medical students rotate through various specialties such as surgery, pediatrics, or neurology to learn about each field so they can decide which is of most interest to them. You’ll see them in hospitals, but they haven’t finished their training, and they are not licensed doctors.
Once a medical student finishes the four years of medical school, she graduates and adds the MD (medical doctor) or DO (doctor of osteopathy) to her name and becomes a resident.
As students finish medical school, they apply for a "residency" program. Some medical schools use the term intern to describe the first year of residency. Residency training is also the time when new doctors begin to draw a paycheck for their work with patients. The name "resident" comes from the fact that years ago, many residents lived in hospital-supplied housing so they could be on call 24/7.
In some states, doctors are licensed to practice general medicine after finishing medical school and a one-year residency-internship.
To become licensed as a specialist, these new doctors still have many more years of study to go, depending on their chosen specialty. For example, to be a general internist, a doctor may study for three more years. To be a neurologist may require six or seven more years.
Some highly specialized programs and sub-specialties, such as endocrinology or pediatric cardiology, may require even more training. This is known as a fellowship.
Once a doctor has completed his residency training and fellowship, if its required for his specialty, he'll be considered an "attending physician" and can practice medicine on his own. In most states, this is when he'll receive his license. He may also choose to become board certified, which means he has completed not just the education required, but certain forms of experience, too.
Attending physicians who affiliate with teaching hospitals or academic medical centers will also be put in charge of residents who are practicing their new skills.
Confusion Over Resident v. Attending PhysicianPatients need to understand that residents are not full-fledged doctors, even though they have MD or DO next to their names. Residents are still students, receiving on-the-job training, practicing on real patients with real medical problems. Most residents work in hospitals. While they work under the auspices of an attending doctor, it's not unusual for the patient never to see that attending doctor. Wise patients know to ask the doctor they see in a hospital whether she is a resident or an attending physician. If problems arise, or if you anticipate problems could arise, be sure to insist you be treated directly by the attending physician.
This is particularly important when you need surgery. Surgeries are often performed by residents, meaning, residents are getting their on-the-job training on real patients who may need delicate surgeries. The attending surgeon will usually be watching nearby.
If your surgery is one that is common, you might not mind if a resident performs it. This is how residents get their practice to become attending physicians. However, if your surgery is at all unusual, or if you have other medical problems that make the surgery more delicate or tricky, you'll want to insist that the attending physician be the one to actually perform your surgery.
Many surgery patients have told me they were sure the attending surgeon was poised to perform the surgery, only to find out later from a nurse, an anesthisiologist or an operating room technician that it was a resident who operated on them.
To make sure that doesn't happen to you, you'll need to be assertive. If you are scheduled for surgery, specifically ask who will be performing that surgery. If you are told the attending physician will be performing that surgery, ask if there will be residents in attendence. You will want to insist that the attending surgeon will actually be holding the scalpel, making the incisions, and otherwise performing the actual surgery itself.
Continuing EducationA doctor's education never ends. Post residency, she’ll pursue continuing education requirements so that she stays up to date in her field. She'll earn CMEs, continuing medical education credits, that help her learn new advancements in her specialty field. Her certification board will require a certain number of CMEs annually to allow her to keep that certification.
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