A person graduates with a BS in bio, spends four years in med school, then becomes an M.D. What subsequent path do they have to follow to get certified in a specialty? A subspecialty? I saw a doctor who was an electrocardiologist, and I have no idea what he did between med school and getting board certified. But to my knowledge there is nothing like a graduate med school for classes on specialty and advanced topics. Are there formal classes, or do these doctors learn their specialties in a practical residency, like some kind of apprenticeship program?
In general, after med school, you must follow an internship for, I believe, a minimum of two years. My DIL followed a three year residency at the end of which she was certified as a specialist in family medicine. But that was an unusual hospital in that all the interns were actually being trained in family medicine. It may have been the only such program in the country.
Anyway, following a 2 year internship–and examinations–you can hang up a shingle and start to practice. However most choose residency in some medical specialty. Then they pass an exam and become certified specialists. They may instead–or at a later date–pursue a fellowship, as it is called, in a subspecialty.
IANAD, but - from the little I understand, you start to get trained a bit in your specialty in your last year or so of med school, then do the multi-year residency. My brother just graduated as an otorhinolaryngologist (ear, nose, throat) and will now do a 5-year residency in that field at a Pennsylvania hospital before he can be a full-fledged doctor.
Some fields are a lot more competitive than others, you cannot just choose one you want. Neurosurgeons are in a highly selective field because it’s highly prestigious and perceived as the K2 of medicine; dermatology is in even higher demand because it’s perceived as a relatively easy and low stress yet high paying field. Family medicine is one of the least competitive and easiest to get into.
And to the actual specifics of the process, there is a National Match Day where newly minted MDs are “matched” to the residency programs they applied to. This is a big deal for those doctors and their families.
Obviously the more desirable the specialty and location (dermatology, anesthesia, etc) the more competitive the matching process is.
You can read about it here: https://www.nrmp.org/
After your residency you are generally allowed to practice in your field, although many providers will also want to become “Board Certified” which requires a series of examinations in your specialty (and perhaps sub-specialty as well). That is run by whatever board controls the certification process in your specialty (ABIM for Internal Medicine for example).
And, as mentioned, if you want to do a sub-specialty you would apply for a fellowship in that field after your residency has been completed.
Basically this. First year out of medical school used to be referred to as ‘internship’. The new doc is closely supervised and mentored in a comprehensive overview of medical topics. Years two and three of residency the emerging doc specializes evermore increasingly in the area of medicine they wish to eventually specialize in, while still being supervised and mentored. For some specialities they then apply for a ‘fellowship’, which are additional years acquiring more experience and in-depth expertise, while practicing much more independently.
The trick is, in medical school you have to apply for that initial residency in a specific area of practice like dermatology, surgery, family practice, pediatrics, etc. The exceptionally competitive and rigorous residency matching process can be more gruesome than trying to get into medical school in the first place. Here’s a good explanation:
Many specialists stack multiple residencies or fellowships to super specialize. I have a doctor that is board certified (which comes after finishing a residency or fellowship and after being scrutinized for mastery by the accrediting professional body) who is triple board certified in neurology, ophthalmology and micro surgery. We joke about the decade he spent in limbo after graduating from medical school.
A child of mine is finishing a fifth year of residency and then fellowship to be certified in child/adolescent psychiatry. They think the residency matching in medical school to be the most grueling part of the entire process of becoming a physician and that is saying something. Heartless, random, inexplicable, mystical voodoo.
Just to complicate things a bit:
There are physicians practicing in specialties who don’t have board certification - one reason why it’s a good idea to check on your doc’s background.
Physicians graduating from med school need one or two years of residency training to get their medical licenses. However, in at least one state physicians can see and treat patients without any postgraduate education.
This kind of hints at what I’m asking about, see bold terms above. I gather that this training and postgraduate education (when they do get it) is all just working under experienced doctors in that specialty. Like, an ophthalmologist doesn’t have to take “Eyeballs 701 for Ophthalmologists.”
You don’t need a BS in biology to go to medical school, you just need to take the med school prerequisites.
Medical school curriculum is standardized and is the same for all the students, with the exception of the fact that there is elective time in 4th year, so most students choose to do electives in the specialty they want to go into. But officially, the way you choose your specialty is to apply to residency programs in that specialty. You can’t, e.g, major in cardiology in medical school.
Some fields are subspecialities of other specialties. Postgraduate training to train in a subspeciality after residency is called a fellowship. For example, to become a cardiologist, one first does a residency in internal medicine, then a fellowship in cardiology. A cardiac electrophysiologist is a doctor who has done an additional electrophysiology fellowship after the cardiology fellowship.
Residency and fellowship programs do include a didactics element with weekly lectures by faculty, and an expectation that residents/fellows will read this or that textbook chapter or journal article. But there are no formal “eyeballs 701” style courses with academic credit, homework, midterms/finals, etc.
Yeah, but those docs in Missouri get called “Assistant Physicians” (not to be confused with Physician Assistants, who don’t have an MD degree). They must be supervised by a more thoroughly trained fully licensed MD.
Nearly all states now require at least 2 years of post grad training after med school to get licensed. That leaves a LOT of MDs who managed to get a year of internship (but no more than that) out in the cold. I laud Missouri since it gives some kind of employment to the unfortunate docs who didn’t match or get past their first year post grad training. Of course, you must move to Missouri to work, but oh well.
Back when I graduated from the East Baltimore Dispensary (1983), Maryland would grant a license to us new grads almost automatically, as they didn’t require post grad training back then. I declined their offer, since I was leaving the state and didn’t have the spare change. They discontinued that a while back
Hah, reverse boaster, back when I did my Advanced Training at the Happy Chandler Medical Center, we had horse-drawn ambulances (and hearses).
Hah! When I google your term, I get a respectable medical school as a result. When I google East Baltimore Dispensary, I get a list of Cannabis stores. So things really haven’t changed there . . .
And we walked 12 miles uphill both ways thru snow to make rounds, & made our progress notes on the blades of shovels with a piece of coal. Medical students pulled the ambulances thru the streets too.
The specialist I know of who did or are going through training…
My neighbour in residence was a year behind me. He spent 2 years pursuing a BS degree - after 2 years, before he completed that degree, his marks and interview got him into medical school. Some needed to go 3 years before getting in… after that, you are not likely to be admitted. Whereas my step-brother was a Navy officer, flight instructor, and had a degree in Aeronautical Engineering, before asking to become a doctor - the navy sent him to medical school in his 30’s. He became a neurosurgeon and is the closest thing I know to combination rocket scientist-brain surgeon.
(Isaac Asimov recounts trying to get into medical school and being turned down twice. When he went for a Master’s in Chemical Engineering, a faculty member told him - “if this is just marking time hoping to get into medical school - you won’t.”)
After 4 years of basic medical school my neighbour graduated, did 2 years internship, and became an MD (i.e. real doctor). He then took the specialist courses (I assume, like unto a Master’s degree) to become an anesthetist. I believe it was 3 years. Not sure if he then had to go do a similar internship for his specialty, or if it was wrapped up in the 3-year course. Another doctor I’m aware of is currently doing 3 years toward a pediatrician specialty at a medical school.
Note the time-line: he graduated at 18, spent 2 years in general biological science, then 4 years in med school. add 2 years internship, and you aren’t a “real doctor” until you’re about 26, Doogie Howser notwithstanding. Now do a specialty, and you’re around 30 before you are qualified, in case someone says doctors and specialists make too much money. To be fair, my friend would spend summers and time off working part time in his father’s practice for real doctor money while doing his specialist stint on he completed his first internship. So did his doctor wife (they met and married in med school, because you have no life outside of that), so they were not short of income…
Just a nitpick, an MD would be an anesthesiologist.
This is exactly what I was wondering about and gets to the heart of my question. Thanks!
Per my perusal of the FSMB website, the majority of states require 1 year of US grads.
You are correct. It’s the non US grads that mostly have the greater requirements, though a lot of states are now requiring them to have 2 years also. But far from the majority.
And thanks for the info and the link to that interesting website.
Just to add to what’s already been very well covered, being multiboarded is not necessarily as impressive as it sounds. Many specialties have several boards you can be eligible for and obtain without having to do much extra work. In general cardiology, for instance, I am triple boarded (internal medicine - usually required by fellowship programs, general cardiology, echo, could also have done nuclear medicine and cardiac CT without much any extra training as well). Being multiboarded in different specialties is something else. My colleague is one of the few OB gyn/cardiology dual boards. Rare in part because the two paths split at the immediate post grad level, vs two sub specialties within the same field, i.e. overarching internal medicine).
To add an anecdote, a childhood friend of mine went to graduated from medical school and then did a residency in urology. After that he did a fellowship in pediatric urology. He is a surgeon. I am not sure if the surgery part was part of the residency or the fellowship. He did the board exams at the end. He was pushing 30 before he took his final academic test.
He’d do surgery in both a urology residency and pediatric urology fellowship. It’s a surgical specialty/subspecialty.
To add to this, there are some subspecialties in which it used to be possible to become board-certified simply by passing the board exam, without having done a fellowship. Most of these pathways have been phased out, but those who became board-certified that way were grandfathered in. One which still exists is Addiction Medicine, though I’ve heard they can be pretty picky about the evidence you have to submit that you’ve spent 1920 hours working in an addiction setting.