This article was originally posted on blog.accepted.com.
For this section of our What to Expect After Medical School series, I’ll provide a brief rundown of what happens after you graduate from medical school. As you have probably realized by now, medicine requires a commitment to lifelong learning. There will always be new procedures, new medications, and new lab tests to learn about. Treatments we thought were going to be around forever will fade away.
As a great anatomy professor once said, “Fifty percent of what you learn in medical school will be useless; the problem is, we don’t know which 50%.” Your job is to keep replenishing your knowledge base and replacing that 50%. The years after medical school are when your knowledge begins to take root and fly. This is when you figure out the main purpose of medical school: Teaching you how to learn. The rest is up to you.
There are three basic types of internships, and some residencies accept interns from more than one type. Check with the AAMC (Association of American Medical Colleges) and the ERAS (Electronic Residency Application Service) for current requirements.
There is also an increasing number of combined residencies, which allow you to specialize in two fields at one time, with the goal being to use your skills in a wider range of situations. Examples include family medicine–psychiatry, internal medicine–pediatrics, and emergency medicine–anesthesiology. These hybrid programs give you singular training in each specialty but also integrate fields into a meaningful and unique skill set. Refer to AAMC for the training requirements of specialties.
As you progress through the years of PGY-1, 2, 3, and so on, expect to gain more confidence and responsibility. By your final year, you can admit, treat, and discharge patients on your own and do some procedures without supervision. You will also know when to consult someone from another specialty and when to confer with a more experienced person in your own field. The goal is never to reach the point of knowing everything but rather to know your limits and when you need additional expertise or collaboration.
During residency, you will begin to present cases at M&M (morbidity and mortality) conferences, which sometimes feel like a public confessional. The upside of this process is that you will learn that other MDs have faced similar clinical challenges. While other physicians might suggest what you could have done differently (Monday morning quarterbacking), they will confirm that you did the best you could. Most residencies see M&Ms as an essential learning experience because they encourage physicians to get in the habit of disclosing, rather than concealing, errors in judgment. This allows you to get feedback on ways to manage a situation in the future, and it allows other physicians, residents, and students to learn from your experience and hopefully not make a similar mistake.
Here are some of the many options available to you after you finish training:
The ways in which you cope with stress will likely change over your lifetime, as will the stressors themselves. If you opt to raise a family, these years can be some of the most challenging. Many physicians decide to slow down their career while building a family. While this has traditionally affected women far more than men (leading to less career advancement and income), many male physicians are now opting to spend more time at home and less in the hospital. Finding a job with regular hours is ideal for physicians with a family, while periods of intense shift work followed by extended breaks allow others to pursue travel and other interests.
Teaching is a great way to your keep knowledge current and is not limited to academic settings. Almost anyone can volunteer their time to teach or mentor residents, med students, premeds, nursing students, undergrads, or medical assistants. This is a time-honored way of paying it forward and your chance to ensure that we have competent, compassionate, and skilled providers in the future. The bonus? You will probably learn as much from them as they will from you!What’s next for you, and how can you achieve your goals? Work one-on-one with an expert advisor who will walk you through the process of deciding what steps to take next, applying to relevant degree programs/internships/residency programs/fellowships, and getting ACCEPTED. Check out our Admissions Consulting Services for more information.
For this section of our What to Expect After Medical School series, I’ll provide a brief rundown of what happens after you graduate from medical school. As you have probably realized by now, medicine requires a commitment to lifelong learning. There will always be new procedures, new medications, and new lab tests to learn about. Treatments we thought were going to be around forever will fade away.
As a great anatomy professor once said, “Fifty percent of what you learn in medical school will be useless; the problem is, we don’t know which 50%.” Your job is to keep replenishing your knowledge base and replacing that 50%. The years after medical school are when your knowledge begins to take root and fly. This is when you figure out the main purpose of medical school: Teaching you how to learn. The rest is up to you.
From medical school to your first “real” job
You don’t just graduate from med school and then apply for a job. Let’s take a look at the different stops you’ll make along the way.Phase 1: Internship year
Some programs call the internship a PGY-1 (post-graduate Year 1). At this stage, you have an MD or DO after your name, but you are not yet licensed by your state (you need a licensed resident to sign all prescriptions and supervise you during procedures).There are three basic types of internships, and some residencies accept interns from more than one type. Check with the AAMC (Association of American Medical Colleges) and the ERAS (Electronic Residency Application Service) for current requirements.
- Categorical: A categorical internship is embedded in a residency and does not require a separate application. You are accepted for a residency and complete your entire training, including internship, in that program. Internal medicine, pediatrics, family medicine, emergency medicine, and ob-gyn are managed this way. Some general surgery programs also accept applicants for the full training. A categorical internship might expose you to other fields of medicine; however, it primarily provides a strong foundation in your chosen specialty.
- Transitional: Some specialties require a transitional internship, which you apply separately to in ERAS and might have to complete at a different institution from the one at which you complete your residency. The drawback of this is having to pick up and move two times. The benefit is that you experience both medical and surgical practices and gain the skills needed to take and pass the USMLE (United States Medical Licensing Examination) Step 3. More programs these days are offering transitional years at the same location where interns do their residency, so there is less need for those participants to move a second time.
- Preliminary: These internships are similar to the transitional year, but rather than rotating through various specialties, you focus on either surgery or medicine. Some surgical subspecialties require a preliminary surgery internship (e.g., urology), while medical specialties (e.g., neurology) require a medical internship. Some specialties (e.g., anesthesia, dermatology) accept either one. Many institutions offer more preliminary internships than residency spots (cheap labor), so interns who have not been accepted to residency can work hard and hope for acceptance (or at least a good letter of recommendation) the following year.
Phase 2: USMLE Step 3
Generally taken at the end of the internship year, Step 3 assesses your grasp of clinical concepts relevant to patient care. These concepts include knowledge of human growth and development, disease states, and clinical skills. Through patient case scenarios, the exam tests your ability to formulate a diagnosis based on a patient’s history, their physical exam, and the associated lab findings, and also tests your ability to manage a patient. Passing Step 3 is a prerequisite for licensing for most state licensing boards.Phase 3: Residency
Residency lengths vary, depending on the specialty involved and the amount of experience you need to be well trained. Family medicine, internal medicine, and pediatrics are three years. Psychiatry and ob-gyn are four years. Surgery is a minimum of five years, with several surgical specialties being longer. To subspecialize in any field, you will need to do a post-residency fellowship, which can range from one to three years (more on this later in the post).There is also an increasing number of combined residencies, which allow you to specialize in two fields at one time, with the goal being to use your skills in a wider range of situations. Examples include family medicine–psychiatry, internal medicine–pediatrics, and emergency medicine–anesthesiology. These hybrid programs give you singular training in each specialty but also integrate fields into a meaningful and unique skill set. Refer to AAMC for the training requirements of specialties.
As you progress through the years of PGY-1, 2, 3, and so on, expect to gain more confidence and responsibility. By your final year, you can admit, treat, and discharge patients on your own and do some procedures without supervision. You will also know when to consult someone from another specialty and when to confer with a more experienced person in your own field. The goal is never to reach the point of knowing everything but rather to know your limits and when you need additional expertise or collaboration.
During residency, you will begin to present cases at M&M (morbidity and mortality) conferences, which sometimes feel like a public confessional. The upside of this process is that you will learn that other MDs have faced similar clinical challenges. While other physicians might suggest what you could have done differently (Monday morning quarterbacking), they will confirm that you did the best you could. Most residencies see M&Ms as an essential learning experience because they encourage physicians to get in the habit of disclosing, rather than concealing, errors in judgment. This allows you to get feedback on ways to manage a situation in the future, and it allows other physicians, residents, and students to learn from your experience and hopefully not make a similar mistake.
Phase 4: Specialty board exams
If you’ve ever wondered where the term “board certified” comes from, it is a label granted to an individual by a medical specialty board after that person passes a specific final exam. For some specialties, the exam is written; for others, it is oral. In some cases, you must collect a case list of patients in your first two years of practice and then submit and discuss this list during oral boards. Board certification is considered a high honor, and you are generally required to maintain your board certification status through ongoing training and CME (continuing medical education). Some boards also require that you take a recertification exam every few years.Phase 5: Additional training programs
There are basically two options here:- Fellowships: Many specialties offer “subspecialization” in the form of a fellowship. This usually requires another one to three years of training. Depending on the length of your residency, you will start applying to fellowships sometime before your last year.
- Additional degrees: Some MDs will go on to pursue additional degrees, such as an MBA, MPH, JD, and/or PhD.
Phase 6: Applying for jobs
Once you have completed your residency and/or fellowship, it’s time to apply for your first real job! Years ago, physicians often decided to hang up a sign and go into solo practice, but now, most doctors join established groups. Doing this allows you to share resources, on-call shifts, and collective wisdom. If you join a smaller group, you might need training in business practices, legal contracts, and financial issues. If you join a larger group or a university, the business aspects are often handled by a human resources department.Here are some of the many options available to you after you finish training:
- Private practice – individual
- Private practice – small group
- Community clinic – focus on underserved patients
- Public health – research, community health, CDC/epidemiology
- Single specialty group – ER, anesthesia, others
- Multi-specialty group – variety of primary care and specialties
- Academic medicine – clinical and/or research focused
- Research based – clinical versus basic science
- Hospitalist – does not have an outpatient site
- Nocturnist – works only nights to relive daytime physicians
- Telemedicine – sees patients online
- Concierge medicine – sees patients in their home
- Clinical Informaticist – adapts electronic medical records to meet clinical needs and collects data to inform practice
- Physician Executive – leads hospital or healthcare group in business improvement, finances, hiring, and compliance with health industry regulations
Phase 7: Continuing education
- Continuing Medication Education (CME)
- Individual Learning
Maintaining work-life balance throughout these phases
With all this new information coming at you, you will also need to find new ways to combat the effects of stress. We know that chronic, lifestyle-related diseases are amplified by the stress hormone cortisol, and it is apparent that physicians are not immune to the effects of stress. Perhaps the greatest thing you will discover is how to forge a balance between life and a career in medicine. By making your health a priority, you will be better able to teach your patients how to protect their health when they need to make similar changes. Whether you look to diet, exercise, mindfulness, meditation, art, music, or other pursuit, figuring out how to reduce your stress will make you a better doctor.The ways in which you cope with stress will likely change over your lifetime, as will the stressors themselves. If you opt to raise a family, these years can be some of the most challenging. Many physicians decide to slow down their career while building a family. While this has traditionally affected women far more than men (leading to less career advancement and income), many male physicians are now opting to spend more time at home and less in the hospital. Finding a job with regular hours is ideal for physicians with a family, while periods of intense shift work followed by extended breaks allow others to pursue travel and other interests.
Teaching is a great way to your keep knowledge current and is not limited to academic settings. Almost anyone can volunteer their time to teach or mentor residents, med students, premeds, nursing students, undergrads, or medical assistants. This is a time-honored way of paying it forward and your chance to ensure that we have competent, compassionate, and skilled providers in the future. The bonus? You will probably learn as much from them as they will from you!What’s next for you, and how can you achieve your goals? Work one-on-one with an expert advisor who will walk you through the process of deciding what steps to take next, applying to relevant degree programs/internships/residency programs/fellowships, and getting ACCEPTED. Check out our Admissions Consulting Services for more information.
