Physicians serve a fundamental role in our society and have an effect upon all our lives. They diagnose illnesses and prescribe and administer treatment for people suffering from injury or disease. Physicians examine patients, obtain medical histories, and order, perform, and interpret diagnostic tests. They counsel patients on diet, hygiene, and preventive health care. There are two types of physicians: The M.D.-Doctor of Medicine-and the D.O.-Doctor of Osteopathic Medicine. M.D.s are also known as allopathic physicians.
About a third of allopathic physicians are primary care physicians. They practice general and family medicine, general internal medicine, or general pediatrics and are usually the first health professionals patients consult. Primary care physicians tend to see the same patients on a regular basis for preventive care and to treat a variety of ailments. General and family practitioners emphasize comprehensive health care for patients of all ages and for the family as a group. Those in general internal medicine provide care mainly for adults who may have problems associated with the body's organs. General pediatricians focus on the whole range of children's health issues. When appropriate, primary care physicians refer patients to specialists, who are experts in medical fields such as obstetrics and gynecology, cardiology, psychiatry, or surgery.
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.
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.
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. 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 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.