Medical School in the United States

As I explained yesterday, every Monday until I run out of volunteers I’m going to be featuring a description of medical education around the world. Today’s country is the United States. Please let me know if I left out anything you are curious about and come back next week to learn about Belgium’s system!

Getting In:
How old is one when they begin medical school?
It varies depending on if you start right after college (22-ish), take a few years off or go back after a long time out of college. The average age in our class is probably around 26 or 27.
What exams does one have to take to get in?

The Medical College Admissions Test (commonly known as “MCAT”) is the entrance exam for medical school. It’s a 4ish hour computerized exam that covers physical sciences (physics and inorganic chemistry) and biological sciences (biology and organic chemistry), as well as verbal/reading skills and writing abilities.
Is there any required pre-requisite coursework?
Most schools require one year each of Biology with Laboratory, Inorganic Chemistry with Laboratory, Organic Chemistry with Laboratory, Physics with Labratory and English, as well as one semester (half-year) each of Calculus and Biochemistry.

Is it a competitive occupation?
I would say getting into medical school in the United States is relatively competitive. You need to have a record of good scores for your four years of college and a good score on the MCAT, as well as clinical experience and volunteering history. That being said, it is by no means impossible. Obviously.
What are you called at this stage of training?


Being In:
How long is it?

Four years
How are the years broken down?

Two years of basic sciences, two years of clinical training.
Describe your typical day.

1st/2nd Years (“MS1/MS2”): Several hours of lecture a day followed by long stretches of studying and lots of exam-taking. 3rd/4th years (“MS3/MS4”): As best I know, since I’m not quite there yet, in the third and fourth year you basically spend your day in the hospital or clinic seeing patients and receiving instruction from your teaching doctors (“attendings”). There are six 3rd year rotations – Family Practice, Obstetrics/Gynecology, Internal Medicine, Psychiatry, Pediatrics and Surgery, with a shelf exam at the conclusion of each rotation.
If you choose a specialty, when do you have to decide by?

Most people will decide what specialty they want to go into by the end of their 3rd year rotations.
What are you called at this stage of training?

“Medical Student” or “MS” followed by your year in school (1, 2, 3, or 4).

Getting Out:
What exams do you have to take?
We are required to pass the United States Medical Licensing Exam (“USMLE”) prior to working as a doctor. We take “USMLE Step 1” after our second year, it is an 8 hour exam covering basic clinical sciences. “USMLE Step 2” has a clinical knowledge part and clinical skills part that has to be passed before graduation at the end of your 4th year. “USMLE Step 3” is taken at the end of your residency training.
Do most people graduate?
From what I understand the graduation rate at US medical schools is over 96%. Some people have to repeat years or take a year off, but most people do eventually successfully graduate.
When are you finally considered a “doctor?”
After your 4th year of med school you graduate and are offically an “MD.” (Note: There is a osteopathic medicine degree called “DO” in the US – it is essentially the same degree as an MD except they have additional training in Osteopathic Manipulative Medicine. Doctors with DO degrees can do all the same things doctors with MD degrees can do and their training track is almost identical.)
Do you have additional training or do you start working immediately?
In the US we must complete a residency training program before practicing alone as a physician. Residencies range from 3 – 7 years depending on the specialty you’re learning to practice in. During this time you are paid around $40,000/year, which comes to $10/hour for 80 hour work weeks. Nope, not a typo – 80 hours/week…and that’s the restricted amount that was put into place a few years ago because residents were sometimes working 100+ hours/week. You apply to residency as a 4th year medical student (MS4) and begin working after graduation. Some residency positions are extremely competitive (Radiology, Dermatology, Orthopedic Surgery, anything at a big-name, famous hospital, etc.) and others are not.
What’s the average debt for attendance?
The national average for Medical School debt (before interest is added) is about $158,000 (USD). Some people graduate with significantly less and some who attend very expensive schools may graduate with over $200,000. This would be in addition to any college debt one had accrued as an undergraduate before beginning school.
What are you called at this stage of training?
After graduation you are officially a “doctor.” For your first year of residency you’ll be considered an “intern” and for the rest of your residency training you will be referred to as a “resident physician.”

Being Out:
What’s the average salary?
The numbers for this are significantly different between specialties and states, so it’s hard to give a true estimate (not to mention, every source you refer to has different information). According to the US Bureau of Labor Statistics – in 2008 physicians working in primary care field had total median annual compensation of $186,044, and physicians practicing in medical specialties earned total median annual compensation of $339,738. Here’s a good blog post from KevinMD on the subject of physician compensation in the US.
Is the job security good?
I don’t think most doctors struggle to find a job, but then again I have never looked for a job as a physician.
Can you go back and choose a different specialty?
If you do your residency in Pediatrics and suddenly decide you would like to become a surgeon you have to re-apply to residency. If you get accepted your pay drops back down to the $40,000/year resident salary and you are required to complete another residency before you can switch fields. So, yes – you can switch specialties, but no – it is not easy or painless.
What are you called at this stage of training?
PGY-1 (Post-Graduate Year 1, this is the first year of residency) = Intern. PGY-2+ you are simply a Resident Physician. Following graduation from residency you are considered an “attending physician” which just signifies that you have completed your full medical training.