Medical School in Belgium

When I deployed my initial desperate plea for non-US medical students or doctors who were willing to help me out with this series
@bramzo, a 2nd year medical student in Belgium, was the first to agree. He was excited about the series and wrote exquisitely about his interest in Neurosurgery, his experiences in the Belgian medical education system and what he has ahead of him in the next few years. When I read his interview and saw that it was dang-near grammatically perfect, I was sure English had to be his primary language. But oh no, friends, English is not his first language, nor is it his second language…English is his THIRD language. This Belgian rockstar fluently speaks Dutch, French and English and is well on his way to becoming a brain surgeon! Sorry to burst your bubbles, ladies, but you should know that Bram has been with his girlfriend for 6 years now and I get the impression that she’s a pretty great catch. When he’s not studying about a homunculus, Bram enjoys cycling, photography and Mac products…sounds like he and I would get along just beautifully – I hope he’s prepared to house me should I ever decide to make an impromptu visit to Belgium. Keep reading for a great look inside the medical education system in Belgium, I’ve added just a couple of things which are printed in orange.
Photo by Bram. Stolen from his Instagram. 🙂

Getting In:
How old is one when they begin medical school?
Most are 18 years old. Some that don’t pass the entrance exam wait another year and enter the education at 19.
What exams does one have to take to get in?
Everyone applying for medical school (doctor or dentist) needs to pass the entrance exam (one exam for all the Dutch speaking Belgian applying med students). It’s an exam testing the chemical, physical, biological, and math skills that one should have after high school, as well as IQ and reading skills. The best 25% of students get approved. I was one of them. There is a chance to do a redo the exam in the same year after a month or two. Those that fail twice have to wait another year.
Is there any required pre-requisite coursework?
Pre-requisite coursework is not required, but some courses are organized by universities to help students pass for the entrance exam.
Is it a competitive occupation?
Only the top 25% get approved, but at this stage you don’t know the other students.
What are you called at this stage of training?  

Being In:
How long is it?
Basic medical education is 7 years, but the government shortened it to 6 years recently. I’m still in the 7-year program. After that, it’s another 2 years minimum to be a General Practitioner (GP) or 3 – 6 years for specializing.
How are the years broken down?
First 3 years is Bachelor degree: physics, biology, chemistry, bio-chemics, immunology, embryology and some basic clinical skills like history taking and basic physical exam.
Next 4 years is the Master degree.
  •  First year is still pure theory, but more clinical: pathology, nephrology, cardiology, pharmacology, etc.
  • Second year is theory and internships. Again: theory is more clinical like ob/gyn, gastro-enterology, etc. and courses are given in the afternoon. In the morning we go to our internship, which rotates every month.
  • Third year is also theory and internships but the last 4 months of this year we do our end-exams. This is one exam of Surgery, Medical, Ob/Gyn and Pediatrics. The scores earned on these exams are critical to be approved for a specialization.
  • Fourth year is basically a preparation for your specialty or GP career.

Describe your typical day.

As I’m in my second Master, I go to the clinic in the morning for my internship of that month (this month anesthesiology, previous month pediatrics, next month neurosurgery). In the afternoon I go to class (2 pm ‘till 6 pm). When I come home in the evening I study or relax. There also has to be a student on call at the ER every day. So, 2 to 3 times a month it’s my turn to do the on call and that’s from 8 am ‘til 11 pm.
If you choose a specialty, when do you have to decide by?  
At the end of your 6th year (3rd Master) you should decide what specialty you want to do. Students apply after 6th year and get approved in the first months of the 7th year.
What are you called at this stage of training?
A med student, most people call me by my first name.

Getting Out:
What exams do you have to take?
At the end of the 6th year you have to pass the “end-exams” where you do an internship of one month on Surgery, Meds, Ob/Gyn and Pediatrics then do a theoretical exam of the respective subject.
Do most people graduate?
Since the entrance exam is pretty hard, most people that begin med school graduate. I think 95% graduates. However, not every one get’s approved for a specialty, so they will work as General Practitioners instead. Only the best 50% of each class can specialize, so it’s very competitive in the 5th and 6th year.
When are you finally considered a “doctor?”
The title of doctor is given after your 7th year, no matter what specialty you choose.
Do you have additional training or do you start working immediately?
After 7th year you go for an additional training of 2 years if you choose GP or 3 – 6 years if you choose to specialize. Neurosurgery is 6 years of additional training after the 7th year.
What’s the average debt for attendance?
This is the good part of med school in Belgium: none. Med school is not expensive, as it is highly subsidized by the government. We only pay € 550 ($782.87 USD) for a year of med school (excluding books, stethoscope, etc.) and our entire living is paid for by our parents (housing, car, food, etc.).
What are you called at this stage of training?
After graduating the 7th year you are an assistant. Patients call you doctor during your additional training.

Being Out:
What’s the average salary?
This is a tough one – it depends on specialty, academic or private clinic. It varies from
€ 80.000 ($113,872 USD) to € 350.000 ($498,190 USD) annually, with an average for a specialty doctor of € 200.000 ($284,680 USD).
Is the job security good?
Yes, almost everyone graduating as a doctor finds a job.
Can you switch specialties?
It’s possible, but then you have to start from where you were after the 7th year. Some do this after the first year of additional training.
What are you called at this stage of training?
Patients still call you a doctor, but the degree in clinic varies from resident à head of clinic à head of department.