|
A physician is a person who practices medicine. In the United States the term physician is traditional and commonly used. In
Britain and Australia, the term
doctor is more common as physician refers to specialists in internal medicine.
Training
United Kingdom
In the UK a doctor's training normally follows this path:
- Degree level Preclinical - Doctors must study medicine in university or medical school for two to three years
"preclinical" (meaning little patient contact). However following recommendations by the British Medical
Association (BMA) many universities are following a "Problem-based learning" approach, which stresses basing the studies
around actual patient cases.
- Clinical - This time is spent in a teaching
hospital and typically lasts two or three years. After this is completed the student doctor is awarded a Bachelor of Medicine
(BM or MB) and Bachelor of Surgery (BCh or BS). He/she is now entitled to use the honorary prefix of "Dr", although he/she is not
recognised as a "doctor" in the academic sense of the word (see Doctorate).
- House Officer (HO) - At this stage the student is allowed provisional registration as a junior doctor, but
must complete two, six month periods as a house officer in a hospital.
- Senior house officer (SHO) - This lasts from between two and seven years depending on the specialty chosen.
The doctor is now officially registered and must complete the time in a clinical position in a hospital.
At this stage the doctor can choose to become a General Practitioner (GP) or a hospital doctor with a few filtering off into
public health medicine. All routes involve further assessments and examinations. The vast majority in the UK work as GP's, who
are the first port of call for patients. They diagnose illness and refer patients for further examination by specialists if
necessary. 90% of all patients are managed by their GP without the need for further referral.
Hospital doctors are promoted after sitting relevant postgraduate exams within their chosen specialty, from SHO to Registrar
and eventually consultant, which is the highest level in a specialty team (with the exception of University-linked Professors).
The time taken to get from SHO to consultant varies from specialty to specialty.
United States
In the United States and countries following the U.S. method, the path to a medical degree is somewhat different.
- Admissions: Admission into medical school requires either three years of undergraduate study or a a four-year post-secondary bachelor's degree from an accredited college or university, depending on medical institution. Admissions
criteria include overall performance in the undergraduate years, performance in a group of courses specifically required by U.S.
medical schools (biology, general chemistry, organic chemistry, physics, calculus or sometimes statistics, and sometimes English
composition), score on the MCAT (Medical College Admissions Test--a national standardized
test), application essays, and interview.
- Medical School: Once admitted to medical school, it takes four years to earn a Doctor of Medicine (M.D.) degree. The course of study is divided into
two roughly equal parts. Preclinical study generally comprises the first two years and consists of classroom and
laboratory instruction in core subjects such as anatomy, biochemistry, physiology, pharmacology, microbiology, pathology, and neurosciences.
Once the student successfully completes preclinical training, he or she moves on to the clinical portion. This usually
occupies the final two years of medical school and takes place almost exclusively on the wards of a teaching hospital. The students observe and take part in the care of
actual patients under the supervision of residents and attending physicians. Rotations on clinical services such as internal medicine, surgery,
pediatrics, obstetrics/gynecology, and psychiatry are the foundation of this curriculum, but many specialty electives may be chosen as well. Upon
completion of medical school, the student earns the title of doctor, but cannot practice independently until completing further
training.
- Internship: During the last year of medical school, students apply for postgraduate residencies in
their chosen field of specialization. These are more or less competitive depending upon the desirability of the specialty,
prestige of the program, and the number of applicants relative to the number of available positions. All but a few positions are
granted via a national computer match which pairs an applicant's preference with the programs' preference for applicants. The
first year of any residency is known as "internship". Completion of this year is the minimum training requirement for
obtaining a license to practice medicine in the U.S.
- Residency: Each of the specialties in medicine has established its own curriculum, which defines the length
and content of residency training necessary to practice in that specialty. Programs range from three years after medical school
for internal medicine to five years for surgery to eight or nine for neurosurgery. Each specialty incorporates an internship year
to satisfy the requirements of licensure. All specialties hold a board exam (either written or written and oral) at the
completion of training in order to confer "Board Certification" in that specialty.
- Fellowship: Certain highly specialized fields require formal training beyond residency. Examples of these
are cardiology, endocrinology, oncology after internal medicine; cardiothoracic surgery, pediatric surgery, surgical oncology after general surgery
to name just a few. There are many others for each field of study. The training programs for these fields are known as
fellowships and their participants are "Fellows" to denote that they already have completed a residency and are
"Board Eligible" or "Board Certified" in their basic specialty. Fellowships range in length from one to three years and are
granted by application to the individual program or sub-specialty organizing board.
- Attendings: The physician or surgeon who has completed her or his residency and possibly fellowship training
and is in the practice of their specialty is known as an Attending. These are the physicians who may independently care
for patients and are the final arbiters of care. They are responsible for all care decisions and may bill for their
services.
However, medicine is an extremely diverse profession with many options available. Some doctors work in pharmaceutical research,
occupational medicine (within a company), public health medicine (working for the general health of a population in an area), or
join the armed forces.
Regulation
In most jurisdictions, physicians need government permission to practise. This is known as licensing in the United States, as colegiation in Spain, as ishi
men'kyo in Japan and as registration in Australia. In France, civilian physicians must be a member of the Order of physicians to practice medicine.
Regulating authorities will revoke permision to practice in cases of malpractice or serious misconduct.
External links
|