Training
Whatever the specialty, the route to becoming a physician is similar. It typically involves a bachelor’s degree from an accredited college, followed by medical school, residency, and licensure within your state. The duration of training can vary as can the schools and programs you enter.
You can opt to attend a medical school that offers a doctor of medicine (MD) degree or a doctor of osteopathic medicine (DO) degree. Upon completion of your residency, you can pursue additional training in a medical subspecialty through an accredited fellowship program.
Medical Ethics
A physician is trained to diagnose, treat, manage, and prevent diseases, injuries, and physical or mental impairments. Physicians must achieve the highest level of competency in not only the academics of medicine (including anatomy, biology, physiology, and pharmacology) but also in the ideals of medicine as embodied in part by the Hippocratic Oath (to work for the “benefit of the sick” and to “do no harm”).
This includes adherence to medical ethics, “best practices,” and the prescribed codes of conduct. Physicians will also direct care based on peer-reviewed, evidence-based science as outlined in the clinical guidelines of accredited medical societies (such as the American College of Cardiology and National Comprehensive Cancer Network) or public health authorities (such as the U.S. Preventive Services Task Force [USPSTF] or the Centers for Disease Control and Prevention).
If a physician believes it is necessary to sway from the guidelines, they will do so based on clinical experience and informed judgment, weighing the benefits and risks of treatment as well as the legal and ethical implications.
To this end, physicians must be capable communicators, providing the patient with all of the information needed to make a fully informed choice without coercion or judgment.
With medicine and technologies ever-changing, physicians must also maintain continuing medical education (CME) training to ensure that their knowledge is current and to renew their licenses and board certifications.
Procedural Expertise
Physicians diagnose and treat injuries or illnesses. Among their duties, they perform physical exams, take medical histories, prescribe medications, and order, perform, and interpret diagnostic tests.
They will also counsel their patients on general health and wellness (including diet, exercise, and smoking cessation) and implement preventive measures to ensure ongoing good health.
Physical Examination
A physical exam with a review of a patient’s medical history is the first step in the diagnostic process. The exam may be routine (such as an annual physical), used for screening purposes, or used to diagnose and monitor an illness. A physical exam typically involves four techniques:
Inspection: Using the naked eye Auscultation: Using a stethoscope Palpation: Applying hand or finger pressure to determine the condition of an underlying organ Percussion: Tapping of a body part to determine the size, consistency, and borders of an organ
Other tests—like a blood pressure reading, reflex test, otoscopic exam (to view inside the ear), and ophthalmoscopic exam (to view inside the eye)—may also be used.
Based on the findings, the physician may order tests and procedures to explore the possible causes of your symptoms.
Lab Tests
Physicians routinely order tests to evaluate body fluids, tissue samples, or even the composition of your breath. The types of tests can be broadly classified by their purpose:
Diagnostics tests include a complete blood count (CBC) to check for infection, fasting plasma glucose (FPG) to diagnose diabetes, and a urinalysis to identify kidney disease. Screening tests include a Pap smear, STD screen, and prenatal quad screening. Monitoring tests help manage recovery or a chronic condition like diabetes, high cholesterol, HIV, hepatitis, or kidney disease.
Samples may be obtained via blood draw, saliva swab, lumbar puncture, biopsy, amniocentesis, or resected organ. The samples would then be sent to a pathology lab where they would be evaluated visually, chemically, microscopically, and sometimes molecularly.
Imaging Studies
Medical imaging involves various technologies that provide a doctor with an indirect look inside the body. The most common can be broadly described as follows:
Radiography: Including X-ray, fluoroscopy, and DEXA scanUltrasound: Including Doppler ultrasound and echocardiogramMagnetic resonance imaging (MRI): Including a cardiac MRITomography: Including computed tomography (CT) and positron emission tomography (PET)Nuclear medicine: Including a nuclear stress test, SPECT scan, and bone scan
Endoscopy
Endoscopy is a technique involving the use of a scope to directly view internal structures. Endoscopy generally takes specialized training for a physician to perform the procedure. Some may be conducted in an office; others may require a hospital or inpatient facilities. Examples include:
Arthroscopy: To look inside a joint Bronchoscopy: To view the lower respiratory tract Colonoscopy: To look inside the colon Colposcopy: To view the cervix Cystoscopy: To look inside the urinary tract Gastroscopy: To view the upper digestive tract Laparoscopy: To view abdominal or pelvic organs
In addition to diagnosis, endoscopy may aid in the removal of lesions, polyps, or tumors, or to resect (cut away) or ablate (remove) diseased tissue.
Medications
Physicians will commonly prescribe medications in the course of their practice. These not only include pharmaceutical drugs that require a doctor’s prescription but over-the-counter (OTC) drugs that you can purchase at the drugstore.
The proper use of a prescription drug is largely directed by the terms of its approval by the Food and Drug Administration (FDA). Medications are sometimes used off-label (meaning for purposes other than those approved by the FDA) if there is evidence of a benefit. One such example is the use of the female fertility drug Clomid (clomiphene) in men with a low sperm count.
Among the drugs a physician may prescribe or recommend:
Pharmaceutical drugs are grouped by classes and typically require years of safety and efficacy research before they are approved. OTC drugs like aspirin and antihistamines are not as stringently regulated and are allowed to be sold under the GRAS/E (generally recognized as safe and effective) classification. Dietary supplements, including vitamins, herbal remedies, and bodybuilding supplements, are substances that are considered safe and potentially beneficial but do not “cure” a disease or medical condition.
Treatment
The selection of an appropriate treatment is based on a physician’s clinical experience, the prescribed guidelines, and the needs, limitations, or desires of the individual patient. If a certain treatment is beyond the scope of a doctor’s practice, the patient will commonly be referred to another specialist.
The clinical practice guidelines are formulated and reviewed by a panel of experts under the auspices of an accredited medical body. The guidelines may be revised whenever new research has shown that a certain drug, treatment, or diagnostic approach is superior or that a traditional approach is either harmful or inferior.
Every medical specialty and subspecialty will have clinical guidelines to help direct treatment decisions. Examples include the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) from the American Psychiatric Association (APA) or HIV screening recommendations issued by the USPSTF.
Specialties
After completion of medical school, physicians will usually further their education by choosing a medical specialty. Depending on the specialty, you may need to undergo several years in a medical residency program with an additional one or more years in fellowship training. From start to finish, some specialties may take up to 18 years of education and training.
Some specialties fall under broader fields of medicines such as internal medicine or surgery. Others are their own specialty. Each specialty has its own board certification body, most of which fall under the umbrella of the American Board of Medical Specialties (ABMS).
Currently, there are 24 different medical specialty boards, and some have multiple subspecialties under them:
Allergy and Immunology Anesthesiology Colon and Rectal Surgery Dermatology Emergency Medicine Family Medicine Internal Medicine Medical Genetics and Genomics Neurological Surgery Nuclear Medicine Obstetrics and Gynecology Ophthalmology Orthopedic Surgery Otolaryngology/Head and Neck Surgery Pathology Pediatrics Physical Medicine and Rehabilitation Plastic Surgery Preventive Medicine Psychiatry and Neurology Radiology Surgery Thoracic Surgery Urology
Training and Certification
The training needed to become a physician is extensive compared to most careers. The educational pathway can vary significantly based on the type of medicine you decide to practice. With that being said, there is a common structure to the educational and training process.
Undergraduate Studies
All doctors must start by obtaining an undergraduate degree from a four-year college or university. While some colleges offer dedicated pre-medicine (“premed”) programs, you can also simply meet the entry requirements of a medical school by completing the prerequisite courses in advanced math, chemistry, biology, physics, and social science.
Additionally, you will need to pass the scored Medical College Admission Test (MCAT), available from January to September. Many people will take the MCAT the year they intend to graduate from college, but others start sooner. This, along with your application, transcripts, grade point average, and interview, is essentially what a medical school needs to assess your eligibility.
Medical School
There are currently 38 medical schools that offer DO degrees in the United States and 141 that offer MD degrees. Deciding which to attend is purely a personal choice. Although osteopathy is considered by some to be the more “holistic” of the two practices, the core medical curriculum is pretty much identical.
Upon entry, you would spend the first two years mainly in the classroom and laboratory. The coursework would cover anatomy, biology, pharmacology, pathology, and other medical sciences. Students would also study the practice of medicine and the legal and ethical issues related to health care.
Much of the second two years would be spent doing clinical rotations in different medical facilities under the supervision of an experienced physician. The rotations offer you broad exposure to different fields of medicine including neurology, radiology, pediatrics, and family medicine.
Residency
Upon graduation from medical school, you would start a residency program. The process would actually start in your fourth year of medical school as you begin making applications to the programs you are interested in.
Depending on medical specialty, a residency can last anywhere from three to seven years. Most residents complete their programs in hospitals under the supervision of an attending physician. The first year is typically devoted to general practice, referred to as an internship.
Residents earn a stipend to cover basic living expenses. Average payment for the first year is about $56,000, and stipends increase with each year that residents advance in their training.
Licensure and Certification
All physicians are required to be licensed in the state in which they intend to practice. To do so, you would need to graduate from medical school and pass a national exam. In some cases you can become licensed as an MD without completing a residency, after your internship. Contact your state medical board for details.
Physicians with an MD degree must complete a three-part test called the U.S. Medical Licensing Examination (USMLE). Those with a DO degree can opt to take the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) instead.
Having board certification can increase your job opportunities and is required by certain hospitals, research facilities, and academic institutions.
Physicians from other countries must complete the Educational Commission for Foreign Medical Graduates (ECFMG) to practice in the United States. The process entails paperwork to verify your degree attendance in medical school as well as an exam to confirm language and medical skills.
A Word From Verywell
It takes dedication to become a physician. In addition to the extensive training, doctors invariably put in long hours for many years and often experience burnout along the way.
Many doctors work 40 to 60 hours per week at the very least, with some averaging between 61 and 80 hours weekly. A typical day might include six to eight hours seeing patients in an office with one to two hours making rounds in hospitals. Many specialties require you to be on-call or to work night shifts and weekends.
It is for this reason that you need to carefully consider which field of medicine is right for you. Ideally, it would be one you can remain passionate about while providing you the work-life balance you need. The rewards, both personal and financial, can make it all worth it.
