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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. They may be part of a team that coordinates care for a population of patients.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. While M.D.'s and D.O.'s may use all accepted methods of treatment, including drugs and surgery, D.O.'s place special emphasis on the body's musculoskeletal system. They believe that good health requires proper alignment of bones, muscles, ligaments, and nerves. D.O's use osteopathic manipulative techniques to diagnose and treat patients.
About one third of M.D.'s are primary care physicians—pediatricians, general and family practitioners, or general internists—who are usually the first health professionals patients consult. They tend to see the same patients on a regular basis for preventive care and to treat a variety of ailments. When appropriate, they refer patients to other specialists (See table 1.) D.O.'s are more likely to be primary care providers than allopathic physicians, although they can be found in all specialties.
Table 1. Percent distributions of M.D.'s by specialty, 1993Percent Total 100.0 General and family practice 10.7 Internal medicine 16.5 Pediatrics 6.9 Medical specialties Allergy .5 Cardiovascular diseases 2.6 Dermatology 1.2 Gastroenterology 1.2 Obstetrics and gynecology 5.3 Pediatric cardiology .2 Pulmonary diseases 1.0 Surgical specialties Colon and rectal surgery .1 General surgery 5.7 Neurological surgery .7 Ophthalmology 2.5 Orthopedic surgery 3.1 Otalaryngology 1.3 Plastic surgery .7 Thoracic surgery .3 Urological surgery 1.4 Other specialties Aerospace medicine .1 Anesthesiology 4.4 Child psychiatry 2.8 Emergency medicine 2.4 Forensic pathology .1 General preventive medicine .2 Neurology 1.5 Nuclear medicine .2 Occupational medicine .4 Pathology 2.6 Physical medicine and rehabilitation .7 Psychiatry 5.5 Public health .3 Radiology 1.1 Radiation oncology .5 Other specialty 1.1 Unspecified/unknown/inactive 13.4Source: American Medical Association
Many physicians work long, irregular hours. About one-half of all full-timers in 1994 worked 60 hours a week or more. In general, as doctors approach retirement age, they may accept fewer new patients and tend to work shorter hours. Physicians who are on-call may make emergency visits to hospitals. Increasingly, physicians are practicing in groups or health care organizations that provide back-up coverage and allow for more time off. Many physicians must travel frequently between office and hospital to care for their patients.
Physicians (M.D.'s and D.O.'s) held about 539,000 jobs in 1994. About 2 out of 3 were in office-based practice, including clinics and HMO's; about one-quarter were employed in 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.
The Northeast and West have the highest ratio of physicians to population; the South, 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. Some rural and inner city areas remain underserved, although the situation has improved.
Osteopathic physicians locate chiefly in States that have osteopathic schools and hospitals. In 1995, 3 out of 4 D.O.'s practiced in 12 States. Michigan had the most D.O.'s, followed by Pennsylvania, Ohio, Florida, New Jersey, and Texas.
It usually takes about 11 years to become a physician: 4 years of undergraduate school, 4 years of medical school, and 3 years in residency. However, a few medical schools offer a combined college and medical school program that lasts 6 years instead of the customary 8 years. For some specialties, residency may take longer, up to 8 years.Premedical students must complete undergraduate work in physics, biology, mathematics, English, and inorganic and organic chemistry. Students should also take courses in humanities and the social sciences. Applicants may also want to volunteer at a local hospital or clinic 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 141 medical schools in the United States—125 teach allopathic medicine and award a Doctor of Medicine (M.D.); 16 teach osteopathic medicine and award the Doctor of Osteopathy (D.O.). Acceptance to medical school is very competitive. Applicants must submit transcripts, scores from the Medical College Admission Test (MCAT), and letters of recommendation. Most schools require an interview with an admissions officer. Schools also consider character, personality, leadership qualities, and participation in extracurricular activities.
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 recognize symptoms. 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 go directly on to graduate medical education, called a residency. All students, including foreign medical school graduates, applying for licensure—a requirement for the job of resident—take a standard examination. Most D.O.'s serve a 12-month rotating internship after graduation. The National Board of Osteopathic Medical Examiners gives an examination for internship application. Following their internship, many D.O.'s take a residency program in a specialty area.
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—a residency for M.D.'s and an internship and residency for D.O.'s. 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 qualify for licensure after passing an examination and completing a U.S. hospital residency training program.
M.D.'s and D.O.'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: Allergy and immunology; anesthesiology; colon and rectal surgery; dermatology; emergency medicine; family practice; internal medicine; neurological surgery; nuclear medicine; obstetrics and gynecology; ophthalmology; orthopedic surgery; otolaryngology; pathology; pediatrics; physical medicine and rehabilitation; plastic surgery; preventive medicine; psychiatry and neurology; radiology; surgery; thoracic surgery; and urology. For those training in a subspecialty, another 1 to 2 years of residency is usual.
To teach or do research, physicians may need a master's or Ph.D. in such fields as biochemistryor microbiology. They may otherwise spend 1 year or more in research or in an advanced clinical training fellowship.
A physician's training is costly. While 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. Prospective physicians must also be willing to study throughout their career to keep up with medical advances. Physicians should have a good bedside manner, emotional stability, and the ability to make decisions in emergencies.
Employment of physicians is expected to grow faster than the average for all occupations through the year 2005 due to continued expansion of the health industry. New technologies permit more intensive care: Physicians can do more tests, perform more procedures, and treat conditions previously regarded as untreatable. In addition, the population is growing and aging, and health care needs increase sharply with age. The need to replace physicians is lower than for most occupations because almost all physicians remain in the profession until they retire.Job prospects are good for primary care physicians such as family practitioners and internists, and for geriatric and preventive care specialists. Because of efforts to control health care costs and increased reliance on utilization guidelines that often limit the use of specialty services, a lower percentage of specialists will be in demand. Some shortages have been reported in the specialty area of general surgery, and in some rural and low income areas. This is because physicians find these areas unattractive due to low earnings potential, isolation from medical colleagues, or other reasons, not because of any overall shortage.
Some health care analysts believe that there is, or that there soon could be a general oversupply of physicians; others disagree. In analyzing job prospects, it should be kept in mind that an oversupply may not necessarily limit the ability of physicians to find employment or to set up and maintain a practice. It could result in physicians delegating fewer tasks and working fewer hours. Physicians might be able to spend more time with each patient, give more attention to preventive care, and provide more services in rural and poor areas. It is also possible that physicians trained in specialties would provide services outside their specialty area.
Unlike their predecessors, newly trained physicians face radically different choices of where and how to practice. Many new physicians are less likely to enter solo practice and more likely to take salaried jobs in group medical practices, clinics, and HMO's in order to have regular work hours and the opportunity for peer consultation. Others will take salaried positions simply because they cannot afford the high costs of establishing a private practice while paying off student loans.
Physicians have among the highest earnings of any occupation. According to the American Medical Association, average (mean) income, after expenses, for allopathic physicians was about $189,300 in 1993, and median income was $156,000. The middle 50 percent earned between $108,000 and $240,000. Self-employed physicians—those who own or are part owners of their medical practice——had higher median incomes than salaried physicians. Earnings vary according to number of years in practice; geographic region; hours worked; and skill, personality, and professional reputation. As shown in table 2, median income of allopathic physicians, after expenses, also varies by specialty.
Table 2. Median net income of M.D.'s after expenses, 1993All physicians $156,000 Radiology 240,000 Surgery 225,000 Anesthesiology 220,000 Obstetrics/gynecology 200,000 Pathology 170,000 Emergency medicine 164,000 Internal medicine 150,000 Psychiatry 120,000 Pediatrics 120,000 General/Family practice 110,000Source: American Medical Association
Average salaries of medical residents ranged from $30,753 in 1994-95 for those in their first year of residency to $41,895 for those in their eighth year, according to the Association of American Medical Colleges.
Physicians work to prevent, diagnose, and treat diseases, disorders, and injuries. Professionals in other occupations that require similar kinds of skill and critical judgment include acupuncturists, audiologists, chiropractors, dentists, nurse practitioners, optometrists, podiatrists, speech pathologists, and veterinarians.
For a list of allopathic medical schools, as well as general information on premedical education, financial aid, and medicine as a career, contact:
American Medical Association, 515 N. State St., Chicago, IL 60610.Association of American Medical Colleges, Section for Student Services, 2450 N St. NW., Washington, DC 20037-1131.
For general information on osteopathic medicine as a career, contact:
American Osteopathic Association, Department of Public Relations, 142 East Ontario St., Chicago, IL 60611. American Association of Colleges of Osteopathic Medicine, 6110 Executive Blvd., Suite 405, Rockville, MD 20852.Information on Federal scholarships and loans is available from the directors of student financial aid at schools of allopathic and osteopathic medicine.
Information on licensing is available from State boards of examiners.
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