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Nature of the Work
* Amid reports of an oversupply of physicians, opportunities will be best in primary care fields of general and family medicine, internal medicine, and general pediatrics.
* Physicians are much more likely to work as salaried employees of group medical practices, clinics, or health care networks than in the past.
* It takes many years of education and training to become a physician, but earnings are among the highest of any occupation.
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.
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, preventive medicine, and holistic patient care.
About one third of M.D.'s are primary care physicians. They practice general and family medicine, general internal medicine, or general pediatrics and are usually the first health professionals patients consult. Primary care physicians tend to see the same patients on a regular basis for preventive care and to treat a variety of ailments. General and family practitioners emphasize comprehensive health care for patients of all ages and for the family as a group. Those in general internal medicine provide care mainly for adults who have a wide range of problems associated with the body's organs. General pediatricians focus on children's health. When appropriate, primary care physicians refer patients to specialists, who are experts in medical fields such as obstetrics and gynecology, cardiology, psychiatry, or surgery (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 distribution of M.D.'s by specialty, 1995
Percent Total 100.0 Primary care General internal medicine 16.0 General and family medicine 10.5 General pediatrics 7.0 Medical specialties Allergy .5 Cardiovascular diseases 2.6 Dermatology 1.2 Gastroenterology 1.3 Obstetrics and gynecology 5.2 Pediatric cardiology .2 Pulmonary diseases 1.0 Surgical specialties Colon and rectal surgery .1 General surgery 5.2 Neurological surgery .7 Ophthalmology 2.4 Orthopedic surgery 3.1 Otalaryngology 1.3 Plastic surgery .8 Thoracic surgery .3 Urological surgery 1.4 Other specialties Aerospace medicine .1 Anesthesiology 4.6 Child psychiatry .8 Diagnostic radiology 2.7 Emergency medicine 2.7 Forensic pathology .1 General preventive medicine .2 Neurology 1.6 Nuclear medicine .2 Occupational medicine .4 Pathology 2.5 Physical medicine and rehabilitation .8 Psychiatry 5.3 Public health .2 Radiology 1.1 Radiation oncology .5 Other specialty 1.0 Unspecified/unknown/inactive 14.4
Many physicians work long, irregular hours. About one-third of all full-time physicians worked 60 hours or more a week in 1996. They must travel frequently between office and hospital to care for their patients. Increasingly, physicians practice in groups or health care organizations that provide back-up coverage and allow for more time off. These physicians work as part of a team that coordinates care for a population of patients; they are less independent than solo practitioners of the past. Physicians who are on-call deal with many patients' concerns over the phone, and may make emergency visits to hospitals.
Physicians (M.D.'s and D.O.'s) held about 560,000 jobs in 1996. About 7 out of 10 were in office-based practice, including clinics and HMO's; about 2 out of 10 were employed by 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. Also, hospitals are integrating physician practices into health care networks that provide a continuum of care both inside and outside of the hospital setting.
The Northeastern and Western States have the highest ratio of physicians to population; the South Central States, 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.
Osteopathic physicians locate chiefly in States that have osteopathic schools and hospitals. In 1997, about one-half of active D.O.'s practiced in six States: Pennsylvania, Michigan, Ohio, Florida, New Jersey, and Texas.
It takes many years of education and training to become a physician: 4 years of undergraduate school, 4 years of medical school, and 3 to 8 years of internship and residency, depending on the specialty selected. A few medical schools offer a combined undergraduate and medical school program that lasts 6 years instead of the customary 8 years.
Premedical students must complete undergraduate work in physics, biology, mathematics, English, and inorganic and organic chemistry. Students also take courses in the humanities and the social sciences. Some students also volunteer at local hospitals or clinics 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 142 medical schools in the United States125 teach allopathic medicine and award a Doctor of Medicine (M.D.); 17 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, and letters of recommendation. Schools also consider character, personality, leadership qualities, and participation in extracurricular activities. Most schools require an interview with members of the admissions committee.
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 diagnose illness. 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 enter a residencygraduate medical education in a specialty that takes the form of paid on-the-job training, usually in a hospital. Most D.O.'s serve a 12-month rotating internship after graduation before entering a residency which may last 2 to 6 years. Physicians may benefit from residencies in managed care settings by gaining experience with this increasingly common type of medical practice.
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. 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. residency.
M.D.'s and D.O.'s seeking board certification in a specialty may spend up to 7 yearsdepending on the specialtyin 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, ranging from allergy and immunology to urology. For certification in a subspecialty, physicians usually need another 1 to 2 years of residency.
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. Physicians must also have a good bedside manner, emotional stability, and the ability to make decisions in emergencies. Prospective physicians must be willing to study throughout their career to keep up with medical advances. They will also need to be flexible to respond to the changing demands of a rapidly evolving health care system.
Employment of physicians will grow faster than the average for all occupations through the year 2006 due to continued expansion of the health care industries. The growing and aging population will drive overall growth in the number of physicians. In addition, new technologies permit more intensive care: Physicians can do more tests, perform more procedures, and treat conditions previously regarded as untreatable. Job prospects will be best for primary care physicians such as general and family practitioners, general pediatricians, and general 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. At the same time, the number of specialists continues to grow. Competition for jobs among specialists will be especially keen in large urban and suburban areas, and for those who work directly for hospitals, such as anesthesiologists and radiologists.
A number of prestigious organizations, including the National Academy of Sciences Institute of Medicine and the Pew Health Professions Commission, have found a current oversupply of physicians. They suggest that measures should be taken to reduce the number being trained through such means as a reduction in the number of residency slots. If successful, a reduction in the number of new physicians entering the workforce will help to alleviate the effects of any physician oversupply.
A physician oversupply may not substantially limit the ability of physicians to find employment. However, it could result in physicians working fewer hours, having lower earnings, and having to practice in underserved areas. Opportunities should be good in some rural and low income areas, because some physicians find these areas unattractive due to lower earnings potential, isolation from medical colleagues, or other reasons. It is also possible that physicians trained in specialties will provide primary care services as well as specialty care.
Unlike their predecessors, newly trained physicians face radically different choices of where and how to practice. New physicians are much less likely to enter solo practice and more likely to take salaried jobs in group medical practices, clinics, and health care networks.
Physicians have among the highest earnings of any occupation. According to the American Medical Association, median income, after expenses, for allopathic physicians was about $160,000 in 1995. The middle 50 percent earned between $115,000 and $238,000. Self-employed physiciansthose who own or are part owners of their medical practicehad 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.
Average salaries of medical residents ranged from $32,789 in 1996-97 for those in their first year of residency to $40,849 for those in their sixth year, according to the Association of American Medical Colleges.
Table 2. Median net income of M.D.'s after expenses, 1995
All physicians $160,000 Radiology 230,000 Surgery 225,000 Anesthesiology 203,000 Obstetrics/gynecology 200,000 Pathology 185,000 Emergency medicine 170,000 General internal medicine 138,000 Pediatrics 129,000 Psychiatry 124,000 General/Family practice 124,000
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, physician assistants, podiatrists, speech pathologists, and veterinarians.
For a list of allopathic medical schools and residency programs, 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. Homepage: http://www.aamc.org
For general information on osteopathic medicine as a career, contact:
American Osteopathic Association, Department of Public Relations, 142 East Ontario St., Chicago, IL 60611. Homepage: http://www.am-osteo-assn.org
American Association of Colleges of Osteopathic Medicine, 5550 Friendship Blvd., Suite 310, Chevy Chase, MD 20815-7321. Homepage: http://www.aacom.org
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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