Who should read this chapter? All those who are interested in pursuing a career requiring a college education.
Summary: College educational requirements are highly variable for different career paths. Having a basic understanding of these college requirements permits a student to make a more informed career choice decision and better college planning. This chapter compares the college requirements for a variety of career choices, but it focuses mostly on careers in health care and medicine. The medical education system in this country is described at the end of this chapter. Terms such as intern, resident, fellow, specialist and subspecialist are explained.
When I was growing up, I did not know how long I had to go to school. I thought I wanted to be a biologist, teacher, doctor, businessman, or something like that. It would be nice to know how much schooling each of these requires. Many parents do not know the answers to these questions and many school counselors may not have all the answers either. The purpose of this chapter is to provide a guide to help answer these questions.
Some of the background information here is provided in the chapter on selecting a college which reviews the differences between small, medium and large colleges and universities. Attending school until age 18 is required in most states, but graduation with a high school diploma is not necessarily required. Hopefully, if you're reading this chapter, you are planning a college education for your children no matter what career they decide on. Licensing requirements for jobs may differ in each state, but the following table provides a rough idea of what is required.
Keep in mind that for any type of job, a college degree may not be required, but in many instances, not having a college degree will put one at a competitive disadvantage making it essentially impossible to get the job without a college degree.
One of the most interesting educational requirements that I find unexpected is that most nurses have 2-year college degrees (associate degrees). One would think that for a job which is so closely depended upon in the care patients with serious illness, a higher educational level would be required. In fact, most registered nurses (RN's) do not have bachelor degrees. Licensed practical nurses (LPN's) are on a lower pay and skill level, with a lower educational requirement. LPN's generally assist RN's in patient care, while RN's carry out most of the physician orders.
The medical education system is something that is difficult to understand so I think it might be useful to some, to understand it just in case your children might be interested in becoming a physician. I remember when I was in college, I didn't understand any of this. The following sequence of events is how most physicians are trained:
In college, most students who want to go on to medical school are known as pre-med students. In some colleges, there is a major called "pre-med", but in most colleges, you must pick a specific major that has an actual subject such as biology, chemistry, anatomy, physiology, microbiology, zoology, biochemistry, medical technology, etc. These are the undergraduate majors that will provide students with the most background that builds a useful base of information in preparation for medical school. Students majoring in non-biomedical subjects such as sociology, accounting, foreign language, math, computer science, engineering, etc., are not excluded from medical school, but these students have a disadvantage at entering medical school and if they do get accepted to medical school, these students have to learn a lot more basic science that is assumed to have been learned in college.
The medical school entrance examination known as MCAT (medical college admission test) is taken during college. A student's MCAT scores are very important. Many students will take the MCAT 2 or 3 times in an attempt to improve their scores. Since the MCAT contains specific subject area scores in biology, chemistry and physics, students who have majored in the sciences generally have higher scores in these areas. Thus, there is a substantial advantage for students who major in the biomedical sciences during college compared to those who do not.
During college, it is important for students to gain some actual experience in the health care field. This demonstrates a commitment and serious dedication on the student's part and it provides valuable insight into the career area that the student is about to enter. Most students get this experience through volunteer work in a hospital or biomedical research with a professor. Volunteer work in a hospital is often a superficial experience without value (other than to say that "I was a volunteer") unless this is taken seriously by spending at least 8 hours a week volunteering. If less than 8 hours per week are spent, then the volunteer is not there long enough to know the hospital staff and their routines. If the staff doesn't get to know the volunteer well enough, they won't trust the volunteer to do anything other than to change linen or take a cup of urine to the lab.
Most students do not go to graduate school (a master's degree program), because a master's degree is not required for medical school entry. A master's degree should be considered optional since it will take an additional 1-2 years to complete. Many students enter a master's degree program if they are not accepted to medical school on their first attempt. A master's degree gives students an advantage in getting into medical school since they have a higher level of academic achievement than those student applicants with bachelor degrees. Common majors in master's degree programs that give students an advantage in medical school include, biomedical sciences and public health.
Medical school itself is usually 4 years. Tuition is highly variable, but it ranges from $10,000 per year to $40,000 per year or more. There are some medical schools that will graduate you in 3 years. There are also some programs that will accept students into a 6 year MD program directly out of high school. But in most instances, medical school is 4 years with the first two years focussing on the basic sciences of biochemistry, anatomy, cell biology, histology, physiology, pharmacology and pathology, with the last two years focussing on the clinical sciences of internal medicine, surgery, pediatrics, obstetrics, gynecology, psychiatry, family practice, emergency medicine and some of the other specialties.
During medical school (usually by the beginning of their fourth year), medical students must decide on a specialty choice and apply for a position in a residency training program. Most students choose one of the six major specialties of internal medicine, surgery, pediatrics, obstetrics/gynecology (known as Ob/Gyn), psychiatry and family practice. Fewer will apply into residency training programs in anesthesiology, dermatology, ophthalmology, ENT (ear, nose, throat) surgery, orthopedics, emergency medicine and radiology.
Once a student graduates from medical school, they have an MD or DO degree and they are now officially a physician (doctor). Most major medical schools grant MD (doctor of medicine) degrees, but some other schools grant DO (doctor of osteopathic medicine) degrees. DO's are known as "osteopathic physicians" or "osteopaths" for short. MD's are known as "allopathic physicians" or "physicians" for short. While they are known as doctors, they are not licensed to practice medicine unless they enter an internship or a residency training program.
An "intern" is a physician in their first year of training. A "resident" is a physician in a residency training program. Thus, a "first year resident" and an "intern" mean roughly the same thing. After medical school, the newly graduated physicians enter residency training programs in a specialty. A few new physicians opt for a rotating internship instead of residency. The rotating internship used to be routine in the past, but currently only a few physicians enter rotating internships; when newly graduated physicians rotate through two month blocks of internal medicine, surgery, pediatrics, psychiatry, ob/gyn and family practice. Nowadays, most newly graduated physicians enter straight into residencies. The advantage of this is that physicians spend more time in their specialty training, but the disadvantage is that physicians are not as well rounded in the other specialties as they used to be.
The good news as interns and residents, these young physicians are now paid. At age 26, they will finally get a paycheck as a physician. Residents render a service in the hospital because they help to provide necessary medical services, usually within the hospitals. Hospitals pay residents for their services. Most large hospitals employ residents in this fashion, often under the training supervision of a university medical school. Thus, the medical school not only trains medical students for 4 years, they also provide the training, supervision and teaching in residency programs. Most medical schools also provide continuing medical education to practicing physicians in addition to their research activities. Most residency programs pay resident physicians about $40,000 per year. This might sound like a lot or a little to you depending on your point of view. Realize that residents are physicians and they generally work very hard, taking turns covering the hospital during nights and weekends.
After residency training is completed, most physicians are now considered specialists in their area of training. They must now take a board certification examination to be board certified in their specialty. Board certification exams are expensive (about $1000) and difficult to pass. Some board exams are lengthy written or computer based exams, while others are combinations of written and live oral exams. Most physicians will become board certified in their specialty within about one year after completing residency training. Physicians who do not take the board certification examination or they fail the exam, can still practice medicine, but they are not board certified. Many patients choose to see physicians who are not board certified.
Specialists can further subspecialize to become a super-specialist (known as a subspecialist), by entering a subspecialty training program. These physicians in subspecialty training are known as fellows. Most fellows are board certified in their basic specialty, but seek training and eventually board certification in a subspecialty. For example, cardiologists must first train in an internal medicine residency. Once they complete this, they must then train in a cardiology fellowship. The following is a partial list of examples of subspecialists and their usual course of training:
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