Nature of the Work
Physicians perform medical examinations, diagnose illnesses, and treat people suffering from injury or disease. They also advise patients on good health practices. There are two types of physicians: The M.D. - Doctor of Medicine, and the D.O. - Doctor of Osteopathy. 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.
In recent years, advances in medical technology have been many and dramatic. Some have resulted in entirely new medical treatments, such as liver and kidney transplants and ultrasound and magnetic resonance imaging. Others, such as laser surgery and lithotripsy, which uses sound waves to pulverize kidney stones, are replacing traditional treatment methods.
High-technology medicine requires much skill and training. Its dominant role in American medical care underlies the system of specialty medicine. In fact, most M.D.'s are specialists. Medical specialties for which there is training include internal medicine, general surgery, obstetrics and gynecology, psychiatry, pediatrics, radiology, anesthesiology, ophthalmology, pathology, and orthopedic surgery. While most M.D.'s specialize, D.O.'s tend to be primary care providers such as family practitioners.
The shift from fee-for-service medicine to managed care is beginning to alter the practice environment as well. Managed care refers to the effort to cut costs by setting guidelines for medical practice, such as the type and number of tests a physician can order, based on each patient's symptoms. Examples of managed care systems are the popular health maintenance organizations (HMO's) and preferred provider organizations (PPO's).
Working Conditions:
Physicians often work long, irregular hours. While one-fourth generally work a 40-hour week, almost half work more than 60 hours a week. Most specialists work fewer hours each week than general and family practitioners. As doctors approach retirement age, they may accept fewer new patients and tend to work shorter hours.
Physicians in salaried positions, such as those in HMO's or group practice, generally have shorter and more regular hours, consult more with peers, and have more flexible work schedules than solo practitioners.
Unlike salaried physicians or those in group practice, solo practitioners are responsible for the business aspect of a practice. This includes handling all administrative tasks such as keeping track of inventory, ordering supplies, paying bills, and hiring support personnel.
Employment:
A majority of the Physicians were in office-based practice; about one-fifth were employed in hospitals; and most of the remainder practiced in HMO's, urgent care centers, surgical centers, public health clinics, and the Federal Government
While some physicians are solo practitioners, a growing number are partners or salaried employees of group practices. Sometimes organized as clinics and sometimes as a group of physicians, medical groups can afford expensive medical equipment and realize other business advantages. For this reason, and because such practices have the flexibility to adapt to changes in the health care environment, group practice is becoming more prevalent.
Currently, more medical students are being exposed to practice in rural communities with the direct support of educational centers and hospitals in more populous areas.
Training and Other Qualifications:
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. A few medical schools offer a combined college and medical school program that lasts 6 years instead of the customary 8.
Required premedical study includes undergraduate work in English, physics, biology, and inorganic and organic chemistry. Students should also take courses in the humanities, mathematics, and the social sciences to acquire a broad general education. Medicine is a popular career, and most applicants to medical school compete with other students who generally have excelled in pre professional education. Application to medical school is much like application to college. Applicants must submit transcripts, their scores from the Medical College Admission Test (MCAT), and letters of recommendation. An interview with an admissions officer may also be necessary. Character, personality, leadership qualities, and participation in extracurricular activities also play a role in the selection process.
Students spend the first 2 years of medical school primarily in laboratories and classrooms taking basic medical courses such as anatomy, biochemistry, physiology, pharmacology, microbiology, pathology, medical ethics, and laws governing medicine. They also learn how to take case histories, perform examinations, and recognize symptoms. Some schools provide students with clinical experience during this lime.
During the last 2 years, students work under supervision in hospitals and clinics to learn acute, chronic, preventive, and rehabilitative care. Through rotations in internal medicine, obstetrics and gynecology, pediatrics, psychiatry, and surgery, they gain experience in the diagnosis and treatment of illness. While in school, most medical school students must take an exam given by the National Board of Medical Examiners (NBME); most osteopathy students must take an exam given by the National Board of Osteopathic Medical Examiners (NBOME).
After graduation, all D.O.'s must serve a 12-month rotating internship which includes experience in surgery, pediatrics, internal medicine, and other specialties. M.D.'s and D.O.'s seeking board certification in a specialty may spend up to 5 years, depending on the specialty, in residency training. For those training in a subspecialty, another 1 to 2 years of residency is usual. A final examination immediately after residency, or after 1 or 2 years of practice, is also necessary for certification.
All States, the District of Columbia, and U.S. territories require physicians to be licensed. Licensure requirements for both D.O.'s and M.D.'s include graduation from an accredited professional school, completion of a licensing examination, and, in most States, between 1 and 6 years of supervised practice in an accredited graduate medical education program (internship/residency).
Graduates of foreign medical schools can generally begin practice in the United States after completing a U.S. hospital residency training program. To enter an approved residency, graduates of foreign medical schools must pass an examination administered by the Educational Commission for Foreign Medical Graduates and be certified by that organization. After 1 year of work in an approved residency, foreign medical graduates, as well as graduates of U.S. medical schools who have not taken the NBME or NBOME test, must take the Federation Licensing Examination (FLEX) that all jurisdictions accept. Although physicians licensed in one State can usually get a license to practice in another without further examination, some States limit reciprocity.
To teach or do research, physicians may acquire a master's or Ph.D. in such fields as biochemistry or 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. Scholarships, while still available, have become harder to find. Loans are available, but subsidies to reduce interest rates are limited.
Persons who wish to become physicians must have a desire to serve the sick and injured, be self-motivated, and be able to survive the pressures of premedical and medical education. The workload associated with internship/residency that follows medical school is very heavy, with residents often working 24-hour shifts and 80 hours a week or more. Efforts, however, are being made to limit the hours a resident can work without a break. Prospective physicians must also be willing to study throughout their career in order to keep up with advances in medical science. Physicians should have a good bedside manner, be emotionally stable, and be able to make decisions in emergencies.
Job Outlook:
Employment of physicians is expected to grow faster than the average for all occupations, due to continued expansion of the health industry. Population growth and aging; continued introduction of new treatments and procedures; and the widespread ability to pay for services through private insurance, Medicare, and Medicaid will underlie future growth in demand for physicians. Tending to constrain what would otherwise be faster growth, however, are managed care arrangements such as HMO's which place greater reliance on physician assistants and nurse practitioners to provide services. The need to replace physicians is low because almost all physicians remain in the profession until they retire.
The number of medical school graduates remains at current high levels, the supply of physicians is expected to exceed demand. The surplus of physicians will continue to affect patient load, earnings, geographic location, specialty choice, and practice selling. Some communities may have too many physicians - leading to fewer patient visits per physician and correspondingly lower earnings. There is already some evidence that the over-supply of physicians in large metropolitan areas has encouraged some to relocate to historically underserved areas. However, areas that are too sparsely populated, or too poor, are not likely to attract doctors.
Despite prospects of a general oversupply of physicians, there may not be a surplus of primary care physicians, specifically general/family practitioners and internists, or of specialists in geriatric and preventive medicine.
On the other hand, some medical specialties will experience even greater competition in the future. These specialties include many of the surgical subspecialties, such as neurosurgery and orthopedic surgery, as well as ophthalmology, pathology, and radiology. The specialty imbalances mentioned above assume that specialty choices will not change markedly in the future. Decisions about the specialty to pursue are governed by factors such as lifestyle and faculty role models as well as by economic considerations.
Unlike their predecessors, newly trained physicians face radically different choices of where and how to practice. Many new physicians are likely to avoid solo practice and 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 associated with establishing a private practice while paying off student loans.
Graduates of foreign medical schools have long been a source of physicians in the United States. It seems unlikely; however, that they will continue to augment the supply of U.S.-trained physicians to the extent they have had in the past. This is due to such factors as lower foreign medical school enrollments, more difficult qualifying entrance exams for foreign-trained students seeking U.S. residencies, and keener competition for a residency once having passed the exams.
Related Occupations
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 audiologists, chiropractors, dentists, optometrists, podiatrists, speech pathologists, and veterinarians.
