These questions are from a recent Q&A with the fantastic pre-med society at BYU-Idaho. We wanted to be sure to give each question its due attention for their benefit and for any others with similar questions.
On average, how long is medical school?
I’m wondering if there is an additional question here. The actual path to becoming a physician is quite convoluted and often the time between graduating from undergrad and starting your first job as a fully trained attending physician is called “med school” by the general public. It took me almost 3 years before I actually figured out what the path was. Also, why an intern and a resident were the same but different. (All interns are residents, not all residents are interns. More on this in a minute)
On average, medical school in the US is 4 years for a standard MD or DO, so 8 years to get the degree (4 undergrad + 4 med school). If you decided to do one of those combined BS/MD programs, you might shave off 1-2 years. Alternatively, if you opt to go for the eternal medical student route of the MD/PhD, the medical school portion can take you 7+ years, but you graduate with the dual degrees. And everyone will automatically know you are better than them.
Another common option is to take a year or two off at some point before your 4th year to delay graduation and complete some extra research (not usually leading to a PhD) in order to make yourself a more competitive candidate for ultra-competitive specialties and programs. Some people might complete other degrees during this time as well, like a Master’s in public health or MBA. This sort of thing is becoming more common unfortunately. Pretty soon Derm hopefuls may be forced into taking a research year just to match.
After graduating medical school, you are a physician. But you aren’t licensed yet. You essentially have some expensive credentials behind your name without much earning potential. Unless your plan all along was to leave medicine and go work in industry developing drugs or medical devices.
In order for you to be licensed, you have to pass your boards, and if you want a job, you have to complete a residency program.
What is the difference between residency and fellowship?
Residency is the post-medical school training where you are functioning as a doctor and earning money. Usually $55K-63K at the start. You can prescribe medications, do procedures, admit and discharge patients, but happens under some form of supervision. The actual length of residency varies widely depending on the specialty. Usually 3-7 years. This is when you actually learn how to be a doctor. Med school prepares you for residency, residency prepares you to be a doctor.
So, what is fellowship? Fellowship is like residency, but it is typically more focused into a single area within a specialty or branch of medicine, and it takes place AFTER residency. They vary in length between 1-4 years, again, depending on specialty. Fellowship allows you to gain extra training to learn advanced procedures, manage more complex conditions, or gain acceptance into the ranks of particular sub-specialties.
Fellowships are also paid, usually starting at $65K-75K (depends on how long your residency was). Fellows have more autonomy than residents and can do many things without supervision. They really only require supervision in a few areas.
There is a hierarchy to all this of course. If you mistake an attending for a fellow, they get pissed. If you call a fellow “resident”, they get pissed. If you call a resident a medical student, they get pissed. And they all forget about that poor medical student standing awkwardly in the corner.
Breaking it down
Only the people who have gone through medical training themselves or with a significant other truly understand the process. You will exhaust yourself trying to explain to people which phase you are in, and nobody understands the stress and strain you are under while preparing for exams and application cycles.
The life cycle of a doctor:
- An undifferentiated undergraduate student watches an episode of house, a pre-med is born.
- The pre-med toils in undergrad for 4 years and is accepted to medical school.
- The newly minted medical student, again, works very hard and discovers their passion within medicine. Over 4 years they check all the boxes of the residency application. They match into their dream specialty.
- They are finally an MD/DO. Alas, they once again find themselves at the bottom of the totem pole, for they are a lowly first year doctor, a PGY-1, an Intern. Some residencies/specialties offer internships connected to the main residency program, called “categorical positions”. Others accept you on the condition that you complete an internship somewhere else before showing up, termed “advanced positions”. Intern year is a combination of general medical or surgical rotations with a smattering of electives intended to give you broad-based knowledge to build upon in subsequent years. And it traditionally sucks eggs.
- The interns emerge victorious and claim their place as PGY-2s and, depending on the length of their residency program, are either “junior residents” or “senior residents”. The “senior” distinction is made if they are technically more than halfway done with their program at this point.
- The resident slogs through potentially several more years of PGY-X roles, gaining confidence and assuming more responsibility and autonomy with each year of experience. Eventually, they perceive a light at the end of the tunnel, giving them hope that they will overcome their suffocating debt and be able to reclaim control of their own lives and schedules at last. Or, perhaps they postpone their day in the sun for another 1-3 years to pursue further training as a fellow.
- They graduate and pass their board certifications. The journey to fully functioning attending is complete and it only took 11-16 years. Now the actual work can begin. It starts out feeling uncomfortable to be flying solo, but soon the attending settles into a rhythm.
I don’t know about you, but I’m exhausted. I think I’ll go take a nap. Oh that’s right, I can’t. I have to study.
