Journey to being a Doctor

An informal overview of how doctors become doctors

This is @NotInMedicine's (that’s still me) perspective on a doctor’s path to being a doctor. Much of this may or may not exist in reality.

K-12

From a young age, they are told that they will be a doctor someday because that is what most parents dream for their children (at least before nerds and influencers became filthy rich). They see signs that they were meant to be a doctor; for example, their blood type is A+. They go through grade school aceing (or is it acing? I’ll ask Dr. Viv) all their classes. They take the ACT and SAT, the first set of standardized tests they’ll worry about because it unfairly influences where they can get in for college. Keep in mind that all the standardized tests they take on this journey are probably terrible indicators of how well they will perform.

Based on the ACT/SAT scores, they apply to schools based on location and a list that some news organization makes up. They open all the emails of acceptances and rejections, but more acceptances. They choose the highest school on that list, and their parents are slightly disappointed.

Undergraduate (Grades 13-16)

Then, they start collecting loans for undergraduate school, where they get a bachelor of science degree; if they are courageous, they will major in bioengineering.

Trauma bonding yay!

Then, they take the MCAT, where the questions are as ferocious as the name. The scoring is as mysterious as the black alley cat, with a high score of 528. This test decides the fate of what medical schools they can get into. No worries, though; to make it this far, they must be a good test taker anyway; that’s a good thing because there is much more to come.

Based on the MCAT score, they apply to schools based on location and a list that some news organization makes up. They do interviews at multiple schools (but at least they are virtual. They had to pay their own way before COVID) and eventually get accepted and choose a school, and their parents are slightly disappointed.

Medical School (Grades 17-20)

Once they get into medical school, they are rewarded with a short white coat and even more loans! The length of the white coat will differentiate them from more experienced doctors with longer white coats. But before they go into the clinical setting, they have two more years of being in the classroom and the start of another series of standardized tests with USMLE Step 1 (which was switched to pass/fail in 2022 because it stressed students out too much. Talk about a bunch of softies.).

Then, they become underlings of a resident and an assistant during surgeries as they rotate through the hospital's various departments for years 3 and 4. Then, they’ll take another standardized test, USMLE Step 2, which unfairly influences where they can get in for residency.

There’s also a subset of students who are gunners and snipers. Gunners try very hard to get to the top of the class and take down other students when they see an opportunity to. Snipers are gunners but are better at taking other students without being seen and tend to be more malicious.

Trauma bonding yay!

Based on Step 2, they apply to residency programs based on location and a list that some news organization makes up. They do interviews at multiple programs (but at least they are virtual. They had to pay their own way before COVID).

Then, the students rank their programs and the programs rank the students in a process called “The Match”. There is a whole bunch of strategy here and political-like positioning; rankings are treated like secrets.

Usually, the gunners and snipers are aiming for more coveted programs like surgery and dermatology (that’s where the money and prestige are).

Eventually, the computer algorithm does its thing to optimize the matches between medical students and programs based on their rankings.

Then, after much stress, the medical school holds an extravagant ceremony where individuals get envelopes of where they matched. They open the envelopes excitedly but will likely be brought down to earth when they don’t get their first choice.

They graduate, and they are finally doctors (M.D. or D.O., which I do not have the time to go over nor do I want to get in trouble like Hasan Minhaj has with this).

The parents are slightly disappointed that the residency is not closer to home or that it is not their top choice.

Residency (Grades 21-27)

July. The first month of residency. 1st year interns are practicing doctors for the first time. Every hospital system is filled with new doctors on July 1st. They are supervised by more senior residents and attendings (doctors who finished their training). The "July effect" is the idea that the start of medical residencies in July leads to an increase in medical errors and patient complications. While logically, there hasn’t been any evidence of it being true (maybe I should have fact-checked other things in this post…).

Training is grueling. The system limits residents to working 80 hours a week. Why 80 hours? Who knows, but they probably work beyond 80 most weeks anyways.

Trauma bonding yay!

Residency lasts different durations ranging from 3 to 7 years. And much of the time is spent writing notes. These notes are comprehensive and every word is intentional; sometimes the hospital cannot bill for certain things if specific words are not included.

Years spent training are referred to PGY (Post Graduate Year) (e.g. PGY-1, PGY-2). It really stands for Poor Graduate Years because the trainees are get paid very little for the amount worked. Fun fact, most residency programs are funded by the federal government. The American taxpayers are really getting their money’s worth!

After residency, they choose whether to finally get a real job or continue to do more training in a particular specialty.

If they opt for more training, they often have to go through a more specialized “Match”. It’s less ceremonial but just as stress and anxiety-producing.

Oh, if they did their training in another country and want to practice in the US, they’ll have to start with residency again! Yup, that doctor who has been practicing for a decade will be in residency with 20-somethings straight out of medical school.

The parents are disappointed with how infrequently they see their child.

Fellowship (Grades 24+)

Similar to residency but specializing in a particular part of medicine. These people are truly afraid of going into the real world or the people going to make bank.

Trauma bonding yay!

After fellowship, they choose whether to finally get a real job or continue to do more training in a particular specialty.

If they opt for more training, they often have to go through a more specialized “Match”. It’s less ceremonial but just as stress and anxiety-producing.

The parents are disappointed with how infrequently they see their child.

Attending

Finally! After 24 years of education and training, they finally work in the real world at the age of 30 (assuming the minimal number of years of residency).

But the standardized testing is not over! They must get board-certified for each of the training programs. At least it doesn’t determine where they can get a job?

Since they haven’t learned anything but medicine, they don’t know what to do with their finances! They’ll explore their hobbies for the first time in decades (assuming their job has free time).

After about 3 months of working, they realize the real world is terrible and want to go back to training where there is “less responsibility” or retire.

The parents? They want their grandchildren.

Or refer this to someone who would enjoy reading this!