How to Become a Doctor
Ryan Kramer is a student at UNC Chapel Hill, where he is pursuing his B.A. in Philosophy with minors in Chemistry and Biology. After graduation, he plans to earn his MD and Masters in Bioethics through a dual degree program. Eventually, he hopes to research bioethics and health policy while practicing as a pediatric specialist. In the following article, Ryan provides a roadmap for the aspiring doctor, outlining the steps of the journey to earning an MD.
“So which comes first? Your residency, or your fellowship? Do you have to do both?”
“Wait, when is intern year? Is that the same as your residency?”
“How long is a residency? Do you really have to work 100 hours per week?”
Do you find yourself pondering these and other questions? I certainly did. If the medical career stretching before you feels like a maze, take heart. I’m here to offer you a roadmap.
Before we begin, here's a brief outline of the major hurdles along your path:
Internship (the first year of the residency)
The most important part of undergraduate education is fulfilling medical school prerequisites. Most medical schools require two semesters of biology, two semesters of general chemistry, two semesters of organic chemistry (with lab), two semesters of physics, and two semesters of calculus. Many now include biochemistry, and some also require basic competency in psychology, sociology, and statistics. However, each medical school varies, so you should definitely check to see if there are any required courses specific to those at which you plan to apply.
My pre-medical adviser suggests allocating one class’s worth of time for studying for the MCAT. In other words, instead of taking five classes the semester of your exam, take four.
The nature of the courses mentioned above might lead you to conclude that you should major in a STEM-related field. There is some truth to this; however, as long as you fulfill the prerequisites above, you’re welcome to major in whatever you wish. Skeptical? 2016 data shows that, on average, humanities majors had higher MCAT scores and greater matriculation rates than biological science majors. This doesn’t necessarily mean you should drop your chemistry major. What it does mean, however, is that you should feel free to pursue any of your intellectual interests.
Speaking of the MCAT, be prepared to spend 300 to 350 hours studying for this shudder-inducing exam. My pre-medical adviser suggests allocating one class’s worth of time for studying for the MCAT. In other words, instead of taking five classes the semester of your exam, take four. You’ll need to be an expert in these four content areas that make up the exam:
- Biological and Biochemical Foundations of Living Systems
- Chemical and Physical Foundations of Biological Systems
- Psychological, Social, and Biological Foundations of Behavior
- Critical Analysis and Reasoning Skills
After the exam, it’s time to apply for medical school. You will do this senior year or later, depending on whether you choose to take a gap year.
Unlike college applications, medical school applications typically have several rounds. You’ll submit your primary application through a centralized service (likely the AMCAS, the medical school equivalent of the CommonApp). This includes your grades and transcript, MCAT scores, personal statement, information about extracurriculars, and letters of recommendation.
After submitting the primary application, you can either be rejected or receive a secondary application from a particular medical school, which will often ask for additional essays. Medical schools can either reject you, invite you for interviews (the final step of the application), or postpone decisions until after the first round of interviews.
Medical schools vary when it comes to structuring curricula. Some schools have students spend their first two years in the classroom, whereas others require only one year. For the sake of this section, I will discuss the two year curriculum.
The first two years of medical school (M1 and M2) are classroom-based, and emphasize science and the clinical skills. Kaplan describes this as “similar to taking upper-level courses in undergrad, albeit at an accelerated pace.”
At the end of your classroom learning, you’ll take the United States Medical License Exam Step 1 (usually just called Step 1). This may be the most important exam of the entire path to medicine, as it plays a major role in determining residency matching. (We’ll get to that later.) It is more arduous than the MCAT and demands six to nine months of study and preparation.
At the end of your classroom learning, you’ll take the United States Medical License Exam Step 1. This may be the most important exam of the entire path to medicine, as it plays a major role in determining residency matching.
After Step 1, you will be in your third year (M3) and will begin clinical rotation. Clinical rotation involves learning from practicing physicians in different disciplines in a (typically local) hospital. Often, there are core rotations that all medical students will go through, such as: internal medicine, general surgery, pediatrics, OB-GYN, psychiatry, family medicine, and/or neurology, among others. Requirements depend on your specific medical school and can be found online.
M4 is similar to M3, but you have the freedom to choose different electives for rotation. At this stage, having a mentor to guide you in choosing your rotations can be very helpful. This is also an opportunity to rotate at other institutions as a way to “audition” for their residencies.
At the end of this period, you will take USMLE Step 2, which has two components: a multiple choice exam (Step 2 CK), and a simulated-patient interaction section (Step 2 CS). You’ll use both Step 1 and Step 2 (if you have completed it) to apply to residencies.
When applying for residencies, you apply and interview for a number of residency spots. It is difficult to switch, and residencies are arguably just as (if not more) important than your medical school, so this process is a very serious one. After ranking which residencies are your favorite, each hospital will rank which applicants are their favorites. To some of you, this two-sided ranking system might sound like sorority rushing. In fact, it’s an extremely similar algorithm. After you input your rankings, you will receive your matched residency on “Match Day.”
Residency (and Fellowship)
The first year of residency is often referred to as internship. During this time, you’ll be trained hands-on by an attending physician. Just as Step 1 is the most intense exam, internship is likely to be the most intense period of your education. It is a year of fast-paced, hands-on learning, and you’ll likely work long hours. Current law places a cap at 80 hours per week, but this is frequently exceeded due to paperwork and other duties.
After your first year in residency, you’ll take the USMLE Step 3 (the final “Step”). This will license you to provide care without supervision. At this point, you are a licensed doctor!
Just as Step 1 is the most intense exam, internship is likely to be the most intense period of your education. It is a year of fast-paced, hands-on learning, and you’ll likely work long hours.
Depending on which residency you choose, you’ll have approximately three to five more years of residency to complete. As you become more senior, your hours decrease, and your pay increases. You’ll gain more responsibilities; for example, in your second and third years, you might be responsible for medical students and even first-year residents. At the end of your residency, you will take an exam and become board-certified in the residency in which you were placed (e.g. Pediatrics, Dermatology, Anesthesiology, etc.).
After residency, you have the option to apply to fellowships, which allow for further specialization. Fellowships can include Cardiology, Hematology-Oncology, and others. These programs can range in length, but usually extend for two to three years. Upon completing your fellowship, you will take another board exam and become a board-certified specialist. Again, the fellowship is optional, and does not need to be completed immediately after the residency.
Congratulations! At this point, you are a fully-fledged doctor. You’ve spent 11-16 years in training, from undergrad to residency to fellowship. You’ve taken the MCAT, USMLE Step 1, 2, and 3, and your board exams. It’s up to you whether you want to work at a hospital, in academia, or in private practice.
In sum, this is the path to becoming an MD:
Undergraduate education, the MCAT, and medical school applications
Medical school, USMLE Step 1 and 2, and residency matching
Internship (Residency Year 1) and USMLE Step 3
Residency and board exams
An optional Fellowship and board exams
For me, this process is simultaneously daunting and thrilling. As a future doctor, you are devoting your life to serving others through medicine! If you feel nervous, overwhelmed, or hesitant, you’re not alone. Dig into the learning and the work, remember what motivates you, and put one foot in front of the other.
A native of Katonah, New York, Ryan is currently studying Philosophy, Chemistry and Biology at UNC Chapel Hill. After graduation, he hopes to earn his MD and Masters in Bioethics through a dual degree program, and then practice as a pediatric specialist researching bioethics and health policy. In his free time, Ryan enjoys watching hockey, exploring museums, and frequenting coffee shops with friends.