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Healthcare Professionals Message Board


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The first step to determining whether this or any other profession is the right one for you is complete honesty with regard to that which motivates you. It is okay to admit to yourself that you like the prestige, the wealth, or lifestyle a particular profession affords you, as long as you are willing to take its risks and liabilities. More importantly, what do you want out of life? Do you want to be involved with your family as they mature into responsible adults or is it more important for you to provide them with the appearance of attending the right private school and dress in the latest fashions? Do you intend to practice for a long time or are you in it for an early retirement? It may help to talk to several life coaches or counselors who are familiar with you to get a sense of where you might succeed. Sometimes, who we think we are or would like to be is quite different that who we actually are. You are at that age where this might be confusing. I applaud you for your ambition and impetus to ask for more information. The task you are considering is huge and surmountable, but it requires you to do some serious soul-searching first.

Every country has its own "rules" about medical schools and licensing. If you are planning to practice in the U.S., the easiest way is to be a U.S. citizen or Resident Alien (otherwise known as the “green card”), which offers you more options when you graduate from medical school. If you plan to stay in your own country (which is???) you might talk to your own physician or someone at a nearby medical university.

In the U.S., you are required to have about three years of college math and sciences and have taken the MCAT before any medical school will even consider your application. There is an interview process where you and the prospective school meet to see if you like each other. Depending on the year, your chances are about 1 in 4 of getting in. The factors include not only grades and research or other experience, but who you are as a person. I've been on those committees and have turned down honor students who are too full of themselves; I want to train the next generation to be focused on their patients, not on the illusions of their own accomplishments.

Once you get into medical school, you are a Medical Student. You must pass all of your courses and Part I and II of the USMLE before most residencies will consider your application. The first year is called the internship, because you have not passed Part III of the USMLE to obtain a full license. You can choose to finish a residency or not, during which time you are referred to as a Resident. If you plan to practice, it will be almost imperative, as most groups and hospitals will require you to be Board Certified or Board Eligible (BC/BE). If you plan to be in a solo practice in a small rural area, no one may care as long as you do your work well. Keep in mind, though, that if you are ever brought into a court room for some action, they will hold you up to the standard of care in that specialty.

There are different types of practitioners in the U.S. For the medical specialties, the MD and the DO are the only fully licensed medical physicians. The Doctor of Osteopathy (DO's) get extra training in manipulative medicine. The DDS are limited to dental medicine and surgery. Oral Maxillofacial surgeons go through both dental and medical training as well as residencies in both, which makes for a really long road.

The United States has very strict rules regarding foreign medical graduates (FMG). They are generally limited to less competitive fields like Family Practice, Internal Medicine, or Psychiatry although a rare (extraordinary) FMG does occasionally end up finishing a surgical specialty. If you finish training in another country and even have a practice for years, you will still have to go through a complete internship and residency before you can get your license to practice here.

There are other limited medical fields, like Physician's Assistants (PA's) or Nurse Practitioners (NP) who work in conjunction with a physician, and often have their own practice. Some of them even do surgery in the operating room, if they work with a surgeon. They have prescribing authority and can write for medications. Their patients have to be seen by a licensed M.D. or D.O. at regular intervals, but otherwise, they are the primary healthcare professional for their own patients. PA's generally go to school for 2-3 years and also complete 1-3 years of training after completing their degree. NP's have to have been in Nursing for at least 3 years and complete a NP program (equivalent to a Master's Degree in Nursing).

- Podiatrists are foot care specialists. They do everything that a Foot and Ankle Surgeon (subspecialty under Orthopaedics) would do such as surgery, prescribing orthotics, prescribe medications and modalities appropriate to their care, except get involved in other bone and joint problems that aren’t directly involved with the foot and ankle.

- D.C. (Doctor of Chiropractics), in which you practice manipulative medicine but are not allowed to prescribe medications.
- There are also other alternative medicine practices, such as N.D. (Naturopathic Doctor) who cannot prescribe controlled substances, but base their practice on natural remedies. Eastern medicine (acupuncture, etc) are also becoming more accepted.

- Psychologists and Social Workers often do the "therapy" one would expect from psychiatrists, except that they do not have prescription authority.

- Allied Health Professionals, such as Physical Therapists (PT's), Occupational Therapists (OT's), Speech Pathologists, are a college degree program.

- Emergency Medical Technicians (EMT's) are the guys who drive around in ambulances and are the first line in trauma. They specialize in stabilizing patients in the acute setting, but don't have much to do with them once the patients get to the hospitals.

Quite honestly, you have to define what it is that you really want out of a career in the medical field. Being a physician or surgeon has both tremendous rewards and liabilities. The work is as intellectually stimulating as you make it. Your rewards are still largely based upon how hard you want to work. For the most part, people still consider doctors to be essentially honest, intelligent, and contributing members of society, even if their illusions of how much money we make is grossly overestimated and outdated. However, the schooling and training is long and expensive compared to other professions. Many doctors are in their 30’s and $100,000 or more in debt by the time they finish their training. Autonomy is limited; how you practice is often determined by what insurance your patient has and will allow him to receive. The United States is hugely litigious: it's not whether you will get sued or not, but when. So, the bigger your paycheck, the more you pay out in malpractice insurance. People treat you differently, which is good and bad depending on whether you are at a party or at a car dealership. Your schedule really is not as flexible as you might think, since you have to work a certain number of hours just to keep an office running. The buck stops with you, which is a double-edged sword. You are responsible for making sure that your orders are followed, even if someone else makes the mistake reading it or administering the medication or care.

This is a lot of information, and I hope it helps. As a physician and surgeon, I can’t imagine a more fulfilling way to live my life, although there are times when I wish I could just stay at home and be more involved with my family. Being a physician has made me a better person, and being a parent has made me a better physician. I hope you find a good balance in the life ahead.

God bless you!

tari





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