Physician Career

Physicians diagnose, prescribe medicines for, and other­wise treat diseases and disorders of the human body. A physician may also perform surgery and often specializes in one aspect of medical care and treatment. Physicians hold either a doctor of medicine (M.D.) or osteopathic medicine (D.O.) degree. Approximately 567,000 M.D.’s and D.O.’s are employed in the United States.

Physician Career History

The first great physician was Hippocrates, a Greek who lived almost 2,500 years ago. He developed theories about the practice of medicine and the anatomy of the human body, but Hippocrates is remembered today for a set of medical ethics that still influences medical practice. The oath that he administered to his disciples is still adminis­tered to physicians about to start practice. His 87 treatises on medicine, known as the “Hippocratic Collection,” are believed to be the first authoritative record of early medi­cal theory and practice. Hippocratic physicians believed in the theory that health was maintained by a proper balance of four “humors” in the body: blood, phlegm, black bile, and yellow bile.

Another Greek physician, Galen, influenced medical thought for more than a thousand years. Dur­ing the Middle Ages, his works were translated into Arabic and Syriac.

PhysicianThe great civilizations of Egypt, India, and China all developed medical theories of diagnosis and treatment that influenced later cultures of their own countries and those of other countries. The school of medicine at Alexandria, Egypt, for example, incorporated the theories of the ancient Greeks as well as those of the Egyptians. This great medical school flour­ished and was influential for several hundred years. Research specialists there learned more about human anatomy than had ever been learned before.

The theories and practices of medicine were kept alive almost entirely during the Middle Ages by monks in monasteries. Few new theories were developed during this period, but the medical records of most of the great early civilizations were carefully preserved and copied.

The Renaissance saw a renewal of interest in medical research. Swiss physician Paracelsus publicly burned the writings of Galen and Avicena, signifying a break with the past. Concepts of psychology and psychiatry were introduced by Juan Luis Vives, a Spanish humanist and physician.

In the 17th century English physician William Harvey discovered that the blood, propelled by the pumping action of the heart, circulates through the body. Many inventions in other fields helped the progress of med­icine. Anton van Leeuwenhoek, a Dutch lens grinder, made instruments that magnified up to 270 times. He also studied blood circulation and composition, and was the first to see bacteria and protozoans.

During the 18th century the Dutch physician Her­mann Boerhaave introduced clinical instruction (teach­ing at the bedside of patients). Edward Jenner discovered a vaccination against smallpox. Specialization grew rap­idly, as did the growth of medical schools, hospitals, and dispensaries.

The 19th century saw advances in more precise instruments, such as the stethoscope, the ophthalmo­scope, and X rays. Doctors began to use anesthetics like ether and nitrous oxide and antiseptics. Knowledge of the cell, digestion, metabolism, and the vasomotor sys­tem increased.

Among the 20th century discoveries and develop­ments have been the identification of four blood types, the discovery of insulin, development of antibiotics, and immunizations such as the polio vaccine. Techno­logical advances have included the electron microscope, pacemakers, ultrasound, heart-lung machines, dialysis machines, and prostheses, to name only a few. Medical research and practice made giant strides toward the relief of human distress and the prolonging of human life. Every day brings new discoveries and the possibility of major breakthroughs in the areas that have long plagued humans.

Physician Job Description

The greatest number of physicians are in private practice. They see patients by appointment in their offices and examining rooms, and visit patients who are confined to the hospital. In the hospital, they may perform opera­tions or give other kinds of medical treatment. Some physicians also make calls on patients at home if the patient is not able to get to the physician’s office or if the illness is an emergency.

Approximately 13 percent of physicians are general practitioners or family practitioners. They see patients of all ages and both sexes and will diagnose and treat those ailments that are not severe enough or unusual enough to require the services of a specialist. When special prob­lems arise, however, the general practitioner will refer the patient to a specialist.

Not all physicians are engaged in private practice. Some are in academic medicine and teach in medical schools or teaching hospitals. Some are engaged only in research. Some are salaried employees of health mainte­nance organizations or other prepaid health care plans. Some are salaried hospital employees.

Some physicians, often called medical officers, are employed by the federal government, in such positions as public health, or in the service of the Department of Vet­erans Affairs. State and local governments also employ physicians for public health agency work. A large number of physicians serve with the armed forces, both in this country and overseas.

Industrial physicians or occupational physicians are employed by large industrial firms for two main reasons: to prevent illnesses that may be caused by certain kinds of work and to treat accidents or illnesses of employ­ees. Although most industrial physicians may roughly be classified as general practitioners because of the wide variety of illnesses that they must recognize and treat, their knowledge must also extend to public health tech­niques and to understanding such relatively new hazards as radiation and the toxic effects of various chemicals, including insecticides.

A specialized type of industrial or occupational physi­cian is the flight surgeon. Flight surgeons study the effects of high-altitude flying on the physical condition of flight personnel. They place members of the flight staff in spe­cial low-pressure and refrigeration chambers that simu­late high-altitude conditions and study the reactions on their blood pressure, pulse and respiration rate, and body temperature.

Another growing specialty is the field of nuclear med­icine. Some large hospitals have a nuclear research labo­ratory, which functions under the direction of a chief of nuclear medicine, who coordinates the activities of the lab with other hospital departments and medical personnel. These physicians perform tests using nuclear isotopes and use techniques that let physicians see and under­stand organs deep within the body.

M.D.’s may become specialists in any of the 40 differ­ent medical care specialties. (Many of these specialties are discussed elsewhere in this encyclopedia.)

Physician Career Requirements

High School

The physician is required to devote many years to study before being admitted to practice. Interested high school students should enroll in a college preparatory course, and take courses in English, languages (especially Latin), the humanities, social studies, and mathematics, in addi­tion to courses in biology, chemistry, and physics.

Postsecondary Training

To begin a career as a physician you need to first enter a liberal arts program in an accredited undergraduate institution. Some colleges offer a premedical course, but a good general education, with as many science courses as possible and a major in biology or chemistry is con­sidered adequate preparation for the study of medicine. Courses should include physics, biology, inorganic and organic chemistry, English, mathematics, and the social sciences.

College students should begin to apply to medical schools early in their senior year, so it is advisable to begin your research into schools as early as your fresh­man year. There are 126 accredited schools of medicine and 20 accredited schools of osteopathic medicine in the country. For more information, consult a copy of Medical School Admission Requirements, United States and Canada, available from the Association of Ameri­can Medical Colleges or from your college library. It is an annual publication updated each spring. Read care­fully the admissions requirements of the several medical schools to which you hope to apply to avoid making mistakes in choosing a graduate program.

Some students may be admitted to medical school after only three years of study in an undergraduate program. There are a few medical schools that award the bachelor’s degree at the end of the first year of medical school study. This practice is becoming less common as more students seek admission to medical schools. Most premedical stu­dents plan to spend four years in an undergraduate pro­gram and to receive the bachelor’s degree before entering the four-year medical school program.

During your second or third year in college, you should arrange with an adviser to take the Medical Col­lege Admission Test (MCAT). This test is given each spring and each fall at certain selected sites. Your adviser should know the date, place, and time; or you may write for this information to the Association of American Medical Colleges. All medical colleges in the United States require this test for admission, and a student’s MCAT score is one of the factors that is weighed in the decision to accept or reject any applicant. Because the test does not evaluate medical knowledge, most college students who are enrolled in liberal arts programs should not find it to be unduly difficult. The examination covers four areas: verbal facility, quantitative ability, knowledge of the humanities and social sciences, and knowledge of biology, chemistry, and physics.

You are encouraged to apply to at least three insti­tutions to increase your chances of being accepted by one of them. Approximately one out of every two quali­fied applicants to medical schools is admitted each year. To facilitate this process, the American Medical College Application Service (AMCAS) will check, copy, and sub­mit applications to the medical schools you specify. More information about this service may be obtained from AMCAS, premedical advisers, and medical schools.

In addition to the traditional medical schools, there are several schools of basic medical sciences that enroll medical students for the first two years (preclinical expe­rience) of medical school. They offer a preclinical cur­riculum to students similar to that which is offered by a regular medical school. At the end of the two-year pro­gram, you can then apply to a four-year medical school for the final two years of instruction.

Although high scholarship is a determining factor in admitting a student to a medical school, it is actually only one of the criteria considered. By far the greatest number of successful applicants to medical schools are “B” stu­dents. Because admission is also determined by a number of other factors, including a personal interview, other qualities in addition to a high scholastic average are con­sidered desirable for a prospective physician. High on the list of desirable qualities are emotional stability, integrity, reliability, resourcefulness, and a sense of service.

The average student enters medical school at age 21 or 22. Then you begin another four years of formal school­ing. During the first two years of medical school, studies include human anatomy, biochemistry, physiology, phar­macology, psychology, microbiology, pathology, medical ethics, and laws governing medicine. Most instruction in the first two years is given through classroom lectures, laboratories, seminars, independent research, and the reading of textbook material and other types of litera­ture. You also learn to take medical histories, examine patients, and recognize symptoms.

During the last two years in medical school, you become actively involved in the treatment process. You spend a large proportion of the time in the hospital as part of a medical team headed by a teaching physician who specializes in a particular area. Others on the team may be interns or residents. You are closely supervised as you learn techniques such as how to take a patient’s medical history, how to conduct a physical examination, how to work in the laboratory, how to make a diagnosis, and how to keep all the necessary records.

As you rotate from one medical specialty to another, you obtain a broad understanding of each field. You are assigned to duty in internal medicine, pediatrics, psy­chiatry, obstetrics and gynecology, surgery, and other specialties.

In addition to this hospital work, you continue to take course work. You are responsible for assigned studies and also for some independent study.

Most states require all new M.D.’s to complete at least one year of postgraduate training, and a few require an internship plus a one-year residency. If you decide to specialize, you will spend from three to seven years in advanced residency training plus another two or more years of practice in the specialty. Then you must pass a specialty board examination to become a board-certified M.D. The residency years are stressful—residents often work 24-hour shifts and put in up to 80 hours per week.

For a teaching or research career, you may also earn a master’s degree or a Ph.D. in a biology or chemistry subfield, such as biochemistry or microbiology.

Certification or Licensing

After receiving the M.D. degree, the new physician is required to take an examination to be licensed to prac­tice. Every state requires such an examination. It is con­ducted through the board of medical examiners in each state. Some states have reciprocity agreements with other states so that a physician licensed in one state may be automatically licensed in another without being required to pass another examination. This is not true throughout the United States, however, so it is wise to find out about licensing procedures before planning to move.

Other Requirements

You must have some plan for financing your long and costly education. You face a period of at least eight years after college when you will not be self-supporting. While still in school, you may be able to work only during sum­mer vacations, because the necessary laboratory courses of the regular school year are so time consuming that little time is left for activities other than the preparation of daily lessons. Some scholarships and loans are avail­able to qualified students.

If you work directly with patients you need to have great sensitivity to their needs. Interpersonal skills are important, even in isolated research laboratories, since you must work and communicate with other scientists. Since new technology and discoveries happen at such a rapid rate, you must continually pursue further education to keep up with new treatments, tools, and medicines.

Exploring Physician Career

PhysiciansOne of the best introductions to a career in health care is to volunteer at a local hospital, clinic, or nursing home. In this way it is possible to get a feel for what it is like to work around other health care professionals and patients and possibly determine exactly where your interests lie. As in any career, reading as much as possible about the profession, talking with a high school counselor, and interviewing those working in the field are other impor­tant ways to explore your interest.

Employers

There are about 567,000 M.D.’s and D.O.’s working in the United States. Physicians can find employment in a wide variety of settings, including hospitals, nursing homes, managed-care offices, prisons, schools and universities, research laboratories, trauma centers, clinics, and pub­lic health centers. Some are self-employed in their own or group practices. In the past, many physicians went into business for themselves, either by starting their own practice or by becoming a partner in an existing one. Few physicians—about 17 percent—are choosing to follow this path today. There are a number of reasons for this shift. Often, the costs of starting a practice or buying into an existing practice are too high. Most are choos­ing to take salaried positions with hospitals or groups of physicians.

Jobs for physicians are available all over the world, although licensing requirements may vary. In Third World countries, there is great demand for medical pro­fessionals of all types. Conditions, supplies, and equip­ment may be poor and pay is minimal, but there are great rewards in terms of experience. Many doctors fulfill part or all of their residency requirements by practicing in other countries.

Physicians interested in teaching may find employ­ment at medical schools or university hospitals. There are also positions available in government agencies such as the Centers for Disease Control, the National Institutes of Health, and the Food and Drug Administration. Pharmaceutical companies and chemical compa­nies hire physicians to research and develop new drugs, instruments, and procedures.

Starting Out

There are no shortcuts to entering the medical profession. Requirements are an M.D. degree, a licensing examination, a one- or two-year internship, and a period of residency that may extend as long as five years (and seven years if they are pursuing board certification in a specialty).

Upon completing this program, which may take up to 15 years, physicians are then ready to enter practice. They may choose to open a solo private practice, enter a part­nership practice, enter a group practice, or take a salaried job with a managed-care facility or hospital. Salaried posi­tions are also available with federal and state agencies, the military, including the Department of Veterans Affairs, and private companies. Teaching and research jobs are usually obtained after other experience is acquired.

The highest ratio of physicians to patients is in the New England and Middle Atlantic States. The lowest ratio is in the South Central and Mountain States. Most M.D.’s prac­tice in urban areas near hospitals and universities.

Advancement

Physicians who work in a managed-care setting or for a large group or corporation can advance by opening a private practice. The average physician in private practice does not advance in the accustomed sense of the word. Their progress consists of advancing in skill and under­standing, in numbers of patients, and in income. They may be made a fellow in a professional specialty or elected to an important office in the American Medical Associa­tion or American Osteopathic Association. Teaching and research positions may also increase a physician’s status.

Some physicians may become directors of a labo­ratory, managed-care facility, hospital department, or medical school program. Some may move into hospital administration positions.

A physician can achieve recognition by conduct­ing research in new medicines, treatments, and cures, and publishing their findings in medical journals. Par­ticipation in professional organizations can also bring prestige.

A physician can advance by pursuing further educa­tion in a subspecialty or a second field such as biochem­istry or microbiology.

Earnings

Physicians have among the highest average earnings of any occupational group. The level of income for any indi­vidual physician depends on a number of factors, such as region of the country, economic status of the patients, and the physician’s specialty, skill, experience, profes­sional reputation, and personality. The median income in 2005 for family practice physicians was $147,516 per year, according to Physician Search’s annual survey. Pedi­atricians had median earnings of $149,754 and internal medicine physicians earned $160,318. Depending of area of practice, physicians earned between $112,000 and $473,000, annually in 2005 with some surgical specialties earning more than $700,000 per year. According to the U.S. Department of Labor, the median income in 2004 for family practitioners was $137,119; general surgeons, $228,839; anesthesiologists, $259,948; and obstetricians/ gynecologists, $203,270. Physicians who work with the

Department of Veterans Affairs earned starting salaries of about $110,000 or more based on years of experience and location of practice.

In 2004-05, the average first year resident received a stipend of about $40,788 a year, depending on the type of residency, the size of the hospital, and the geographic area. Sixth year residents earned about $50,258 a year. If the physician enters private practice, earnings during the first year may not be impressive. As the patients increase in number, however, earnings will also increase.

Salaried doctors usually earn fringe benefits such as health and dental insurance, paid vacations, and the opportunity to participate in retirement plans.

Work Environment

The offices and examining rooms of most physicians are well equipped, attractive, well lighted, and well venti­lated. There is usually at least one nurse-receptionist on the physician’s staff, and there may be several nurses, a laboratory technician, one or more secretaries, a book­keeper, or receptionist.

Physicians usually see patients by appointments that are scheduled according to individual requirements. They may reserve all mornings for hospital visits and surgery. They may see patients in the office only on cer­tain days of the week.

Physicians spend much of their time at the hospi­tal performing surgery, setting fractures, working in the emergency room, or visiting patients.

Physicians in private practice have the advantages of working independently, but almost one-third of all physicians worked an average of 60 hours or more per week in 2004. Also, they may be called from their homes or offices in times of emergency. Telephone calls may come at any hour of the day or night. It is difficult for physicians to plan leisure-time activities, because their plans may change without notice. One of the advantages of group practice is that members of the group rotate emergency duty.

The areas in most need of physicians are rural hospi­tals and medical centers. Because the physician is nor­mally working alone, and covering a broad territory, the workday can be quite long with little opportunity for vacation. Because placement in rural communities has become so difficult, some towns are providing scholar­ship money to students who pledge to work in the com­munity for a number of years.

Physicians in academic medicine or in research have regular hours, work under good physical conditions, and often determine their own workload. Teaching and research physicians alike are usually provided with the best and most modern equipment.

Physician Assistant Career Outlook

The U.S. Department of Labor reports that this field is expected to grow faster than the average for all other occupations through 2014. Population growth, par­ticularly among the elderly, is a factor in the demand for physicians. Another factor contributing to the pre­dicted increase is the widespread availability of medical insurance, through both private plans and public pro­grams. More physicians will also be needed for medical research, public health, rehabilitation, and industrial medicine. New technology will allow physicians to per­form more procedures to treat ailments once thought incurable.

Employment opportunities will be good for family practitioners and internists, geriatric and preventive care specialists, as well as general pediatricians. Rural and low-income areas are in need of more physicians, and there is a short supply of general surgeons and psychiatrists.

The shift in health care delivery from hospitals to outpatient centers and other nontraditional settings to contain rising costs may mean that more and more phy­sicians will become salaried employees.

There will be considerable competition among newly trained physicians entering practice, particularly in large cities. Physicians willing to locate to inner cities and rural areas—where physicians are scarce—should encounter little difficulty.

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