So You Want to Make Your Mother Proud? Becoming a Doctor

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This is SCIENCE IN THE NEWS in VOA Special English. I'm Bob Doughty. And I'm Barbara Klein.  On our program this week, we look at how people become medical doctors in the United States.

The United States has more than one hundred twenty medical colleges.  The American Association of Medical Colleges says these schools have about seventy thousand students.

How hard is it to get into one of the top medical schools, like for example the one at Yale University in Connecticut?  Last year almost three thousand seven hundred students hoped to get accepted there.  Only one hundred seventy-six -- or less than five percent -- were admitted.

More and more of the students getting accepted to medical schools are women.  In fact, at Yale, those one hundred seventy-six first-year students included more women than men.

People who want to become medical doctors often study large amounts of biology, chemistry and other science.  Some students work for a year or two in a medical or research job before they try to get accepted to medical school.

Most people apply to more than one school.  Some apply to as many as ten.

The Association of American Medical Colleges is changing the Medical College Admission Test, or MCAT.  Starting in January, the MCAT will be offered as a computerized exam only -- no more paper-and-pencil test.  The exam is given throughout North America and also in countries around the world.

The number of test dates will  increase from two a year to twenty-two.  And beginning in two thousand seven, the number of questions on the MCAT will be reduced by about one-third.  So will the permitted testing time.

Students may take the MCAT exam up to three times a year.

A medical education can be very costly, especially at a private school.  One year at a private medical college can cost forty thousand dollars or more.  The average at a public medical school is more than fifteen thousand dollars.

Most students have to take out loans to pay for medical school.  Many finish their education heavily in debt.

Doctors are among the highest paid professionals in the United States.  Specialists in big cities are generally the highest paid.  But there are also doctors who earn considerably less, including those in poor communities.

Medical students spend their first two years in classroom study.  They learn about the body and all of its systems.  And they begin studying diseases -- how to recognize and treat them.

Some students say the first year is the most difficult.  They have to remember lots of information -- like the name of every bone in the body.

By the third year, students -- guided by experienced doctors -- begin working with patients in hospitals.  As the students watch and learn, they think about the kind of medicine they would like to practice as doctors.

During the fourth year, students begin applying to hospital programs for the additional training they will need after medical school.  Competition for a residency at a top hospital can be fierce.

Medical residents treat patients under the supervision of professors and other experienced doctors.

Most states require a person to complete at least one year of medical residency before taking examinations to work as a doctor.

Doctors-in-training are usually called interns during their first year of residency.

Medical residents get experience in different kinds of care.  Interns, for example, may work with children one month.  Then the next month they may be in the operating room.  How long a residency lasts depends on the chosen area of medicine.

There are many specialties.  Some people become cardiologists and care for the heart.  Others become oncologists and treat cancer patients.  Still others become pediatricians and take care of children.  And some doctors go into medical research, either at a university or a biotechnology company.

But whatever they choose, first they need training.  Some doctors spend up to ten years serving in hospitals before they are fully trained in a specialty.  Surgeons, for example, spend many years performing operations as residents.

A doctor in Chicago, Illinois, remembers that before his internship, he wanted to work in crisis medicine.  But he lost that interest after he interned in a hospital emergency room.

He saw many patients who needed help immediately -- like accident victims and victims of gunshot wounds.  One of the things he likes about the specialty he chose, surgery, is that he usually has more time to decide how to help his patients.

Medical residents do not get paid very much and have traditionally been expected to work long hours without much sleep.  A young family doctor in the state of Virginia says she learned a lot as a resident.  But she says she might have learned even more if she had not been so tired.

In nineteen ninety-nine, the Institute of Medicine of the National Academies published a report on medical mistakes in American hospitals.  The report said preventable errors resulted in at least forty-four thousand and perhaps as many as ninety-eight thousand deaths each year.

In two thousand four, the New England Journal of Medicine published two government-financed studies of serious errors made by interns.

The researchers found that the error rates in two intensive-care departments decreased when interns worked fewer hours.  The interns made fewer mistakes when they had to prescribe medicines and identify conditions.

Some residents, however, say they need extended time with patients to observe changes in their condition.  And some say residents need to work as much as they can so they can become good doctors.

But in two thousand three, the Accreditation Council for Graduate Medical Education reduced the hours that residents may work.  The council supervises the training of residents.  Some residents were spending one hundred or more hours a week at their hospitals.  They were often on duty more than thirty-six hours at a time, with limited sleep.

The new rules limit residents to thirty hours of duty at a time.  And a hospital is not supposed to require more than eighty hours of duty in a week.  In addition, interns and residents must have one day off in every seven.  But some residents say the new rules are not being followed by all hospitals.

Paul Rockey is a medical educator in Illinois who has worked for years with residents.  He says residencies today are more difficult than before.  Patients do not stay as long in the hospital as they once did.  So Doctor Rockey says there is a lot of pressure on young doctors to learn quickly.

He says the difficulties of a medical education may be great.  But, he adds, people also get great satisfaction seeing themselves gain the knowledge and skills to become good doctors.

We have talked about people who want to go to medical school in the United States.  What about those who already have a medical education -- a foreign medical education -- and now want to work here as doctors?  Traditionally this has not been easy.  States require foreign doctors to pass tests and finish an approved residency or other medical program in the United States.

To be accepted for a residency, a person must meet the requirements of the Educational Commission for Foreign Medical Graduates.  This certification process involves several tests before a person can receive a visa to stay in the United States for the training period.

Foreign medical graduates may be required to return to their own country for at least two years after they complete the training.  But because of doctor shortages or other needs, some have been able to get visas without the required two-year stay in their home country.

SCIENCE IN THE NEWS was written by Jerilyn Watson and produced by Brianna Bake.  Internet users can find MP3 files and transcripts of our programs at voaspecialenglish.com.  I'm Bob Doughty. And I'm Barbara Klein.  Listen again next week for more news about science in Special English on the Voice of America.

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