Written by Zach West MD
Published: 23 May 2020
Becoming a Dr in the USA
Wow – I just graduated from Emory University School of Medicine and can finally call myself a doctor. As I reflect back on my expectations going into medical school, I recognize that I had little to no idea what the next four years would have in store for me. I write this quick guide so those in similar shoes to have a better road map of what medical school in the United States looks like.
The journey is long, difficult, and exhausting, but in the end, it is worth it. In the United States, there are many paths towards the career of a doctor – before medical school, some of my colleagues sold medical devices, worked as a principal investigator in research, taught third graders, and signed up for the US Navy, to name a few. Circuitous paths to medical school have grown more common and there is incredible insight that those students bring to their studies and their patients. I say that to highlight that there is no normal route and what follows in the description of becoming a doctor in the USA is simply an overview of the prerequisites as of 2020.
Typically a four year program, students have to take certain classes to be able to apply into medical school: two years of chemistry (including organic chemistry) and one year of biology, physics and English. Yet, that does not mean that students have to major in a scientific degree; many choose to focus their studies on humanities, social sciences, or other fields. Some students may realize that they want to go into medicine later and take graduate courses with post-baccalaureate programs.
Aside from the transcript from these courses, an important part of the medical application is the Medical College Admission Test (MCAT), a standardized test that students must take before submitting their application. Applicants also write personal statements and send accomplishments from their CVs, usually including a background of extracurricular activities such as volunteering, teaching, and/or time spent shadowing doctors in the clinical. None of these extracurriculars are necessary, but they do help make an applicant more appealing and provide an opportunity to demonstrate the values that the applicant may have. This goes to say, it is not recommended to participate in activities just to boost a resume: one should be passionate about the work she or he is doing.
With their undergraduate transcript, MCAT scores, letters of recommendation, a personal statement, and a CV in hand, students apply to allopathic (MD) and osteopathic (DO) medical schools starting in June every year. Usually, in the following months, schools send secondary essay prompts for students to respond to that will highlight aspects such as the student’s contribution of diversity to the program, insight into the medical field, or interest in the specific school. All of this information comes together to form a student’s portfolio. In the US, approximately 43% of applicants matriculate into medical school each year.
Medical school itself is another four years of schooling (though there are discussions of cramming it into 3 years). For most schools, education is divided into two main portions: preclinical education and clinical rotations.
Mostly centered in large lecture halls, this is where the foundation of one’s medical learning is done. This period can vary from 1-2 years depending on the medical school. Classes are divided into system-based modules (nephrology, cardiology, etc.) with cumulative tests. Anatomy dissections runs concurrently with some of the modules.
At the end, students typically take the United States Medical Licensing Exam (USMLE) Step 1, a test based mostly on the preclinical knowledge focusing on basic science and disease processes. Although this test was originally designed to be pass/fail to indicate whether students have sufficient knowledge, the scoring has played a big role in residency selection process and, thus, the specialty that students can pursue. Yet, this year, it was announced that the test will transition BACK to pass/fail starting no earlier than January 2022, a move that has received mixed messages in the medical community. Students taking Step 1 before then, however, still face the tremendous stress and anxiety surrounding this test.
After preclinicals, students join healthcare workers in the hospitals and clinics, going through all the major specialties: pediatrics, internal medicine, surgery, obstetrics/gynecology, psychology, family medicine, neurology, emergency medicine, and critical care. There is also time for elective rotations, which can be clinical or non-clinical.
At the end of the core clinical rotations, students take USMLE Step 2, which is divided into two components: Clinical Knowledge (CK) and Clinical Skills (CS). Step 2 CK is very similar to Step 1, but focuses more on clinical decision making, diagnostics, and therapeutics. Step 2 CS is an in-person exam with standardized patient actors. The goal is to evaluate students on their ability to take a thorough history, perform physical exams, and communicate their plan and understanding to patients. While it is necessary to pass these tests, according to surveys of residency program directors, they do not factor as much into residency applications as Step 1.
Apply to residency
In September of the last year of medical school, students submit an application to the Electronic Residency Application Service (ERAS) applying into their specialty of choice. The application consists of step scores, grades, extracurriculars, letters of recommendation, and usually a cumulative letter written by a dean. Some specialties, like emergency medicine, require letters from away rotations. Applicants travel to programs for interviews between October and February. In mid-February, applicants and programs submit lists ranking each other and, in March, the National Resident Matching Program (NRMP) runs their computer algorithm that determines the combinations of students and programs on what is called “Match Day.” Two to three months later, the student becomes a doctor at their matched institution!
Now, remember that medicine is all about lifelong learning, so the process may not stop there. After residency, doctors may choose to subspecialize in fields like nephrology, pulmonology critical care medicine, or cardiology. General surgeons may pursue careers in trauma, transplant, or pediatric surgery. Again, the process is yours and yours alone. One of the best pieces of advice I have received is to “stay in your lane” and I encourage those whom I advise to do the same. Good luck!