Medical Education in the USA: Universities and Employment. Medical education in the USA: features
Admission to medical schools for a foreign student is not an easy task. First, because less than half of all US medical schools accept students from abroad. And even they accept very few foreigners, preferring local students. Secondly, because of the high entry requirements.
The financial issue here also plays an important role. Medical programs in all countries of the world are among the most expensive, as they require a lot of laboratory work, clinical practice, and the almost constant participation of a supervisor. In addition, US medical education is the most expensive in the world.
Tuition fees and scholarships
Medical education takes 11 to 15 years, including a bachelor's degree, and prices in American medical schools are rising every year. Thus, over the past 10 years, the cost of medical programs has increased by more than 40%. On average, it is worth focusing on the cost of $40’000-50’000 and above.
International students in medical schools almost never have to rely on scholarships - although there are rare exceptions to this rule. But given the highest competition, to receive a scholarship you need to have really outstanding knowledge, academic and life achievements, have brilliant recommendations, write exceptional motivation letters.
General requirements for medical school applicants
The general requirements of medical schools for applicants are as follows:
- Bachelor's degree with compulsory study of biology and chemistry. Some schools also require hours in a range of liberal arts, English, math, and science.
- Good results on the MCAT, a mandatory test for admission to medical schools in the United States. If necessary / desired, the results of other standard tests are indicated - GRE, GMAT, LSAT.
- Good results on the knowledge test in English- TOEFL, IELTS or other.
In addition, the applicant must carefully read all the requirements of the university, which will often differ from the standard ones. Additional tests, exams and interviews may be required, which will be conducted directly by representatives of the university.
Application and admission
International students submit unified applications to all US medical schools through the AMCAS - American Medical College Application Service. The application system is administered by the Association of American Medical Colleges.
The applicant fills out a standard form, including personal information about him and his family, all educational institutions he attended, subjects studied, grades, activities directly related to medicine, letters of recommendation available.
Then the applicant indicates the medical universities to which he plans to send an application. After that, he adds motivational essays - from one to three, depending on the program and level of study. Applicants to M.D. or Ph.D required: personal motivational essay - Personal Comments Essay, master's or doctoral essay - M.D./ Ph.D. as well as an essay describing the student's research experience - Significant Research Experience essay.
Education
Studying at a US medical school lasts 4 years, continuing with residency training from 3 to 7 years. After that, for those wishing to expand or deepen their specialization, to strengthen their practical skills, there are additional programs that last from one to four years and do not lead to the award of degrees. Students must be prepared for huge and diverse workloads - long hours in classrooms, laboratories and anatomical theater, practice in clinics.
To obtain a medical diploma, students must pass a comprehensive United States Medical Licensing Examination (USMLE), or Board exam, which consists of three stages:
- The first exam is taken at the end of the second year of medical school,
- The second - during the fourth year of study,
- The third - after the first year of residency.
These exams vary in structure and content, but together they ensure that a young professional's knowledge and skills meet the standards of American medical education.
Degrees
Graduates of US medical schools are awarded the following degrees: Doctor of Medicine, M.D., Doctor of Osteopathic Medicine D.O., Ph.D.
In America, there is no more difficult, exhausting and time-consuming way to get higher education than the path to becoming a doctor. It is no coincidence that doctors in America are called eternal students. From the beginning of training to the opportunity to practice independently, it usually takes from 11 to 15 years.
In order to start this difficult path, you must finish high school. Americans themselves admit that their level of secondary education is not very high. Therefore, students who dream of becoming doctors in the future should mobilize as much as possible in high school in order to get into colleges with a good reputation and a high level of training.
One of the main conditions for achieving this goal is the passing of a written exam called the Scholastic Aptitude Test, or SAT. This exam is a test of mathematical intelligence and knowledge of the English language. You must pass this exam very well. Otherwise, the chances of getting into a prestigious college are significantly reduced.
Recently in America there has been a trend towards less rigid selection. Some fairly prestigious colleges have stopped requiring mandatory SAT and enroll applicants based on the grades contained in the certificate of secondary education. But at this stage, such an order of enrollment in prestigious colleges is the exception rather than the rule.
It takes an average of four years to complete a college education. If desired, this time can be reduced to three years or stretched indefinitely - it all depends on the number of subjects that the student chooses in each semester. Unlike those countries where all students study according to a single curriculum, in America you can choose not only the number of subjects, but also the subjects themselves.
Thus, students of the same college can choose a completely different specialization. Those of them who plan to enter medical schools in the future should choose subjects with the combined name Premed. This is a set of courses with an emphasis on biology, chemistry, physics and sociology. The presence of these subjects in the diploma at the end of college is a prerequisite for admission to medical school.
On last year college students who want to go to medical school must take another test. The test is called the Medical College Admission Test, or MRU for short. This test is difficult, and good knowledge of the above disciplines is required to pass it.
In order to enter a prestigious medical school, getting high scores when passing the IRU is not enough. It is also necessary to have letters of recommendation, write a decent essay on the topic "Why I want to become a doctor" and pass a difficult interview.
Many college students take an annual sabbatical during their studies. Such a vacation is needed in order to engage in scientific activities. Engaging in science, especially if it culminates in publication in a scientific journal, certainly increases an applicant's chances of getting into medical school.
Education in medical school lasts four years. Variations are also possible here, but it is almost impossible to complete the training in a shorter period of time. Medical school schedules are much tighter than college, but like college, medical students have the option to choose a different number of subjects each semester. It all depends on how soon they want to graduate.
The first two years of study at medical school are spent in the knowledge of fundamental disciplines. Communication with patients at this time among students is extremely limited. Within two years, in various combinations, students pass the following disciplines:
— anatomy, neuroanatomy, pharmacology, biochemistry, fundamentals of psychiatry, physiology, histology;
- pathology;
- Embryology.
Such a system of education, which is close and understandable to us in its structure, has recently begun to be subjected to certain criticism. Many progressive and serious medical schools, including even Harvard Medical School, have switched to a new system called Double helix, which means “Double Helix”. This system of education is built on the principle of merging theory and practice, when students from the first year begin to immerse themselves in clinical medicine, while simultaneously studying the above fundamental disciplines.
At the end of their second year of medical school, all students must pass the first part (Step 1) of the United States Medial Licensing Examination, or USMLE for short, which means "US Medical Licensing Examination".
The third and fourth years of medical school are entirely devoted to the study of clinical medicine. Students are attached to a team of resident physicians with whom they manage patients and attend educational clinical conferences. At the same time, students are supervised by instructor doctors who help them with the analysis of clinical scenarios, examination of patients, etc.
When undergoing such practice in most medical schools, the system of rotational education (Rotations) is widespread, when students can choose the sequence of studying medical disciplines. They spend most of their time in the departments of therapy, surgery and gynecology. At the same time, it is possible to choose a number of other disciplines (Subspecialties), such as dermatology, nephrology, neurology, etc. Although such a system may seem frivolous and disorganized, American students receive very serious and comprehensive training.
Each course or subject studied by students both in hospital and outpatient settings ends with a written assessment of their performance by resident doctors and instructor doctors. Such grades are important for students and greatly influence their further fate. They become the student's rating in relation to fellow students. These same grades serve as the basis for those letters of recommendation that the dean of the medical school writes for each of the students at the beginning of the fourth year of study. In the future, these letters are sent to residency programs (postgraduate education) and are one of the most important factors when considering a student's candidacy for admission to residency.
At the end of their fourth year, all students take the second part (Step 2) of the USMLE medical exam. This exam is about testing clinical knowledge.
After completing their studies at medical school, students are awarded the title of Doctor of Medicine. However, having a diploma does not give the right to practice independently, and all graduates of medical schools are required to complete postgraduate training. In America, this training is called residency.
A residency is somewhat similar to a clinical residency, but there are notable differences in the approach to teaching. Thus, the residency has a strict structure and schedule, which clearly describes the number of hours spent by the resident in the hospital, on an outpatient basis, as well as the number of lectures and seminars.
The duration of training also differs. Depending on the specialty, it lasts from 3 (therapy) to 5 (surgery) years. Upon completion of the residency, the doctor receives a general education in the specialties "surgery", "therapy", "gynecology" and some others.
It is residents who are the main workforce in many American hospitals. They work an average of at least twelve hours a day in a six-day work week. A ninety-hour work week for residents is a fairly common phenomenon. At the same time, the annual salary in the years of postgraduate training rarely exceeds $40,000, which is about three times lower than the salary of a medical practitioner.
The first year of residency is called Internship, or internship. Regardless of the specialty, this is the most difficult time in the life of a resident. Interns are run by everyone from second-year residents to attending physicians.
Interns spend almost the entire year in hospitals. A lot of time is devoted to work in intensive care units (Surgical Intensive Care Unit - SICU, Medical Intensive Care Unit - MICU, etc.), in the emergency room (ER), as well as night shifts (Night float). The amount of time spent in these departments depends on the specialty and is set by each residency individually.
Starting from the second year of study, the life of residents gradually becomes easier and more interesting. They lead resident teams that include one or two interns and a few medical students. Being in direct contact with the attending physicians, they are directly involved in the development of plans for the examination and treatment of patients. Their responsibilities also include teaching interns and students. At the same time, residents spend more time working with narrow specialists. They choose the disciplines that are most interesting to them and work as assistants to medical specialists. This form of learning is called Electives.
Each resident during the training must pass one more exam - Step 3 USMLE. It is allowed to take it from the first year of study in residency. The purpose of this exam is to assess the clinical knowledge of residents. It includes questions on internal medicine, surgery, obstetrics and gynecology, pediatrics and psychiatry. Since this exam is taken after admission to residency, the points obtained do not really matter.
Upon completion of the residency, each doctor has the opportunity to pass an examination in the specialty (Board certification). Successful passing of such an exam leads to certification by the American Association of Physicians in the chosen specialty. Although it is not mandatory to take this exam, almost everyone passes it. Having a certificate significantly increases the prestige and helps in further employment.
The American Associations of Medical Professionals wield significant influence both in medical circles and in society as a whole. They are actively involved in state health policy and control most of the licensing medical organizations in the United States.
At the end of the residency, the American doctor finally gets the opportunity to independently engage in medical practice. However, many doctors, after completing their residency, specialize in one of the narrow disciplines. This specialization is called Fellowship and takes from one to five years. Thus, a general practitioner who wishes to become a cardiologist must spend at least three years specializing in this discipline.
Education in the medical specialty takes not only many years, but also has a high cost. A graduate of medical school whose parents did not cover the cost of education, goes into life with an average debt of 150-250 thousand dollars. He will be able to start paying off this debt only by starting an independent activity, i.e. after completing residency.
Despite the foregoing, medicine continues to be an elitist profession. Until now, medical schools accept the best students from the best colleges. Until now, the parents of many girls dream of a doctor-in-law. The doctor in the family continues to be a subject of special respect and special pride.
Such respect for doctors in society is due not only to their high income, but also to their diligence and determination, which they demonstrate at all stages of their professional career. And although many doctors complain about the declining prestige of the specialty, they, no doubt, do not cease to be the elite of American society.
A recent survey among college students showed that those who value high wages in particular do not put medicine in the first place. They are much more interested in such specialties as economics, law and information technology.
However, the situation is not so sad. Despite the long term of study and the high cost of medical education, American doctors are among the highly paid category of people. Earnings vary depending on the specialty and place of work, but they are similar in their "six figures", i.e. exceed one hundred thousand dollars a year.
Schematically, the entire path of obtaining medical education from the moment of graduation from high school to the beginning of independent medical activity is shown in Fig. 1.
From the book by V. Bogin "How to become a doctor in America"
“My doctor gave me six months to live, but when I couldn’t pay the bill he gave me six months more.”
2nd way less expensive and almost 100%. Caribbean schools are gaining more and more popularity among Americans. For example St. George University in the Caribbean. Among the students of such schools, 69% are US citizens.
First, enroll in such honey. schools are much easier (4 out of 5 applicants enrolled)
Second, cheap tuition compared to North American medical schools, cheap insurance and accommodation
Thirdly, a diploma issued in the Caribbean is recognized in the USA (students take USMLE)
Fourth, all rotations take place in US hospitals.
There are three exams in total:
USMLE Step 1 cost 740 dollars (Basic Science: physiology, pathology, anatomy, pathology, microbiology, pharmacology, embryology, behavioral science, biochemistry, etc.), further
USMLE Step 2 cost $840 (Clinical Knowledge: all clinical subjects) and last
USMLE Step 2 cost $ 1200 (Clinical Skills - delivery of practical skills on actors).
In total, the third method costs about 2 thousand dollars. True, this is without a flight to the USA (practical skills are rented only in America).
The length of the first and second step: 8 hours each, given on a computer in the form of a test. Practical skills take 2 days for 8 hours on actors in a special center. After passing, you apply for a match in which you choose a clinic, and she chooses you. You go for an interview and sign a contract (if offered). After residency, you pass the final exam for a medical license, and voila - you are a doctor! with a minimum starting salary for a therapist in a hospital of 15 thousand dollars a month (minus tax from 22 to 33%, you will receive $ 12 thousand in your hands),
Despite salaries of 15, 30 and even 50 thousand dollars a month, there is a shortage of doctors in America, and this is not only the high cost of education, but the duration of training, competition for admission, exhausting studies in medical school and a large amount of work in the future. For example, the almost 100 hour schedule per week of a medical resident is not surprising, so probably many do not even consider such a complicated and expensive path as a doctor. (video just about it).
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Yes, I came from Russia. I don't know the answer to the second question. Maybe you need to get a job (I did).
Everyone is different. I don't know what your knowledge base is. Some people prepare for the first exam for 2 weeks (usually they are Indians from England), for my friends from Russia it takes from 1 to 2 years to prepare for the first exam.
Exams in America are hard to pass, especially USMLE Step 1.
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Do I need to pass exams in this specialty for admission? besides ultrasound diagnostics, who else can you learn without having a basic medical education? not for long within 1-2 years? And where is the best place to learn? jefferson? what is the salary of ultrasound specialists and others of this kind when you can learn without basic medical. Thank you. in our time in Russia, at 36 I wanted to change the direction of work.
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You can learn to become an X-ray laboratory technician (training for 2 years), the salary is 55 thousand per year (on an MRI or CT scan it can reach 85 thousand). I don't know where they teach better. For me, it’s better to study at a community college, it’s cheaper and easier to do.
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Excuse me, what does MPT or KT mean?
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MRI - magnetic resonance imaging, CT - computed tomography. More accurate research methods internal organs human using nuclear magnetic resonance (MRI) or x-rays (CT).
Doctors work on such machines in Russia together with X-ray technicians, in the USA only special technicians - x-ray. or MRI, CT technician, or radiology technician.
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Thanks for the clarification. Can you tell me which exams to take? One user also wrote on your blog that training is from 6 to 10 pm - I doubt that this is so, but can it really be?? I ask, because I have a family and I think whether it will be possible to study, while taking care of the children.
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Hello. I need your advice, I need it very much. I live in Georgia in Tbilisi, I'm studying at the state medical university for 19 years. I want to become a cardio surgeon from childhood, this is probably a dream and a goal of my whole life. I want to go to the USA. I know that it’s difficult, etc. it really was a big blow for me. He said that I had almost no chances to get into surgery in the USA. He himself has 99% in both steps, and says that even with such glasses you can’t get into surgery. He says or change his views or change the country of residence. I could come to Moscow to my people and study there in residency, but I want to go to the USA. Probably because of the salaries. in the US for surgery? Let's say BY CONFIDENCE I get high scores, do I have a chance? What should I do, I'm lost after talking with a friend, as if someone had died mourning (Thanks in advance. For 2 years now I’ve been reading and I’ve been learning about usmle, I know that sooner or later I will be there. If I take a goal in life, I go to the end, and now it turns out I have no chance ,because I live in Georgia and do not study at a prestigious university in the USA? …
Or to Russia. I have a friend who is an interventional cardiac surgeon (small invasive operations such as stenting, balloon angioplasty, etc.) earns 10 thousand dollars a month in Russia. True, he is the only one in the department, but still.
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I wrote a bit wrong. Since childhood, I have dreamed of becoming a heart surgeon, except for dreams, I am a good student. That is, in any case, I should be a heart surgeon, even if I am poor ... it’s just that in America they will pay me very, very well for my dream. It’s even strange when for your dream is being paid. Do I have a chance? At least some? What to do advise ... I wrote as much as possible about myself. Thank you
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I'm sorry, my previous comment didn't save.
Your friend is right. Getting into residency in cardiac surgery is not easy, and for IMG it is almost impossible. I think that in 10 years only US graduates will be admitted to any residency. In any case, such work is already underway here (for example, an increase in university entrants).
But theoretically there is always a chance. Contacts in the USA will help you. To find such connections, you need to search the entire Internet for internships, clinical clerkship, observership in American hospitals where there are residency programs. Or perhaps a professor from the USA is visiting your city and you need to befriend him and convince him that you really need a clinical internship. In any case, you need to achieve such an internship or training program.
During such an internship, you demonstrate your knowledge and desire to work (come to the hospital by 5-6 in the morning), leave by the last hour at 11 pm. Know by heart everything about all patients. Actively participate in student reports. Report one or two patients to the rounds every day, help the interns (call the pharmacy, quarrel with the MR tech, etc.). Earn referrals from attendings, meet the program director. Finally, get the highest scores on the USMLE exam.
Of all my IMG acquaintances (number of 40 people), one person got into radiology (according to the complexity of admission, almost the same as cardiac surgery).
Dare!
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Please tell me, in Russia, an internship in radiology also involves a description of the images taken on CT and MRI. You wrote above that doctors in the USA do not do CT and MRI. Then what do radiologists in the US do? I doubt that only a description of radiographs .. Maybe then radiation therapy?
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You helped me a lot, I try to take everything in life easier, but this information from a friend had a great effect on me. So, all the same, there is a chance if you do all this ... and out of these 40 people, about how many tried to enter surgery? Such a question comes immediately to cardiac surgery or to start with general and only then in cardio? And another question, is it possible to get, for example, to therapy and then go to surgery? thanks for answers
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If you buy a lottery ticket and ask me if I have a chance to win, I will answer - yes, but a small one. Also here, there is, but small. Buy a “ticket” to get started (i.e. pass the first exam for 260)
Of the 40 people, few were going to surgery, so my example is not entirely correct. True, almost no one in their homeland was engaged in therapy, and in the states they ended up in internal medicine and primary care.
First you need to go through a prelim 1 year in therapy, then in general surgery (4-6 years, depending on the program), and then in cardiac surgery.
If you pass a residency in therapy, then in surgery you are protected only for one year (and then therapy), everything else needs to be re-passed, so there is probably no point in entering internal medicine, and then in surgery (IMHO)
Good afternoon Roman,
If I'm not mistaken, then you need a surgical residency (general). In the first year you will have a prelim in therapy, then for 4 years in general surgery, and then in cardio. But first you need to pass the steps, and pass very well (not lower than 240).
In my opinion, the difference is in the procedures, cardio mainly on the coronaries, and a little on the periphery, the radiologist cava filters, embolizations, and the head with its aneurysms (collation) is probably for neurosurgeons.
Here is the list (IC-cardio, IR radiologist)
IC does:
a. coronary angio
b. coronary interventions (plasty, stents, ia thrombolysis, thrombectomy)
c. renal angio/intervention
d. peripheral angio/intervention
e. carotid angio/interventionIR does:
c-e plus
– embolization therapy for various applications (pre-op tumors, uterine fibroids, varicocele, pelvic congestion, penetrating trauma, blunt trauma, GI bleeds, hemoptysis, AVMs)
– trans-catheter liver tumor treatment (chemo or radio-embolization of HCC and chemo-resistant colorectal mets)
– biliary intervention (percutaneous biliary drainage etc.)
– GU intervention (perc. nephrostomies, ureteral stents)
– abscess drainage
– tubal re-canalization / tubal occlusion
– percutaneous gastrostomy tubes
– biopsies of various solid organs, lymph nodes using imaging guidance
– image guided tumor ablation (liver, kidney, lung, bone-mets)
– transvenous liver biopsy
– placement of IVC filters
– retrieval of IVC filters
– dialysis access management (intervention on dialysis access grafts/fistulas, Perm-A-Caths)
– venous access (difficult PICCs, central lines, chest-ports)
– catheter directed thrombolysis (arterial bypass grafts, DVT)Like
What about citizenship? Is it possible to enter residency without him? or with him?
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Anton, it will be great if we can look at medical cases little by little. Especially the first step .. because. it was long enough.
Apparently some of the cycles at the Medical Institute passed me by .. please clarify what kind of subject is behavioral science?
Good afternoon. Tell me if there are any age restrictions for admission to residency in the US???
Dormitory programs are not provided. Residents are paid a stipend of $4,000 per month, which is comparable to the average salary in the US.
I want to tell you how Americans get medical education, how many years it takes them, how to become a general practitioner, dentist, surgeon, what kind of payment system exists.
In the USA, a doctor is a respected person
The work of a doctor in the United States is almost the most prestigious. Eight first places in the ranking of the highest paid professions in the country are consistently occupied by doctors. And the anesthesiologist is the most profitable specialty: the salary of these doctors reaches 290 thousand dollars a year. The average salary of a doctor in the US is $150,000 a year.Doctors are rich and powerful social group. But the requirements for doctors in America are very high. They are obliged to have not only the highest level of education, but also to improve it throughout the service, increasing their qualifications. And of course get professional education And getting promoted isn't cheap. In total, to receive a medical education in the United States, you will have to pay from 100 to 150 thousand dollars.
Americans are used to thinking that medicine in the United States is the most professional in the world. Anyone who wants to become a doctor and practice in America must go through a very difficult path, and no exceptions are made for anyone.
We study for a doctor for a very long time. As a rule, the doctor begins to conduct independent practice only by the age of forty. No one expects all doctors to become geniuses, professors and academics, with broad knowledge and a super approach to patients. The main thing is that the patient must be sure that the doctor he addresses will not make a gross mistake.
The system of medical education in the United States and its structure is significantly different from the rest. After all, we do not have free higher education. All students have to pay tuition - both those who study at private universities and those who attend state universities. Sociologists argue that education costs are second only to the purchase of a house in the budget of the average American family. Nevertheless, the country has a system in place to reduce, sometimes quite significantly, the financial burden on the family budget, which entails studying at a college or university. This is possible thanks to the widespread system of scholarships and grants.
Medical schools - as higher medical schools are called in the United States - are mainly funded from the budgets of the states in which they are located. Therefore, upon admission, priority is given first of all to residents of this state, and secondly to US citizens.
Since the profession of a doctor is considered one of the most prestigious, studying to be a doctor is an expensive allowance. It is much more expensive than, say, studying to be an economist or a lawyer. In addition, the organization of the educational process in this specialty requires a lot of specialized equipment and expensive consumables (especially in the specialty "Dentistry"). Therefore, tuition fees in medical school are always very high, and a student cannot do without a loan. Scholarships are paid only to units. We will talk about this system below.
Bachelor's degree - compulsory intermediate level
After graduating from high school at the age of 18, a young person must complete a bachelor's degree from a university. Discipline does not play a special role, but it is better if it is the natural sciences.In parallel with obtaining a bachelor's degree, the student additionally undergoes a training program in preparatory medical courses (Pre-Med). The main thing is what kind of doctor you want to become: a dentist or an osteopath, or you want to get a different medical specialty. The chosen medical specialty determines which exam you will need to pass after completing the Pre-Med program. For example, allopaths and osteopaths must take the Medical College Admission Test (MCAT), dentists the Dental College Admission Test (DAT), and ophthalmologists the Special College of Ophthalmology Admission Test (OAT). Well, the type of exam is determined depending on the subjects that you will study as part of Pre-Med. The duration of the program is not limited in the sense that once the student has completed all the required courses, he can sign up for the exams. This can be done in the third and fourth year of study. It all depends on the student himself - on how quickly he masters the program. A plus is having experience in the health care field. The competition is 4-5 people per seat. And in the most prestigious schools of the country, up to 10 applicants can apply for one place. The exam can be retaken any number of times. However, you need to keep in mind that all medical schools where you apply will find out about all your attempts.
You can study to be a nurse. Nursing training departments are open as part of multidisciplinary colleges, and there are also separate specialized nursing colleges (College of Nursing). Education in the nursing department includes practice in hospitals, schools, utility agencies, centers for the homeless. Students learn the basics of health care, medical ethics and other subjects. Top Programs accredited to the National League of Nursing. Upon completion of training, a Bachelor of Science (Bachelor in Science) degree may be awarded.
Those wishing to become doctors can apply to medical school only after completing their studies at the university.
Long road to graduation
There are about 120 medical schools in the US. As a reminder, only students with the best grades are admitted to medical schools.Each of them sets its own standards and selection procedure. The Medical School Admission Requirements directory is published annually, containing a set of admission requirements for each of the medical schools and statistics on the results of the last year's entrance exams. But the MCAT entrance test, developed by the AAMC in collaboration with medical schools in America and Canada, is the same for all applicants. We have already talked about it.
Some schools have an MD/PhD (Doctor of Medicine/Doctor of Philosophy) double degree program. However, about 98% of all medical graduates receive one diploma - MD. There is also an MD / MBA (Doctor of Medicine / Master of Business Administration) diploma - medicine plus business, but this is even less common. The duration of study at the MD/PhD is 7-8 years, which is about twice as long as at the MD.
Traditionally, training at a medical school lasts 4 years, of which half of the term is lectures and laboratory works. Then - the same amount of clinical practice.
The first 2 years are studied anatomy, biochemistry, pathology, physiology, pharmacology, histology and microbiology. The most impressive at this time was the first experience of working in an anatomical laboratory.
In the third year, during clinical practice, the student encounters a patient for the first time.
The year is usually divided into several periods: the student visits the departments of pediatrics, internal medicine, surgery, obstetrics and gynecology, psychiatry and family medicine. Any period lasts 6-8 weeks, and each student, under the supervision of doctors, provides assistance to hospitalized patients. The work includes taking an anamnesis, examining and compiling a list of possible diagnoses and treatment plans.
During the fourth year, the student's practice increases, he is given more responsibility towards the patient, and he works in a series of monthly courses in areas of greatest interest. For example, a student with an interest in pediatrics may spend one month of training in the Department of Pediatric Cardiology.
Some medical schools do not follow this traditional curriculum and are more integrated. Students enter clinical practice much earlier, studying and attending lectures for all four years.
8 years after graduating from High School, it's time for residency. After receiving a diploma, students take the state exam - USMLE. According to its results, they are distributed to residency - an analogue of the Russian residency, only taking more years. Residency in the USA - postgraduate hospital training of doctors, providing for specialization for one year as an intern and for 3 to 8 years as a resident.
For example, students interested in pediatrics apply for residencies at children's hospitals, and those who want to become surgeons apply for surgical departments at university clinics. Residency, like medical school, is a highly competitive process. Admissions committees they select students with the best grades, and also favorably treat those who volunteered and helped others who did scientific work, who performed well during the interview.
For the duration of the residency, the young specialist is hired by the hospital, receives a salary, works about 60-80 hours a week and provides care to both hospitalized and outpatient patients, but under the guidance of a more qualified doctor.
A resident may be the first physician to contact a patient, but seeks the advice of a more experienced colleague before starting treatment.
Upon completion of this level of specialization, the graduate becomes a fully licensed physician. He can work as a therapist and provide assistance in private practice. For example, a graduate of a residency in pediatrics may work as a pediatrician in a clinic as part of a team of pediatricians. An alternative may be to receive additional, highly specialized education in a particular area. Then it is called "fellowship" and includes training for another 3-6 years. For example, after completing a residency in pediatrics, a young physician may choose an additional four years of training to become a gastroenterologist.
The general picture of obtaining permission for independent practice is approximately the following. If you are going to work in an ambulance, it will take 3-4 years; engage in family practice or pediatrics - 3 years. Gynecology and psychiatry will take 4 additional years. Urology and general surgery - 5 years each. Specialized surgery, including plastic surgery - 5-6 years (depending on specialization). And if you dream of becoming, for example, a cardiologist, add 7 years, a neurosurgeon - 8 years.
After this stage comes the "last battle". He, respectively, "the most difficult". The doctor passes a difficult exam and, finally, receives the degree of Doctor of Medicine - MD (Medical Doctor). After that, you can work as a doctor in the USA.
An Important Difference in the American Medical Tradition
I want to draw the attention of readers to the fact that in the United States there is a practice when not the whole person is treated, but his individual organs. Treatment is at the mercy of "narrow" specialists who pay attention only to what is the object of their professional qualification, not noticing the rest of the body.A distinctive feature of American medicine is the special personal relationship between doctor and patient. The patient is considered a partner of the doctor, the patient is explained in detail his condition and listen to his opinion when choosing treatment tactics. In assessing the quality of medical care, the patient's opinion is of great, sometimes excessive importance. This situation, according to a number of experts, leads to a distortion of the assessment, since the patient is always subjective and is far from always able to objectively assess the quality of service. This state of affairs is most likely due to the fear of lawsuits.
Paul Frumkin, USA
To the medical specialty - through the Caribbean
Maxim Chumak was born in Ukraine. In 1992 he immigrated to Israel, and from there to the United States. Even before moving to America, he was educated as a nurse and dreamed of a career as a doctor.
“When I came to the USA, I was 26 years old, and I understood that if I didn’t go to study as a doctor now, I would never do it,” Maxim recalls.
In order to save some money on education, he decided to study in one of the Caribbean countries - at the American University of Antigua. Caribbean medical colleges are slightly cheaper and have a more streamlined admissions process. However, only 4 of them are recognized by all states, and the American University of Antigua is one of them. You also need to keep in mind that finding a place for a residency (analogous to an internship) after graduating from a university in the Caribbean is still more difficult than after an American college. When considering applications, priority is usually given to graduates of American medical colleges, then students who graduated from medical school in the Caribbean are considered, and then everyone else.
Maxim's training lasted from 2003 to 2008: first he studied at medical school and practiced in Chicago for 2 more years.
“My tuition cost something like $36,000 a year. I paid part of the amount on my own, and to pay for the second part I took a loan from a bank,” says Maxim Chumak.
During his studies, Maxim managed to earn extra money as a nurse - he had previously confirmed the corresponding education received in Israel in the United States.
After university, you had to get into residency. It was not at all easy to do this - in some hospitals, as Maxim recalls, the competition was about 900 people per place, depending on the specialty.
In search of a hospital for an internship, he went to several interviews. Thanks to his perseverance, 2 weeks before the start of the practice, he received a call from the hospital at the University of Michigan and was offered a place with a contract for 1-2 years in surgery. Maxim agreed. After working there for a year, he moved to the Henry Ford Hospital and changed his specialty to a family doctor. He now works in the Emergency room at Memorial Hospital in Hollywood, Florida.
In parallel with this, Maxim was selected for the reserve of the American army, where he received the rank of captain, and serves as a contract military doctor. When signing a contract, the army gives you the opportunity to take advantage of various benefits, one of which is the repayment of student loans.
After several years of working in hospitals, Dr. Chumak wants to work for himself and is now opening his own practice.
Three options
There are several ways to become a registered doctor in the USA.
1. Studying at a US medical college
It takes about 10 years or more if you want to become a neurosurgeon or a plastic surgeon. Requires solid financial investments - the cost of training can vary from $150 to $400 thousand dollars.
2. Study at a medical college in a Caribbean country
Certain medical colleges in the Caribbean are recognized in the US. The cost of education is significantly lower than in the US. It's easier to get on. Residency can be completed in an American clinic, which will eventually allow a person to get the desired profession.
3. Confirmation of a doctor's diploma
This way is the most budgetary, fastest, but difficult. In addition to passing difficult exams, you need to find a place for residency, and for this category of applicants, this is quite difficult. It is impossible to obtain a doctor's license and practice in the United States without completing a residency. The positive point in this case is that doctors do not acquire huge debts during retraining, and from the moment they get a place in the hospital, they begin to work “in plus”.
Evidence of professionalism
Lyubov Klemin moved to the USA from Ukraine in 1995. She settled in Chicago with her husband. Prior to that, in her homeland, she worked as an obstetrician-gynecologist for 11 years. In the USA, I decided to confirm my specialty. She prepared for the exams herself with the help of American medical textbooks. It took 9 months to prepare. The exam was called USMLE and consisted of 3 stages, which she successfully passed and began a 3-year residency in the hospital under the Match program.
Dr. Klemin. Photo from personal archive
Its essence lies in the fact that students are looking for a place to complete a residency program, and programs choose their own residents. It's like the TV program Love at First Sight - the interests of the applicant and the hospital will or will not coincide.
“Now it is very difficult for a foreigner to get into residency,” says Lyubov Klemin. - In my time it was more realistic, because there was a shortage of doctors in the United States. In addition, it is important for American hospitals that no more than 3 years pass after the graduation of a medical school by a foreign specialist they are considering. That is great experience no one is interested here and is considered rather as a minus.
In residency, a medical specialist works under the supervision of other doctors, but still as a doctor, not as a student. Moreover, he receives a good salary for a professional who has not yet taken place, by American standards - $ 50-60 thousand a year.
“In order to get a residency, I sent out my resumes to hospitals. I had 3 interviews related to obstetrics and 3 as a family doctor. I practiced, as a result, as an obstetrician-gynecologist. Well, after the residency, I got a license and started my own practice in Chicago as a family doctor and obstetrician-gynecologist, ”says Lyubov Klemin.
Lyubov loves her job and says that she does not see any disadvantages in the work of an American doctor. “If you have already gone through this difficult path, then it will be easy. And the pay is great. But the important point is that you should always be aware of the latest research and innovations in medicine. You cannot smear a wound, for example, with green paint, if all the doctors in the United States already treat wounds differently. That is, an American doctor needs to constantly engage in self-development. Every year something changes! This is a huge difference compared to the healthcare system in Ukraine,” says Lyubov.
What you need to confirm a doctor's degree in the USA
- Register on the site ECFMG ( Educational Commission for Foreign Medical Graduates ). Application fee — $65;
- Send documents: diploma translation, completed questionnaires, photos.
- Register for the first exam and pass it: USMLE Step 1 Basic Science (Fundamentals of science: physiology, pathology, anatomy, pathology, microbiology, pharmacology, embryology, behavioral science, biochemistry, etc.). Cost - $ 880;
- Pass the second USMLE Step 2 Clinical Knowledge exam (clinical subjects). Cost — $880;
- Pass the third USMLE Step 2 Clinical Skills exam (a practical exam that tests knowledge using actors). The cost is $1,535.
- After successfully passing the exams, you participate in the Match program, pass interviews at the clinics that invite you, and, if successful, conclude a contract for residency.
- After completing your residency and passing the medical license exam, you become an American physician.
good time
Alexander Merson moved to New York from Riga in the 1990s. In Latvia, he worked on blood diseases and malignant lymphomas for 13 years. He also defended his Ph.D. thesis on this profile.
According to Alexander, the 90s were a good time to confirm a medical degree, since in the mid-1980s an AIDS outbreak began in America, and the healthcare system was not ready for this. Doctors were needed, but there were none.
Doctor Merson. Photo: from personal archive
Alexander decided to confirm his diploma. He was prepared for the exams at the famous Kaplan preparatory courses, which at that time cost $1,000. The Russian doctor passed the exams with excellent marks and found a place for residency.
“I remember very well my first month in residency. It was terribly complex. I, as an ignorant person, was put in the worst place - I was an errand doctor and did all the bestial work. I wandered around 3 hospitals, where I had a rotation. By the way, one of them was a soldier. In the first week, I came home only 2 times, because I finished my shift at 1-2 am and stayed overnight in the hospital. I don't know how I even survived. On the other hand, thanks to this experience, I learned to do absolutely everything: sew up wounds, and put a hose in my mouth for feeding, and even stop malaria. I did and saw things that I only read about in textbooks, ”the doctor shares his impressions.
When Alexander was doing residency, there was still no law in force prohibiting a doctor from working more than 24 hours in a row. Thus, often he could be on his feet for 36 hours - day shift, night shift and the next day shift.
For his practice, the doctor received $ 34,000 a year. This salary allowed his family of 4 to exist normally. For comparison, Alexander then paid $ 700 for an apartment.
“I completed my residency in 2 years instead of the required 3. The program director requested that I be allowed to finish early. However, New York did not give a license, and I had to complete an additional two-year fellowship in blood diseases (hematology),” says the doctor.
In September 1995, Alexander had already opened his practice in Brooklyn, having bought an office where he had previously received a Chinese doctor. “I found an advertisement for the sale of the practice in the New York Times. It turned out that the office is a 5-minute walk from my house. It was very convenient, and the declared value was low, which allowed me to take this deal. Of course, many clients left after the former owner of the office, but the place was habitable, and they began to visit me, ”Alexander shares his memories.
For more than 20 years he has been working as an internal medicine doctor in his office. His working week is 6 days: 4 days he receives patients, and the remaining two go to him to fill out government papers. The doctor frankly dislikes the current US President Barack Obama because of his reforms, which have made life difficult for doctors.
“I used to go into medicine because of my great love for it. Things are different now: I spend a lot of time on paperwork after Barack Obama introduced the ObamaCare program. As the famous US neurosurgeon, Ben Carson, said: “Obamacare is the worst event in America after slavery,” Alexander confesses. According to him, after the introduction of ObamaCare, many doctors lost their patients, but many checks were carried out and the cost of liability insurance for doctors increased dramatically, because of which some ended their practice and left the profession.
Alexander hopes that Donald Trump will win the next presidential election, who promised to cancel ObamaCare if he wins, and advises everyone to think three times before linking their lives with medicine: “This is a very difficult and long way, a loan of $ 200-300 thousand , if you study in the USA, and work in insane conditions.”
But those who still overcome this path will get a good bonus - on average, doctors' salaries start at $100,000 a year and, according to Payscale, can reach up to $800,000.