The long, arduous process of becoming a doctor is easier said than done. Meet a student completing medical school, and learn what challenges still lay ahead.
“Easier said than done.” It’s a common expression, and yet very aptly describes the process that faces high school graduates who dream of becoming doctors.
Those who think all it takes is four years of college and four years of medical school don’t realize that students also must work through three to seven years of residencies. That totals 11 to 15 years of training before they are licensed and entitled to be addressed as “doctor.” The intensive studying, long work hours, personal sacrifices and financial challenges are indeed daunting.
For Diana Metropulos, a fourth-year student at University of Illinois College of Medicine, Rockford, the long road to becoming a doctor began with intensive study to prepare for the Medical College Application Test (MCAT).
“I first applied online to the programs that I was interested in,” Metropulos says. “This involved sending my transcripts and making a personal statement of intention. Once that’s successfully done, the program directors want to know more about prospective students, so we’re asked to send a second application. The next step is being invited to interview.”
Metropulos describes the interview process as a half-day session, which includes a tour of the campus, along with one-on-one or multiple-person interviews conducted by faculty and staff.
Dr. Martin Lipsky, dean, explains that all medical students are required to hold a bachelor’s degree, usually, but not always, in some medical-related field, such as biology. “Students seeking admission to the University of Illinois College of Medicine first apply through the American Medical College Application Service,” Lipsky says. “The service collects information from students such as transcripts, MCAT results, grade point average, biographical data and letters of recommendation, and then forwards the file to schools selected by the applicant. At the University of Illinois, the admissions office develops a cognitive index score based on the student’s academic performance, to screen students for those meeting admission standards. The score is weighted by various factors. For example, a student who got an A in a course from Harvard weighs in more heavily than if he or she had received an A in the same course at a smaller, less competitive college. Typically, we receive about 7,000 applications annually for 300 available slots. It’s tough to get into medical school.”
Students who meet the academic standards are asked to send a second supplemental application with more supporting information. They submit a personal statement, explain their career goals and answer questions such as, “Why did you choose to apply to the University of Illinois?” Among the 7,000 applicants, about 2,000 submit secondary applications.
“The admissions committee reviews all of these secondary applications and then weighs non-cognitive factors, such as a student’s commitment to medicine, research experience, leadership skills and community commitment,” Lipsky explains. “This is where activities such as volunteer work are assessed. Students who meet academic standards and subjectively appear to have the qualities the admissions committee feels are important to being a successful physician, are then invited for an interview. The interview is an important part of the process, since it offers a face-to-face opportunity to assess factors such as personality, integrity, honesty – those types of things which don’t easily show up on paper – as well as a candidate’s ability to communicate and make eye contact easily.”
About 800 applicants are interviewed, and about 600 are offered admission.
“In our experience, about half of those offered admission end up accepting and joining the class,” Lipsky says. “The offer-to-acceptance rate is considered a marker of a school’s desirability among students. U of I has a 1.7 offer-to-acceptance rate, which is better than the national average.”
The rigorous process and the work of the admissions committee are vital to future success both for the school and for students, Lipsky says.
“When you make sure you’re working with highly-motivated and intellectually capable students, not only is it less costly to educate them, but also you’re able to develop high-caliber physicians. It’s a given that they’re all smart, but there’s so much more required of them,” Lipsky says. “Four years of medical school is intense. I remember being surprised, myself. What I felt was that one-quarter’s worth of material in [undergraduate] college was condensed into a week or two. Handling the volume of material, effectively managing time and coping with how life itself can sometimes make things challenging, is difficult for even the most capable students.”
And there’s the adjustment of realizing you’re no longer the smartest kid in the room.
“Typically, these students are used to being at the top of the class, and now they’re thrown together with other students who also were at the top of their classes,” says Lipsky. “Obviously, not everyone can be at the top of the class, and this can be a difficult adjustment.”
Once students graduate, their medical training is nowhere near done.
“They’re still not licensed to practice,” Lipsky explains. “They all must get into post-graduate medical education programs to be licensed and, if they choose to sub-specialize, to be eligible for fellowships. And while they get paid for residencies, it’s much less than a licensed doctor is paid.” As an aside, Lipsky adds: “Considering the expectations and caliber of today’s students, many of us feel lucky we got admitted to medical school when
we did.”
The number of applicants to medical school often mirrors the economy, Lipsky says. When the economy is struggling, and workforce levels for medical fields are lower, student interest in medicine rises, even when it means 80-hour work weeks to reach goals.
Debt is another important factor that prospective medical students must consider.
“The average student attending public medical school incurs about $120,000 in debt, while private college medical students invest around $160,000,” Lipsky says. “Our student median is $140,000, but for some students, it may top $300,000 before they earn their first penny.”
Dr. Vivek S. Kantayya, FAAFP, assistant professor and interim head of the Department of Family and Community Medicine, believes that becoming a doctor begins with a strong calling or vision of what the future might hold.
“They face so many challenges, many long and difficult hours of preparation ahead of them,” Kantayya says. “If they don’t have firm convictions, they will encounter many points at which they may give up.”
Role models often motivate students to become doctors.
“I don’t have anyone in my family who is in the medical profession,” Metropulos says. “But growing up, I loved my pediatrician. Many of my classmates have parents or other relatives who are doctors.”
Kantayya had such role models in his family.
“I watched my grandfather, who was a doctor in India, and my uncle, who was a surgeon,” Kantayya explains. “Medicine was ingrained into my heart and mind, along with the skills, strengths and talents I would need to succeed.”
While today’s resident students no longer deal with unrestricted duty hours, Kantayya says they still often ask themselves, “Why am I doing this?” Dedicated students have sensed God’s call to devote their lives to service, says Kantayya. After all, he adds, doctors meet people at the most critical times in their lives.
“A good med student must feel a deep-seated conviction that being a doctor is what he or she was born to be,” Kantayya says. “Additionally, students need to have compassion, humbleness and a need to serve. Occasionally, doctors become arrogant and bitter – they begin to feel that they are the ones to whom service is owed. These are the doctors who get into trouble. To be a truly great doctor, one must have a servant’s heart, filled with loving kindness, compassion and caring. Anyone can be a run-of-the-mill doctor, but to be really good, it takes strength of character and perseverance.”
It also takes patience to work through tough courses, Kantayya points out.
“For some, pharmacology is the hardest course, while others have the most trouble with anatomy,” he says. “I am naturally very visual. I have no trouble with anatomy and things I can see. But pharmacology is tough because I can’t see it. Instead, to excel in that subject, we must memorize the brand generic names of the drugs, their side effects and possible interactions.”
Metropulos says her toughest class was pathology, especially the forensics section, but she really liked the biochemistry and pharmacology courses.
“It all depends on the kind of person you are,” she adds.
Others struggle with the clinics and making rounds at hospitals, Kantayya says.
“While most lectures start at 8:30 a.m., hospital rounds require a student to be up by 5 a.m., and at the hospital by 6:30 a.m.,” he says. “It’s such a different format from the normal student routine. Plus, they become a part of a team during rounds. Time management is another one of those skills a medical student needs to master to succeed.”
Residency presents another set of challenges. In the transition from student to doctor, a resident actually writes out orders for patients. During part of the first year, each is reviewed by a third-year resident or the attending doctor, but it’s impossible for the doctor to cover every order.
“Suddenly, the resident is responsible for the patient’s hospital care,” Kantayya says. “It’s a very daunting prospect.”
Through the long years of education and residency, it’s not unusual for students to drop out, for a variety of reasons.
“We have only 46 in our class, so we get to know each other well over the years,” Metropulos says. “We’ve had some students take time off for family issues. It’s hard to deal with personal concerns when you’re trying to study and work.”
Students can split their first year into two segments, an option that’s offered at University of Illinois in Champaign.
“You get a ton of material thrown at you that first year,” Metropulos says. “I went through it in one year, but others choose to break it up in two.”
Some of the challenges are unique to the medical education process.
“I know of one resident who dropped out because he just couldn’t get enough sleep. Now he teaches,” Kantayya says. “Before restrictions on duty hours, it was common for residents to work 30 to 36 hours in a stretch. Students must listen to their minds and bodies to understand when they’ve reached their limits. After four years of medical school, they need several years in residency. For neurology or cardiology, plus fellowships, they’re looking at a very long haul.”
Kantayya says medical school debt is one factor in medical students choosing to become cardiologists instead of family practice physicians. They can pay off the huge debts more quickly.
“Medical students normally make the final decision on which field or specialty to pursue, in the fourth year,” Kantayya explains. “After eight to 12 weeks’ experience in different practices, they have a feel for what they want to do. This is when role models are extremely important. They see the joy and satisfaction which comes from the patients, family and community. If they haven’t had this influence before, it’s hard to understand why being a doctor is so amazing.”
“You truly don’t understand, until you get into the process, what it’s like,” Metropulos adds. “We devote our lives to it.”
This doesn’t mean that students have no social life.
“The college does a good job of helping us to balance our study and work schedules with time off,” Metropulos says. “At the beginning of our second year, we have a little more free time for sports, movies or just hanging out together.”
But some things do suffer. “Much of the time, we aren’t doing anything but studying and working,” she says. “We have each made sacrifices to be here. Our families and friends understand. But we do need some balance, or we would go crazy.”
Graduation is by no means the end of a medical student’s education. The next step is finding a residency, where the learning can be put into practice in a real healing environment. Now in her fourth year, Metropulos is working on that search.
“There are a lot of choices, depending on which specialty a student is interested in,” she says. “Some programs are more competitive than others, especially those with fewer openings available.”
Through this step, as in all others, Metropulos and her fellow students support each other and share their experiences.
“I’m looking for a three-year residency in general pediatrics,” Metropulos says. “I haven’t found a specialty I’m interested in, so that’s my goal right now.”
As U of I residency coordinator for Family Medicine, Brett Ruiz explains the process by which med school graduates evolve into board-certified doctors.
“You’ve probably seen this on the news,” Ruiz says. “It’s called match week.”
Essentially, medical students apply to their programs of choice during their senior years. “The students are invited to interview through the winter,” says Ruiz. “After all the interviews are completed, both the students and the programs rank each other, in top-down order, as to which they most prefer. The National Resident Matching Program, an independent organization, coordinates the lists from both students and programs, and assigns the matches. The third week in March is match week.”
Residencies typically begin on July 1.
“Medical school graduates fall into two different types,” Ruiz says. “United States students typically graduate in April or May, and go on to their chosen residency in July. But international medical school students may have just graduated, as well, or may have previously practiced in their homelands.
Regardless, they still must complete the same licensing exams as United States medical graduates prior to being admitted to a residency program.
“Residency graduates may choose to pursue fellowship training to further focus their fields,” explains Ruiz. “For example, a family medicine graduate could opt for a geriatrics or sports medicine fellowship, if those are specific areas in which he or she chooses to practice,” Ruiz says. “To be licensed as a doctor in Illinois, a student must have completed two years of residency. However, to be board certified, he or she must have completed the entire length of training for that specialty and passed the board certification exam.”
Easier said than done. The title of “doctor” doesn’t come easily. But all of the hard work, time, financial debt and sacrifices are worth it to those who feel called to make a difference in the lives of patients and their loved ones.