Physicians perform medical examinations, diagnose illnesses, and treat people who are suffering from injury or disease. They also advise patients on maintaining good health. There are two types of physicians: the M.D.--Doctor of Medicine--and the D.O.--Doctor of Osteopathy. Despite differences in training and philosophy of treatment, both M.D.'s and D.O.'s use all accepted methods of treatment, including drugs and surgery. Osteopathic physicians, however, place special emphasis on the musculoskeletal system of the body-- bones, muscles, ligaments, and nerves. One of the basic treatments or therapies used by osteopathic physicians centers on manipulating this system with the hands.
Physician may be general practitioners or they may specialize in a particular field of medicine. Most D.O.'s are general practitioners, providing primary care; about 25 percent are specialists. On the other hand, about 85 percent of the M.D.'s who provide patient care are specialists. The largest of the medical specialties for which there is graduate medical training are internal medicine, family medicine, general surgery, obstetrics and gynecology, psychiatry, pediatrics, radiology, anesthesiology, ophthalmology, pathology, and orthopedic surgery. Some of the primary care specialties have shown especially rapid growth--family practice, internal medicine, and pediatrics. Some physicians combine the practice of medicine with research or teaching in medical schools.
Advances in medical technology in recent years have been many and dramatic. Liver and kidney transplants, laser surgery, and ultrasound and magnetic resonance imaging are but a few of these new technologies. Some are opening entirely new areas of medical practice; others are replacing traditional treatment methods.
The emphasis on technology has implications for the way physicians are trained and the way they practice medicine. High-technology medicine requires extensive skills and training. Its dominant role in American medical care underlies the system of specialty medicine, whereby most M.D.'s are specialists and a few are general practitioners. Further, the cost of technology is largely responsible for making the hospital the site of the most advanced medical care. Only hospitals and very large clinics or group medical practices can afford to purchases the most costly equipment. It is beyond the means of individual physicians or small groups.
Physicians who practice alone or in small groups generally work long, irregular hours. Most specialists work fewer hours each week than general practitioners. As doctors approach retirement age, they may accept fewer new patients and tend to work shorter hours. However, many continue in practice well beyond 70 years of age.
Contractual arrangements in the rapidly evolving outpatient care sector vary enormously. An outpatient surgical center, for example, may be operated by several physicians as a group medical practice. Work patterns of such physicians resemble those of other physicians in group practice. Physicians in many outpatient care settings such as health maintenance organizations (HMO's) and urgent care centers are salaried employees. They generally work a standard 40-hour week, although some are moonlighters and work on a part-time basis.
Physicians held about 537,000 jobs in 1990. About 2 out of 3 were in office-based practice; about one-fifth were employed in hospitals; and most of the remainder practiced in HMO's, urgent care centers, surgicenters, public health clinics, and the Federal Government.
The number of medical school graduates rose substantially during the 1970's--a deliberate, publicly subsidized response to the perceived shortage of medical personnel. If the number of medical school graduates remains at current high levels, the supply of physicians is expected to exceed demand.
Training and Other Qualifications
All states, the District of Columbia, and Puerto Rico require physicians to be licensed. Licensure requirements for both D.O.'s and M.D.'s include graduation from an accredited professional school, successful completion of a licensing examination, and , in most States, 1 or 2 years of supervised practice in an accredited graduate medical education program (internship/residency). The licensing examination taken by most graduates of U.S. medical schools is the National Board of Medical Examiners (NBME) test that all States except Texas and Louisiana accept.
Graduates of foreign medical schools generally begin practice in the United States after completing a U.S. hospital residency training program. To enter an approved residency, graduates of foreign medical schools usually must pass an examination administered by the Education Commission for Foreign Medical Graduates and be certified by that organization. After 1 year of work in an approved residency, foreign medical graduates, as well as graduates of U.S. medical schools who have not taken the NBME test, must take the Federation Licensure Examination (FLEX) that all jurisdictions accept. Although physicians licensed in one State usually can get a license to practice in another without further examination, some States limit reciprocity.
Of the 127 accredited schools in the United States in which students can begin study for the M.D. degree, 126 award the degree of Doctor of Medicine (M.D.). One school offers a 2-year program in the basic medical sciences to students who transfer to another medical school for the last semesters of study. Fifteen schools of osteopathic medicine award the degree of Doctor of Osteopathic Medicine (D.O.).
The minimum educational requirement for entry to a medical or osteopathic school is normally 3 years of college; some schools allow exceptional students to begin their professional study after 2 years of college. Most students have at least a bachelor's degree, and many have advanced degrees.
Required premedical study includes undergraduate work in English, physics, biology, and inorganic and organic chemistry. Students also should take courses in the humanities, mathematics, and the social sciences to acquire a broad general education. Studies have shown that medical students with undergraduate majors in the humanities do as well in their medical studies as those who major in the sciences or a "premedical curriculum."
Medicine is a popular field of study, and applicants must compete for entry with highly motivated students who generally have excelled in preprofessional eduction. Factors considered by the schools in admitting students include their academic record and their scores on the Medical College Admission Test, which almost all applicants take. Consideration also is given to the applicant's character, personality, and leadership qualities, as shown by personal interviews, letters of recommendation, and extracurricular activities. Osteopathic colleges give considerable weight to a favorable recommendation by an osteopathic physician familiar with the applicant's background. Many State supported schools give preference to State residents and, sometimes, to residents of nearby States.
Students spend the first semesters of medical school primarily in laboratories and classrooms learning basic medical sciences such as anatomy, biochemistry, physiology, pharmacology, microbiology, and pathology. Students in most schools gain some clinical experience with patients during the first 2 years of study, learning to take case histories, perform examinations, and recognize symptoms. During the last semesters, students work under supervision in hospitals and clinics to learn the important aspects of acute, chronic, preventive, and rehabilitative care. Through these required rotations in internal medicine, obstetrics and gynecology, pediatrics, psychiatry, and surgery, they gain experience in the diagnosis and treatment of illness.
After graduation, almost all M.D.'s complete 1 or 2 years of graduate medical education (residency). Nearly all D.O.'s serve a 12-month rotating internship (including experience in surgery, pediatrics, internal medicine, and other specialties.)
Physicians who have completed 1 year of graduate medical education and enter active military duty initially serve as captains in the Army or Air Force or as lieutenants in the Navy. Graduates also qualify for professional medical positions in the Federal civil service.
Physicians seeking certification in a specialty spend from 3 to 5 years--depending on the specialty--in advanced residency training, followed by 2 or more years of practice in the specialty. Training in a medical specialty is lengthy and rigorous but virtually indispensable in view of the enormous amount of information to be absorbed. Moreover, technologically based medical practice requires such a high level of skill that an extensive period of supervised experience is necessary. Passing the appropriate specialty board examination is the final step in becoming a board-certified M.D. or D.O.
Physicians who want to teach or do research may take graduate work leading to a master's or Ph.D. degree in a field such as biochemistry or microbiology.
A physician's training is very costly. However, loans and scholarships are available from the Federal Government, State and local governments, and private sources. To receive this aid, the student may have to demonstrate financial need or agree to serve at least 3 years in the Armed Forces upon graduation.
Persons who wish to become physicians must have a strong desire to serve the sick and injured. They must be self-motivated and competitive to survive the pressures of premedical and medical education and the demanding workload during the internship/residency that follows medical schools. They must study a great deal to keep up with the latest advances in medical science. Sincerity and a pleasant personality are helpful in gaining the confidence of patients. Physicians should be emotionally stable and able to make decisions in emergencies.
In view of the variation in State laws, students interested in becoming physicians should study carefully the professional and legal requirements of the State in which they plan to practice.
Job opportunities for physicians through the mid-1990's will reflect faster than average employment growth plus the need to replace experienced physicians who leave the medical profession.
Population growth and aging contribute to the need for more physicians. Especially rapid growth is projected for the elderly population, which makes much greater use of physicians' services than younger persons. Demand for medical care is governed by ability to pay, and access to physicians' services is widespread as a result of broad health insurance coverage--through private insurance, now a standard employee benefit, as well as though public programs including Medicare and Medicaid. In addition, more physicians will be needed for medical research and for the growing fields of public health, rehabilitation, and industrial medicine.
Replacement needs in medicine and osteopathic medicine account for fewer job openings than in most other occupations, because physicians exhibit very strong attachment to their work. Once having completed training and entered medical practice, physicians tend to remain in the labor force until they retire. Moreover, relatively few leave medicine for other careers.
The supply of physicians may exceed demand in the decade ahead. The prospective oversupply reflects past decisions about expanding the capacity of the Nation's medical schools, and has relatively little to do with sweeping changes in the organization and financing of health care that are currently underway. About 20 years ago, a perceived shortage of doctors ignited an explosion in medical school enrollments that ended in the late 1970's. Enrollment levels have changed little since then, but that expansion left in place an enlarged student "pipeline" that will produce an abundant supply of newly trained practitioners through the year 2000.
Foreign-trained physicians (including U.S. citizens who receive their medical training abroad) are an important element in the nation's supply of physicians, although the Bureau of Health Professions expects fewer foreign-trained physicians to enter practice in the decade ahead than was true in the past.
The Nation's health care system is being altered in important ways. Changes in the way government pays for hospital care under Medicare and Medicaid, together with efforts by insurance companies and major corporations to contain outlays for employee health benefits, have sharply blunted the rising use of hospitals and shifted some of that demand to outpatient facilities.
The implications of these changes for physicians will be greatest in the area of practice setting and contractual arrangements (salaried employee or fee-for-service practitioner). The increased popularity of HMO's, free-standing birthing centers, and other outpatient facilities means that more physicians are working in what are still viewed as "nontraditional" practice settings. As these and other emerging organizations play an increasingly dominant role in the medical care market, more and more physicians will work for a salary.
It is possible that prepaid arrangements such as HMO's could dampen demand for physicians. If, as scattered evidence suggests, HMO's can provide care with fewer physicians than fee-for-service practice, accelerated growth of HMO's would mean fewer new jobs for physicians than currently anticipated.
Competition for graduate medical residencies will intensify since the number of first- year residency positions will closely match the number of graduates from U.S. medical schools. Newly trained physicians are likely to experience competition as they seek to launch a practice. Competition will be especially stiff in large cities, and in areas considered attractive due to educational or recreational resources or natural beauty. Physicians in many such areas already report declines in patient load or earnings. Those who are willing to locate in inner cities, rural areas, and other places where doctors are not in oversupply should have little difficulty.
Intensified competition due to substantial growth in the supply of newly qualified M.D.'s and D.O.'s is certain to affect physicians' earnings.
Earnings Physicians have among the highest average annual earnings of any occupations. Average income, after expenses for all physicians was about $137,600 in 1990; those under 36 years of age averaged $99,900. Earnings vary according to specialty; the number of years in practice; geographic region; hours worked; and the physician's skills, personality and professional reputation. Self-employed physicians--those who own or are part owners of their medical practice--had an average income of $152,000, while those who were employed by others earned an average of $103,580 a year.
Physicians work to prevent, diagnose, and treat diseases, disorders, and injuries. Professionals in other occupations that require similar kinds of skill and critical judgment include audiologists, chiropractors, dentists, optometrists, podiatrists, speech pathologists, and veterinarians.
Sources of Additional Information
For a list of approved medical schools, as well as general information on premedical education, financial aid, and medicine as a career, contact:
American Medical Association, 535 N. Dearborn St., Chicago Ill. 60610.
Association of American Medical Colleges, One Dupont Circle NW., Suite 200, Washington, D.C. 20036.
For general information on osteopathic medicine as a career, contact:
American Osteopathic Association, Department of Public Relations, 212 East Ohio St., Chicago, Ill. 60611.
American Association of Colleges of Osteopathic Medicine, 6110 Executive Blvd., Rockville, Md. 20852.
Information on Federal scholarships and loans is available from the directors of student financial aid at schools of medicine and osteopathic medicine. Information about Armed Forces Health Professions Scholarships is available from any local military recruiting office.
Persons who wish to practice medicine or osteopathic medicine in a particular State should inquire about licensure requirements directly from the board of examiners of that State.