Physicians examine patients; obtain medical histories; and order, perform, and interpret diagnostic tests. They diagnose illnesses, and prescribe and administer treatment for people suffering from injury or disease. Physicians counsel patients on diet, hygiene, and preventive health care. Those in private practices may handle or oversee the business aspects of running an office.
There are two types of physicians: The M.D. Doctor of Medicine and the D.O. Doctor of Osteopathy. M.D.'s are also known as allopathic physicians. While M.D.'s and D.O.'s may use all accepted methods of treatment, including drugs and surgery, D.O.'s place special emphasis on the body's musculoskeletal system. They believe that good health requires proper alignment of bones, muscles, ligaments, and nerves.
Most M.D.'s specialize. (See table 1.) Pediatricians, general and family practitioners, and general internists are often called primary care physicians since they are the first health professionals patients usually consult. They tend to see the same patients on a regular basis for a variety of ailments and preventive treatment. When appropriate, they refer patients to other specialists. D.O.'s are more likely to be primary care providers than allopathic physicians, although they can be found in all specialties.
Physicians often work long, irregular hours.
Physicians often work long, irregular hours. One-half of all full-timers in 1992 worked 60 hours a week or more; 2 out of 10 typically worked 50-59 hours a week. In general, as doctors approach retirement age, they may accept fewer new patients and tend to work shorter hours. Physicians who are on-call may make emergency visits to hospitals. Many physicians must travel frequently between office and hospital to care for their patients.
Physicians (M.D.'s and D.O.'s) held about 556,000 jobs in 1992. About 2 out of 3 were in office-based practice, including clinics and HMO's; about one-fifth were employed in hospitals. Others practiced in the Federal Government, most in Department of Veterans Affairs hospitals and clinics or in the Public Health Service of the Department of Health and Human Services.
While physicians have traditionally been solo practitioners, a growing number are partners or salaried employees of group practices. Organized as clinics or as groups of physicians, medical groups can afford expensive medical equipment and realize other business advantages.
Table 1. Percent distribution of M.D.'s by specialty, 1992
Total.......................................................100.0
General and family practice..................................11.0
Medical specialties
Allergy.................................................... 0.5
Cardiovascular diseases.................................... 2.5
Dermatology................................................ 1.2
Gastroenterology........................................... 1.2
Internal medicine..........................................16.7
Pediatrics................................................. 6.9
Pediatric cardiology....................................... 0.2
Pulmonary diseases......................................... 1.0
Surgical specialties
Colon and rectal surgery................................... 0.1
General surgery............................................ 6.0
Neurological surgery....................................... 0.7
Obstetrics and gynecology.................................. 5.4
Ophthalmology.............................................. 2.5
Orthopedic surgery......................................... 3.2
Otalaryngology............................................. 1.3
Plastic surgery............................................ 0.7
Thoracic surgery........................................... 0.3
Urological surgery......................................... 1.4
Other specialties
Aerospace medicine......................................... 0.1
Anesthesiology............................................. 4.3
Child psychiatry........................................... 0.7
Diagnostic radiology....................................... 2.6
Emergency medicine......................................... 2.4
Forensic pathology......................................... 0.1
General preventive medicine................................ 0.2
Neurology.................................................. 1.5
Nuclear medicine........................................... 0.2
Occupational medicine...................................... 0.4
Pathology.................................................. 2.6
Physical medicine and rehabilitation....................... 0.7
Psychiatry................................................. 5.6
Public health.............................................. 0.3
Radiology.................................................. 1.2
Radiation oncology......................................... 0.5
Other specialty............................................ 1.5
Unspecified/unknown/inactive...............................12.6
SOURCE: American Medical Association
The Northeast and West have the highest ratio of physicians to population; the South, the lowest. D.O.'s tend to practice in small cities and towns and in rural areas. M.D.'s, on the other hand, tend to locate in urban areas, close to hospital and educational centers. Some rural areas remain underserved, although the situation is improving somewhat.
Osteopathic physicians are located chiefly in States that have osteopathic schools and hospitals. In 1993, 3 out of 4 D.O.'s were practicing in 12 States. Michigan had the most D.O.'s, followed by Pennsylvania, Ohio, Florida, New Jersey, and Texas.
All States, the District of Columbia, and U.S. territories require physicians to be licensed. Licensure requirements for both D.O.'s and M.D.'s include graduation from an accredited medical school (usually 4 years), completion of a licensing examination, and between 1 and 7 years of graduate medical education, that is, a residency for M.D.'s and an internship and residency for D.O.'s. Although physicians licensed in one State can usually get a license to practice in another without further examination, some States limit reciprocity. Graduates of foreign medical schools can generally begin practice in the United States after passing an examination and completing a U.S. hospital residency training program.
The minimum educational requirement for entry to a medical or osteopathic school is 3 years of college; most applicants, however, have at least a bachelor's degree, and many have advanced degrees. A few medical schools offer a combined college and medical school program that lasts 6 years instead of the customary 8 years.
Required premedical study includes undergraduate work in physics, biology, and inorganic and organic chemistry. Students should also take courses in English, other humanities, mathematics, and the social sciences. Applicants should also consider volunteering at a local hospital or clinic to gain practical experience in the health professions.
There are 141 medical schools in the United States 125 teach allopathic medicine and award a Doctor of Medicine (M.D.); 16 teach osteopathic medicine and award the Doctor of Osteopathy (D.O.). Acceptance to medical school is very competitive. Applicants must submit transcripts, scores from the Medical College Admission Test (MCAT), and letters of recommendation. An interview with an admissions officer may also be necessary. Character, personality, leadership qualities, and participation in extracurricular activities also are considered.
Students spend the first 2 years of medical school primarily in laboratories and classrooms taking courses such as anatomy, biochemistry, physiology, pharmacology, psychology, microbiology, pathology, medical ethics, and laws governing medicine. They also learn to take medical histories, examine patients, and recognize symptoms. During the last 2 years, students work with patients under the supervision of experienced physicians in hospitals and clinics to learn acute, chronic, preventive, and rehabilitative care. Through rotations in internal medicine, family practice, obstetrics and gynecology, pediatrics, psychiatry, and surgery, they gain experience in the diagnosis and treatment of illness.
Following medical school, almost all M.D.'s go directly on to graduate medical education, called a residency. The National Board of Medical Examiners (NBME) gives a standard examination for all students, including foreign medical school graduates, applying for an M.D. residency. Most D.O.'s serve a 12-month rotating internship after graduation. The National Board of Osteopathic Medical Examiners gives an examination for internship application. Following their internship, many D.O.'s take a residency program in a specialty area.
M.D.'s and D.O.'s seeking board certification in a specialty may spend up to 7 years depending on the specialty in residency training. A final examination immediately after residency, or after 1 or 2 years of practice, is also necessary for board certification by the American Board of Medical Specialists (ABMS) or the American Osteopathic Association (AOA). There are certifications in 23 specialties: Allergy and immunology; anesthesiology; colon and rectal surgery; dermatology; emergency medicine; family practice; internal medicine; neurological surgery; nuclear medicine; obstetrics and gynecology; ophthalmology; orthopaedic surgery; otolaryngology; pathology; pediatrics; physical medicine and rehabilitation; plastic surgery; preventive medicine; psychiatry and neurology; radiology; surgery; thoracic surgery; and urology. For those training in a subspecialty, another 1 to 2 years of residency is usual.
To teach or do research, physicians may acquire a master's or Ph.D. in such fields as biochemistry or microbiology. They may otherwise spend 1 year or more in research or in an advanced clinical training fellowship.
A physician's training is costly. While education costs have increased, student financial assistance has not. Scholarships have become harder to find. Loans are available, but subsidies to reduce interest rates are limited.
People who wish to become physicians must have a desire to serve patients, be self-motivated, and be able to survive the pressures and long hours of medical education. For example, medical residents often work 24-hour shifts and 80 hours a week or more. Efforts, however, are being made to limit the hours residents work. Prospective physicians must also be willing to study throughout their career to keep up with medical advances. Physicians should have a good bedside manner, emotional stability, and the ability to make decisions in emergencies.
Employment of physicians is expected to grow faster than the average for all occupations through the year 2005 due to continued expansion of the health industry. New technologies permit more intensive care: Physicians can do more tests, perform more procedures, and treat conditions previously regarded as untreatable. In addition, the population is growing and aging, and health care needs increase sharply with age. The need to replace physicians is lower than for most occupations because almost all physicians remain in the profession until they retire.
Job prospects are good for primary care physicians such as family practitioners and internists, and for geriatric and preventive care specialists. Some shortages have been reported in the specialty areas of general surgery and psychiatry, and in some rural and low income areas. This is because physicians find these areas unattractive due to low earnings potential, isolation from medical colleagues, or other reasons, not because of any overall shortage.
Some health care analysts believe that there is, or that there soon could be a general oversupply of physicians; others disagree. In analyzing job prospects, it should be kept in mind that an oversupply may not necessarily limit the ability of physicians to find employment or to set up and maintain a practice. It could result in physicians performing more procedures than otherwise and delegating fewer tasks, or it could result in their providing more time to each patient, giving more attention to preventive care, and providing more services in rural and poor areas. It is also possible that where surpluses are due to specialty imbalances, physicians in surplus specialities would provide services outside of their specialty area.
Unlike their predecessors, newly trained physicians face radically different choices of where and how to practice. Many new physicians are likely to avoid solo practice and take salaried jobs in group medical practices, clinics, and HMO's in order to have regular work hours and the opportunity for peer consultation. Others will take salaried positions simply because they cannot afford the high costs of establishing a private practice while paying off student loans.
Physicians have among the highest earnings of any occupation. According to the American Medical Association, average (mean) income, after expenses, for allopathic physicians was about $170,600 in 1991, and median income was $139,000. The middle 50 percent earned between $95,000 and $210,000. Earnings vary according to specialty; the number of years in practice; geographic region; hours worked; and skill, personality, and professional reputation. Self- employed physicians those who own or are part owners of their medical practice had a median income of $155,000, while those who were employed by others had a median of $110,000 a year.
As shown in table 2, median income of allopathic physicians, after expenses, varies by specialty.
Salaries of medical residents averaged $28,618 in 1992-93 for those in their first year of residency to $36,258 for those in their sixth year, according to the Association of American Medical Colleges.
Physicians who enter private practice usually make a sizable financial investment.
Table 2. Median net income of M.D.'s after expenses, 1991
All physicians..............................................$139,000
Radiology................................................... 223,000
Surgery..................................................... 200,000
Obstetrics/gynecology....................................... 200,000
Anesthesiology.............................................. 210,000
Pathology................................................... 153,000
Emergency medicine.......................................... 135,000
Internal medicine........................................... 125,000
Psychiatry.................................................. 110,000
Pediatrics.................................................. 105,000
General/Family practice..................................... 98,000
SOURCE: American Medical Association
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 acupuncturists, audiologists, chiropractors, dentists, optometrists, podiatrists, speech pathologists, and veterinarians.
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Reprinted with Permission of U. S. Department of Labor