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Lesson 3
Medicine
Early 1800's Medical Training
Early medical training in the United States was done by an apprenticeship with a practicing physician. In
the early 1800's, a few medical schools are in operation in the United States. One of the earliest was Harvard
University in Boston, Massachusetts, which offered at its early beginnings a bachelor of medicine. These
first physicians graduated as generalists in the field of medicine. Medical specialists did not come until
many years later. As the number of medical schools increased, so did their abilities to train better physicians,
all graduating with a Doctor of Medicine degree. There are about 150 medical schools located within the
United States. Their training is now considered the best in the world. Most of the major hospitals have
residency programs for the training of medical doctors after they have finished their four years of medical
school training.
Questions:
How were the early medical doctors trained in the United States?
About how many medical schools are there in the United States today?
Where were the first medical schools located in the United States?
What is a residency program for medical doctors?
WORK DESCRIPTION
Physicians examine patients, obtain medical histories, and order, perform, and interpret diagnostic tests.
They diagnose illnesses, prescribe medications and administer treatment for people suffering from injury or
disease. Physicians counsel patients on diet, hygiene, exercise, 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 Doctor of Medicine (M.D.), and the Doctor of Osteopathy (D.O.).
M.D.'s are 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. Pediatricians, ob/gyn, family practitioners, and 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 and 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.
Questions:
What are the two different types of medical degrees within the United States?
What are the different types of primary physicians?
What it a M.D.?
What is a D.O.?
WORKING CONDITIONS
Physicians often work long, irregular hours. One-half of all full-time physicians work 60 hours a week or
more; two out of ten typically work 50-59 hours a week. In general, as doctors approach retirement age, they
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 between office and hospital to care for their patients.
Questions:
How many hour a week do physicians generally work?
EMPLOYMENT
Physicians (M.D.'s and D.O.'s) hold about 660,000 jobs. About two out of three are in office-based practice
including clinics and HMOs; about one-fifth are employed in hospitals. Others practice in the Federal
government, most in Veteran 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.
Questions:
How many physicians are there in the United States?
In what hat kind of settings do physicians work?
The Northeast and West Coast have the highest ratio of physicians to population; the South has 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 hospitals and educational centers. Some rural areas remain under served, although
the situation is improving somewhat. Osteopathic physicians are located chiefly in States that have
osteopathic schools and hospitals. Three out of four D.O.'s were practice in 12 States. Michigan has the
most D.O.'s followed by Pennsylvania, Ohio, Florida, New Jersey, and Texas.
Questions:
In what areas of the United States are most physicians located?
Which area of the United States has the least number of physicians?
In which State(s) do most D.O.'s practice?
In what parts of the United States are we being under served by physicians?
The following indicates the percent distribution of by specialty.
MEDICAL SPECIALITIES
Allergy 0.5
Cardiovascular diseases 2.5
Dermatology 1.2
Gastroenterology 1.2
General and family practice 11.0
Internal medicine 16.7
Pediatrics 6.9
Pediatric cardiology 0.2
Pulmonary diseases 1.0
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
Physician medicine and rehabilitation 0.7
Psychiatry 5.6
Public health 0.3
Radiology 1.2
Radiation oncology 0.5
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
Otolaryngology 1.3
Plastic surgery 0.7
Thoracic surgery 0.3
Urological surgery 1.4
Other specialty 1.5
Unspecified/unknown/inactive 12.6
TOTAL 100.0
Source: American Medical Association
MEDICAL SPECIALTIES
ADOLESCENT MEDICINE. Adolescent medicine is a relatively new medical specialty.
Physicians who practice in this area treat patient from puberty to maturities that range in age from
11 to 21. The physicians have specialty training in adolescent psychiatry. Patients who seek this
service may have drug dependency, behavioral, self-image, or perhaps psychiatric problems. In
some cases, the physician will admit the patient to an adolescent unit in a hospital setting for
acute treatment of their condition.
ALLERGY AND IMMUNOLOGY. An allergist treats abnormal responses or acquired
hypersensitivity to substances with medical methods including testing and desensitization.
Pediatricians and internists may sit for the board examination in allergy and immunology after
taking several years of additional training.
ANESTHESIOLOGY. An anesthesiologist is trained to administer both local and general drugs
to induce a complete or partial loss of feeling (anesthesia) during a surgical procedure. This
physician provides respiratory and cardiovascular support during surgery. The anesthesiologist
meets with the patient before the surgical procedure to explain the type of anesthetic that will be
used. Certified registered nurse anesthesiologists (CRNA) may administer anesthetics. An
anesthesiologist will work either directly for a hospital or as a member of a group of
anesthesiologists who contract with a hospital or other health care facility.
CARDIOLOGY. A cardiologist is trained to treat cardiovascular disease. This physician has
received special training in the diseases and disorders of the heart and blood vessels. A
cardiologist specializing in the treatment of children's heart disease receives special training as a
pediatric cardiologist.
DERMATOLOGY. A dermatologist treats injuries, growths, and infections relating to the skin,
hair, and nails. This physician may treat patients either medically or surgically. A dermatologist
removes growths such as warts, moles, benign cysts, birthmarks, and skin cancers. In some
cases, they have received additional training in cosmetic surgery including skin grafts,
dermabrasion, hair transplants, and use of the laser.
EMERGENCY MEDICINE (Primary Medicine). The physician who specializes in emergency
medicine has received additional training as an emergency medical resident. Emergency
medicine specialists typically work in hospital emergency rooms and walk-in emergency centers.
They possess the ability or skills to quickly recognize and prioritize (triage) acute injuries,
trauma, and illnesses. They supervise paramedic pre hospital care.
FAMILY PRACTICE (Primary Medicine). The family practitioner physician will treat the
entire family regardless of age and sex. In some cases, they will refer patients to other specialists
such as nephrologists for the treatment of renal (kidney) diseases.
GERIATRIC MEDICINE. The practice of geriatrics is focused on the care of diseases and
disorders of the elderly. Gerontology is a relatively new field of medicine and is the direct result
of the larger aging population.
HEMATALOGY. Hematology is the study of blood and blood-forming tissues.
INFECTION CONTROL. Infection control is the prevention of infectious disease by
maintaining medical asepsis, practicing good hygiene, and obtaining immunizations.
ONCOLOGY. Oncology is the study of cancer and cancer-related tumors.
INTERNAL MEDICINE (Primary Medicine). Internists are physicians who treat adult patients
with medical problems. They are skilled in diagnosis and treatment of non-surgical problems.
Sub-specialties within internal medicine include: cardiology, endocrinology, gastroenterology,
hematology, immunology, nephrology, oncology, and pulmonary medicine.
NEUROLOGY. The neurologist treats the non-surgical patient who has a disorder or disease of
the nervous system.
NEPHROLOGY. The nephrologist specializes in pathology of the kidney including disorders
and diseases. A nephrologist is skilled in both medical and surgical treatments including kidney
dialysis.
NUCLEAR MEDICINE. The physician specializing in this field of study uses radioactive
substances for the diagnosis and treatment of diseases such as cancer.
OBSTETRICS AND GYNECOLOGY (Primary Medicine). An obstetrician treats the female
as she begins prenatal care and continues through labor, delivery, and the postpartum period. A
gynecologist provides both medical and surgical treatment of diseases and disorders of the female
reproductive system. There is a sub-specialty, which deals with infertility, the study of a
diminished capacity or inability to produce offspring.
OPHTHALMOLOGIST. An ophthalmologist treats disorders of the eye. The study of
ophthalmology includes the diagnosis and treatment of vision problems using both medical and
surgical procedures.
ORTHOPEDICS. An orthopedist specializes in the branch of medicine that deals with the
prevention and correction of disorders of the musculoskeletal system. An orthopedic surgeon
specializes in surgical procedures relating to this specialty.
OTORHINOLARYNGOLOGIST (ENT). The otorhinolaryngologist specializes in the medical
and surgical treatment of ear, nose, and throat disorders. This includes the study of otology (ear),
rhinology (noses), and laryngology (throat) and it is also known as otorhinolaryncology.
PATHOLOGY. A pathologist specializes in diagnosing the abnormal changes in tissues that are
removed during a surgical operation and in postmortem examinations. A forensic pathologist is
an expert in determining the identity of a person based on such evidence as body parts, dental
records, and tissue samples.
PEDIATRICS (Primary Medicine). The pediatrician specializes in the development and care of
children from birth to maturity.
PHYSICAL MEDICINE/REHABILITATIVE MEDICINE.
Physical medicine and/or
rehabilitative medical specialists treat patients after they have suffered an injury or disability.
The purpose of treatment is to return patients to their former state of physical health if possible.
This rapidly growing field is closely associated with sports medicine in which the physician treats
athletes using preventive and diagnostic medicine.
PREVENTATIVE MEDICINE. The preventive medical specialist focuses treatment on the
prevention of both physical and mental illness or disability.
PSYCHIATRY. The psychiatrist specializes in the diagnosis and treatment of patients with
mental, behavioral, or emotional disorders. A psychiatrist is qualified to administer and prescribe
medications. This specialist may also practice psychotherapy.
RADIOLOGY. A radiologist specializes in the study of tissue and organs that are based on xray visualization. This physician has been tested and approved by the American Board of
Radiology.
RHEUMATOLOGY. A rheumatologist treats disorders and diseases characterized by
inflammation of the joints such as arthritis.
SURGERY. A surgeon corrects illness, trauma, and deformities using an operative procedure.
Surgery is described as any invasive procedure, which requires entering the body by making an
incision or passing instruments through the skin and organs. General surgery includes all areas of
surgery. General surgeons may restrict their practices to abdominal surgical procedures.
However, many surgeons specialize in areas such as neurosurgery, cardiovascular surgery and
orthopedic surgery. Some of the more common surgical sub-specialties are described below.
Cardiovascular surgery is the surgical treatment of the heart and blood vessels.
Colorectal surgery involves the surgical treatment of the lower intestinal tract (colon and rectum).
Plastic surgery intervention is used to correct structural defects or remove scars and signs of
aging.
Hand surgery is orthopedic surgery that involves surgical treatment of defects, traumas, and
disorders of
the hand. Hand surgeons may employ physical therapy staff and have xray equipment at their disposal.
Neurosurgery involves surgical intervention for diseases and disorders of the central nervous
system.
Orthopedic surgery treats musculoskeletal injuries and disorders, congenital deformities, and
spinal curvatures through surgical means.
Oral surgery involves treatment of disorders of the jaws and teeth by means of incision and
surgery as well as the extraction of teeth.
Thoracic surgery involves treatment of disorders and diseases of the chest with surgical
intervention.
Questions:
What is the major area of patient care for each of these medical specialties?
Emergency care
Family practitioner
Internist
Allergist
Gastroenterologist
Otorhinolaryngologist
Dermatologist
Oncologist
Obstetrician
Gynecologist
Orthopedist
Pathologist
Psychiatrist
Surgeon
Which ones of the above physicians practice as primary physicians?
TRAINING, OTHER QUALIFICATIONS, AND ADVANCEMENT
All States, the District of Columbia, and U.S. territories require physicians to be licensed.
Licensor requirements for both D.O.'s and M.D.'s include graduation from an accredited medical
school (usually four years), completion of a licensing examination, and between one and seven
years of graduate medical education, that is, a residency for M.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 three 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
six years instead of the customary eight years.
Required premedical study includes undergraduate work in physics, biology, and inorganic and
organic chemistry. Students should take courses in English, other humanities, mathematics, and
the social sciences. Applicants should consider volunteering at a local hospital or clinic to gain
practical experience in the health professions.
There are about 150 medical schools in the United States; 130 teach allopathic medicine and
award a Doctor of Medicine (M.D.); 20 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 admission officer may be necessary. Character,
personality, leadership qualities, and participation in extracurricular activities are considered.
Students spend the first two 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 learn to take
medical histories, examine patients, and recognize symptoms. During the last two 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 onto graduate medical education called
their residency requirement. The National Board of Medical Examiners (NBME) gives a
standard examination for all students, including foreign medical school graduates applying for
medical residency. D.O.'s must serve medical residency after graduation. The National Board of
Osteopathic Medical Examiners (NBOME) gives an examination for residency application.
M.D.'s and D.O.'s seeking board certification in a specialty may spend up to eleven years,
depending on the specialty, in residency and sub-specialty training, most serve about four. A
final examination immediately after residency, or after one or two years of practice, is necessary
for board certification by the American Board of Medical Specialists (ABMS) or the American
Osteopathic Association (AOA). There are currently certifications in 23 specialties.
To teach or do research, physicians may acquire a master's or Ph.D. in such fields as
biochemistry, public health, immunology, or microbiology. They may otherwise spend one 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.
Individuals who have a desire to become physicians must have a desire to serve patients, be selfmotivated, and be able to survive the pressures and long hours of medical education. For
example, medical residents often work long hours, some as much as 80 hours a week or more.
Efforts, however, are being made to limit the number of hours residents work. Prospective
physicians must 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.
Questions:
What is required of all M.D.'s after they finish medical schooling?
Do D.O.'s have this same requirement?
What is a medical residency?
What is required if M.D.'s or D.O.'s want to teach in a medical school?
JOB OUTLOOK
Employment of physicians is expected to grow faster than the average for all occupations through
the year 2010 due to continued expansion of the health industry. New technologies permit more
intensive care: Physicians 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 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 possible that where surpluses are due to specialty imbalances, physicians in surplus
specialties 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.
What is expected to happen with the number of new jobs for physicians?
EARNINGS
Physicians have among the highest earnings of any occupation. According to the American
Medical Association, average income, after expenses, for allopathic physicians is about $180,000
in 2004, and median income is $120,000. The middle 50 percent earn between $95,000 and
$220,000. Earnings vary according to specialty, the number of years in a 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
$165,000 while those who were employed by others had a median of $120,000 a year. As shown
below, median income of allopathic physicians, after expenses, varies by specialty.
Salaries of medical residents averaged $45,000 in 20004 for those in their first year of residency,
to $70,000 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.
Median Net Income of M.D.'s,
Radiology
Surgery
$230,000
220,000
Obstetrics/Gynecology
Anesthesiology
Pathology
Emergency medicine
Internal medicine
Psychiatry
Pediatrics
General/Family practice
220,000
220,000
160,000
155,000
155,000
140,000
135,000
125,000
All physicians average $159,000; Source: American Medical Association
Questions:
What is the average salary for medical residents?
What is the average salary for M.D.'s?
RELATED OCCUPATIONS
Physicians work to prevent, diagnose, and treat diseases, disorders, and injuries. Professionals in
other occupations that require similar kinds of skill and critical judgments include acupuncturists,
audiologists, chiropractors, dentists, optometrists, podiatrists, speech pathologists, and
veterinarians.
SOURCES OF ADDITIONAL INFORMATION
For a list of allopathic medical schools, as well as general information on premedical education,
financial aid, and medicine as a career, contacts:
American Medical Association, 515 N. State St., Chicago, IL 60610
For general information on osteopathic medicine as a career, contact:
American Osteopathic Association, Department of Public Relations, 142 East Ontario St.,
Chicago, IL 60611
American Association of Colleges of Osteopathic Medicine, 6110 Executive Blvd., Suite
405, Rockville, MD 20852.