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By Valerie M. Harrison Before you can be licensed as a physician, you must complete internship and residency, a sort of on-the-job training for doctors. Depending on your specialty, residency can last from a minimum of 2 years to 6 or more. After accumulating debt over the previous 8 years, you will finally be drawing a small paycheck. The pay starts at about $32,000 for the first year and tops out around $48,000 for 6th year residents. The first year of training after medical school is called internship, or PGY-1 (post graduate year #1), the second year is PGY-2, and so on. During your clinical rotations you will have gotten a pretty good idea in which area you might want to specialize. Competition for residency in some specialties can be fierce, however in 1999 "80.5 percent of graduating seniors matched into one of their first three choices for first and second-year programs...57 percent matched to their first choice, 15 percent to their second choice, and 8 percent to their third choice." (UT Southwestern). As with your application to medical school, there is a centralized service used to compile your information and place you into a residency program. ERAS, NRMS, the "Match", and the "Scramble": The Electronic Residency Application System (ERAS) is designed to compile your information and submit it to your selected residency programs in a standardized format. Completion and submission of the application is similar to using AMCAS to apply for medical school. What takes place next is the "Match". Using the ERAS applications, the National Residency Matching System (NRMS) helps recent graduates find residency positions and helps hospitals find residents to fill their slots. As with the AMCAS process, students must start applying early to the programs that interest them, travel to interviews if invited, and await a decision from the admissions committee. If a graduate doesn't get a slot in this way, they must suffer through the "scramble". Those that do not match are notified two days before the official results and can participate in the scramble, where unmatched graduates telephone unmatched residency programs in an attempt to find jobs. Visit the AAMC for more information. The System: The residency program is a fundamental part of our healthcare system and the use of low-paid interns and residents help control costs. Residents work long hours and are "on call" every 2 to 4 days. They often spend 30 to 36 hours at a time in the hospital, often with little or no sleep. In recent years there has been an outcry about the harsh working conditions to which new doctors are submitted. Organizations like the American Medical Student Association (AMSA) are making some progress toward limiting the hours worked by student doctors. " The American Medical Student Association is committed to addressing the issue of health professional overwork. In many hospitals, resident-physicians often work over 100 hours a week and 36 hours consecutively. This is a situation that is healthy for neither the residents nor the patients that they treat." (AMSA) The following statistics were recently compiled by the AMSA:
The overloading of residents is a long-standing tradition in medicine that is not likely to disappear any time soon. The older doctors believe that the more experience you have treating patients and their diseases the better you will be as a physician. An old saying in medicine goes "the only thing wrong with being on call every other night is that you only get to see half the patients. " Beside being the hardest worked member of the medical team, an intern is at the bottom of the food chain at a teaching hospital. Any unpleasant, menial task (called "scut" work) is the intern's job. After the intern year, residents spend more and more time focusing on their area of specialty. Beginning with relatively simple procedures, they learn progressively more complex tasks. Medicine is taught on the premise "see one, do one, teach one." In other words; watch a procedure performed, do the procedure yourself, then teach someone else how to do it. Residency is without a doubt a grueling experience, but the US consistently turns out the best doctors in the world, so despite it's drawbacks, it is a highly effective form of education for new physicians. For support during residency try the MomMD
residents forum and connect with other residents. More resident
resources at MomMD. Articles in this series:
Visit all the MomMD resources
for becoming a doctor.
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