Additional training for specialization, how does it work??

[MeltingPoint]

How does someone become a specialized physician (for example) in any field?

After 4+4 years of school and a couple years training (from what I remember), do they go back to school to become specialized?

Or do they go learn during those 8 ish years? What happens if the hospitals won't hire your specialty? Do you go back and learn another? How long does it take? I don't even know where to begin XD Thanks for reading.

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[xroc]

How does someone become a specialized physician (for example) in any field?

After 4+4 years of school and a couple years training (from what I remember), do they go back to school to become specialized?

Or do they go learn during those 8 ish years? What happens if the hospitals won't hire your specialty? Do you go back and learn another? How long does it take? I don't even know where to begin XD Thanks for reading.

All physicians are technically specialized. Yes, even a family medicine is considered a specialty. After doing 4 years of undergrad and 4 years of med school, all MD/DO graduates must pursue a residency (specialty). Family Medicine, for example is 3 years after med school. Others, such as neurosurgery, are much longer (around 7 years). After you finish your residency, for many (or probably all) specialties, you have the option to sub-specialize by doing a fellowship, which requires additional training. So, for example, if you want to become a cardiologist, you need to do 4 years of undergrad, 4 years of med school, a 3 year internal medicine residency and a 3 year cardiology fellowship.

Hope this helps!

 

[MeltingPoint]

All physicians are technically specialized. Yes, even a family medicine is considered a specialty. After doing 4 years of undergrad and 4 years of med school, all MD/DO graduates must pursue a residency (specialty). Family Medicine, for example is 3 years after med school. Others, such as neurosurgery, are much longer (around 7 years). After you finish your residency, for many (or probably all) specialties, you have the option to sub-specialize by doing a fellowship, which requires additional training. So, for example, if you want to become a cardiologist, you need to do 4 years of undergrad, 4 years of med school, a 3 year internal medicine residency and a 3 year cardiology fellowship.

Hope this helps!

Thanks, that does help a bunch.

After the 4 years of med school, do you get paid for the residency and fellowship? If so, how much? Is it like on job training?

 

[xroc]

Thanks, that does help a bunch.

After the 4 years of med school, do you get paid for the residency and fellowship? If so, how much? Is it like on job training?

Yes, you do get paid for residency and fellowship. I think it starts around $50,000 for your first year of residency and goes up slightly each year after that. Keep in mind that recently, there was a law passed that limits residency work hours to an average of 80 hours per week, so it's definitely not a 9-5 job in residency. I don't believe fellowships have work hour restrictions, so you may be living your entire life in the hospital depending on the program.

 

[BigRedBeta]

Yes, you do get paid for residency and fellowship. I think it starts around $50,000 for your first year of residency and goes up slightly each year after that. Keep in mind that recently, there was a law passed that limits residency work hours to an average of 80 hours per week, so it's definitely not a 9-5 job in residency. I don't believe fellowships have work hour restrictions, so you may be living your entire life in the hospital depending on the program.

Current fellow right here. Fellowships still enforce work hour restrictions (which is not a law...just agreed upon practice that would result in disciplinary action against a residency or fellowship if they didn't follow the rules), as governed by the ACGME (which accredits residency and fellowship programs). An important caveat is that the 80 hours a week rule is averaged over 4 weeks, so it's okay to work 110 hours one week (I've done it) so long as another week is only 50. That said, I've seen a lot of fellows in a lot of different fields and there's generally a culture of kind of looking the other way when it comes to work hours, usually because there is only so much time to see the unique, difficult, or rare cases before you become the "authority" in your field. Given that there are no work hour rules for attendings, the closer you are to that position the more pressure to flaunt the work hour rules with sort of a wink and a nod if anyone were to ask you how many hours you worked. So the doc that's specializing in Cardiac Electrophysiology (a 7th year of training after 3 in Internal Med, and then 3 in cardiology) is more likely to disregard the work hour rules than the first year endocrinology fellow. Of course, your specialty also plays a huge role in that sort of cultural expectation - the Developmental and Behavioral Pediatrician is rarely ever going to have an opportunity to defy the rules whereas the Peds Critical Care fellow may feel obligated to stay with a dying child and their family on not an infrequent basis. This is probably even more pronounced in surgical fields where there is a technical proficiency requirement and the need to complete an adequate case volume. Definitely seen some fellows in various surgical fields still on their feet after 36+ consecutive hours...

Of note, there are some fellowships that are not ACGME approved - for example, Emergency Medical Services, which focuses on how to manage pre-hospital medical providers (EMS/Paramedic/etc) was not ACGME accredited prior to 2013 but fellowship positions existed for years for people who had an interest in that sort of professional role - that operate in somewhat of a gray area in terms of work hours.

As for job finding, the key to remember is that sometimes you have to make sacrifices to get a position that meets your skill set. For example, I'm a peds critical care medicine fellow, and no matter how much I might like to live in Jackson Hole, Wyoming, there will never be a Peds ICU there for me to work in. I knew, as I was applying for fellowship, that I was choosing a career that was mostly tied to academic medical centers in large(ish) cities. I knew that there was a certain level of freedom I was giving up in order to practice in a field that appealed the most to me. For most people choosing a subspecialty, they're picking it because that's how they will be fulfilled best as a professional. When combined with student loan debt and the realities of being in your early to mid 30's, the idea of going back for more training for a different field isn't often plausible. So you find a location or a job that you can live with.