do you have to do a residency?

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md mayhem

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someone asked me this and i didnt have a definitive answer..

do you have to do a residency to practice medicine?
what if someone just wants to get an MD and start his own clinic in some rural town, or simply teach for the rest of their life, can you even get licensed without a completed residency program? what CAN someone do with just an MD and no residency training? is residency mandatory?
and finally. what is the meaning of life.

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someone asked me this and i didnt have a definitive answer..

do you have to do a residency to practice medicine?
what if someone just wants to get an MD and start his own clinic in some rural town, or simply teach for the rest of their life, can you even get licensed without a completed residency program? what CAN someone do with just an MD and no residency training? is residency mandatory?
and finally. what is the meaning of life.


You do not have to enter a residency program. You can be a general practitioner without doing a residency. You just need to pass the licensing exams.

It seems like it would be a good idea to do a residency in Family Medicine (if you're interested in working in a primary care clinic), because it's kinda hard now-a-days with insurance and all the other overhead to just strike out on your own and open up a clinic, even if it is somewhere rural.

The meaning of life is probably not something you'll find the answer to on SDN...but I suppose it might be possible. :)
 
What tacrum said. Also, a couple of doctors I've talked to say its getting harder and harder to get malpractice insurance if you go the GP route. So the insurance companies are in a way making residencies "mandatory."

But I'm sure if you were going to a very rural area it wouldn't be too much of an issue.
 
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Yeah a year of PGY is needed, especially if you are talking about doing well on USMLE 3.

I'll answer the question with a couple of questions.

Do you want to be able to accept insurance from a wide variety of carriers?

Do you want to be able to buy malpractice insurance?

Do you want to be board certified?

You can be licensed (pass step 3) but not board certified. Specialties require residencies to take their boards.
 
Contrary to what the above posts say, every state now requires at least one year of residency to obtain a license.

Thats the internship. The OP asked about residency.

Are they really not considered separate things? Whenever I speak to doctors they always talk about one and then the other.
 
Thats the internship. The OP asked about residency.

Are they really not considered separate things? Whenever I speak to doctors they always talk about one and then the other.

Techincally, it's all considered residency, and divided into PGY-1, 2, 3, etc. "Internship" is a remnant of old school medicine, where they were completely separate, and you decided on your residency during your intern year. -- a la House of God.
 
After all the work you put into getting through undergrad, into med school, passing Step 1 & 2, I can't imagine why you wouldn't want to do a residency. The era of the GP has passed. Although it is technically possible to get licensed with only one year of internship, no one should even consider this as an option, unless they performed so poorly that they have no chance of obtaining a slot.
 
Techincally, it's all considered residency, and divided into PGY-1, 2, 3, etc. "Internship" is a remnant of old school medicine, where they were completely separate, and you decided on your residency during your intern year. -- a la House of God.

Ah ok. Yeah most of the doctors I know are 40+
 
Do people ever do the one year residency thing and then practice until paying off the loans before going back to do a 4 year residency? I'm just wondering how common this is.
 
I cant answer the residency question because it will be too long and hard to answer, but i did find you an answer for your second question about What the Meaning of Life is....


[edit] Popular beliefs
"What is the meaning of life?" is a question many people ask themselves at some point during their lives, most in the context "What is the purpose of life?" Here are some of the many potential answers to this perplexing question. The responses are shown to overlap in many ways but may be grouped into the following categories:

Survival and temporal success

...to live everyday like it is your last and to do your best at everything that comes before you
...to be always satisfied
...to live, go to school, work, and die
...to accumulate wealth and increase social status
...to survive and reproduce
...to participate in natural human evolution, or to contribute to the gene pool of the human race
...to advance technological evolution, or to actively develop the future of intelligent life
...to compete or co-operate with others
...to destroy others who harm you, or to practice nonviolence and nonresistance
...to die having succeeded in your purpose
...to gain and exercise power
...to leave a legacy, such as a work of art or a book
...to live
...to be holy
...to prepare for death
...to produce offspring through sexual reproduction (alike to participating in evolution)
...to protect and preserve one's kin, clan, or tribe (akin to participating in evolution)
...to pursue a dream, vision, or destiny
...to seek freedom, either physically, mentally or financially
...to observe the ultimate fate of humanity to the furthest possible extent
...to seek happiness and flourish, experience pleasure or celebrate
...to survive, including the pursuit of immortality through scientific means (see life extension)
...to complete your list of life goals
...to find something to believe in
...to attempt to have many sexual conquests (as in Arthur Schopenhauer's will to procreate)
...to succeed in our dreams, and live at your best and satisfaction.
...to think, and open the other 85% of our minds.
...to have fun, and enjoy life the way you desire.
...to be a part of history
Wisdom and knowledge

...to be without questions, or to keep asking questions
...to try to discover and understand the meaning of life
...to expand one's perception of the world
...to explore, to expand beyond our frontiers
...to learn from one's own and others' mistakes
...to seek truth, knowledge, understanding, or wisdom
...to understand and be mindful of creation or the cosmos
...to lead the world towards a desired situation
...to satisfy the natural curiosity felt by man about life
Ethical

...to express compassion
...to follow the "Golden Rule"
...to give and receive love
...to live in a way such that you do not harm yourself and do not harm your environment
...to work for justice and freedom
...to live in peace with each other, and in harmony with our natural environment (see utopia)
...to protect humanity, or more generally the environment
...to serve others, or do good deeds
Religious and spiritual

...to find perfect love and a complete expression of one's humanness in a relationship with God
...to achieve a supernatural connection within the natural context
...to achieve enlightenment and inner peace
...to become like God, or divine
...to be experience personal justice (i.e. to be rewarded for goodness)
...to experience existence from an infinite number of perspectives in order to expand the consciousness of all there is (i.e. to seek objectivity)
...to be a filter of creation between heaven and hell
...to produce useful structure in the universe over and above consumption (see net creativity)
...to reach Heaven in the afterlife
...to seek and acquire virtue, to live a virtuous life
...to turn fear into joy at a constant rate achieving on literal and metaphorical levels: immortality, enlightenment, and atonement
...to understand and follow the "Word of God"
...to worship, serve, or achieve union with God
...to discover who you are

Other

...to be emotionally fulfilled
...to find true love
...to live, love, and laugh
...to achieve self-actualisation
...to contribute to collective meaning ("we" or "us") without having individual meaning ("I" or "me")
...to find a purpose, a "reason" for living that hopefully raises the quality of one's experience of life, or even life in general
...to live, and enjoy the passage of time
...to participate in the inevitable increase in entropy of the universe
...to make conformists' lives miserable (see nonconformism)
...to participate in the chain of events which has led from the creation of the universe until its possible end (either freely chosen or determined, this is a subject widely debated amongst philosophers)
...to relate to, connect with, or achieve unity with others
...to resolve all problems that one faces, or to ignore them and attempt to fully continue life without them, or to detach oneself from all problems faced (see Buddhism)
...to seek and find beauty
...to contemplate "the meaning of life"
...to make life as difficult as possible for others (i.e. to compete)
...all possible meanings have some validity (see existentialism)
...death is the meaning of life
...to know yourself
...a combination of any of the above
No purpose, and therefore...

...to die.
...to simply live until one dies (there is no universal or celestial purpose)
...a series of events
...nature taking its course
...the wheel of time keeps on turning
...the cycle of life
...whatever you see you see, as in "projection makes perception"
...there is no purpose or meaning whatsoever (see nihilism)
...life may actually not exist, or may be illusory (see solipsism or nihilism)
...to contemplate "the meaning of the end of life"
...teleology is an illusion brought on by evolution, which shaped our instincts
Philosophical

...life in itself has no meaning, for its purpose is an opportunity to create that meaning
See also
Evolutionary psychology origin of life - Evolution of life
abiogenesis- the origins of biological life
cosmogeny- the origins of the universe
gene-centered view of evolution
semiotics- relationship of life to its environment


Scientific approaches and theories
Where scientists and philosophers converge on the quest for the meaning of life is an assumption that the mechanics of life (i.e., the universe) are determinable, thus the meaning of life may eventually be derived through our understanding of the mechanics of the universe in which we live, including the mechanics of the human body.

There are, however, strictly speaking, no scientific views on the meaning of biological life other than its observable biological function: to continue. In this regard, science simply addresses quantitative questions such as: "What does it do?", "By what means?", and "To what extent?", rather than the "For what purpose?".


Scientific analysis of teleology
A very promising idea about the purpose of life probably arised many years ago (it's a common statement that "biology debunked teleology a century ago"), although it has been further popularized recently. This "debunking" is said to have coincided with or resulted from advances in biological knowledge such as the publication of Charles Darwin's On the Origin of Species (i.e. the creation of the theory of natural selection). It is not unlikely however, that it was philosophized long before that teleology (perceived meaning or purpose) is an illusion that has no bearing on reality and that ultimately there is no objective purpose to anything.

The proposition follows basically like this: setting goals and finding potential goals in physical objects and abstract ideas is an instinct deeply seated in the primate mind, as it was a characteristic fashioned by natural selection; part of the evolution of humanity's ancestors. This instinct, which is the search for purpose (or "meaning") is often known as teleology. We, as human beings, are all innately teleological thinkers. Teleological thinking is useful in the natural (and modern) world, making it a favorable trait for species to have. However, when we use this instinct when thinking philosophically about life, the universe, and everything, it misfires and we come up with an unsolvable conundrum - one which doesn't really exist in the first place. Teleological instincts apply well to physical objects such as food (purpose: to eat) but fail when they are attempted to be applied to the more abstract, like subjective experience. The failure of teleology can be demonstrated not just with abstract concepts, but objects that serve no known utility to human beings. What, for example, is the purpose of an asteroid floating around light years outside of this galaxy? We can objectively explain the cause of things like space rocks, but we must conclude, if we are to embrace teleological thinking, that either a) far away asteroids have no purpose or b) purpose doesn't exist in objective reality.

The argument about teleological thinking as a result of natural selection is put forward in various books and articles. The best-selling author and evolutionary biologist Richard Dawkins puts forward the explanation in his Discovery Science video The Big Question: why are we here?.

This explanation of our famous (or infamous) teleological conundrum is to many the most probable, satisfying, and ultimate answer we have attained for the problem of the meaning of life, especially since it is falsifiable and can be backed up with specific scientific evidence, such as neurological research, while it is already supported by general scientific evidence, such as the evidence for evolution.


[edit] Science and the five questions
But, like philosophy, science doesn't rest when it comes to asking and answering questions, and scientists have tackled each of the five interpretations of the meaning of life question head-on, attempting to answer each from the perspective of what exists, or in relation to the human being (for which science itself serves), offering empirical answers from relevant scientific fields...

What is the origin of life?
Thus, the question "What is the origin of life?" is answered in the sciences in the areas of abiogenesis (for the origins of biological life) and cosmogeny (for the origins of the universe). Both of these areas are quite hypothetical, cosmogeny because no existing physical model can accurately describe the very early universe (the instant of the Big Bang), and abiogeneis because the environment of the young earth is not known, and because the conditions and chemical processes that may have taken billions of years to produce life cannot (as of yet) be reproduced in a laboratory.

However, general consensus is that an early protein replicator was formed by the gradual build up of amino acids in the oceans, and then proceeded to dominate the primeval soup, occasionally mutating into a more (or less) successful form. Eventually a primitive cell was formed, and life continued to evolve by the mechanisms of mutation and natural selection. Based on these or similar theories, some philosophers say that because life was entirely coincidental, one cannot expect life to have any meaning at all, other than its own self-perpetuation — reproduction.


What is the nature of life (and of the universe in which we live)?
Toward answering "What is the nature of life (and of the universe in which we live)?", scientists have proposed various theories or worldviews over the centuries, including the heliocentric view by Copernicus and Galileo, through the mechanistic clockwork universe of René Descartes and Isaac Newton, to Albert Einstein's Theory of General Relativity, to the Quantum Mechanics of Heisenberg and Schrödinger in an effort to understand the universe in which we live.

Meanwhile, countless scientists in the biological and medical fields have dissected the human body to its very smallest components to acquire an understanding of the nature of biological life, to determine what makes us tick. Near the end of the 20th century, equipped with insights from the gene-centered view of evolution, biologists began to suggest that in so far as there may be a primary function to life, it is the survival of genes. In this approach, success isn't measured in terms of the survival of species, but one level deeper, in terms of the successful replication of genes over the eons, from one species to the next, and so on.


What is the significance of life?
The question "What is the significance of life?" has turned philosophers toward the study of significance itself and how it is derived and presented (see semiotics). The question has also been extensively explored by those who attempt to explain the relationship of life to its environment (the universe), and vice versa. Thus, from a scientific point of view, the significance of life is what it is, what it does, and what mechanisms are behind it. In psychology and biology, it is evident significance only exists within human and animal minds; significance is subjective and is an emotional function of brains, making it impossible to exist outside of people's thoughts and feelings.


The remaining two questions, and the social sciences
The questions "What is valuable in life?" and "What is the purpose of, or in, (one's) life?" are staples of the social sciences. These questions are explored by scientists every day, from the perspective of the life forms being studied, in an effort to explain the behaviors and interactions of human beings (and every other type of animal as well). The study of value has resulted in the fields of Economics and Sociology. The study of motives (which reflect what is valuable to a person) and the perception of value are subjects of the field of Psychology.
 
I'm not sure how far the OP is in their medical education, but as a second year I don't know jack. Some of my friends are fourth years and they'll readily admit that they don't know jack, so I've got to think that even after a year of internship you're just starting to get around to knowing a little jack. Old docs used to be able to do it because there was a lot less knowledge to learn and fewer procedures to master. Nowadays the thought of throwing up a shingle and being responsible for the health and welfare of an entire town after such limited training should scare the bejesus out of most people.
 
Do people ever do the one year residency thing and then practice until paying off the loans before going back to do a 4 year residency? I'm just wondering how common this is.

This is a low yield move. If you could even find a position as a GP, the income differential means (even with interest you pay of loans deffered) you'll do much better off doing a residency first, then starting practice.
 
I'm planning on doing the 3 week infomercial residency. It is going to be tough getting in to a good program, though, since I'm an MD student and not a DO student.
 
someone asked me this and i didnt have a definitive answer..

do you have to do a residency to practice medicine?
what if someone just wants to get an MD and start his own clinic in some rural town, or simply teach for the rest of their life, can you even get licensed without a completed residency program? what CAN someone do with just an MD and no residency training? is residency mandatory?
and finally. what is the meaning of life.
Yes and no. You could probably teach with just an MD, but you'd be teaching high school, maybe college (though to do that you'd be better off with a research post-doc). You could do a rural clinic, but you'd need to do at least an intern year to do step III, be licensed, and be able to prescribe drugs. I've been told you can do some work in law and business with an MD w/o/an internship+residency, but you'd be much more valuable with a license.

Oh, and 42.
 
I actually know someone in this situation. A woman I worked under went to medical school but did not do a residency.
After she got her MD, she worked for the FDA on drug stuff, and now does politcal/health care stuff.
(I assume one could also do basic science research)

So, apparently you don't need to do a residency, but like everyone else says, don't expect to practice.
 
I worked in a (very) rural hospital for 3 weeks last summer, and there was a physician who worked in the ED who had only done an intern year. He went into anesthesia, hated it, quit, and was grandfathered into the ED at this hospital. He also made a ton of money investing in beach-front property after a hurricane, and only works one week a month. While it may end up being an easy lifestyle, both ventures carry exhorborant amounts of risk.
I talked to him about it, and he said that it's extremely unlikely that one could intentionally follow this career path. If you want to practice clinical medicine, yes, you could only do one year, but you'd be very limited in potential work.
That being said, there are a variety of jobs that don't require you to do even an intern year. Basically anyone willing to pay extra to say they have an "MD" working for them (i.e. big pharm, clinical research, scientific research companies) will give you a job w/o an intern year.
 
Residents often work on their own after passing Step III (you techinically need only 10 months of PG work to sit for it but most wait a full year....learned that factoid in our USMLE intro a couple weeks ago), but most continue in their residency. It's called moonlighting, which I'm sure most people here have heard of. Once you pass Step III you're licensed and can pretty easily find work in rural EDs and make good money. I know a surgery resident that said he would bring in $60-80/hour in a couple different rural ERs. He would typically do them in the middle of the night when it was pretty slow so he could sleep some as well. He got paid, and the rural hospital had a more competent ED physician than they were used to (he had probably seen more emergencies/trauma than that small hospitals' entire ED staff)....win-win for everyone.

Of course to be board eligible in any specialty you need more than the minimum requirements for licensure. You have to complete the minimum number of years in an accredited residency/fellowship.
 
While we're on the topic, I forgot to mention something. If you have a couple of minutes, try http://medschoolhell.blogspot.com/

I started at the very beginning and read through all the posts. It's great, but be forewarned, he may actually convince you to do the same!
 
Yes and no. You could probably teach with just an MD, but you'd be teaching high school, maybe college (though to do that you'd be better off with a research post-doc). You could do a rural clinic, but you'd need to do at least an intern year to do step III, be licensed, and be able to prescribe drugs. I've been told you can do some work in law and business with an MD w/o/an internship+residency, but you'd be much more valuable with a license.

Oh, and 42.

RxnMan wins! 42 is the correct answer!!! hooray! :D
(sorry helpfuldoc2b)

thanks for the info guys, much appreciated.
 
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