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Medical school (general medical knowledge) —> residency (specific field) —> fellowship (optional further specialization past residency)
 
VTDSPMed said:
I've been researching for a while now and haven't come to a concrete conclusion. I know during medical school your last two years you spend doing rotations, however, what does "specializing" do? During usually the third year of medical school you declare a speciality in a certain thing like surgery, primary care, etc. Despite that, you still graduate medical school as a general practice doctor right? It's not like you graduate medical school and you're like, "Woo I'm a plastic surgeon now!"

For example, let's say I wanted to become a plastic surgeon or family doctor. What is the process there?
During my third year I declare my speciality in surgery or primary care, then hopefully get matched to a program where I'm practicing plastic surgery or primary care, and after the residency I'm officially a plastic surgeon or family practitioner? And where do fellowships work into all this?!?!

Please help clarify this for me!
Click to expand...

AnatomyGrey12 said:
Medical school (general medical knowledge) —> residency (specific field) —> fellowship (optional further specialization past residency)
Click to expand...

A little incomplete, so I will expand.

Medical school comes first. During your fourth year (MS4), you apply to residency. When you graduate medical school, you are an MD (or DO). You are not a 'general practice doctor'. You can not obtain a state license to practice medicine. In order to practice medicine in the US, you need to have some amount of residency training. The majority of people will complete a full residency in a particular specialty. Some (rare) will complete less. Without completing residency, you can not sit for a specialty's board exams and can not be 'board certified' in the field. I am not versed in every state's laws, but the majority require at least a single year of residency to complete your licensure to practice medicine. Which leads us to the far harder to understand part...

Once you have obtained a state medical license, you can legally do just about anything. At that point the question of "How do I become a specialized doctor?" is really a, "How do I convince a hospital to give me privileges to practice XYZ?" and a "How do I convince patients to come to me for XYZ?" Because you can legally do anything under the sun once you are licensed, you will find many physicians practicing medicine without formal (or any?) training in what they do. However, there are some broad strokes answers to those questions.

"How do I convince a hospital to give me privileges to practice XYZ?" - Board certification is often a requirement. If you want to practice plastic surgery at a hospital, they can require that you are board certified. This requires you to have completed a residency (or general surgery + fellowship) in plastic surgery. Although it is becoming a vestige of the past in many places, another way is to simply demonstrate that you have been safely doing whatever it is you want to do previously and that the hospital should let you continue to do it. Or... you could simply open your own practice, own your own facility and do whatever the heck you want which leads us to...

"How do I convince patients to come to me for XYZ?" - If you setup your own practice and function independent of a hospital or facility that has requirements, you can do whatever you want. But, you have to convince patients that they should allow you to treat them. This can be challenging for some or simple for others.
 
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