Can someone explain to me the next what I might expect for the next 20 years?

[yenuwine]

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Hey everyone, I was just wondering if some people could fill in the details to my understanding of the pre-med to doctor track. Ok, so after undergrad, there's 4 years of med school and after that I've heard there are 3-7 years of residency depending on your specialization. I'm guessing the longer ones are probably for those wanting to go into surgery. I know normal residency pay is really low, around 30K, but is this true for all 3-7 years? or does it increase some towards the end? Also, is there a difference between the residencies, are some of the harder to obtain residencies also higher paying?

After residency my knowledge gets especially hazy. I've heard there are programs called fellowships, can someone please explain what these are? Otherwise after residency/fellowship I'm guessing you can either go and start your own practice or work in a hospital. If you start your own practice, from there I guess you can do whatever you want, but is there any real career path for those working in hospitals, and especially surgery, or is it more like now you do your job for the next 30 or so years. Also, I know that after graduating any med school everyone is a doctor, but are there differences, and if so to what extent, in the opportunities afforded to those who graduate from say Harvard, Stanford, or Columbia (highly regarded med schools) and those who graduate from less recognized institutions?

Thanks, thats a lot of stuff, hopefully you guys can provide some insight into what I might be getting myself into.

 

[Mumpu]

You are basically correct about residencies. The pay goes up somewhat towards the end ($3-4 thou per year). Pay of the residency largely depends on the cost of living (i.e. you can buy a car and a house in Denver for the cost of a 2x2 cardboard box under a bridge in San Francisco). Competitiveness of the residencies depends on how popular the profession is (e.g. emergency medicine offers a great lifestyle and is therefore very popular) and/or the number of open positions (e.g. ENT has very few openings nationwide). Fellowships are additional specialty training. For example, if you want to be an adult cardiologist, you first finish a 3-year residency in internal medicine, and then do a 2-3 year fellowship in cardiology. If you want to be a pediatric cardiologist, you do pediatrics residency and then a peds cardio fellowship. Some specalties like neurology and anesthesiology have their own residencies and require you to do only a year of general residency.

After you graduate, you can do whatever you want. Medicine is extremely flexible in that respect.

Unlike law and business, name and prestige of the school are not worth much in medicine. If you work hard, you will be able to do whatever you want no matter where you go. As a bonus, since med school is paid for by loans, a less-famous state school can cost you 2-3 times less (I'm talking $100,000 versus $200-300,000) than an Ivy-league school. As with everything else in life, "highly-regarded" does not equal "right for you." I was very turned off by some of the higher-ranked schools and did not even want to apply there, and I'm very happy at the humble U of Colorado which I liked much better than several of the Top-10 schools I interviewed at. Just a matter of opinion.

Finally, this is not the place to learn about medicine. You should seek out opportunities to shadow physicians and see what their day-to-day work is like. Many hospitals have immersion programs for high school and college students, and you absolutely must get some first-hand patient care experience to make sure medicine is right for you.

Good luck!

 

[UseUrHeadFred]

To reiterate some of the above points, different residencies pay about the same within a few thousand dollars. The major advantage of being closer to the end of your residency is that work hours and call time significantly decrease.

For a first year resident (an intern) it is not uncommon to work more than 100 hours in a week for some specialties. For a third or fourth year, that is much rarer.

After residency, you are an "attending" physician. Part of your responsibilities in a hospital would generally include teaching residents. However at that point you are in a free market and can choose the terms of your employment. Of course, if you start your own clinic or join a partnership, it's a whole nother ballgame.

 

[sahir j]

how do fellowships compare to residencies in terms of hours/pay/responsibility?

 

[xSTALLiONx]

i've heard the term used before but could someone explain moonlighting? Someone said it's a way to quickly pick up some cash to pay off loans.

 

[UseUrHeadFred]

Fellowships follow the same pattern as residency. They get more money than earlier residents, but far less than attending physicians.

For example, take a student who wants to practice theoretical specialty "A".

For Internship, he or she is paid $32k. For Post Graduate Year 2, $34k. For PGY 3, $36k, PGY 4 $40k, and for PGY 5 $43k. All the while, the hours are approaching those of a normal attending - a very large number of hours in PGY 1 and 2, fewer and fewer in later years.

After PGY 5, he or she is now board certified in "A" and could choose to go on and practice as an attending.

However, this person decides to take a fellowship in subspecialty "Ab". Thus, he or she would be PGY 6 and make around $50k, and works far fewer hours than a PGY 1 or 2, but still a few more than an attending in that subspecialty. Mercifully, subspecialty "Ab" is only a one year fellowship, and now he or she is certified as a subspecialist attending.

An attending for subspecialty "Ab" makes $200k and works an average of 50 hours a week.

Regarding moonlighting: In short, this means getting a second job. You work here and there for an hourly wage.

 

[yenuwine]

Thanks for the replies, they've cleared up a few things, anyone else have any insight into this?