I think the term "doctor's doctor" used to be validly applied to pathologists, in the days when people were doctors first and became pathologists second. Many pathologists these days don't seem to carry that aura, as it were, nor really seem intent on developing it.
It's quite interesting to hear the perspective on the 5th year. When I was looking to go into pathology I heard about the number of years, and started looking at websites for programs, some of which alluded to an intern year or giving limited credit for clinical experience, etc., and my impression was they wanted you to have post-med-school clinical experience. The closer I got to actually starting pathology, however, the more people made it sound like that was an antiquated notion and I had been sorely mistaken in my interpretation; the 5th year was a credentialing year at the end, not the beginning, that you had to do but could do anything with it -- focus on one or two subspecialty areas, do research, etc. Dropping the credentialing year requirement supposedly didn't change much, since "most" people would do a fellowship anyway. Personally, I think a bigger problem is the lack of graduated responsibility to the level of independence during residency, which has its own history and issues.
Personally I did do an intern year, in Australia. It was great, not just because of the experience, but because I really had nothing to lose. As long as my work was done and patients were being taken care of, I really didn't have to take crap from anybody -- I knew I could quit and not lose anything, so despite some long hours I didn't stress in the same way a lot of other interns did. That wouldn't have quite been the same story had I been in the U.S. or it was required to continue to residency. And I absolutely walked away at the end with a much better comprehension of the real world for clinicians -- not the same as an attending, but better than the average finishing medical student. This included not just communication, but what was important to a clinician at any given moment, what was typically looked at and not looked at, what was shotgun ordered and why, what clinicians were taking seriously and what they were not, why certain critical values were and were not "critical" to a clinician for a given patient, etc. etc. etc.
As for med school, with rare exceptions it doesn't come anywhere close to exposing you to the real world responsibilities of an intern, resident, or attending. For the most part, the basic science years of medical school are hurdles to cull out those not willing to work and wait. Which is unfortunate, because the clinical years barely offer enough time and background to understand medicine...much less be able to "practice" medicine after graduation. (Thus, of course, we have internship/residency prior to progressing to more specialized training.)
