A look at the process in the U.S., which has more than 120 medical colleges.
VOICE ONE:
This is SCIENCE IN THE NEWS in VOA Special English. I'm Bob Doughty.
VOICE TWO:
And I'm--------- Faith Lapidus. On our program this week, we look at how people become medical doctors in the United States.
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VOICE ONE:
It is not easy to become a doctor in the United States. The first step is getting into a medical college. More than one hundred twenty American schools offer study programs for people wanting to be doctors.
People can get advice about medical schools from many resources. One of these is the Princeton Review. The publication provides information about colleges, study programs and jobs.
The Princeton Review says competition to enter medical schools is strong. American medical schools have only about 16,000 openings for students. But more than two times this many seek entry. Many of those seeking to be admitted are women.
VOICE TWO:
Most people seeking admission contact more than one medical school. Some applicants contact many. An important part of the application usually is the Medical College Admission Test, or MCAT. The Association of American Medical Colleges provides the test by computer. It is offered in the United States and in other countries.
The applicant is rated on reasoning, physical and biological sciences and an example of writing. Applicants for medical school need to do well on the MCAT. They also need a good record in their college studies.
VOICE ONE:
People who want to become doctors often study a lot of biology, chemistry or other science. Some students work for a year or two in a medical or research job before they attempt to enter medical school.
A direct meeting, or interview, also is usually required for entrance to medical schools. This means talking with a school representative. The interviewer wants to know if the person understands the demands of life as a medical student and doctor in training. The interviewer wants to know about the person's goals for a life in medicine.
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VOICE TWO:
A medical education can cost a lot. One year at a private medical college can cost 40,000 dollars or more. The average cost at a public medical school is more than 15,000 dollars. Most students need loans to pay for medical school. Many finish their education heavily in debt.
Some Americans become doctors by joining the United States Army, Navy, Air Force or Public Health Service. They attend the F. Edward Hebert School of Medicine of the Uniformed Services University of the Health Sciences in Bethesda, Maryland. These students attend without having to pay. In return, they spend seven years in government service.
Doctors are among the highest paid people in the United States. Big-city doctors who work in specialties like eye care usually earn the most money. But some other doctors earn far less. That is especially true in poor communities.
VOICE ONE:
Most medical students spend their first two years mainly in classroom study. They learn about the body and all its systems. They also begin studying how to recognize and treat disease.
By the third year, students begin working with patients in hospitals. Experienced doctors who have treated many patients guide them as they work. As the students learn, they think about the kind of medical skills they will need to work as doctors.
During the 4th year, students begin contacting hospital programs for the additional training they will need after medical school. Competition to work at a top hospital can be fierce.
VOICE TWO:
Doctors-in-training in hospitals are known as interns or residents. They are usually called interns during their first year. After that, the name of the job is resident. The trainees treat patients guided by medical professors and other experts.
All 50 states require at least one year of hospital work for doctors-in-training educated at medical schools in the United States. Graduates of study programs at most foreign medical schools may have to complete two or three years of residency, although there are exceptions.
VOICE ONE:
To be accepted for a residency, a person must meet the requirements of the Educational Commission for Foreign Medical Graduates. This process involves several tests before a person can receive a visa to stay in the United States for the training period.
Those completing study programs at foreign medical schools may be required to return to their own country for at least two years after their training ends. But because of doctor shortages or other needs, some have been able to get visas without the required two-year stay in their home country.
Doctors-in-training receive experience in different kinds of care. Interns, for example, may work with children for one month. The next month, they may be assisting at births. How long a residency lasts depends on the chosen area of medicine.
VOICE TWO:
There are many medical specialties. Some people become cardiologists and care for the heart. Others become oncologists and treat cancer patients. Still others become pediatricians and take care of children. And some doctors go into medical research, either at a university or with a private company.
But whatever they choose, they first need experience. Some doctors work a long time in hospitals before they are fully trained in a specialty. Some spend six years or more as residents before beginning private practice.
A doctor in Illinois remembers that before his internship, he wanted to work in crisis medicine in the emergency room. But later he chose surgery, because it lets him have more time to decide how to help his patients.
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VOICE ONE:
In 1999, the Institute of Medicine of the National Academies, the I.O.M., released a report on mistakes in American hospitals. The report said preventable mistakes resulted in at least 44,000 deaths each year.
5 years ago, the New England Journal of Medicine published two government-financed studies of serious mistakes. The studies found that the mistake rate in two intensive-care areas decreased when interns worked fewer hours.
The Accreditation Council for Graduate Medical Education supervises medical education. In two thousand three, the Council reduced the hours that residents may work. It limited residents to no more than 30 hours of continuous duty. A hospital was not supposed to require more than eighty hours of duty in a week. Some residents were spending more than one hundred hours a week at their hospitals.
VOICE TWO:
Last year, the United States Congress ordered the I.O.M. to study the situation again. The I.O.M. reported that the shorter work week did not help residents. It said they were getting far less sleep than they should.
The report said the residents were attempting to do as much work in the shorter time as they had done while working more hours. So the I.O.M. proposed that residents be required to get five continuous hours of rest for every sixteen hours on duty. It also asked that residents be given fewer duties and more supervision.
VOICE ONE:
Yet some American researchers have questioned the value of the I.O.M. proposals. They say the proposed changes could cost American hospitals about one billion six hundred million dollars a year.
The researchers work for the RAND Corporation and the University of California at Los Angeles. Their report was published last month in The New England Journal of Medicine.
The report also said few medical mistakes cause injury. And, it said changing work rules could cause other kinds of mistakes. If resident doctors work shorter hours, for example, mistakes could happen when one resident takes over a patient's care from another.
VOICE TWO:
The New England Journal of Medicine published an editorial with the report. The writers expressed concern that the proposed changes would place too much importance on the number of hours worked. They said residents would face ethical questions about making others responsible for sick patients just because their working hours were ending. The editorial questioned whether reduced work hours could give the residents the education they will need as doctors.
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VOICE ONE:
This SCIENCE IN THE NEWS was written by Jerilyn Watson and produced by Mario Ritter. I'm Bob Doughty.
VOICE TWO:
And I'm Faith Lapidus. Read and listen to our programs at voaspecialenglish.com. Listen again next week for more news about science in Special English on the Voice of America.
