Home Medicine articles Physician
A physician is a person who practices medicine.
See that article for more information on what physicians do
in their practices; this article focuses on physician training
In the United States, the term physician is
traditional and commonly used. In Britain, Australia, Pakistan
and India, the term doctor is more common as physician refers
to specialists in internal medicine.
Because of the extensive training requirements,
physicians are traditionally considered to be members of a learned
Medicine in the UK is an undergraduate subject.
Students can begin training after leaving the school at 18 years
of age. Medical school training lasts either five or six years,
depending on the institution, and combines academic and practical
training. Junior doctors then enter a vocational training phase.
In the UK a doctor's training normally follows this path:
Degree level preclinical - Doctors must
study medicine in university or medical school for two to
three years "preclinical" (meaning little patient
contact). However following recommendations by the British
Medical Association (BMA) many universities are following
a "Problem-based learning" approach, which stresses
basing the studies around actual patient cases.
Clinical - This time is spent in a teaching
hospital and typically lasts two or three years. After this
is completed the student doctor is awarded a Bachelor of
Medicine (BM or MB) and Bachelor of Surgery (BCh or BS).
An honorary prefix of "Dr" is now entitled to
be used, although it is not recognised in the academic sense
of the word (see Doctorate). Doctors who graduated overseas
have to pass the Professional and Linguistic Assessment
Board test (PLAB) to be eligible for further postgraduate
training and jobs in UK.
The Foundation Programme - Due to recent
changes in the training of junior doctors, newly qualified
doctors enter a two year Foundation Programme, where they
train in a variety of different specialities. These must
include training in General Medicine and General Surgery
but can also include other fields such as Paediatrics or
Following completion of the Foundation Programme
a doctor can choose to specialise in one field. All routes involve
further assessment and examinations. The majority in the UK
work in the community as General Practitioners (GPs), who are
the first port of call for patients. They diagnose illness and
refer patients for further examination by specialists if necessary.
The majority of patients are managed by their GP without the
need for further referral.
Hospital doctors are promoted after sitting
relevant postgraduate exams within their chosen specialty (e.g.
Member of the Royal College of Physicians MRCP, Member of the
Royal College of Surgeons [MRCS]) and a competitive interview
selection process from SHO to Specialist Registrar and eventually
Consultant on completion of the CCST (Certificate of Completion
of Specialist Training), which is the highest level in a specialty
team (with the exception of university-linked professors). The
competition is great for those who wish to attain consultant
level and many now complete higher degrees in research such
as a Doctorate of Medicine (MD) which is a thesis-based award
based on at least two years full-time research or PhD which
involves at least three years of full-time research. The time
taken to get from graduation from medical school to becoming
a Consultant varies from speciality to speciality but can be
anything from 7 to 10 years, or longer in some specialities.
In the United States and countries following
the U.S. method, the path to a medical degree is somewhat different.
Admissions: Admission into medical school requires
either three years of undergraduate study or a four-year post-secondary
bachelor's degree from an accredited college or university,
depending on medical institution. Most require that the applicant
have attained a bachelor's degree prior to matriculation. Admissions
criteria include overall performance in the undergraduate years
and performance in a group of courses specifically required
by U.S. medical schools, the score on the Medical College Admissions
Test (a national standardized test), application essays, letters
of recommendation (number varies, but at least 1 from science
faculty and 1 from non-science faculty), and interview(s). The
list of courses required are as follows:
biology (1 year)
general chemistry (1 year
organic chemistry (1 year)
physics (1 year)
calculus or sometimes statistics (1 year)
English composition (1 year)
sometimes behavior science and/or biochemistry
Medical School: Once admitted to medical
school, it takes four years to earn a Doctor of Medicine
(M.D.) or Doctor of Osteopathic Medicine (D.O.) degree.
The course of study is divided into two roughly equal parts.
Preclinical study generally comprises the first two years
and consists of classroom and laboratory instruction in
core subjects such as anatomy, biochemistry, physiology,
pharmacology, microbiology, pathology, and neurosciences.
Once the student successfully completes preclinical training,
he or she moves on to the clinical portion. This usually
occupies the final two years of medical school and takes
place almost exclusively on the wards of a teaching hospital
or, occasionally, with community physicians. The students
observe and take part in the care of actual patients under
the supervision of residents and attending physicians. Rotations
on clinical services such as internal medicine, surgery,
pediatrics, obstetrics/gynecology, and psychiatry are the
foundation of this curriculum, but many specialty electives
may be chosen as well. Upon completion of medical school,
the student earns the title of doctor, but cannot practice
independently until completing further training. Also, several
universities across the U.S. admit high school students
to both their undergraduate colleges and the medical schools
simultaneously; students attend a single seven-year or eight-year
integrated program consisting of three or four years of
an undergraduate curriculum and four years of medical school
curriculum, culminating in both a bachelor's and M.D. degree.
Internship: During the last year of medical
school, students apply for postgraduate residencies in their
chosen field of specialization. These are more or less competitive
depending upon the desirability of the specialty, prestige
of the program, and the number of applicants relative to
the number of available positions. All but a few positions
are granted via a national computer match which pairs an
applicant's preference with the programs' preference for
applicants. The first year of any residency is known as
"internship". Completion of this year is the minimum
training requirement for obtaining a license to practice
medicine in the U.S.
Residency: Each of the specialties in
medicine has established its own curriculum, which defines
the length and content of residency training necessary to
practice in that specialty. Programs range from three years
after medical school for internal medicine to five years
for surgery to eight or nine for neurosurgery. This does
not include research years that may last from 1 year up
to a completion of a Ph.D. Each specialty incorporates an
internship year to satisfy the requirements of licensure.
All specialties hold a board exam (either written or written
and oral) at the completion of training in order to confer
"Board Certification" in that specialty.
Fellowship: Certain highly specialized
fields require formal training beyond residency. Examples
of these are cardiology, endocrinology, oncology after internal
medicine; cardiothoracic surgery, pediatric surgery, surgical
oncology after general surgery to name just a few. There
are many others for each field of study. The training programs
for these fields are known as fellowships and their participants
are "Fellows" to denote that they already have
completed a residency and are "Board Eligible"
or "Board Certified" in their basic specialty.
Fellowships range in length from one to three years and
are granted by application to the individual program or
sub-specialty organizing board.
Attendings and Consultants: The physician
or surgeon who has completed his or her residency and possibly
fellowship training and is in the practice of their specialty
is known as an Attending or Consultant. These are the physicians
who may independently care for patients and are the final
arbiters of care. They are responsible for all care decisions
and may bill for their services.
However, medicine is an extremely diverse profession
with many options available. Some doctors work in pharmaceutical
research, occupational medicine (within a company), public health
medicine (working for the general health of a population in
an area), or join the armed forces.
In France, a doctor's training is performed
in public university hospital, called Centre hospitalier universitaire
or CHU; it consists in:
the first year is common with the
dentists and the midwives; the rank at the final examination
determines in which branch the student can go on; it
is called "PCEM1" (premier cycle des études
médicales, first cycle of medical studies) or "P1";
the second year is called "PCEM2"
and is dedicated to the fundamental sciences (or propédeutique,
propaedeutics): anatomy, human physiology, biochemistry,
The first year is called "DCEM1"
(deuxième cycle des études médicales, second cycle of
medical studies), and is also dédicated to the study
The second, third and fourth years
(DCEM2-4) are called externat, and are dedicated to
the study of clinical medicine; they end with a classifying
examination, the rank determines in which speciality
(the general medicine is one of them) the student can
make an internat: the first graduate can choose speciality,
and at the rank n, the graduate must choose amongst
the places left; the graduate also gets a Certificat
de synthèse clinique et thérapeutique (certificate of
clinical and therapeutical synthesis).
The internat is two years and a half
(general medicine) or four years (specialist) of initial
professional experience under the responsibility of a senior;
the interne can prescribe, replacements of liberal phsicians
can be made, and usually the student works in an hospital.
This ends with a doctorate, a research work
which most of times consist in a statistical study of cases
to propose a care strategy of a specific affection (in an epidemiological,
diagnostical, or therapeutical point of view). A specialist
also gets a DES (diplôme d'études spécialisées, diploma for
specialised studies). The initial training thus consist in eight
years and a half for a general practitioner, and ten years for
a specialist (including a surgeon).
In most jurisdictions, physicians need government
permission to practise. This is known as licensing in the United
States, as colegiation in Spain, as ishi menkyo in Japan, as
approbation in Germany, and as registration in Australia and
the United Kingdom. In France, civilian physicians must be a
member of the Order of physicians to practice medicine. In some
countries, including the United Kingdom, the profession regulates
itself, with the government affirming the regulating body's
authority (in the UK the General Medical Council [GMC]).
Regulating authorities will revoke permission
to practice in cases of malpractice or serious misconduct.
Graduates of Foreign Medical Schools, who enter
USA have to pass USMLE step 1 and 2 ECFMG old nameand do a residency
program to qualify for a state license. After graduating from
medical school, American physicians usually take a standardized
exam which enables them to obtain a certificate to practice
from the appropriate state agency. All American states have
an agency which is usually called the "Medical Board,"
although there are alternate names such as "Board of Medicine,"
"Board of Medical Examiners," "Board of Medical
Licensure," "Board of Healing Arts," etc. Australian
states usually have a "Medical Board," while Canadian
provinces usually have a "College of Physicians and Surgeons."
In the United States, as a result of the war
on drugs, pharmaceuticals are strictly regulated at the federal
level by the Food and Drug Administration and the Drug Enforcement
Administration. All practicing American physicians who intend
to prescribe controlled substances must obtain a number from
the DEA, and that DEA number must appear on all their prescriptions.
Use of the DEA number enables dispensing pharmacists or the
DEA to ensure that a physician is not dispensing potentially
addictive or harmful drugs, such as opiates or stimulants, in
contravention to accepted standards of care.