Introduction

Medical school is grueling, a time of travail and testing: an initiation into a demanding yet satisfying profession. Medical dramas glam up the profession but don’t make the classic mistake of assuming that having an MD degree will set you on the path of instant prosperity.

Studying never really ends for doctors as they need to constantly renew their knowledge and skills to remain current with today’s high-tech, high-pressure world of medicine.

Many wannabe doctors see only the six figure salaries that come with an MD, and assume that the big bucks are just a few years away.

The plain truth: the vast majority of doctors don’t earn very much fresh out of medical school. But with time doctors easily earn $200,000 or more a year in gross income in the United States.

Nail-biting medical dilemmas, long hours, stressful conditions and years of schooling (and in many cases, student loans) are part and parcel of a doctor’s life. Studying never really ends for doctors as they need to constantly renew their knowledge and skills to remain current with today’s high-tech, high-pressure world of medicine.

It also takes discernible time between ten to 12 years to become a doctor. Account for four years of undergraduate studies, four years of medical school, then three to six years of residency depending on your specialization. That can easily pan out to some 12 years or more before you can head off to work as a doctor. 

Doctors Are Held In High Public Esteem

A recent Harris Poll found that Americans ranked being a doctor as one of the most prestigious occupations. Sixty-three percent of those surveyed said firefighters have "very great" prestige, followed by doctors at 58%, nurses at 55%, scientists at 54%, teachers’ at 52% and military officers at 51%. Ranking lowest in prestige were the wheeler-and-dealer types: real estate brokers at 6%, stockbrokers at 11%.

Another poll emphasized that doctors remain the most trusted professionals among the public. A survey by MORI conducted for the British Medical Association found that 91% of the public believe doctors tell the truth. They were followed by teachers 87%, professors 74% and judges 72%.

Is Medicine Your Calling?

Ironically, the best part of the job — the doctor-patient relationship —can also constitute the hardest. Most doctors say that it just isn't possible to get used to breaking bad news.

Applicants should also have a keen interest in the basic sciences because the root of medical studies lies in them.

It is a humane calling and you have to ask yourself whether you have the giving personality to be a doctor. Most importantly, do you have the doggedness to complete the training? Do you have the ability to get good grades? Are you willing to make the sacrifices to get through med school and a brutal residency? And finally, do you have a desire to help people?

Along the way you will have to develop all the qualities you’d want in your own doctor: technical expertise, a feel for the human factor, and empathy. Doctors literally touch lives as they go about healing and saving lives.

Medical schools expect applicants to have a grasp of the health-care industry. Familiarity with current medical issues and trends is important as interview questions can revolve around them. You should have an inclination towards medical ‘technology’ which includes new drugs, techniques and tools of communication. Applicants should also have a keen interest in the basic sciences because the root of medical studies lies in them.

Professionally you will be required to interact not just with patients but with various colleagues and staff. Interpersonal skills are important.

Money Matters

Recent surveys show that most doctors work an average of 60 hours per week and see 20 to 25 patients per day. For all the extremely long years doctors invest in their medical studies, they are compensated well and are positioned among the highest-paid professionals in the United States and most countries around the world.

A recent Physician Compensation and Production Report, prepared by Medical Group Management Association, indicates the median annual income for certain areas of practice as follows:

Note: Annual Incomes listed are after expenses but before taxes.

Resident doctors though don’t have it this good. The national median salary for them is about $35,000. Most hospitals depend on them as cheap labor.

Medical Education: The Long Haul

Medical schools view scores above 10 as superior.

Medical education in the United States, as in most countries, is a long haul. It can easily stretch beyond ten years from entry-level training through to continuing education depending on the chosen specialty. Typically, the process can be outlined as below:

Undergraduate Education— Admission into medical school usually requires a bachelor's degree from an accredited college or university. It can takefour years to earn a BS or BA degree, usually with a strong emphasis on basic sciences, such as biology, chemistry and physics (some students do enter medical school with other areas of emphasis).

Thorough preparation for the MCAT holds the key to success in the test.

It can take four years or more at one of the Liaison Committee on Medical Education(LCME) accredited US medical schools to obtain a pre-medical education degree. The course of study is roughly divided into two equal components: pre-clinical (didactic courses in the basic sciences:anatomy, biochemistry, physiology, microbiology, pathology and pharmacology, as well as behavioral sciences) and clinical (rotations through different wards of a teaching hospital). After completing medical school, a student is granted Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree. Both allow the degree holder to practice medicine after completing an additional accredited residency program.

As there can be educational, language and cultural differences, many US medical schools encourage international applicants to enroll for at least one year of undergraduate coursework at a regionally-accredited American university prior to starting medical school.

Residency Program (Graduate Medical Education)

For all the extremely long years doctors invest in their medical studies, they are compensated well and are positioned among the highest-paid professionals in the United States and most countries around the world.

Newly graduated MDs enter into a residency program that is 3 to 7 years or more of professional training under the supervision of senior physician educators. Applications for postgraduate residencies in a chosen field of specialization are sent during the last year of medical school.

The length and content of residency training varies depending on the specialty chosen: family practice, internal medicine, and pediatrics, for example, require 3 years of training; general surgery requires 5 years. A residency program is granted through a national matching program which pairs an applicant’s preference with the program’s preference for applicants. All but a few positions are granted. Each specialty training program incorporates an internship year to satisfy the requirements of state licensures.

International medical graduates (IMG) need to be certified by the Education Commission for Foreign Medical Graduates (ECFMG) before starting their residency. They need to take the United States Medical Licensure Examination (USMLE), send their credentials as proof of medical education, take the ECFMG-administered English test and clear the Clinical Skills Assessment exam.

Fellowships

Since the United States offers one of the best medical educations in the world, the application process is tough.

One to three years of additional formal training in a sub-specialty is an option for some doctors who want to become highly specialized in a particular field, such as cardiology, endocrinology, oncology after internal medicine; cardiothoracic surgery, pediatric surgery, surgical oncology after general surgery. 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 are granted by application to the individual program or sub-specialty organizing board. Fellowships often contain a research component.

On completing undergraduate, medical school, and graduate medical education, a physician must obtain a license to practice medicine from a state or jurisdiction of the United States in which they are planning to practice. They can apply for the permanent license after clearing a series of exams and completing a minimum number of years of graduate medical education.

A majority of physicians also choose to become board certified, which is an optional, voluntary process. Certification ensures that the doctor has been tested to assess his or her knowledge, skills, and experience in a specialty and is deemed qualified to provide quality patient care in that specialty. There are two levels of certification through 24 specialty medical boards — doctors can be certified in 36 general medical specialties and in an additional 88 subspecialty fields. Most certifications must be renewed after 6 to 10 years, depending on the specialty.

Learning does not end when physicians complete their residency or fellowship training. Doctors continue to receive credits for continuing medical education, and some states require a certain number of CME credits per year to ensure the doctor's knowledge and skills remain current.

Medical School Admission Requirements

Since the United States offers one of the best medical educations in the world, the application process is tough. You are likely to be competing with some 40,000 applicants for 18,000 seats across medical schools. The table below shows the average scores of recently accepted medical student in America:

The Grade Point Average (GPA) score is extremely important as it indicates the applicants’ academic readiness. That’s the reason medical schools do their initial screening using GPA and MCAT scores.

While having great scores is important, most medical schools also assess the interest of candidates in the profession itself and their overall attributes

While having great scores is important, most medical schools also assess the interest of candidates in the profession itself and their overall attributes. This could include some experience in scientific academic research, display of leadership roles along with volunteer and extracurricular activities. A well-written personal statement and strong recommendation letters weigh equally with other factors in the admission process.

An interview with an admissions officerisheld towards the end of the application process.Many medical schools invite the most promising applicants to an interview with faculty and other members of the admissions committee. If this poses a problem for you as a foreign student, you can request a telephone interview which might not always be granted.

All Applications have to go through American Medical College Admission Service (AMCAS) which is a centralized processing service for all the member medical schools

The MCAT CBT

Second in importance to your GPA score is the Medical College Admission Test Computer-Based Test (MCAT CBT) which is administered by AAMC. The MCAT assesses mastery of basic concepts in biology, chemistry (general and organic), physics, scientific problem solving, critical thinking and writing skills. It consists of four separate parts: verbal reasoning, physical sciences, biological sciences and the writing sample. A score on a scale of 1 to 15 is given for verbal reasoning and the sciences. Medical schools view scores above 10 as superior. The writing portion requires two essays that give a single score (a letter between J and T where J is low and T is high). The essays are important for foreign students as they reflect their ability to communicate fluently in English.

The MCAT is a five and a half hour long multiple choice standardized exam and 19 test dates are available in a year. Scores are released about 30 days after the exam. Nearly all medical schools suggest you take it in the spring of the year before you aim to gain admission.

Thorough preparation for the MCAT holds the key to success in the test. Students spend months studying and practicing the test, both online and by poring over material and questions asked in previous tests.

The Personal Statement

The personal statement is the final clincher. it should be lucid, well-structured, relevant and inspiring

The personal statement is the final clincher. Draw from personal experiences that define why you want to make medicine your career. Admission officers scan essays closely for genuine motivation and qualities that define a good doctor. The essay should also reflect your intellectual strength and ability to work hard, especially under pressure. Most importantly, it should be lucid, well-structured, relevant and inspiring enough for the committee to want to read it.

Secondary and Recommendation Letters

After receiving an application, a medical school might ask for a “secondary” to be filled out by you. On the face of it, the topics seem extremely straightforward asking you to write a few paragraphs about your favorite book, hobbies, future plans, or your greatest academic achievement — remember these responses offer the admission committee vital clues about you as a person. Take the time to give a meaningful response to each query, so that you come across as a “thinking” and well-rounded personality.

Remember these responses offer the admission committee vital clues about you as a person.

Letters of recommendation can be from a previous professor, a doctor, an employer or someone who is familiar with your talents either academically, personally or professionally. The person writing a recommendation for you should know you well enough to be able to highlight your special ability to tackle the intellectual challenge of a challenging medical career. Getting letters from big names in the medical fraternity doesn’t automatically grab attention unless it is a moving recommendation. Submit only the number of letters asked for by each school that you are applying to.

The Interview

For some medical schools, the interview is the final deciding factor while for some it is just part of the process. For most applicants it is a relief to be called for an interview as it is a sign of definite interest in your application.

What works best is presenting your true self without any charade.

Some schools have a one-on-one and others a panel interview conducted by a Medical Selection Committee. Their primary aim is to ascertain your determination to pursue medical studies and to gauge your skills beyond academics. What works best is presenting your true self without any charade. Remember, the people across the table are seasoned interviewers, skilled in the art of sifting the wheat from the chaff.

Questions can range from the mundane to the bizarre. To prepare for the interview, brush up on your knowledge of current medical trends and issues. Interviewers want to gauge your views. “Medical schools are looking for students with maturity, empathy and superior interpersonal skills,” says “The Princeton Review of the Best 168 Medical Schools.”

Rate of Acceptance at US Medical Schools

Admission to US medical schools is highly competitive and it is more so for international applicants. As per the US Educational Advisory Service (EAS), many US medical schools, especially state-supported ones, still will not consider international students for MD programs. Barely 1% of foreign students manage admission at US medical schools. Understandably, the schools have a primary obligation to train US citizens.

But the good news is that given the ethnic diversity of its population, US schools are becoming more accepting of minority applicants. A student can also establish permanent residency status prior to applying to overcome this barrier. Here is a valuable tip: most international students accepted by US medical schools had completed at least one year at a US undergraduate institution.

More choices to make

Generally the term ‘medicine’ implies doctors that have at least one internal medicine specialty. There are numerous specialties which can further have many sub-specialties. For instance, surgical specialties can be broken into general surgery, cardiovascular surgery, maxillofacial surgery, orthopedic surgery, otolaryngology, plastic surgery, oncologic surgery, vascular surgery and pediatric surgery. Likewise, there are several sub-disciplines of internal medicine: cardiology, critical care medicine, endocrinology, gastroenterology, hepatology, geriatrics, hematology, infectious diseases, nephrology, oncology and neurology.

A medical student can also opt for a diagnostic specialty which focuses purely on diagnosing disorders. Clinical laboratory sciences, for instance concentrate on clinical diagnostic services which use laboratory techniques for diagnosis. These services are supervised by a pathologist. The personnel that work in medical labs are technically trained professionals who do not hold medical degrees, but who usually hold an undergraduate medical technology degree. They perform the tests and procedures needed for providing specific diagnosis.

Radiology as a diagnostic specialty deals with imaging the human body and deals with x-rays, x-ray computed tomography and ultrasonography.

Some other specialties include anesthetics, clinical neurophysiology, ophthalmology, dermatology, emergency medicine, obstetrics and gynaecology, palliative care, pediatrics, psychiatry.

Interdisciplinary sub-specialties of medicine are: general practice, family practice, family medicine

Legal Restrictions

A foreign student holding a US professional medical degree does not get the automatic right to work in the United States. It is legally required that a doctor be licensed or registered. This involves acquiring a medical degree from a US university and accreditation by a medical board or an equivalent national organization, which may ask the applicant to pass exams. This ensures that all physicians are trained and qualified and meet national standards.

Expenses and Financial Aid

Most students rely on external loans to pay for their education

If you happen to be one of the lucky few who manage to enter the sacred gates of a medical school, your next worry will revolve around cost of tuition and living which in no uncertain terms is extremely high. By the time you graduate, your debt could add up to a staggering total that will have to be diligently worked off. The choice of a private school (upwards of $34,000) or public school (upwards of 18,000) will determine how much you owe. The average debt of recent medical graduates ranged from $119,131 to $149,460.

Your best bet for starting your search for financial assistance is at the institute you wish to enroll in. Some may offer financial aid to international students in the form of loan, grant, scholarship, teaching or research assistance (for postgraduates), tuition waiver or work-study. You can have a direct chat with the admissions office to see what’s on offer.

Most students rely on external loans to pay for their education. Loan amounts and repayment options vary depending on the field, level and length of study as well as other factors. Read the fine print before committing to a loan as interest rates have a big bearing on how much you eventually owe.

A foreign student holding a US professional medical degree does not get the automatic right to work in the United States.

There are very few scholarships available to international students and loans are generally not available from US lending institutions without a US citizen as a co-borrower. Individuals with permanent residency in the US may be eligible for federal student loan programs. It usually takes a permanent resident one year as a non-student to establish residency in a state. State residency will allow you to pay in-state tuition fees, which are lower than both out-of-state and private university fees.

While contemplating the costs of a medical education, it helps to keep sight of the fact that as a doctor you will eventually rank among the highest-paid professionals besides enjoying a fulfilling career.

Choosing a Top Medical Schools

The primary aim of studying medicine is to learn the art of treating patients. In the US, famous medical schools don't have a monopoly on providing a great medical education. Medical school rankings are always a point of debate as no single method for determining these rankings works perfectly. Therefore, the US News and World Reports split the rankings into research and primary care categories.

US News and World Report recently ranked Top Medical Schools as:

Research

Harvard University

Johns Hopkins University

University of Pennsylvania

Washington University in St. Louis

University of California–San Francisco

University of Washington

Stanford University

Duke University
Yale University

Baylor College of Medicine (TX)
Columbia University College of Physicians and Surgeons (NY)

Complete list of Top Medical Schools - Research

Primary Care

University of Washington

University of North Carolina–Chapel Hill

University of Colorado–Denver and Health Sciences Center

Oregon Health and Science University

Michigan State University College of Osteopathic Medicine

East Carolina University (Brody) (NC)

University of Vermont

University of California–San Francisco

University of Wisconsin–Madison

University of Nebraska College of Medicine

Useful web resources

American Medical Association

American Board of Medical Specialities

www.aamc.org/students/amcas / AMCAS

www.edupass.org : Edupass guide to studying in the US as an international student includes information about financial aid and scholarships.

www.nafsa.org : Provides a list of some of the books and Internet resources you may want to use while searching for financial aid.

www.bibl.u-szeged.hu/oseas/europe.html : OSEAS-Europe links page. A good reference for financial aid and scholarship links for international students.

www.collegeapps.about.com/education/collegeapps/msub32.html : Links to sites that offer information about financial aid and scholarships for students wishing to study in the US.

www.usinfo.state.gov : General information for international undergraduate and postgraduate students in the US (includes financial aid information).

www.iefa.org/public/search.html : Database of scholarships available for study in the US. Search by field of study.

www.globalgrant.com : Global Grants offers a service that matches scholarships and international students.

www.cashe.com/runsearch.html : Free online scholarship search offered by student lender Sallie Mae. This site carries information on scholarships in the form of grants, tuition waivers, fellowships, internships, competitions, work co-operative programmes and loans. Information for international students can be found in the FAQ link.

Application Essay Review service

The EAS Guide to postgraduate study in the United States provides an informative overview of the application procedure to US universities.