Lesson 3
Medicine
Early 1800's Medical Training
Early medical training in the United States was done by an apprenticeship with a practicing physician. In the early 1800's, a few medical schools are in operation in the United States. One of the earliest was HarvardUniversity in Boston, Massachusetts, which offered at its early beginnings a bachelor of medicine. These first physicians graduated as generalists in the field of medicine. Medical specialists did not come until many years later. As the number of medical schools increased, so did their abilities to train better physicians, all graduating with a Doctor of Medicine degree. There are about 150 medical schools located within the United States. Their training is now considered the best in the world. Most of the major hospitals have residency programs for the training of medical doctors after they have finished their four years of medical school training.
Questions:
How were the early medical doctorstrained in the United States?
About how many medical schools are there in the United States today?
Where were the first medical schools located in the United States?
What is a residency program for medical doctors?
WORK DESCRIPTION
Physicians examine patients, obtain medical histories, and order, perform, and interpret diagnostic tests. They diagnose illnesses, prescribe medications and administer treatment for people suffering from injury or disease. Physicians counsel patients on diet, hygiene, exercise, and preventive health care. Those in private practices may handle or oversee the business aspects of running an office.
There are two types of physicians: The Doctor of Medicine (M.D.), and the Doctor of Osteopathy (D.O.). M.D.'s are known as allopathic physicians. While M.D.' s and D.O.'s may use all accepted methods of treatment, including drugs and surgery, D.O.'s place special emphasis on the body's musculoskeletal system. They believe that good health requires proper alignment of bones, muscles, ligaments, and nerves.
Most M.D.'s specialize. Pediatricians, ob/gyn, family practitioners, and internists are often called primary care physicians since they are the first health professionals patients usually consult. They tend to see the same patients on a regular basis for a variety of ailments and preventive treatment and when appropriate, they refer patients to other specialists. D.O.'s are more likely to be primary care providers than allopathic physicians, although they can be found in all specialties.
Questions:
What are the two different types of medical degrees within the United States?
What are the different types of primary physicians?
What it a M.D.?
What is a D.O.?
WORKING CONDITIONS
Physicians often work long, irregular hours. One-half of all full-time physicians work 60 hours a week or more; two out of ten typically work 50-59 hours a week. In general, as doctors approach retirement age, they accept fewer new patients and tend to work shorter hours. Physicians who are on-call may make emergency visits to hospitals. Many physicians must travel between office and hospital to care for their patients.
Questions:
How many hour a week do physicians generally work?
EMPLOYMENT
Physicians (M.D.'s and D.O.'s) hold about 660,000 jobs. About two out of three are in office-based practice including clinics and HMOs; about one-fifth are employed in hospitals. Others practice in the Federal government, most in Veteran hospitals and clinics or in the Public Health Service of the Department of Health and Human Services.
While physicians have traditionally been solo practitioners, a growing number are partners or salaried employees of group practices. Organized as clinics or as groups of physicians, medical groups can afford expensive medical equipment and realize other business advantages.
Questions:
How many physicians are there in the United States?
In what hat kind of settings do physicians work?
The Northeast and West Coast have the highest ratio of physicians to population; the South has the lowest. D.O.'s tend to practice in small cities and towns and in rural areas. M.D.'s, on the other hand, tend to locate in urban areas, close to hospitals and educational centers. Some rural areas remain under served, although the situation is improving somewhat. Osteopathic physicians are located chiefly in States that have osteopathic schools and hospitals. Three out of four D.O.'s were practice in 12 States. Michigan has the most D.O.'s followed by Pennsylvania, Ohio, Florida, New Jersey, and Texas.
Questions:
In what areas of the United States are most physicians located?
Which area of the United States has the least number of physicians?
In which State(s) do most D.O.'s practice?
In what parts of the United States are we being under served by physicians?
The following indicates the percent distribution of by specialty.
MEDICAL SPECIALITIES
Allergy 0.5
Cardiovascular diseases 2.5
Dermatology 1.2
Gastroenterology 1.2
General and family practice 11.0
Internal medicine 16.7
Pediatrics 6.9
Pediatric cardiology 0.2
Pulmonary diseases 1.0
Aerospace medicine 0.1
Anesthesiology 4.3
Child psychiatry 0.7
Diagnostic radiology 2.6
Emergency medicine 2.4
Forensic pathology 0.1
General preventive medicine 0.2
Neurology 1.5
Nuclear medicine 0.2
Occupational medicine 0.4
Pathology 2.6
Physician medicine and rehabilitation 0.7
Psychiatry 5.6
Public health 0.3
Radiology 1.2
Radiation oncology 0.5
SURGICAL SPECIALTIES
Colon and rectal surgery 0.1
General surgery 6.0
Neurological surgery 0.7
Obstetrics and gynecology 5.4
Ophthalmology 2.5
Orthopedic surgery 3.2
Otolaryngology 1.3
Plastic surgery 0.7
Thoracic surgery 0.3
Urological surgery 1.4
Other specialty 1.5
Unspecified/unknown/inactive 12.6
TOTAL 100.0
Source: American Medical Association
MEDICAL SPECIALTIES
ADOLESCENT MEDICINE. Adolescent medicine is a relatively new medical specialty. Physicians who practice in this area treat patient from puberty to maturities that range in age from 11 to 21. The physicians have specialty training in adolescent psychiatry. Patients who seek this service may have drug dependency, behavioral, self-image, or perhaps psychiatric problems. In some cases, the physician will admit the patient to an adolescent unit in a hospital setting for acute treatment of their condition.
ALLERGY AND IMMUNOLOGY. An allergist treats abnormal responses or acquired hypersensitivity to substances with medical methods including testing and desensitization. Pediatricians and internists may sit for the board examination in allergy and immunology after taking several years of additional training.
ANESTHESIOLOGY. An anesthesiologist is trained to administer both local and general drugs to induce a complete or partial loss of feeling (anesthesia) during a surgical procedure. This physician provides respiratory and cardiovascular support during surgery. The anesthesiologist meets with the patient before the surgical procedure to explain the type of anesthetic that will be used. Certified registered nurse anesthesiologists (CRNA) may administer anesthetics. An anesthesiologist will work either directly for a hospital or as a member of a group of anesthesiologists who contract with a hospital or other health care facility.
CARDIOLOGY. A cardiologist is trained to treat cardiovascular disease. This physician has received special training in the diseases and disorders of the heart and blood vessels. A cardiologist specializing in the treatment of children's heart disease receives special training as a pediatric cardiologist.
DERMATOLOGY. A dermatologist treats injuries, growths, and infections relating to the skin, hair, and nails. This physician may treat patients either medically or surgically. A dermatologist removes growths such as warts, moles, benign cysts, birthmarks, and skin cancers. In some cases, they have received additional training in cosmetic surgery including skin grafts, dermabrasion, hair transplants, and use of the laser.
EMERGENCY MEDICINE (Primary Medicine). The physician who specializes in emergency medicine has received additional training as an emergency medical resident. Emergency medicine specialists typically work in hospital emergency rooms and walk-in emergency centers. They possess the ability or skills to quickly recognize and prioritize (triage) acute injuries, trauma, and illnesses. They supervise paramedic pre hospital care.
FAMILY PRACTICE (Primary Medicine). The family practitioner physician will treat the entire family regardless of age and sex. In some cases, they will refer patients to other specialists such as nephrologists for the treatment of renal (kidney) diseases.
GERIATRIC MEDICINE. The practice of geriatrics is focused on the care of diseases and disorders of the elderly. Gerontology is a relatively new field of medicine and is the direct result of the larger aging population.
HEMATALOGY. Hematology is the study of blood and blood-forming tissues.
INFECTION CONTROL. Infection control is the prevention of infectious disease by maintaining medical asepsis, practicing good hygiene, and obtaining immunizations.
ONCOLOGY. Oncology is the study of cancer and cancer-related tumors.
INTERNAL MEDICINE (Primary Medicine). Internists are physicians who treat adult patients with medical problems. They are skilled in diagnosis and treatment of non-surgical problems. Sub-specialties within internal medicine include: cardiology, endocrinology, gastroenterology, hematology, immunology, nephrology, oncology, and pulmonary medicine.
NEUROLOGY. The neurologist treats the non-surgical patient who has a disorder or disease of the nervous system.
NEPHROLOGY. The nephrologist specializes in pathology of the kidney including disorders and diseases. A nephrologist is skilled in both medical and surgical treatments including kidney dialysis.
NUCLEAR MEDICINE. The physician specializing in this field of study uses radioactive substances for the diagnosis and treatment of diseases such as cancer.
OBSTETRICS AND GYNECOLOGY (Primary Medicine). An obstetrician treats the female as she begins prenatal care and continues through labor, delivery, and the postpartum period. A gynecologist provides both medical and surgical treatment of diseases and disorders of the female reproductive system. There is a sub-specialty, which deals with infertility, the study of a diminished capacity or inability to produce offspring.
OPHTHALMOLOGIST. An ophthalmologist treats disorders of the eye. The study of ophthalmology includes the diagnosis and treatment of vision problems using both medical and surgical procedures.
ORTHOPEDICS. An orthopedist specializes in the branch of medicine that deals with the prevention and correction of disorders of the musculoskeletal system. An orthopedic surgeon specializes in surgical procedures relating to this specialty.
OTORHINOLARYNGOLOGIST (ENT). The otorhinolaryngologist specializes in the medical and surgical treatment of ear, nose, and throat disorders. This includes the study of otology (ear), rhinology (noses), and laryngology (throat) and it is also known as otorhinolaryncology.
PATHOLOGY. A pathologist specializes in diagnosing the abnormal changes in tissues that are removed during a surgical operation and in postmortem examinations. A forensic pathologist is an expert in determining the identity of a person based on such evidence as body parts, dental records, and tissue samples.
PEDIATRICS (Primary Medicine). The pediatrician specializes in the development and care of children from birth to maturity.
PHYSICAL MEDICINE/REHABILITATIVE MEDICINE. Physical medicine and/or rehabilitative medical specialists treat patients after they have suffered an injury or disability. The purpose of treatment is to return patients to their former state of physical health if possible. This rapidly growing field is closely associated with sports medicine in which the physician treats athletes using preventive and diagnostic medicine.
PREVENTATIVE MEDICINE. The preventive medical specialist focuses treatment on the prevention of both physical and mental illness or disability.
PSYCHIATRY. The psychiatrist specializes in the diagnosis and treatment of patients with mental, behavioral, or emotional disorders. A psychiatrist is qualified to administer and prescribe medications. This specialist may also practice psychotherapy.
RADIOLOGY. A radiologist specializes in the study of tissue and organs that are based on x-ray visualization. This physician has been tested and approved by the American Board of Radiology.
RHEUMATOLOGY. A rheumatologist treats disorders and diseases characterized by inflammation of the joints such as arthritis.
SURGERY. A surgeon corrects illness, trauma, and deformities using an operative procedure. Surgery is described as any invasive procedure, which requires entering the body by making an incision or passing instruments through the skin and organs. General surgery includes all areas of surgery. General surgeons may restrict their practices to abdominal surgical procedures. However, many surgeons specialize in areas such as neurosurgery, cardiovascular surgery and orthopedic surgery. Some of the more common surgical sub-specialties are described below.
Cardiovascular surgery is the surgical treatment of the heart and blood vessels.
Colorectal surgery involves the surgical treatment of the lower intestinal tract (colon and rectum).
Plastic surgery intervention is used to correct structural defects or remove scars and signs of aging.
Hand surgery is orthopedic surgery that involves surgical treatment of defects, traumas, and disorders of the hand. Hand surgeons may employ physical therapy staff and have x-ray equipment at their disposal.
Neurosurgery involves surgical intervention for diseases and disorders of the central nervous system.
Orthopedic surgery treats musculoskeletal injuries and disorders, congenital deformities, and spinal curvatures through surgical means.
Oral surgery involves treatment of disorders of the jaws and teeth by means of incision and surgery as well as the extraction of teeth.
Thoracic surgery involves treatment of disorders and diseases of the chest with surgical intervention.
Questions:
What is the major area of patient care for each of these medical specialties?
Emergency care
Family practitioner
Internist
Allergist
Gastroenterologist
Otorhinolaryngologist
Dermatologist
Oncologist
Obstetrician
Gynecologist
Orthopedist
Pathologist
Psychiatrist
Surgeon
Which ones of the above physicians practice as primary physicians?
TRAINING, OTHER QUALIFICATIONS, AND ADVANCEMENT
All States, the District of Columbia, and U.S. territories require physicians to be licensed. Licensor requirements for both D.O.'s and M.D.'s include graduation from an accredited medical school (usually four years), completion of a licensing examination, and between one and seven years of graduate medical education, that is, a residency for M.S. and an internship and residency for D.O.'s. Although physicians licensed in one State can usually get a license to practice in another without further examination, some States limit reciprocity. Graduates of foreign medical schools can generally begin practice in the United States after passing an examination and completing a U.S. hospital residency training program.
The minimum educational requirement for entry to a medical or osteopathic school is three years of college; most applicants, however, have at least a bachelor's degree and many have advanced degrees. A few medical schools offer a combined college and medical school program that lasts six years instead of the customary eight years.
Required premedical study includes undergraduate work in physics, biology, and inorganic and organic chemistry. Students should take courses in English, other humanities, mathematics, and the social sciences. Applicants should consider volunteering at a local hospital or clinic to gain practical experience in the health professions.
There are about 150 medical schools in the United States; 130 teach allopathic medicine and award a Doctor of Medicine (M.D.); 20 teach osteopathic medicine and award the Doctor of Osteopathy (D.O.). Acceptance to medical school is very competitive. Applicants must submit transcripts, scores from the Medical College Admission Test (MCAT), and letters of recommendation. An interview with an admission officer may be necessary. Character, personality, leadership qualities, and participation in extracurricular activities are considered.
Students spend the first two years of medical school primarily in laboratories and classrooms taking courses such as anatomy, biochemistry, physiology, pharmacology, psychology, microbiology, pathology, medical ethics, and laws governing medicine. They learn to take medical histories, examine patients, and recognize symptoms. During the last two years students work with patients under the supervision of experienced physicians in hospitals and clinics to learn acute, chronic, preventive, and rehabilitative care. Through rotations in internal medicine, family practice, obstetrics and gynecology, pediatrics, psychiatry, and surgery, they gain experience in the diagnosis and treatment of illness.
Following medical school, almost all M.D.'s go directly onto graduate medical education called their residency requirement. The National Board of Medical Examiners (NBME) gives a standard examination for all students, including foreign medical school graduates applying for medical residency. D.O.'s must serve medical residency after graduation. The National Board of Osteopathic Medical Examiners (NBOME) gives an examination for residency application.
M.D.'s and D.O.'s seeking board certification in a specialty may spend up to eleven years, depending on the specialty, in residency and sub-specialty training, most serve about four. A final examination immediately after residency, or after one or two years of practice, is necessary for board certification by the American Board of Medical Specialists (ABMS) or the American Osteopathic Association (AOA). There are currently certifications in 23 specialties.
To teach or do research, physicians may acquire a master's or Ph.D. in such fields as biochemistry, public health, immunology, or microbiology. They may otherwise spend one year or more in research or in an advanced clinical training fellowship.
A physician's training is costly. While education costs have increased, student financial assistance has not. Scholarships have become harder to find. Loans are available, but subsidies to reduce interest rates are limited.
Individuals who have a desire to become physicians must have a desire to serve patients, be self-motivated, and be able to survive the pressures and long hours of medical education. For example, medical residents often work long hours, some as much as 80 hours a week or more. Efforts, however, are being made to limit the number of hours residents work. Prospective physicians must be willing to study throughout their career to keep up with medical advances. Physicians should have a good bedside manner, emotional stability, and the ability to make decisions in emergencies.
Questions:
What is required of all M.D.'s after they finish medical schooling?
Do D.O.'s have this same requirement?
What is a medical residency?
What is required if M.D.'s or D.O.'s want to teach in a medical school?