Medical careers: Key stages for training as a medical doctor
In our next series of articles, we will be talking to those who have forged diverse career paths in the medical profession. Central determinants to success include, a care of duty to others and the ability to assimilate and apply knowledge under pressure, whilst keeping abreast of key advances and changing guidelines.
In our first article, we reflect on training requirements to become a medical doctor and the career trajectories available, including general practice and consultant specialisms.
Becoming a Practising Medical Doctor
Education and Training
For most of those wanting to start a career as a medical doctor, the first step in the process is a graduate qualification in medicine. Competition for entry onto degree courses is fierce, and top grades at high school level, to include biology and chemistry subjects, are normally a prerequisite. Training is a lengthy process, something that should be taken into consideration before you start.
For example, in the UK after you’ve been accepted into medical school at University, you embark on studying for a degree in Medicine that can last 5-6 years. The longer variant in length applies, if the option is taken of intercalating a BSc. during the course. This is followed by postgraduate training for two years — a period known as a foundation programme. The latter includes residency rotations to gain practice in different specialisms, for example general practice, psychiatry, obstetrics and gynaecology. In the first year (F1), trainees work under supervision with an aim to demonstrate their ability and knowledge to apply for full general medical council (GMC) registration that is required to practice in the UK. In the second year (F2), the main goal is to work more independently, develop practical skills, and a sound understanding of how to manage acutely ill patients.
There are then different ongoing training options after the 2 year foundation is complete, dependent upon whether you choose to become a family physician, referred to as a general practitioner (GP) in the UK, or become a specialist. There are over 30 available specialist medical fields, and over a 100 diverse paths, if you take sub-specialisms into account. Typically, family doctors train a further 3 years in rotation in core fields that are applicable to working as a GP, such as emergency, paediatrics and psychiatry. Those wanting to pursue a career as a specialist train for a minimum of 6-8 years, after the initial 2 year foundation is complete. If you’re considering work in the UK, further information on training pathways can be found on the British Medical Association website.
As a guideline to pay, in the UK, doctors in training start in the region of £27K and can earn up to £46K towards the end of their training. Experienced doctors and specialty fields can earn up to £70K, and highly experienced doctors and consultants can earn £100K+.
"Experienced doctors and specialty fields can earn up to £70K, and highly experienced doctors and consultants can earn £100K+."
Elsewhere in Europe, there are some differences in training. In Germany, medicine degrees take 6 years to complete, concluding with a state examination. Passing the latter examination leads to your official license to practice medicine, known as an ‘approbation’. The course itself is split into 3 phases. The initial stage, known as the preclinical phase, lasts for a 2 year period and provides academic grounding in biological sciences and medicine. It concludes with an examination. The second stage is a clinical phase, lasting 3 years that combines lectures, internships and practical courses. The final phase of the course is entirely practical, comprising one-year of hands-on clinical training, which concludes with the state exam.
Courses are conducted in German, although a good level of English is seen as an advantage, as it is the language in which much of the international medical literature is written. If you are going on to become a medical specialist, it can take a further 6 years in Germany, during which time you are paid as an ‘assistant physician’. Note that requirements for training are different for each of the 17 areas of the country and conclude with examination. Further information can be found on the German Medical Association website.
"Unlike studying medicine in Europe, studying for a medical degree in the US has a prerequisite of having already gained a bachelor’s degree."
Unlike studying medicine in Europe, studying for a medical degree in the US has a prerequisite of having already gained a bachelor’s degree. Medical schools have differing requirements but most stipulate that your first degree should be in biology, chemistry or a medical related field. In addition, entry normally requires passing a Medical College Admissions Test (MCAT) entry exam. The degree course itself, lasts for four years. It usually consists of two halves, 2 years of lecture-lead pre-clinical learning and a second clinical period of work rotations, typically in a teaching hospital.
The US, UK and German examples given here are subject to many international variations but most have the same fundamental training basis.
At the end of your medical degree you have the option of choosing which field of medicine you want to practice in. A primary care or family doctor, (known as a GP in the UK, Hausarzt in Germany), is one option. The training times required for this line are shorter, (as stipulated above), and usually require covering a range of hospital specialities for broader knowledge, before specialist training as a family doctor.
The training times for medical specialisms are considerably longer covering roles oncology, paediatrics, psychiatry, anaesthesia, surgery and more. Another option, academic medicine is a joint university research and hospital role and requires that you undertake a PhD (doctorate of philosophy) or MD (medical doctorate), usually after specialty training year 3. The UK National Health Service (NHS) has a useful quick take guide on specialities here.
There may be many reasons on why you decide on a specific medical specialty as your final career choice. We spoke to Dr. Vijay James who is currently working as a Consultant Psychiatrist in Jersey, UK, about his rationale and experience of specialising in psychiatry in the UK. We asked Dr. James why he chose to become a medical specialist in psychiatry and the key influencers in his decision.
"Of all the specialist fields in medical careers, I found psychiatry the most interesting. Even within psychiatry, are many fields of sub-specialisation..."
“Of all the specialist fields in medical careers, I found psychiatry the most interesting. Even within psychiatry, are many fields of sub-specialisation, such as forensic psychiatry, older adult psychiatry, child & adolescent psychiatry, perinatal psychiatry, eating disorders psychiatry, addiction psychiatry and several others, which are all diverse and fascinating. To me, disorders of the mind and the personality are far more interesting, challenging and complex than disorders of the body, and psychiatry offers a unique insight into people's lives.
The personality, empathy and compassion of the clinician are often the most versatile and valuable therapeutic tools in psychiatry, allowing for a highly creative and individual approach, more so than in most other fields of medical practice.’
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Foundation Training Information UK: http://www.foundationprogramme.nhs.uk/pages/home
General Medical Council UK: Education and Training: http://www.gmc-uk.org/education/27007.asp
Insiders Guide to Medical Specialities: NHS UK: https://www.bma.org.uk/advice/career/studying-medicine/insiders-guide-to-medical-specialties/nhs-career-choices
German Medical Association: http://www.bundesaerztekammer.de/weitere-sprachen/english/german-medical-association/
American Medical Association: https://www.ama-assn.org/about