THE BIG PICTURE OF BECOMING A DOCTOR
What is an MD vs. DO?
There are 2 types of medical schools in the United States -- allopathic and osteopathic. If you go to an allopathic medical school, you become a medical doctor, or MD. If you go to an osteopathic medical school, you become a doctor or osteopathy, or DO.
There are 154 MD programs in the U.S., but only 37 DO programs. That means that it’s actually more competitive to get into a DO program because there are less of them. However, the average GPA and MCAT score is a little bit lower for getting into a DO program than it is for an MD program.
Today, more than 25% of medical students attend osteopathic schools to become DO doctors.
The major difference between these is that DO schools take a more holistic approach to health. They emphasize the connection between mind, body, and spirit. DO students also complete 200 hours of training in osteopathic manipulative medicine, which is a hands-on approach to treatment of many conditions.
Whether you’re a DO or an MD, the basics of the process are the same — you have to get a college degree, take certain science classes, take the MCAT, complete 4 years of medical school, and complete a residency. You will have essentially the same opportunities to pursue specialty training as either an MD or DO.
What is Primary Care vs. a Specialty?
When you’re thinking of becoming a doctor, it helps to think about whether you want to become a primary care doctor or a specialist.
What’s the difference?
You can think of your primary care doctor as your main doctor. This is the person you go to for your yearly check-ups and management of most chronic conditions, such as high blood pressure and diabetes. Many primary care doctors also feel comfortable treating basic mental health conditions like depression or anxiety, prescribing birth control for women, and doing simple procedures (like stitches).
Primary care doctors include doctors who train in internal medicine (which focuses on adults), pediatrics (which focuses on kids up to age 18), and family medicine (which combines adults, children, and pregnant women). Their job is to take care of your general health — help you prevent certain diseases, help you manage chronic conditions, and and help detect major problems (like cancer or heart disease) early.
Specialists typically focus on one organ system - for example, a cardiologist focuses on the cardiovascular system (which includes the heart and blood vessels); a pulmonologist focuses on the respiratory system (which includes the lungs and air passages); an endocrinologist focuses on the endocrine system (which includes all of the glands in your body that produce hormones, such as the thyroid gland in your neck); a psychiatrist focuses on treating mental health conditions such as depression, anxiety, bipolar disorder, schizophrenia, addictions, and personality disorders. An orthopedic surgeon focuses on the skeletal system (which includes all of the bones of the body). There are a LOT of different specialties — way too many to list here.
If you go see your primary care doctor for a problem that they can’t help you with, they might refer you to a specialist. For example, if you’ve been having headaches and nothing you and your doctor have trie is working, they might refer you to a neurologist who specializes in brain disorders like migraine headaches.
How competitive is it to get into medical school?
Getting into medical school can be really competitive. Let’s look at the numbers:
For MD schools in 2020, there were about 53,000 students who applied and only about 22,000 got in. That means that about 42%, or 42 out of 100, students who applied were accepted.
For DO schools in 2018, there were about 22,000 students who applied and only about 7,500 got in. That means that about 35%, or 35 out of 100, students who applied were accepted.
The average college GPA for getting into MD schools is about 3.6, and the average college GPA for DO schools is about 3.5.
The average MCAT score for MD schools was 511, and for DO schools it was 504.
Even though GPA and MCAT scores are important, there is NO magical GPA or MCAT score that will get you into medical school. Even if you have a college GPA of 3.9 and an MCAT score of 520 (which is very high), your chances of getting in are only about 90%. This means that medical schools really do care about who you are as a person and your commitment to being a doctor, not just your grades and test scores.
If you don’t get accepted your first time around, you are allowed to re-apply. Lots of people do it. Just realize that it means more time and more money, but it may well be worth it!
What’s the standard timeline for becoming a doctor?
The most straightforward way to become a doctor is this:
4 years of College/University (to earn a bachelor’s degree)
4 years of Medical School (allopathic or osteopathic)
3-6 years of Residency Training (exact years depend on specialty)
1-3 years of Fellowship Training (OPTIONAL)
That means it will take anywhere from 11-16 years after high school to become a doctor. Becoming a primary care doctor takes the least amount of time (usually 11 years), whereas becoming a very specific type of specialist takes longer. For example, becoming a pediatric neurosurgeon can take 15 years.
If you catch yourself thinking, “But that means I’ll be in my 30s before I finish!” just remember — you’ll someday be in your 30s whether or not you go to medical school. Why not have something to be really proud of that can enable you to earn a good living and help a lot of people by the time you’re in your 30s?
Some people may take extra time to do research, get a master’s degree or PhD, or take time off somewhere in there.
What should I do in college to prepare?
PREMEDICAL REQUIREMENTS
These requirements vary by school! Check the AAMC website to see details for MD schools, and the AACOM website to see details for DO schools.
The most typical requirements for classes you need to take in college are:
1 year of biology
2 years of chemistry
1 year of physics
1 year of English
Most schools also require that you spend a certain number of hours of shadowing doctors, to make sure that you really understand what day-to-day life will be like as a doctor. If you don’t know any doctors, you will need to ask around for opportunities.
Many schools require some experience in research, but not all do. Research experiences can vary from basic bench research working on mouse models of disease to social science research trying to understand human behavior. Talk to other students and your professors to try to find opportunities to do research if that will be required. Even if it’s not required, it can be a good opportunity to learn important science skills.
You must take the Medical College Admissions Test (MCAT). This is an 8-hour-long test that tries to determine how well you learned the material in your biology, chemistry, physics, and English classes. Take it seriously, study hard, and do the best you can. There are many courses you can take to help you prepare, and even some programs that offer free help.
MAKE THE MOST OF YOUR COLLEGE EXPERIENCE
Remember: you don’t have to major in biology. You can major in anything you want as long as you take the classes required to apply to medical school. You might even be viewed as a more interesting applicant if you major in something like history, philosophy, or engineering.
Even though there is a checklist of premedical requirements, try not to think of college only as a checklist. Recognize that college is an opportunity to discover your interests, develop skills, grow as a person, and develop lifelong relationships.
Take time to pursue extra-curricular activities, like volunteering, sports, religion, or purposeful work. Just because all of the other premeds are doing cancer research or volunteering at the homeless shelter doesn’t mean you have to. Find opportunities that actually interest you and figure out how you can maximize your learning and growth through them.
If there is a study abroad programs at your school, don’t be afraid to take advantage of it! International travel can be a wonderful opportunity to expand your perspective. Your school will most likely help you figure out how to pay for it.
As you pursue your education, try to distinguish yourself from other people who will be applying to medical school. Admissions committees don’t want cookie-cutter applicants who all have exactly the same exact experiences. You are unique, and your experiences should reflect that.
APPLYING TO MEDICAL SCHOOL
You will have one master application that gets submitted to multiple schools through the online AMCAS (for MD schools) or AACOMAS (for DO schools). You will be required to submit the following for your application:
Transcripts of all college/university grades
Your score report for the Medical College Admissions Test (MCAT)
A summary of volunteer, work, research, and shadowing experiences
A personal statement explaining to the admissions committee why you want to become a doctor. This is REALLY important. A generic essay about how you want to help people just won’t cut it. You will probably write multiple drafts and have at least one person provide feedback.
Letters of recommendation from 2-4 teachers, bosses, or other supervisors that know you well and can brag about why you’d make a great doctor.
(Notice that there is a lot of stuff to submit. Start early and give yourself plenty of time!)
Once you submit your application to as many schools as you choose, the schools that like you will invite you to submit a “secondary” application. This will require you to submit a few more written statements or essays, as well as another fee.
If the school likes your secondary application, they will invite you to interview at their school.
Of the schools that interview you, some will offer you admission to their school. If you get multiple admission offers, you will need to decide where the best opportunity is for you.
If you will be taking time off between graduating from college and starting medical school, try to do something that contributes to your application — for example, a job in a hospital or clinic, research, or graduate school. (We know Covid has made this more difficult for some, but just do the best you can.)
What is medical school like?
Your first two years are your pre-clinical years, meaning you spend most of your time in the classroom learning a lot.
You will study biochemistry, anatomy, physiology, microbiology, pharmacology, pathology, and much more. You will take a lot of tests.
You will also take classes where you learn how to interview patients and perform a physical exam. You may get to practice your interview and exam skills on actors posing on patients.
You may spend half a day per week shadowing a doctor in the community, and practicing your interview and exam skills on real patients.
At the end of your first two years, you will take an exam (the USMLE Step 1 for MD students, or the COMLEX-1 for DO students). You generally have to pass this exam before you move onto your third year.
Your third and fourth years are your clinical years, meaning you spend most of your time in clinics or hospitals working with patients.
During your third year you will spend a few weeks to a few months on each of your required “core” rotations — these may include family medicine, internal medicine, pediatrics, obstetrics & gynecology, surgery, neurology, and psychiatry. At the end of each of your core rotations, you will take an exam that you need to pass in order to graduate.
During your fourth year, you get to explore other specialties that might interest you — for example, radiology, anesthesiology, dermatology, pathology, and many more. You are not required to take exams, but you get evaluated by the people you work with.
During your fourth year, you can also choose to do “away rotations” where you travel to another hospital and spend a month doing a rotation there. This can be helpful if you want to apply to that hospital’s program and want them to get to know you.
There are a few more exams you need to pass at the end medical school, called the USMLE Step 2 (for MD students) or COMLEX-2 (for DO students).
Most people apply to residency during their fourth year through the National Residency Match Program. This is a lot like applying to medical school — you have to submit transcripts, exam scores, letters of recommendation, and a personal statement. You will be invited to interview at some programs. A complicated computer program helps to match you to a residency program. If you match, then in March you will get together with all of your classmates and you will each open an envelope that will reveal where you “matched” to a residency program.
How much does this all cost?
College (these are averages)
Community college costs about $5,000/yr
In-state public university costs about $26,000/yr
Out-of state public university costs about $43,000/yr
4 years at a private university costs a whopping $55,000/yr!
Applying to Medical School
On average $3500 to submit applications to 20 schools
Airfare and travel expenses are extra, depending on how many schools invite you to interview
Medical school
4 years of medical school costs anywhere from $250,000 (public) to $340,000 (private)
The average student debt after medical school is about $200,000. Remember, this is an average and some students will owe less while others will owe more.
Residency
You finally start getting paid when you’re a resident! The average first year resident salary is $56,000. It goes up a little for each year of residency you complete.
You can choose to put your loans in “forbearance” while you’re in residency (meaning that you don’t have to start paying them back, but the debt can grow because of interest that adds up), or you can start paying them back (there are income-based options that allow you to pay back just what you can afford based on how much money you make).
How can I afford that?
Apply to as many scholarship programs as you can, starting before college, in order to limit the loans you need to take out.
If your family doesn’t have a lot of financial resources, you may have to rely mostly on student loans. Remember to submit your FAFSA every year by the deadline in order to qualify for grants and loans!
Some programs offer to pay all of your medical school expenses in exchange for years of service after you finish training. These can be well worth it, but keep in mind you can end up being sent anywhere you are needed.
National Health Service Corps - helps place doctors in underserved areas of the U.S.
U.S. Military
The U.S. Government (through the Health Resources Service Administration) and many states also offer loan repayment programs. These programs help you to pay back your loans after training if you agree to work in certain public clinics or hospitals. There is also a program through the federal government that will forgive your loans if you work for a public hospital or clinic full-time for 10 years and keep up on your loan payments during that time.
You may need to pay back anywhere from few hundred dollars to a few thousand dollars a month based on how much you’re making after you finish your medical training. It can seem like a lot, but if you plan ahead wisely (and don’t overspend!) you can pay it back and still live a comfortable life.
Traditional vs. nontraditional pathways
Not everyone knows they want to be a doctor when they’re in college. Not everyone goes to college right after high school. Some people need time to really figure out their goals in life, while others know right away what they want to do. You can start on the path to medical school from almost anywhere!
A helpful resource for non-traditional students is The National Society for Nontraditional Premedical & Medical Students, Inc., which you can find out more about at OldPreMeds.org. They even have a great podcast!
How much can I earn as a doctor? (Averages taken from the Medscape 2020 survey)
Here are average yearly salaries:
$243,000 per year for primary care doctors.
$346,000 per year for specialists.
Unfortunately (or fortunately?), some specialists make a lot more money than others.
Pediatricians — the lowest paid specialty — make an average of about $230,000 a year.
Orthopedic surgeons — the highest-paid specialty — make an average of about $510,000 a year.
Unfortunately, sex also matter. Men make about 25% more than women do in primary care, and men make 30% more than women in specialties. The reasons for this are complicated, but we’re pretty sure sexism plays a role.
The setting you work in matters. You might be able to earn more money in a private practice (where you own part of the practice) compared to a public hospital or clinic.
These numbers are for working full-time. If you don’t want to work 50-60 hours per week, which is what can be expected for full-time as a doctor, you might want to adjust your expectations.
Also keep in mind that the more you make, the more taxes you pay. Uncle Sam and other payroll deductions can eat up 30-40% of your salary.