7.1) What are the different medical specialties?

  A good source for learning about the different medical specialties
  is the American Board of Medical Specialties <http://www.abms.org>,
  an organization that coordinates and approves changes in board
  certification policy in the different medical fields.  A complete
  list of the certifying boards and the general and subspecialty
  certificates that they offer can be found on their web site.  A list
  of the major medical specialties can be found below.  No effort has
  been made to list subspecialties.

   Allergy & Immunology   
   Anesthesiology        
   Colon & Rectal Surgery 
   Dermatolology          
   Emergency Medicine     
   Family Practice       
   Internal Medicine      
   Medical Genetics
   Neurological Surgery
   Neurology
   Nuclear Medicine
   Obstetrics & Gynecology
   Ophthalmology
   Orthopaedic Surgery
   Otolaryngology
   Pathology
   Pediatrics
   Physical Medicine & Rehabilitation
   Plastic Surgery
   Preventive Medicine (including Occupational Medicine)
   Psychiatry
   Radiation Oncology
   Radiology
   Surgery
   Thoracic Surgery (including Cardiothoracic Surgery)
   Urology

7.2) What is a residency?

  Upon graduation from medical school, you become a "doctor" having
  earned the M.D. or D.O. degree.  However, this isn't the end of
  formal medical training in this country.  Many moons ago, back when
  almost all physicians were general practitioners, very few
  physicians completed more than a year of post-graduate training.
  That first year of training after medical school was called the
  "internship" and for most physicians it constituted the whole of
  their formal training after medical school; the rest was learned on
  the job.  As medical science advanced and the complexity of and
  demand for medical specialists increased, the time it took to gain
  even a working knowledge of any of the specialties grew to the point
  where it became necessary to continue formal medical training for at
  least several years after medical school.  This training period is
  called a "residency," earning its moniker from the old days when the
  young physicians actually lived in the hospital or on the hospital
  grounds, thus "residing" in the hospital for the period of their
  training.

  During residency, you and your classmates practice under the
  supervision of faculty physicians, generally in large medical
  centers.  Many primary care specialties, however, are based in
  smaller medical centers.  As you grow more experienced, you assume
  more responsibilities and independence until you graduate from the
  residency, and you are released to practice on your own upon an
  unsuspecting populace.

  The length of residency programs varies considerably between
  specialties and even a little within individual specialties. In
  general, the surgical specialties require longer residencies, and
  the primary care residencies the least time.

   Lengths of Some Residencies
   ---------------------------
   All surgical specialties	5+ years
   Obstetrics and Gynecology	4 years
   Family medicine		3 years
   Pediatrics			3 years
   Emergency Medicine		3-4 years
   Psychiatry			3 years

  The AMA maintains a database of almost all of the residency programs
  in the United States, called the Fellowship and Residency Electronic
  Interactive Database Access (FREIDA) system. It is available at
  <http://www.ama-assn.org/go/freida>.

  Recently a new type of residency has emerged, the so-called
  "combined residency."  These residencies train physicians in two
  medical fields, such as internal medicine-pediatrics, or
  psychiatry-neurology.  As these types of residencies are new, they
  are relatively few in number; they provide an opportunity for the
  physician to become "double-boarded" and receive board certification
  in each of the two specialties.  Usually these residencies last one
  or two years less than the total years that would be spent doing
  both residencies.

7.2a) What is an internship?

  In the old days, all physician completed a one year "rotating
  internship" after graduating from medical school.  Such an
  internship consisted of all the major subdivisions of medical
  practice: Internal medicine, surgery, obstetrics and gynecology,
  etc.  The idea was to provide a broad spectrum of training to allow
  the new physician to work in the community as a "general
  practitioner."

  Today, the closest thing we have to the rotating internships of old
  is the "transitional year," also completed after graduating from
  medical school.  For a few specialties, a year of post-gradute
  training is required before beginning a residency in that field.
  Many who want to go into these fields fill that requirement with a
  transitional year.  Fields that require a year before beginning
  residency include radiology, neurology, anesthesiology, and
  ophthalmology.

  In the current lingo, the first year of post-graduate training is
  called "internship," and any medical school graduate in the first
  year of post-graduate training is called an "intern" regardless of
  what that first year of training consists.  Most specialties do not
  require a transitional year, but instead accept medical school
  graduates straight out of medical school.

7.2b) What is a "preliminary" year?  A "categorical" year?

  An alternative to the transitional year for some is the "preliminary
  year."  Preliminary years come in two flavors, internal medicine and
  surgery.  Each of these preliminary years somewhat resembles the
  rotating internships of old, but with a focus on either internal
  medicine or surgery.  Those programs that require a year of
  post-graduate education before beginning residency may accept either
  a transitional year or a preliminary year.  Obviously, surgical
  residencies will require that you do a preliminary surgery year
  while some other specialties will prefer a preliminary medicine
  year.

  The other reason that a new M.D. would go into a preliminary year or
  transitional year would be because he didn't match into the
  specialty of his choice.  The hopeful applicant then takes a
  preliminary or transitional year in the hopes of improving his
  chances and qualifications for the next year's residency match.

  The term "categorical" is used largely to distinguish between the
  interns who are doing a preiminary year and those who are already
  accepted into the residency program.  For instance, a general
  surgery program may have 6 interns every year, but two of them may
  doing surgery as a preliminary year.  Those positions that are
  already accepted into the whole surgical residency program are
  called "categorical."

7.3) What is the Match?

  The Match (also cf 7.4) is a way to bring together residency
  applicants and residency programs in an organized fashion.  After
  applying to and interviewing at various residency programs in their
  specialty of choice, students submit a "rank order list" which
  specifies their preferences for programs in numerical order.
  Residency programs submit similar lists.  After all of the lists
  have been received, a computer matches applicants and programs.  At
  noon Eastern time, on a fateful day in March of each year, all
  applicants across the country receive an envelope telling them where
  they will spend the next several years.

  Controversy has surrounded the Match algorithm in recent years, due
  to a slight preference for residency programs in a very small
  percentage of cases.  The algorithm has since been changed to favor
  applicants' preferences.

  There are several books about residency and the Match.  "First Aid
  for the Match" by Tao Le, et al., and "Getting into a Residency: A
  Guide for Medical Students" by Kenneth Iserson, MD, provide insights
  about how to prepare for the Match.

7.4) What is the NRMP?

  The National Resident Matching Program (NRMP) is the official name
  of the Match, which is run by the Association of American Medical
  Colleges (AAMC).  Its home page may be found at
  <http://www.aamc.org/nrmp/>.

7.5) Are there specialties that don't use the NRMP?

  Several specialties have their own matching programs.  Neurology,
  Neurosurgery, Ophthalmology, Otolaryngology, and Plastic Surgery,
  along with several subspecialty fellowship programs in these fields,
  have their matches coordinated through the San Francisco Matching
  Program <http://www.sfmatch.org>.

  Urology has its own matching program, coordinated by the American
  Urological Association at
  <http://www.auanet.org/students_residents/>.

  The "Match Day" for these specialties occurs in January, instead of
  March as for the NRMP.  Consult the matching programs' web sites for
  schedules.

7.6) What is a fellowship?

  A fellowship is a period of training that you undertake following
  completion of your residency, as a means to subspecialization.  For
  instance, a general surgeon can do a number of different fellowships
  (e.g. cardiothoracic surgery, plastic surgery), a pediatrician can
  complete a fellowship in pediatric endocrinology, etc.  The list of
  possible subspecialties is almost endless.  A fellow is considered
  somewhere in the hierarchy between residents and faculty.  They are
  paid like advanced residents, but nothing close to what a private
  physician makes.  People take fellowships for a number of different
  reasons: The subspecialty may be what they've always wanted to do in
  the first place, they may develop an interest in that field along
  the way, and it's often a path to a faculty position in a residency
  program and medical school.  The length of fellowships also varies
  some, but usually lasts three years or less.

7.7) How many hours do interns/residents work?

  Intern and resident hours vary very widely depending on specialty,
  hospital, and within hospitals between different departments. Some
  specialties are well-known for their less demanding hours during
  residency (and often afterwards as well).  These "lifestyle" fields
  include radiology, anesthesiology, and physical medicine and
  rehabilitation (physiatry).  Specialties whose residencies are
  reputed for difficulty and lack of sleep are general surgery and
  obstetrics and gynecology.  Most of the other specialties fall
  somewhere in between.

  Surgical interns and often internal medicine interns routinely work
  100+ hours a week, with some months requiring a brutal every other
  night call schedule.  This means, for instance, that you go to work
  on Monday morning (around 5-6 am) work all day, stay in the hospital
  all night (with varying amounts of sleep but usually 2-3 hours),
  work the following day as well (hoping that you may get out early),
  then go home for around 6 pm only to repeat the whole cycle again
  the next day.  On months such as these, if you have a spouse,
  children, or pets, you won't see them.  You can do the math to
  figure out how many hours per week that amounts to.  Most call
  schedules for intern years run either every third or every fourth
  night on call.

7.7a) Aren't there limits on this?

  There are a few states that limit the number of hours that a
  resident can work.  Perhaps the most prominent state with a such a
  law is New York.

  New York's law, limiting residents to 80 hours per week, came about
  largely due to the Libby Zion case.  Libby Zion was a young woman
  whose death in a NYC teaching hospital sparked an investigation into
  the large amount of hours that residents work.

  Nevertheless, many hospitals in New York still do not follow this
  law and the state has performed "spot inspections" to attempt to
  verify compliance.  For an excellent discussion of this issue, read
  the book "Residents: The Perils and Promise of Educating Young
  Doctors" by David Ewing Duncan.

7.8) What does "board certified" mean?

  Generally, to become certified by one of the boards recognized by
  the American Board of Medical Specialties <http://www.abms.org>, a
  physician must meet several requirements:

   1) Possess an MD or DO degree from a recognized school of medicine
   2) Complete 3 to 7 years of specialty training in an accredited
      residency
   3) Some boards require assessments of competence from the training
      director
   4) Most boards require the physician to have an unrestricted license
   5) Some boards require experience in full-time practice, usually 2
      years
   6) Pass a written examination, and sometimes an oral examination

  After certification, a physician is given the status of "diplomate"
  in that specialty.  Many boards require recertification at regular
  intervals.

7.9) What does FACP/FACS/FACOG/etc. mean?

  Before discussing this, it may be useful to delineate the
  differences between organizations that physicians may be associated
  with.  Some definitions:

  Association or Academy - A group for physicians in a particular
  field, that often sponsors meetings and publishes journals.
  Example: American Academy of Family Physicians.

  Board - Organization that conducts periodic examinations for
  physicians in a particular field, and offers "certification" (cf
  7.8).  The overseeing organization for all specialty boards is the
  American Board of Medical Specialties <http://www.abms.org>.
  Example: American Board of Internal Medicine.

  College - Similar to an association, but membership is often tied to
  board certification and experience.  More of an honor than simple
  association membership, doctors are often elected to "fellowship"
  after recommendation by their colleagues.  Example: American College
  of Surgeons.

  After a physician has received board certification in his/her field,
  and has gained a set amount of experience in that field (usually a
  specified number of years of practice), that physician can be
  recommended for fellowship status in their specialty college.  After
  approval, the physician can then use their fellowship status on
  stationery and business cards, i.e. Susan M. Avery, M.D.,
  F.A.C.S. signifies that Dr. Avery has received fellowship status in
  the American College of Surgeons.

7.10) What is an IMG/FMG?

  Those who have graduated from medical schools outside of the United
  States and Canada are called International Medical Graduates (IMGs)
  or Foreign Medical Graduates (FMGs).  Sometimes, US citizens who
  have attended foreign schools are called USFMGs to distinguish them
  from non-citizens.

  There has been a move of late among some members of Congress, the
  Accreditation Council for Graduate Medical Education (ACGME), and
  the AAMC, in light of a perceived surplus of physicians in the US,
  to reduce the number of Medicare-funded residency positions to 110%
  of the number of graduating US medical school seniors.  As of yet,
  this has not been implemented.

7.11) What is the ECFMG? The CSA?

  The Educational Commission for Foreign Medical Graduates (ECFMG)
  <http://www.ecfmg.org> is an organization sponsored by the
  Federation of State Medical Boards, the AAMC, the AMA, the American
  Board of Medical Specialties, and others, that coordinates
  certification of graduation, passing grades on the United States
  Medical Licensing Examination (USMLE), and other information about
  FMGs. Prior to applying to residency or fellowship programs in the
  United States that are accredited by the Accreditation Council for
  Graduate Medical Education (ACGME), an FMG must hold a certificate
  from the ECFMG.

  CSA stands for "Clinical Skills Assessment," a new requirement for
  foreign-trained physicians seeking to obtain ECFMG certification.
  Applicants face 10 simulated patients and be evaluated on their
  ability to take a history, perform a physical exam and record a
  written note.  More information can be found on the ECFMG web site
  at <http://www.ecfmg.org/csahome.htm>.

7.12) What is CME?

  A physician's education does not end with medical school and
  residency.  Continuing Medical Education, or CME, allows physicians
  to keep up with new developments in all medical fields.  Physicians
  earn "credits" for hours spent in various learning activities.

  The American Medical Association (AMA) offers the Physician
  Recognition Award (PRA) for doctors who complete 50 hours of CME
  credit per year.  The AMA's classification of CME is as follows:

    Category 1: Formally organized and planned educational meetings, 
                e.g., conferences, symposia.  Also includes residency. 
    Category 2: Less structured learning experiences, e.g., 
                consultations, discussions with colleagues, and 
 		teaching.
	 Other: Reading "authoritative" medical literature, e.g.,
		peer-reviewed journals, textbooks.

  Organizations that receive the nod from the Accreditation Council
  for Continuing Medical Education (ACCME) <http://www.accme.org>, as
  well as state medical societies and other groups recognized by the
  AMA can provide "category 1" CME courses.

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