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What is a Cardiologist?

My Cardiologist has F.A.C.C. after his name, what does it mean?

How much training does a Cardiologist receive?

How long does it take to become a cardiologist?

What education or training is required to become a cardiologist?

What classes do you take to become a cardiologist?

What license is needed to be a cardiologist?

What is an Interventionists cardiologist?

What is the difference between a Cardiac surgeon and lets say a interventional cardiologist?

How long is medical school?

What qualifications do you need to become a doctor?

What is the USMLE?

What is a good USMLE score?

What is AOA?

What is a residency?

What is an internship?

What is a "preliminary" year? A "categorical" year?

What is the Match?

How many hours do interns/residents work?

What does "board certified" mean?

How do a choose a residency program? I need to declare a medical specialty before long, but I have so many conflicting feelings and thoughts about various clinical areas. How can I make the right choice?

Q: What is an internship?

A:  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.

Q: What is a "preliminary" year? A "categorical" year?

A:  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."

Q: What is the Match?

A:  The Match 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.

Q: How many hours do interns/residents work?

A:  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

Q: What does "board certified" mean?

A:  Generally, to become certified by one of the boards recognized by the American Board of Medical Specialties <>, 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


Q: How do a choose a residency program? I need to declare a medical specialty before long, but I have so many conflicting feelings and thoughts about various clinical areas. How can I make the right choice?

A: It's time for fourth year students to get serious about choosing their specialty area. Some of you are lucky, and everything lines up: you know which clinical area interests you most, your board scores and grades/letters are all in the correct range, and you have helpful professors on your side. For you, it's just a matter of doing the paperwork on time. You can stop reading here.
But I know there are many others of you out there who aren't sure what specialty to choose. Or, you're torn between 2 or 3 specialties. Or you know what you don't want but aren't sure what you do want. Or you know what you want, but aren't sure if your qualifications are strong enough. Read on!
If you're stuck, here's a decision tree to follow:

  1. Find or make a list of all the specialties available directly after medical school (ie, skip fellowships).
  2. Cross off the ones you definitely don't want. You don't need a string of reasons beyond the fact that you simply can't see yourself doing it long term.
  3. Perform a Google™ search with the phrase "choosing a medical specialty." When I tried it, I got about 89,800,000 entries. Set a timer for no more than 1 hour and browse through the first several pages. Take some of the "what specialty are you?" quizzes. If nothing else, they will give you some ideas and possibly make you think about specialties you haven't explored. You can safely avoid making an exact ranking of specialties at this point. Just see which specialties you seem to be most suited to and which you should rule out.
  4. Now, list several specialties you can see yourself doing long term, no more than 6.
  5. Research those specialties in your institution. Go to the departments and make friends with the residency program coordinators. If you haven't already done so and haven't rotated in the program, arrange to shadow a faculty member for a day. Talk with 1 or 2 residents and check out the pros and cons of the specialty. Finally, ask the program coordinator if your board scores would be in a competitive range. Most program coordinators won't share their board score cut-off, but they likely would tell you if your scores are within range.
  6. Narrow your list to 2 or 3 specialties. Now, and only now, talk with family and friends. Tell them you're thinking of these specialties, and get their opinions. Listen hard, and get them to articulate the basis for their opinions.
  7. Delete any reasons related to job shortages or oversupply of physicians in a specialty. You don't need 200 jobs, you only need 1, and you should be prepared to relocate somewhere less attractive if you choose a specialty that's overcrowded or not in much demand. Plus, demand can change by the time you finish training.
  8. Delete any reasons related to lifestyle or money, unless those concerns come from your significant other.
  9. Delete heritage reasons ("Your father is a surgeon; you should be one, too").
  10. Now, write down your own pros and cons, independent of all the advice and aptitude testing and board scores. Be honest here. If your priorities are lifestyle, having children during residency, income, opportunities for foreign travel, or avoiding rough circumstances, then rank them appropriately. What fascinates you, what could you be passionate about? Don't be at all logical here.
  11. But do be logical in this next step. And brutally honest with yourself: Did you barely pass the boards? Internal medicine might not be for you, even if you really enjoy outpatient medicine. Do you tend to avoid or dislike patient contact? Don't consider family medicine or pediatrics. Do you have high board scores, want a benign lifestyle, but aren't very visual? Don't pick radiology.
  12. If you follow all these steps, combining thoughtful reflection on what makes you happy with an objective look at your strengths and weaknesses, one option should start singing out louder than the others. And that's your specialty.
Note that you should take other people's views of your strengths and weaknesses into account, but not necessarily follow their advice. Spouses are a special case because you are making a joint life together. Still, the final decision should be yours, informed by some actual data that help you determine "the best fit" between you and your specialty-to-be.
You can do this in a week; don't procrastinate and don't make the problem bigger than it is. If you choose a specialty that turns out to be a bad fit, you can still change after the first year.
Be practical, but don't limit yourself. I know a physician who started medical school at age 38, one who had to take the boards several times, one who barely passed one of her steps by 1 point, and another who doesn't like patient care. The first one is now practicing radiology in a large private clinic, the second is a fellow in a high-risk obstetric anesthesia program at a very prestigious academic medical center after switching from surgery because of physical limitations, the third is a fellow in a neonatal intensive care unit after completing a successful pediatrics residency, and the last is working for a large drug company doing information technology, his real love.
Even if you are "nonstandard," you can find a specialty you will love and which will value you. Good luck!


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