A resident working at the Hospital of the University of Pennsylvania in Philadelphia
FAITH LAPIDUS: This is SCIENCE IN THE NEWS in VOA Special English. I'm Faith Lapidus.
BOB DOUGHTY: And I'm Bob Doughty. This week, we look at how people train to be medical doctors in the United States.
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FAITH LAPIDUS: It is not easy to become a doctor in the United States. The first step is getting into a medical college. More than one hundred twenty American schools offer study programs for people wanting to be doctors.
People can get advice about medical schools from many resources. One of these is a publication, the Princeton Review. It provides information about colleges, study programs and jobs.
The Princeton Review says competition to enter medical schools is strong. American medical schools have only about sixteen thousand openings for students. However, more than two times this many seek entry. Many of those seeking admittance are women.
BOB DOUGHTY: Most people seeking admission contact more than one medical school. Some applicants contact many. An important part of the application usually is the Medical College Admission Test, or MCAT. The Association of American Medical Colleges provides the test by computer. It is offered in the United States and in other countries.
The applicant is rated on reasoning, physical and biological sciences and an example of writing. Applicants for medical school need to do well on the MCAT. They also need a good record in their college studies.
FAITH LAPIDUS: People who want to become doctors often study a lot of biology, chemistry or other science. Some students work for a year or two in a medical or research job before they attempt to enter medical school.
An interview, or direct meeting, also is usually required for entrance to medical schools. This means talking with a school representative. The interviewer wants to know if the person understands the demands of life as a medical student and doctor in training. The interviewer wants to know about the person’s goals for a life in medicine.
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BOB DOUGHTY: A medical education can cost a lot. One year at a private medical college can cost forty thousand dollars -- or more. The average cost at a public medical school is more than fifteen thousand dollars. Most students need loans to pay for medical school. Many finish their education heavily in debt.
Some Americans become doctors by joining the United States Army, Navy, Air Force or Public Health Service. They attend the F. Edward Hebert School of Medicine of the Uniformed Services University of the Health Sciences in Bethesda, Maryland. These students attend without having to pay. In return, they spend seven years in government service.
Doctors are among the highest paid people in the United States. Big-city doctors who work in specialties like eye care usually earn the most money. Some other doctors earn far less. That is especially true in poor communities.
FAITH LAPIDUS: Most medical students spend their first two years mainly in classroom study. They learn about the body and all its parts. They also begin studying how to recognize and treat disease.
By the third year, students begin working with patients in hospitals. Experienced doctors who have treated many patients guide them as they work. As the students learn, they think about the kind of medical skills they will need to work as doctors.
During the fourth year, students begin contacting hospital programs for the additional training they will need after medical school. Competition to work at a top hospital can be fierce.
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BOB DOUGHTY: Doctors-in-training in hospitals are known as interns or residents. Many are called interns during their first year. After that, the name of the job is “resident.”
All fifty states require at least one year of hospital work for doctors-in-training educated at medical schools in the United States. Graduates of study programs at most foreign medical schools may have to complete two or three years of residency, although there are exceptions.
The trainees receive supervision from medical professors and doctors called attending physicians.
FAITH LAPIDUS: A report published by the Journal of General Internal Medicine shows how important preparation and supervision are during residency. David Phillips is a sociology professor with the University of California at San Diego. He and his student, Gwendolyn Barker, examined more than sixty-two million death records from across the United States. These records were from nineteen seventy-nine to two thousand six.
The two researchers closely studied the records that listed errors involving medicines as the main cause of death. They found that these medication mistakes caused ten percent more deaths in July than in other months. They found that the increase took place only in areas with hospitals where new doctors train. There was no such increase in areas with no teaching hospitals.
BOB DOUGHTY: In nineteen ninety-nine, the Institute of Medicine of the National Academies released a report about mistakes in American hospitals. The report said preventable mistakes resulted in at least forty-four thousand deaths each year.
Later, the New England Journal of Medicine published details of two government-financed studies about serious mistakes. The studies found that the mistake rate in two intensive-care areas decreased when interns worked fewer hours.
FAITH LAPIDUS: The Accreditation Council for Graduate Medical Education supervises medical education. In two thousand three, the Council reduced the hours that residents may work. It limited residents to no more than thirty hours of continuous duty. A hospital was not supposed to require more than eighty hours of duty in a week. Some residents had been spending more than one hundred hours a week at their hospitals.
More recently, the Institute of Medicine reported that the shorter workweek did not help residents. It said they were getting far less sleep than they should. The report said the residents were attempting to do as much work in the shorter time as they had done while working more hours. So the Institute of Medicine proposed that residents be required to get five continuous hours of rest for every sixteen hours on duty. It also asked that residents be given fewer duties and more supervision.
These Institute of Medicine proposals have yet to be accepted. That is because the Accreditation Council for Graduate Medical Education has not yet reacted to the report. But it is expected to do so soon.
BOB DOUGHTY: Whatever the Accreditation Council decides, American public opinion about the issue appears clear. That is true, at least, of most of one thousand two hundred people who recently answered questions for a study on the issue.
A team led by Alex Blum of Mount Sinai School of Medicine in New York found that the public wants to limit work hours by resident doctors. The study found there is strong support for restricting work by doctors-in-training to sixteen or fewer hours at one time. The team said that would be similar to what is required in New Zealand, Britain and Europe.
FAITH LAPIDUS: Critics of limiting hours say such a requirement could cost American hospitals about one billion seven hundred million dollars a year.
Researchers for the RAND Corporation and the University of California at Los Angeles have said that few medical errors cause injury. They also said changing work rules could cause other kinds of mistakes. If resident doctors work shorter hours, the researchers said, errors could happen when one resident takes control of a patient’s care from another.
The New England Journal of Medicine published an editorial with that report. The writers expressed concern that the proposed changes would place too much importance on the number of hours worked. The editorial questioned whether reduced work hours could give the residents the education they will need as doctors.
BOB DOUGHTY: Clearly, the hours of service required of doctors in training are disputed. Even if the hours are reduced, they are also clearly demanding. Still, uncounted people throughout the world want to be doctors. And, it does not seem that hard work will stop them.
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FAITH LAPIDUS: This SCIENCE IN THE NEWS was written by Jerilyn Watson. Our producer was June Simms. I’m Faith Lapidus.
BOB DOUGHTY: And I’m Bob Doughty. Listen again next week for more news about science in Special English on the Voice of America.