http://s1/bmiddle/5d1c482506ff582d310b0long journey to become a physician in America" TITLE="[转载]A long journey to become a physician in America" />

Above: The ECFMG (Educational Commission for Foreign Medical Graduates) certificate, the residency in internal medicine certificate, the fellowship in Hematology and Oncology certificate, the American Board of Internal Medicine certificate.

I was talking to my friend on the phone the other day about how to get a residency training in US. As long as you are a graduate from the medical school in China (either 5 year or 8 year) and you have an authorization to work in the states. You could take the USMLE (United States Medical Licensing Exam). There are total 3 steps for written exams and 1 oral exam CSA(clinical skill assessment). The step 1 covers the basic medical science, the step 2 covers all the specialities, internal medicine, surgery, pediatrics, psychiatry, neurology and OB&GYN etc. The step 3 is simliar to step 2 but focus more on clinical management. To become legible for a residency, you have to pass step 1 & 2 and oral exam. As a foreign medical graduate, you have to compete with US and Canadian medical school graduate and have to get higher score if it's possible.

The cost for medical school education: For average American medical school graduates, it's about $50,000 /year for 4 year. Therefore, most American medical school graduates have average $200,000 to $300,000 student load after they graduate from medical school. Then with the very low salary for the residency (only covering the basic living expense), the load would be paid off until they finish their residency training, which takes average 3 years. During the residency, some programs allow their senior residents to do the "moonlighting" after work. Most Americans will use this opportunities to make some extra money, but you have to use your free time.

Due to the high expense, some Americans find a better way to avoid the high tuitions. There are a few ways to do that.

1. If you are super smart to get the scholarship from the medical school, which is very rare. 2. If you join the army or air force, but you have to serve the army or air force back at least 4-5 years during and/or after residency. (Basically exchange your time for the money)

3. If you enroll to a third country medical school which is recognized by US. It will be much easier to get accepted by the medical school and easily ace the oral exam. The downside is that it's very difficult to get accepted to the top residency training program.

As a foreign medical school graduate, I got almost free education when I was in China. In the end, I still paid back 30,000 RMB after I graduated and decided to pursue my graduate study in US. But still it's only about $2,400 for whole 8 years education.

The cost of taking the USMLE exams: Besides the time to read all those test preparing materials, which takes average 6 to 9 months, the registrations alone cost about $500 each for step 1 and 2, $1200 for CSA and $800 for step 3, total $3000. Those books cost another few hundreds. Oral exam is only held in a few cities. When I took it in 2000, it's only in Philadelphia. I had to take the greyhound from Boston to Philly. Fortunately, one of my best friends went to University of Pennsylvania. I stayed at her place, visited UPenn medical school campus and did some sightseeing. American medical students take exactly the same tests.

After passing the step 1&2 and oral exam CSA, you will get the ECFMG (Educational Commission for Foreign Medical Graduates) certificate to become eligible for residency.

There are a lot of specialties to choose from. Most Americans like the specialties with high salary yet great quality of life, such as dermatology, ophthalmology, radiology, emergency medicine and anesthesiology. General medicine and general surgery become less popular because of the long training (medicine 3 years, surgery 5 years) and relatively low salaries. Subspecialties both in medicine and surgery require another 3 to 5 years fellowship training after residency.

The cost for interviews for residency: Once you decide your specialty, you will apply for the programs--another time and money consuming process. Once you get the offer for the interview, you have to arrange your travel by yourself. To save time and money, you wish that you could get the interviews from the programs in the same cities around the same time. Nowadays, due to rock high gas price, travel becomes more expensive. Most programs would not offer free lodging, therefore, you'd better have some friends in the cities you are going to interview. The average cost is very variable. I'll say at least $4000 (application fee $500, air/car travel $2500, hotels $1000). Here the interviewers pay more attention to a person's social skills since the qualifications are already on the paper. Most common questions: Why do you choose this specialty? Which case do you remember the most and why? What's your 5-year and 10-year plan? What's your personal interest besides medicine? For the candidates, during the interview, you'll know how you like the program, the location, the working hour, the working environment, the possibility to advance your career and moonlighting, etc.

After interview, the programs and the candidates will rank their choices and most of them go through the "Match" process. Some programs offer the "pre-match" to the candidates to guarantee that their programs will be fulfilled. Otherwise, the unfilled programs will scramble to get the unmatched candidates. Nobody likes that since some of them never get to know the programs until they get there. Some great programs will get unqualified resident.

The working hours as a resident: When I was an intern, there was no limit for the working hours and I worked 100 hours/week, average 4 days off a month. The surgery residents may work even longer. My schedule was on call every 3rd or 4th night. When on call, there's no time for any sleep. Then the next day, I'd still stay till the end of the day. Realizing the association of medical errors and sleep deprivation, the new rule is set that the residency should not work more than 80 hours a week. I think it starts around 2003 or 2004 at the end of my residency training. It's great to protect both the patients and the residents. But the amount of clinical work seem less compared with the past.

Board certification: After finishing the residency, you will become board eligible and almost every one takes the board certification exam. It's about $1800 for each specialty. At the end of fellowship, you could take specialty board exam. For me, I just took one specialty board last October and will have to take another board for another specialty in November 2009. The first time taker pass rate varies by specialties as well. On New Year Eve, I just got notified that I passed the board, which means that another certificate is on the way. In every 10 year, I have to take another test to maintain my certification. In another word, I have to take the internal medicine board test again in 5 years.

I don't know how much I spent in my education and training, a lot of Birkin bags for sure.