How to Write About: Doctors

So you may be thinking “but Ellie, being a doctor isn’t a medical illness”.

It sort of is though…

No I’m only kidding. This post is primarily for writers who might want a character who is a medical student or a doctor, but might have trouble finding information on what the process of becoming an MD is. In this post I will break down the time line of when and how people start medical school, the ages when we finish up, the day in the life of a Med student, and the process of board certification. I will keep this brief and will throw in little personal stories, that might help you to fully flesh out your doctor character.

As a US medical student I can only comment on the US system and accreditation process.

Timeline to M.D

High school-4 years, most people graduate at 18

Undergraduate– 4 years most people graduate at 22

Medical school– 4 years, if the person went straight to Med school on graduation the person would be 26.

Let’s say you want your character to be older/ younger than 26 when they start residency.

If you want the character to be older many of my colleagues (myself included) took at least one year off before starting medical school. I got a job working in a hospital lab with my B.S in biology. Other people got graduate degrees in human anatomy or public health. Several of my classmates had full careers before starting medical school: one was a mechanical engineer and one worked in the oil field. The oldest member of my class was 39 when he started and will be 43 when he graduates.

If you want your character to be younger:

Let’s say you want to make your character a young genius who is a doctor at a very young age. The variations need to occur before medical school; in most cases medical school is 4 years. Students can’t graduate early, every student takes the same classes and can’t take more or less credit hours the way you can in an undergraduate program. So your character can have graduated high school early or taken college credits in high school so they weren’t in college as long, but the 4 years of medical school are required and can’t be skipped or gotten through faster.

A Day in the Life

Medical school is broken down into 2 sections: the preclinical years and the clinical years.

The preclinical years focus on the basic science and include daily lectures. At my school classes weren’t required and each lecture was recorded so they could be viewed at home. The morning hours were spent listening to 4 lectures a day; lectures were usually done by noon so the afternoon was spent reviewing the information from the morning.

During first year we had anatomy lab where we dissected cadavers. These labs were usually in the afternoon and took place in 2 to 3 hour blocks.

My weekends were spent… studying. Okay so I know 4 hours of lecture a day doesn’t seem that bad, but the information is tough, and it’s thrown at you very fast. So much information is packed into every lecture that there’s no way just one read through would be enough. So my afternoons were spent re-listening to the lectures from that day and studying notecards I had made. Then the next day there is new material to learn; so my weekends were spent getting through the material again, making sure I didn’t miss anything and studying notecards.

We had holidays in Med school but mostly I… studied. Most exams were placed right after a one or two day break so that the extra day could be used to review. So even those weren’t opportunities to relax. The one exception was a two week Christmas break in between semesters. We did have a summer break in between first and second year that I spent shadowing in a clinic 40 hours a week. The “summer break” after second year was used to study for Step 1, the first of the board exams which I will discuss in more detail below.

The Clinical years are third and fourth year and are primarily spent working in hospitals and clinics. Each student goes through required rotations and at the end takes a national exam called “the Shelf”, students are scored based on their performance compared to other students across the nation. The average score on these tests are between 70 to 80. Internal Medicine is one of the harder Shelf exams, as is Pediatrics, OBGYN tends to be a little easier. Students are also scored based on evaluations from residents and attendings. My school has now moved to a Pass/Fail grading system for third year because faculty evaluations tend to be subjective giving students an actual grade ended up being pretty unfair.

Fourth year is a little bit more relaxed. By this point students have chosen a medical specialty and have scheduled rotations within their specialty of interest. All students have to do an AI or “Acting Internship” in the inpatient hospital setting where they are given more responsibility than a third year and are expected to behave like they will as Interns. Students are also required to do an outpatient clinic rotation. AIs and clinic rotations can be done in whatever field the student is going into; so if the student is going into surgery he/she does 4 weeks doing an inpatient surgical rotation and 4 weeks in a surgical clinic. There are also blocks for vacation, and electives. The Fall semester of fourth year is spent traveling to interview for residency programs.

Most students graduate in late May and start residency July 1st.

Can students work during medical school?

Short answer: no

Long answer: probably not, or at least not a normal job. Some students have blogs or other online websites that might generate some income. I had a classmate who was a pianist at a church on Sundays. So it is possible, but I don’t think anyone in my class was a waitress or bartender or anything that would require regular work hours.

Are Med students married?

Yes! My husband and I got married right before medical school started and I have several married classmates.

Several people in my class got married during medical school, and a few people dated other classmates and are now either married or engaged to them!

Do Med Students do things other than medical school?

Yes! I have a book blog! I also do a lot of furniture painting/refinishing, crafting and sewing.

Other students volunteer at animal shelters, or have fashion blogs, or travel during breaks. We have real lives (sometimes).

Board Exams

The process in the US involves four board exams.

USMLE Step 1 (just referred to as Step 1 when doctors/ students are talking to each other)- is taken after the preclinical years. I took 6 weeks to study for it and I studied 12 hour days 6 days a week, and then on Sundays I took a 4 hour practice exam. It is quite honestly the most painful thing I have ever done and you couldn’t pay me enough money to do it again. The exam itself was 7 sections and took about 8 hours. Between sessions you are allowed to use the bathroom and take a lunch break.

USMLE Step 2 Clinical Knowledge (referred to as Step 2 CK)- taken between third and fourth year. I took 4 weeks to study for this exam and mostly did 7 to 8 hour days 5 days a week. This exam was a little “easier” because of the way third year is structured; since a national Shelf exam is taken at the end of every block most of the studying for Step 2 CK is a review.

USMLE Step 2 Clinical Skills (referred to as Step 2 CS)- is an in-person exam that requires each student to prove that they are capable of interacting with patients in a professional manner, coming up with a list of diagnoses (differential diagnosis) and documenting the encounter in a patient note. This exam takes place at one of 6 testing centers in the US and requires students to travel, sometimes far distances, to take it. During the exam there are actors portraying patients and the student is filmed while they go in take a patient history, and do a physical exam. The student then leaves the room and writes a note on the encounter. The full exam includes 12 patient encounters, which are timed with 15 minutes for the history taking portion and 10 minutes to write the note. The exam is pass/fail. It is harder for foreign medical graduates to pass the exam as 1/3 of the grading is “English proficiency”.

USMLE Step 3 (referred to as Step 3) is taken during intern year of residency.

Residency and “the Match”

Bottom line: there are more Med students who want US residency spots than there are spots available for them. This leads to spots being very competitive.

The Match is a national residency matching process that matches applicants with programs.

Short Summary of the match process:

Students apply to residency programs in their field of choice. It depends on the field and if the student is competitive or not but US medical grads probably apply to an average of 40 programs

Students are then given interview spots. Most students probably interview at 10 to 15 programs. This requires students to travel and is very expensive.

After interviews student rank programs from 1 to however many interviews they went on. The programs also rank all the students they interviewed. The due date for this is in mid-February

A computer algorithm matches students to programs based on the students preference.

Students find out which program they matched to on the third Friday in March

Some students do not match at all. Some students match at programs very far down on their list.

Residency

The number of years required for residency differs based on the specialty.

I have listed some of the more common ones below:

Family Medicine– 3 years

Internal medicine– 3 years

Pediatrics– 3 years

Neurology– 4 years

Emergency Medicine– 3 years

General Surgery– 5 years

Neurosurgery– 7 years

There are also combined residencies and fellowships people can do after residency that I’m not going to get into, but feel free to ask me questions if you have them.

You might run into the term PGY# in looking into residencies. This stands for ”Post Grad Year” followed by the number of years since the person graduated medical school. So a PGY1 is in their intern year, or 1st year of residency

In Conclusion:

Doctors are people too.

Med School is rough and expensive. We graduate with an average of $150,000 of Med school debt (not including any undergraduate or other graduate school debt the student might have). That number is also not including interest.

Residents are paid usually about $40,000 to $50,000 a year.

So don’t make your Med student/resident rich unless they have family money.

Residents are capped at an 80 hour workweek but most are probably working all 80 of those hours. They might have some vacation days, but they are probably not sailing around the world just yet.

Questions?

Comment with any questions you might have!

The best way to flesh out a character will be to talk to other Med students, residents or doctors as well to get see what their experiences were like.

Good luck writing!