Explore FAMILY MEDICINE ... A Roadmap for Your Future MANY THANKS This guidebook was developed from Building a Portfolio for Application to College or Health Professions Programs developed by Northwest Missouri Area Health Education Center. Special thanks to Heartland Regional Medical Center, host of Northwest Missouri AHEC. Northwest Missouri AHEC also acknowledges the University of South Carolina Office of Pre-Professional Advising (www.sc.edu/oppa) for helping develop the portfolio. Thanks to the Society of Teachers of Family Medicine (STFM) Special Task Force for review of the guidebook and their helpful suggestions. Much gratitude to Angela Wasson, in the AAFP’s Division of Medical Education for her help in preparing this guidebook. SHOULD I CHOOSE A CAREER Benefits of Working in Health Care IN MEDICINE? According to the U.S. Department of Labor, the health care One of the most important decisions that you will ever make industry is the largest industry in the U.S., with more than is the choice of a career. If you are reading this guide, it is 13 million people working in health care jobs. About 92 probably because you would like more information about percent of wage and salary jobs were in private industry; becoming a physician. Maybe your interest has been the rest were in state and local government hospitals. sparked by contact with a family member who is a physician Health care jobs are found throughout the country, but or by your own experiences with a physician. Although many they are concentrated in the largest states — in particular, students enter college wanting to become physicians, most California, New York, Florida, Texas, and Pennsylvania. students have very little real knowledge of what is involved Workers in health care tend to be older than workers in in the practice of medicine. They know that physicians other industries. Health care workers require a high level of have better than average incomes, that medicine is a highly education and training to be competent and up-to-date with respected profession and that an opportunity exists for the developments in their field. (U.S. Department of Labor, service to others. You may be asking yourself if this career Bureau of Labor Statistics, http://www.bls.gov.oco/cg/ would be right for you. cgs035.htm retrieved March 2009). Getting admitted to medical school and becoming a Physicians will continue to be in demand as the health care physician is no easy task, but just because it is difficult field continues to rapidly grow. Physicians continue to be does not mean that it is impossible. Every year, more than very well-compensated financially, with physicians’ starting 20,000 students are accepted to medical school. These salaries more than double the average salary for U.S. highly motivated students choose to pursue a career that workers. Whether taking care of patients in the office or the is intellectually challenging, financially secure, and very hospital, teaching students, serving as administrative chiefs rewarding. Competition for admission to medical school is of health care systems, or performing medical research, very intense. Students must complete the advanced science physicians are leaders in health care. courses and score well on the Medical College Admission Test (MCAT) as well as fulfill other requirements just to be competitive. Thousands of very bright students apply for admission to medical school each year with only about one- third of those actually gaining admission. FREQUENTLY ASKED QUESTIONS During the clinical years, pressure generated by constantly (FAQS) working with people who are sick, and often dying, is emotionally difficult for many students. Seeing death first-hand What types of physicians are needed? makes most students much more aware of their own mortality, While all types of physicians are needed to care for the health sometimes leading to emotional pressures. of the public, primary care physicians are crucial, especially in There is pressure and uncertainty as medical students compete underserved areas. A health care system built on an adequate for a spot in a good residency program, and there are the supply of primary care physicians is shown to improve health physical and psychological demands made by very long hours outcomes and reduce costs. Primary care specialties include: of hard work. These demands do not cease upon completion of family medicine, general internal medicine, and pediatrics. As residency training as those who are familiar with the long hours providers of more primary care than any other discipline in the required for the successful practice of medicine can testify. Such U.S., the need for family physicians continues to grow. stresses are often difficult for the spouse of a medical student. What is the course of study? Additionally, many are unable or unwilling to accept the fact that the demands of the profession must often take precedence over A conventional medical school requires four years of study. The the social needs of the family. It takes an exceptional spouse first two years, called the preclinical years, are spent primarily to adjust to this fact. Bottom line: It takes a highly motivated in classroom and laboratory settings studying basic medical individual to pursue a career in medicine. sciences. The first year concentrates on the healthy human body with classes in anatomy, biochemistry, physiology, and Is medical school expensive? other courses. The second year emphasizes human disease Financing a costly medical education is often an additional with courses such as pathology, infectious diseases, and stress. The national average debt for medical students is more pharmacology. Courses to discuss medical ethics, interviewing than $100,000, and the cost of tuition continues to rise. (source: patients, and how to do a physical exam are completed Association of American Medical Colleges, March 2009). throughout the first and second years of medical school. While medical education is expensive, it is an investment in a The third and fourth years of medical school are spent working very promising and rewarding career. Physicians can expect with patients in a clinical setting under the supervision of a better than average income after completing many years experienced physicians. During the third year of medical of training and tight budgets. The average starting salary for school, students begin basic required clerkships that cover a family physicians is greater than $140,000 — more than the wide variety of medical specialties such as family medicine, average debt accumulated over four years of medical school. surgery, pediatrics, internal medicine, psychiatry/neurology, If you choose a career in primary care, there are many loan and obstetrics/gynecology. The fourth year is a continuation of forgiveness and loan repayment programs available. The AAFP clinical training. Most programs provide elective opportunities also maintains a listing of programs that send physicians to for students to gain experience in a considered specialty. areas of the country where physicians are most needed. To The U.S. Medical Licensing Exam (USMLE), frequently referred learn about funding resources for practicing in underserved to as the “Board” exam, is the licensure exam that all allopathic areas, visit www.aafp.org/online/en/home/clinical/ students must successfully pass in order to receive their publichealth/culturalprof/underserved.html. medical license. At the end of the second year of medical Keep in mind that 90 percent of medical school students incur school, all students take Step 1 of the USMLE. Most schools some type of student loans to finance their education. Wise require passing scores before beginning the 3rd year clinical medical students will develop a relationship with an informed clerkships. Step 2 of the USMLE is taken towards the end of the financial advisor who can advise them on loan repayment 4th year. Many schools require successful completion of Step 2 options, grants, scholarships, and debt management. for graduation. Step 3 is taken towards the end of the first year of residency training. For more information, check out the AAFP’s Debt Management Guide at www.aafp.org/online/en/home/publications/ Is medical school difficult? otherpubs/debtmgmt.html. There is considerable stress on most medical students. The greatest stress is probably due to the workload. Most medical students agree that the amount of material required during the first two years of preclinical study is double that of their 1 undergraduate workload. fmignet.aafp.org What if I am not sure about Communities with a Family Physician a career in medicine? are Healthier! If you have doubts about whether or not you should continue in Every day, family physicians are making a difference in their pre-medicine, you should keep your options open. Medicine is communities, improving access to medical care, and caring for not for everyone, and there are few successful physicians who patients and their families. Doctors trained in family medicine have not at some time questioned whether or not the rewards are learn to care for the whole person, physically and emotionally, worth the long years of training, cost, and hard work required. throughout life. Family physicians work across the U.S., in Nevertheless, most physicians cannot imagine themselves in urban inner cities, in rural counties, and everywhere in between. any other profession. People who enter the medical profession Recent evidence shows that communities with a family physician to make a great deal of money will likely be very disappointed in are healthier than communities that do not. their career choice over the long run. Most physicians find that Providing patients with a personal medical home, family medicine is an honorable profession that requires talent and physicians deliver a range of acute, chronic, and preventive dedication to practice competently and compassionately. Being medical care services. Besides diagnosing and treating able to positively impact patients’ health is much more rewarding illness, family physicians provide preventive care, including than the lifestyle or the paycheck.