Solving healthcare one doctor at a time

November 4, 2010 5:09 AM

What is the most efficient way to begin practicing medicine in the US?

Let's say that someone had a goal to practice medicine legally in the US. What would be the quickest, most cost effective way to achieve that goal? What would be the most unencumbered way to achieve it?

To frame it, let's assume that the person had the ability to do so and perhaps a BS in science and engineering, if that matters. Everything else would be flexible. Be creative.

posted by TheOtherSide to education (22 answers total)

Become a physician assistant. You can do almost everything a doctor can.
posted by amro at 5:14 AM on November 4, 2010

If they've taken the prerequisite courses, they could take the MCAT, apply the Fall before they wanted to start, then interview Fall/Winter, matriculate the following Fall. Four years later....have fun as an intern.
posted by hubris at 5:15 AM on November 4, 2010

In regards to PA, for just about every program, you need 2000 hours of actual patient care in order to apply. Which would add around another year if you don't have it already. Not a whole bunch of difference.

Also, if you KNOW you want to be a primary care physician, the Lake Erie College of Osteopathic Medicine offers a three year program for primary care that cuts out a lot of the clinical experience you wouldn't need (surgery, neurology, etc.)
posted by hubris at 5:18 AM on November 4, 2010

get degree abroad and then take UMSLE to practice in the States.
posted by k8t at 5:34 AM on November 4, 2010

Nurse Practitioner is probably the most cost-effective way.
posted by availablelight at 5:40 AM on November 4, 2010

"Practicing medicine," in the US, means working as a physician. Physicians' assistants (PAs) do a lot of the things that physicians do, but they cannot practice on their own and must work under the supervision of a licensed physician.

Becoming a physician means going to medical school and completing residency afterward. Medical school is four years--three if you go all year--and residency is three years plus, depending on your field. If you want to specialize, e.g. cardiology, neurology, CT surgery, etc., you probably need a fellowship after that, which adds another two to six years. Becoming a primary care physician is the quickest, but you're still looking at seven years minimum from the time you start med school.

Osteopathic schools will give you a DO, not an MD. There isn't any difference in terms of the things you're allowed to actually do once you're finished your training, but the medical community generally views DOs as people who wanted to be doctors but couldn't get into medical school. This will restrict your job opportunities somewhat--premier medical centers in major urban areas probably won't hire you--but the demand for physicians is such that you're likely to be able to get a job somewhere, you just have to be a little more flexible. You may not get paid quite as much either.

Either way, if you've got a science/engineering degree, you've probably got a lot of the pre-requisites, but it's likely that you're going to need at least some classes like biology and organic chemistry. The easiest way of doing this is a post-baccalaureate pre-medical program. There's a good AskMe about that from last year.
posted by valkyryn at 5:41 AM on November 4, 2010

Depends on what you mean. Do you want to be a physician? In that case, take the MCAT, apply to your state school, study 4, go to residency. Most undergrads apply before they get out, which would save you a year. There exist (but are now uncommon) opportunities to go from 3rd year undergrad to med school directly, not getting the BS.
posted by a robot made out of meat at 5:44 AM on November 4, 2010

Most cost-effective (in terms of personal tuition expenditure and costs of living) would probably be to join the military as an officer (I'm not sure if the process is different if you apply to a military med school vs. a civilian med school). This is how my uncle became a physician, and he has had a great career (first Navy, now civilian).
posted by purlgurly at 5:46 AM on November 4, 2010

I have a few engineer friends who have expressed interested in practicing medicine in the past. However, because of their age they're concerned about the time commitment. They also see medical school as largely too expensive.

But, these are also the type of people who would be willing to try adventurous paths to achieve goals. For example, if there was some international intensive training boot camp where they could cram and train for a couple years and then come back and take a test to validate competency, they'd probably be for it.

The medical pedigree isn't really important, because as the joke goes, "What do they call the person who placed last in his medical class? A doctor." I'm just curious what the most optimal path is to open a medical practice.
posted by TheOtherSide at 5:54 AM on November 4, 2010

Accelerated APRN: no prereqs, three years to FNP. Given your state, this is more or less of 85% of a practitioner.
posted by cobaltnine at 6:44 AM on November 4, 2010

Funny you mention that, I just happened to be looking that up recently.

While a PA isn't 100% independent, the rules are pretty loose. And I would wager that most MDs work in some kind of supervised position most of their careers too. I have no experience with it, but the descriptions seem to suggest that you can practice "routine" medicine mostly unencumbered, with the MD supervisor acting more as a resource than a micromanager.

Plus, if you compare the costs, being a PA might seem like a much freer career path. With little to no debt, a PA has a lot of freedom to take more rewarding jobs or work fewer hours.

Admittedly, there are the costs of getting the training and experience necessary to gain admission, but they still pale in comparison to getting an MD.
posted by gjc at 6:51 AM on November 4, 2010

For example, if there was some international intensive training boot camp where they could cram and train for a couple years and then come back and take a test to validate competency, they'd probably be for it.

In the US, there are very few formal, regulated professions in which you can just walk in, talk a test, and prove your "competency." Most everything almost invariably requires a recognized, accredited degree plus evidence of training. This holds for public school teaching, accounting, 49 out of 50 states for the practice of law (ok, no "experience"/training required there, just the degree and the exam), as well as medicine.

You could attend one of several foreign medical schools in Europe that are cheaper (Trinity University in Dublin was a popular choice of many Americans) and apply for medical residencies in the USA, and after 3 years of training, you can be a primary care physician (that's the catch: it's hard to get into subspecialties from foreign medical schools).

But the standard path is: take the required classes in undergrad, take the MCAT exam, do 4 years of med school, 3-5 years of residency, and n years of fellowship/subspecialization.

They also see medical school as largely too expensive.

The reason why med school is expensive in the USA is because it's worth it, financially speaking. But a medical degree in Europe + trying to get accepting to a US residency program might be the most financially efficient, though you may get shut out of high-paying sub-specialties.
posted by deanc at 6:51 AM on November 4, 2010

I'm sloooowly working toward a medical school application now. So while I don't have much room to talk, I do have a little.

While it is difficult and expensive and frustrating (believe me, as a non-trad student, I KNOW), the ONLY way to be sure that you stand a CHANCE of being a decent physician is to attend an accredited medical school, for all four years, and then to complete a residency program.

It's not unlike joining a monastery or the armed forces - you are taking on a commitment which is greater in scope than just an eventual day job. And honestly, someone who doesn't feel that ANYTHING would be worth it, just to one day have the privilege of practicing medicine... might want to look at other career options. Unless you believe wholeheartedly that it's worth it... it's not worth it, not for you.
posted by julthumbscrew at 7:03 AM on November 4, 2010

I'm at medical school in the UK. Standard medicine courses are five years (straight from school); graduate entry ones are four - this doesn't make it any faster than qualifying in the US, but it is far cheaper. The USMLE has a reputation for being ridiculously hard, but some people take parts of it at the same time as medicine finals so you don't have to revise twice.

If money's the only stopping point, you can get a scholarship for a fully funded degree in Cuba if you satisfy the following criteria:

* Be US citizens (with US passport)
* Be between the ages of 18 and 30
* Have completed college-level pre-med science courses (one year each of biology, inorganic chemistry, organic chemistry, and physics, each with laboratory)
* Be physically and mentally fit
* Come from the humblest and neediest communities in the US
* Be committed to practice medicine in poor and underserved US communities after graduation
posted by Coobeastie at 7:17 AM on November 4, 2010

Krakow school of medicine in Poland
posted by jannw at 8:06 AM on November 4, 2010

If money's the only stopping point, you can get a scholarship for a fully funded degree in Cuba if you satisfy the following criteria:

Yeah, except that travel by US citizens to Cuba is pretty tightly restricted, and getting a degree at a Cuban institution isn't covered. You can take courses there as part of a study abroad program, and you can even teach there, but simply getting a degree at a Cuban university as such isn't going to be supported.

I would be very, very careful about doing this, as the propaganda on the IFCO website aside, I have no confidence that such a degree would make you eligible for residency in a US program.
posted by valkyryn at 8:32 AM on November 4, 2010

With little to no debt, a PA has a lot of freedom to take more rewarding jobs or work fewer hours.

Getting certified as a PA is certainly cheaper than medical school, but "little to no debt" is simply not accurate in most cases. The above link goes to a small school with little-to-no regional prestige, let alone national prestige. Duke charges almost $30k a year. That's a ton less than going to medical school for four years, but it's hardly nothing. Your student loan payments could easily be in the neighborhood of $500-750/month. On a $60-90k salary, that's doable, but it isn't chump change.

On the other hand, you'll be finished your training and have a real job in two or three years instead of seven to twelve. This is not something to be underestimated.
posted by valkyryn at 8:37 AM on November 4, 2010

yeah, if you want to be a doctor, you have to attend medical school. not too many ways around that.

in general, the few docs i know who skipped the US med school path for whatever reason (and chose not to go DO) did the Caribbean route. this is generally discouraged because it makes life a lot more difficult in terms of securing clerkships and residency. they also have high attrition rates, but i am guessing that's because a lot of the class is made up of young people who didn't do as well in undergrad and still aren't quite there in terms of academic ability. carib actually seems to work out ok for those who are disciplined and take it seriously. and it can be cheaper and faster. still, though, it seems that by putting in the extra work upfront and getting into a US MD school, you save yourself a lot of the headaches down the line that you might encounter as a FMG (foreign medical graduate, which you would be if you attend Carib or Europe or whatnot.)

problem for US med schools is that applications are way up. the number of people applying seems to be increasing substantially every year for the past several years. competition is stiff and schools that used to get 5,000 apps are getting 10,000+. for a class of 150. having a 4 year degree is not enough, you really need to have at least 2 of the 3 of- volunteering experience, shadowing experience, research experience. having all 3 is better, and the more time spent on each is better. and this is, of course, in addition to your competitive GPA and MCAT scores. also, if you dont have all your prereqs covered (1 year each of bio, chem, physics and organic chem) you'd have to take what you're missing. depending on how long ago you got your degree, they might not accept your classes anymore at some schools and you'd have to retake those too.

not trying to be a downer. just saying that at one point, i considered the same thing (what is the cheapest and fastest way?) i learned there really isn't one. i just had to suck it up and jump through all the hoops one at a time like everyone else. it took me 3 years and quite a lot of money to build the most solid app i could. but it was worth it, because now i am in. i mean, i think they sort of have to make it hard to get in, so that the only people who end up becoming docs are the ones who are willing to work hard and put in lots of time to show they are serious about the profession. in terms of having an easier admission to school, you'd probably want either DO or carib. if you're lucky enough to live in a state with a state school, maybe you can give that a shot. but overall it seems that you're just looking to save a couple years and a couple bucks . . . in the long run does it matter? especially the money thing. US med school may cost more upfront, but i am certain US medical graduates on average make more than their DO and FMG counterparts. and the saving time thing is tricky. if you attend a US school you'll basically be able to get a residency upon graduation. (maybe not your 1st choice, but something.) what if you attend a foreign school, and you don't match the first time around? then you've already lost a year.

anyway, i could probably keep going until i've written a novel, but i'll stop. i was just in your shoes a few years ago so i know the ins and outs. feel free to PM me for further info. and good luck with whatever you decide!
posted by lblair at 8:47 AM on November 4, 2010

"Practicing medicine," in the US, means working as a physician. Physicians' assistants (PAs) do a lot of the things that physicians do, but they cannot practice on their own and must work under the supervision of a licensed physician.


NP's are independent practitioners.
posted by brevator at 11:09 AM on November 4, 2010

NP's are independent practitioners.

Only in eleven states. The majority require some sort of connection with a physician, though that connection does vary quite a bit.
posted by valkyryn at 12:58 PM on November 4, 2010

If you're talking about becoming a physician, there are two schools in Canada that have an accelerated three-year program - McMaster University and the University of Calgary. McMaster takes international applicants (at a MUCH higher tuition rate - something like 90k/year) and I'm not sure whether UCalgary does. They both accept applicants in their third year of undergrad. Another accelerated option would be to apply to the UK straight out of high school, which would take five years for undergrad and med school combined.

After med school the fastest residency training program would be in family medicine, to become a general practitioner.

I agree with the above posters that you should stay away from the Caribbean schools as much as possible.
posted by mossicle at 10:38 PM on November 6, 2010

@mossicle- i've heard that canadian schools are even harder to get into than american schools. i've heard of the occasional canadian getting into a US med school but rarely the other way around.
posted by lblair at 5:09 PM on November 7, 2010