You don’t just graduate from med school and then apply for a job. Let’s take a look at the path to becoming a doctor following graduation. 

Phase 1: Internship

Some programs call the internship a PGY-1 (post-graduate Year 1). At this stage, you have an MD or DO after your name, but you are not yet licensed by your state. Therefore, you need a licensed resident to sign all prescriptions and supervise you during procedures. 

There are three basic types of internships that are stepping stones to a residency: categorical, transitional, and preliminary. Some residencies accept interns who have completed more than one type of internship. Check with the Association of American Medical Colleges (AAMC) and the Electronic Residency Application Service (ERAS) for current requirements.

Categorical Internships

A categorical internship is embedded within a residency and does not require a separate application. You are accepted for a residency and complete your entire training, including your internship, in that program. Internal medicine, pediatrics, family medicine, emergency medicine, and OB-GYN are managed this way. Some general surgery programs also accept applicants for categorical internships. A categorical internship might expose you to other fields of medicine; however, it primarily provides a strong foundation in your chosen specialty.

Transitional Internships

Some specialties require a transitional internship, to which you apply separately in ERAS and might have to complete at a different institution from the one at which you will complete your residency. The drawback of this is having to move two times. However, you will experience both medical and surgical practices and gain the skills needed to take and pass the United States Medical Licensing Examination (USMLE) Step 3. And some programs offer interns transitional years at the same location where they are doing their residency, enabling them to avoid moving a second time.

Preliminary Internships

These internships are similar to the transitional year – but rather than rotating through various specialties, you focus on either surgery or medicine. Some surgical subspecialties require a preliminary surgery internship (e.g., urology), while medical specialties (e.g., neurology) require a medical internship. Some specialties (e.g., anesthesiology, dermatology) accept either one. Many institutions offer more preliminary internships than residency spots (cheap labor!), so interns who have not been accepted to residency can work hard and hope for acceptance (or at least a good letter of recommendation) the following year.

Phase 2: USMLE Step 3

The USMLE Step 3 exam is generally taken at the end of the internship year. Step 3 assesses your grasp of clinical concepts relevant to patient care. These concepts include knowledge of human growth and development, disease states, and clinical skills. Through patient case scenarios, the exam tests your ability to formulate a diagnosis based on a patient’s history, their physical exam, and the associated lab findings. It also tests your ability to manage a patient. Passing Step 3 is a prerequisite for licensing for most state licensing boards.

Phase 3: Residency

Residency lengths vary, depending on the specialty involved and the amount of experience you need to be well-trained. Family medicine, internal medicine, and pediatrics are three years. Psychiatry and OB-GYN are four years. Surgery is a minimum of five years, with several surgical specialties being longer. (To subspecialize in any field, you must complete a post-residency fellowship, which can range from one to three years; more on this later in the post).  

Combined residencies allow you to specialize in two fields at one time, with the goal of using your skills in a wider range of situations. Examples include family medicine–psychiatry, internal medicine–pediatrics, and emergency medicine–anesthesiology. These hybrid programs give you singular training in each specialty but also integrate fields to build a meaningful and unique skill set. (Refer to the AAMC for the training requirements for dual specialties.)

As you progress through your post-graduate years, expect to gain more confidence and responsibility. By your final year, you will be able to admit, treat, and discharge patients on your own and conduct some procedures without supervision. You will also know when to consult someone from another specialty and when to confer with a more experienced person in your own field. The goal is never to reach the point of knowing everything but rather to know your limits and when you need additional expertise or collaboration.

During residency, you will begin to present cases at morbidity and mortality (M&M) conferences, which sometimes feel like a public confessional. The upside of this process is that you will learn that other MDs have faced similar clinical challenges. While other physicians might suggest what you could have done differently (i.e., Monday morning quarterbacking), they will confirm that you did the best you could. Most residencies see M&Ms as an essential learning experience because they encourage physicians to get in the habit of disclosing, rather than concealing, errors in judgment. This allows you to get feedback on ways to manage a situation in the future, and it allows other physicians, residents, and students to learn from your experience and – hopefully – not make a similar mistake.

Phase 4: Specialty Board Exams

“Board certified” is a label granted to a physician by a medical specialty board after that person passes a specific final exam. For some specialties, the exam is written; for others, it is oral. In some cases, you must collect a case list of patients in your first two years of practice and then submit and discuss this list during oral boards. Board certification is considered a high honor, and you are generally required to maintain your board certification status through ongoing training and continuing medical education (CME). Some boards require that you take a recertification exam every few years.

Phase 5: Additional Training Programs 

Many specialties offer “subspecialization” in the form of a fellowship. This usually requires an additional one to three years of training. Depending on the length of your residency, you will start applying to fellowships sometime before your last year, with deadlines typically in July, November, or December.

Phase 6: Applying for Jobs

Once you have completed your residency and/or fellowship, it’s time to apply for your first real job. Years ago, physicians often decided to hang up a sign and go into solo practice – but now, most doctors join established groups. Doing this allows you to share resources, on-call shifts, and collective wisdom. If you join a smaller group, you might need training in business practices, legal contracts, and financial issues. In contrast, if you join a larger group or a university, the business aspects are often handled by a human resources department.

Here are some of the many employment options available after you finish your training:

• Private practice: Individual or small group
• Community clinic: Focus on underserved patients
• Public health: Research, community health, CDC/epidemiology
• Single-specialty group: ER, anesthesia, others
• Multi-specialty group: Variety of primary care and specialties
• Academic medicine: Clinical and/or research focused
• Research based: Clinical versus basic science

And here are some emerging career options for physicians:

• Lifestyle medicine: Physicians in this role holistically treat the root causes of chronic health issues to promote health, emphasizing behavioral changes to improve conditions. Lifestyle medicine heavily focuses on preventative health measures.
• Cancer immunology: This field focuses on engaging the immune system to fight malignancies via immunotherapy and immunosurveillance – how the immune system can recognize and eliminate cancer cells. 
• Hospitalist: This type of physician focuses on inpatient care with the goal of discharging patients to home. In addition to providing direct medical care, hospitalists focus on teaching, research, and improving hospital systems. 
• Nocturnist: In this role, a physician works through the night admitting patients through the emergency room, establishing a treatment plan, and treating and stabilizing patients, with the aim to provide a smooth transition in care to daytime physicians.
• Telemedicine: Physicians in this role deliver healthcare services remotely including virtual consultations, diagnoses, and treatment recommendations. 
• Concierge medicine: In this role, physicians often see patients in their home, providing enhanced, personalized, and accessible healthcare through a membership model rather than insurance models.
• Physician executive: A physician executive leads a hospital or a healthcare group in business improvement, finances, hiring, and compliance with health industry regulations.

Phase 7: Continuing Education 

Medicine requires a commitment to lifelong learning. There will always be new procedures, new medications, and new lab tests to learn about. Treatments that were once expected to be around forever will become obsolete.

A well-known adage goes like this: “Fifty percent of what you learn in medical school will be useless; the problem is, we don’t know which 50%.” Therefore, as a physician, it’s your responsibility to keep replenishing your knowledge base and replacing that 50%; how you do so is wholly up to you.

Continuing Medical Education

Physicians in every specialty are required to stay current with new research and methods throughout their careers. Through a combination of CME, board recertification, and special training in new diagnostic and treatment options, there are myriad options to stay up to date. Many workplaces have financial allowances for CME courses, which often include travel.

Individual Learning

The pharmaceutical and medical device industry is booming. Biomechanical engineering, software engineering, and robotics are a few of the “hardware” specialties that require physicians to weigh in on the development and use of new and established technology. In past decades, we saw the advent of electronic medical records, telemedicine, motivational interviewing, and robotic surgery. The wise 21st century physician will walk a path that is open to both the old and the new, aiming to advance medicine while improving patient care and outcomes with the use of technology and innovation.

Maintaining Work-Life Balance

Maintaining your own wellness is not selfish. Physicians are exceptionally prone to the effects of stress. Perhaps the greatest thing you will discover is how to forge a balance between life and a career in medicine. By making your health a priority, you will be better able to teach your patients how to protect their health when they need to make similar changes. Whether you look to diet, exercise, mindfulness, meditation, art, music, or another pursuit, figuring out how to reduce your stress will make you a better doctor. 

It is a noble challenge to embrace your own wellness responsibly as you aim to improve the wellness of others. For physicians to integrate habitual wellness practices and self-care in their lives, as a group, it may be necessary to lobby to change employment policies and practices to afford time for themselves and their loved ones. 

Dr. Mary Mahoney, PhD, earned her PhD from the University of Houston and her MFA from Sarah Lawrence College. She is director of medical humanities at a liberal arts college in New York. With more than 20 years’ experience as a tenured English professor, she specializes in personal statements. She also teaches narrative medicine, empathy, health equity, disparity, bias, and social justice. She has a strong track record of helping applicants to medical, psychology, and humanities graduate programs achieve success. Want Mary to help you get Accepted? Click here to get in touch!

Related Resources

• All You Need to Know About Residency Applications and Matching
• Admissions Straight Talk podcast for med school applicants
• M3 Journaling: How It Can Help Your Residency Application