Doctors: Specialties and Training

• Becoming a fully trained physician is a long and arduous task because the education needed to become a doctor is substantial.
• The education requirements have been standardized in the U.S. and begins with the completion of four years of college followed by four years of medical school.
• This is followed by an internship and residency in a particular specialty, and sometimes fellowship training in a subspecialty that may last as long as 10 years.
• Once the initial training is completed, a doctor continues lifelong learning to maintain the skills necessary to optimally practice medicine.

Most medical schools require college graduation, although a few programs combine college or graduate school and medical school. In the United States, medical school lasts four years and includes two years of basic science courses such as the following:

• Anatomy
• Neuroanatomy
• Histology
• Embryology
• Behavioral sciences
• Genetics
• Physiology (neurophysiology)
• Biochemistry
• Microbiology
• Pharmacology
• Pathology

This is followed by two years of clinical sciences during which the medical student sees and treats patients under the close supervision of fully trained physicians. During these two years, the medical students spend one year in two-month-long rotations in specialties such as the following:

• Pediatrics
• Internal medicine
• General surgery
• Obstetrics and gynecology
• Psychiatry
• Family practice
• Emergency medicine

A year of elective choices follows in any of about 50 specialties and subspecialties such as the following:

• Orthopedic surgery
• Plastic surgery
• Ophthalmology
• Neurosurgery
• Oncology
• Radiation oncology
• Cardiology
• Nephrology
• Neonatology
• Rheumatology
• Pulmonology
• Infectious diseases
• Endocrinology

In the United States, medical students are required to pass national board exams that assure they have a firm grasp of basic and clinical sciences. When students have graduated from medical school with a medical degree, and passed the national board exams, they are qualified to advance to residency training. After graduation from medical school, these individuals have earned the right to be called a doctor, but they are a long way from completing the skills necessary to safely practice medicine. Depending on the state they want to practice in, they need at least one to three more years of training. The first postgraduate year of residency is often referred to as internship.

There are two types of medical schools in the United States: allopathic and osteopathic. Students from both medical training programs must pass the same national board exam and may choose to pursue careers in any medical specialty or subspecialty. In the U.S., both types of graduates are equally qualified to practice medicine.

• Allopathic students receive a medical doctorate (MD).
• Osteopathic students receive the equivalent medical degree, a doctorate in osteopathic medicine (DO). Medical schools that train doctors of osteopathic medicine tend to place a greater emphasis on training physicians to be family physicians, although any specialty residency (such as those listed below) can be entered after graduation. Their education is the same as allopathic (MD) school, but in addition, it includes courses in musculoskeletal manipulation and nutrition.
• Medical school curriculums are constantly being reviewed and revised to further the training of future physicians. Many schools will have their students learn basic clinical skills (for example, physical examination) during the first two years of basic science training.

Near the end of medical school, each medical student selects a specialty for residency training. Fully trained physicians must now supervise them for a period of three to five years. The majority of the training occurs in teaching hospitals and hospital-affiliated clinics. Specialty training is a long and difficult process.

There are currently 24 medical specialties recognized by the American Board of Medical Specialties (ABMS). Medical specialties include the following:

• Allergy & immunology
• Anesthesiology
• Colon and rectal surgery
• Dermatology
• Emergency medicine
• Family practice
• Internal medicine
• Medical genetics
• Neurological surgery
• Nuclear medicine
• Obstetrics & gynecology
• Ophthalmology
• Orthopaedic surgery
• Otolaryngology (ear, nose, and throat or ENT)
• Pathology
• Pediatrics
• Physical medicine and rehabilitation
• Plastic surgery
• Preventive medicine
• Psychiatry & neurology
• Radiology
• General surgery
• Thoracic surgery
• Urology

At the completion of residency training, physicians are considered to be specialists and are board eligible. Most graduates elect to take these difficult, additional written and oral board exams, that certify their knowledge base and skills. Physicians who pass these exams are allowed to state that they are a board-certified practitioner in their chosen specialty.

After completing a three- to five-year residency, about 30% of the fully trained physicians elect to pursue additional training to become subspecialists.

Subspecialty training may last an additional one to four years. Usually the focus of subspecialty training is fairly narrow and allows the physician to obtain knowledge and skills needed to perform additional procedures or focus on treating patients with a particular type of problem. Most subspecialties have additional board exams at the end of their training qualifying the physician to be a board-certified subspecialist.

The most common specialties and subspecialties, as well as the years of training required, are listed here. In some cases, more than one specialty training may qualify a physician for fellowship training.

• Dermatology - four years
  • Dermatopathology - one to two years
  • Pediatric dermatology
• Emergency medicine - three to four years
  • Pediatric emergency medicine - two years
  • Sports medicine - one to two years
  • Toxicology - two years
• Family practice - three years
  • Geriatrics - two years
• Neurology - four years
  • Electromyography (EMG) - one to two years
  • Neuromuscular diseases - one to two years
  • Electroencephalography (EEG) - one to two years
  • Epilepsy - one to two years
  • Behavioral neurology/dementia - one to two years
  • Cerebrovascular diseases/stroke - one to two years
  • Movement disorders - one to two years
  • Neuroimmunology - one to two years
  • Neuro-oncology - one to two years
  • Pain - one to two years
  • Headache - one to two years
  • Neuro-ophthalmology - one year
  • Critical care neurology - one year
  • Neuroimaging - one year
  • Sleep - one year
• Ophthalmology - four years
  • Neuro-ophthalmology - two years
  • Retina - two years
  • Glaucoma - two years
  • Oculoplastics - one year
• Plastic surgery - five to six years
  • Hand surgery - two years
• Internal medicine - three years
  • Allergy & immunology - two years
  • Cardiology - three years
  • Critical care - two to three years
  • Endocrinology - two years
  • Gastroenterology - three years
  • Geriatrics -two years
  • Hematology and oncology - two to three years
  • Infectious diseases - two years
  • Nephrology - two years
  • Pulmonology - two to three years
  • Rheumatology - two years
• Obstetrics/gynecology - four years
  • Infertility
• General surgery - five to six years
  • Critical care - two years
  • Pediatric surgery - two years
  • Thoracic surgery - two to three years
  • Transplant surgery - two to three years
  • Trauma - two years
  • Vascular surgery - two years
  • Colon and rectal surgery - two years
• Urology - five years
  • Pediatric urology - one to two years
• Psychiatry - four years
  • Child psychiatry - three years
  • Forensic psychiatry - two to three years
• Neurosurgery - six years
  • Pediatric neurosurgery - one to two years
• Physical medicine - three years
  • Pediatric physical medicine - two years
• Radiology - four years
  • CT - one year
  • MRI - one to two years
  • Ultrasound - one year
  • Interventional - one to two years
  • Neuroradiology - one to two years
  • Breast - one year
  • Chest - one year
  • Musculoskeletal - one year
  • Pediatric - one to two years
  • Nuclear medicine - one to two years
• Orthopedic surgery - five years
  • Hand - two years
  • Spine - two years
  • Hip - two years
  • Foot and ankle - two years
• Anesthesiology - four years
  • Critical care - two years
  • Pediatric anesthesiology - two years
• Pathology - five years
  • Forensics pathology - two years
• Aerospace medicine - two years

• Pediatrics - three years
  • Allergy and immunology - two years
  • Behavioral and developmental - two years
  • Cardiology - two years
  • Critical care - two years
  • Endocrinology - two years
  • Gastroenterology - two years
  • Genetics - two years
  • Hematology and oncology - two years
  • Infectious diseases - two years
  • Neonatology - two years
  • Nephrology - two years
  • Pulmonology - two years
  • Rheumatology - two years

Most states require a minimum of 25-50 hours of continuing medical education credits each year. In addition, most physicians regularly read two to three medical journals each month and attend hospital grand rounds lectures and other training and certification courses for new procedures, therapies, and regulations. Many specialty boards now also require that doctors take tests on an ongoing basis to assure that their knowledgebase is up to date.

To be certain you and your family and loved ones receive the best medical care available, you may want to check to see if your doctor is board certified in his or her specialty. To do this, you may contact any of these groups:

• At the American Board of Medical Specialties, you can check on your doctor's credentials or you can call the ABMS at 866-ASK-ABMS.
• Contact the American Osteopathic Board of Medical Examiners at 800-621-1773.
• Contact your state's medical licensing board.
• Call the American Medical Association at 800-621-8335.

The American Board of Medical Specialties (ABMS) is an organization of 24 approved medical specialty boards. The ABMS serves to coordinate the activities of its member boards and to provide information to the public, the government, the profession, and its members concerning issues involving specialization and certification of medical specialists.