Becoming a doctor or surgeon in the United States isn’t all that straightforward of a process. If you’ve ever wondered what each step of the process is like, you’ve come to the right place.
Let’s first cover the most traditional paths to becoming a doctor. After that, we’ll discuss some variants that can speed up the process or open up additional opportunities based on your specific interests.
Step 1 | College/University
After completing high school, you’ll attend a 4-year university and work towards obtaining your bachelor’s degree. And no—an associate’s degree won’t cut it. Many students and their parents stress much more than they need to regarding college choice. As I’ve spoken about in a previous post on college prestige, in most cases, attending a respectable public university will suffice.
The benefits of attending a highly prestigious private university are present, but are usually overstated and may not be worth the additional cost. My recommendation is to certainly strive to get into the best college possible, but keep in mind other important factors beyond prestige, such as fit, cost, location, culture, and opportunities related to your areas of interest.
Once you’re in college, the big decision you’ll be faced with is what major to pursue. While you can technically major in anything you want (so long as you also complete the medical school prerequisites), there are certainly pros and cons to each major.
For example, choosing a biology major will result in a greater degree of overlap between your major and medical school requirements, and ultimately, a smaller course load, which may translate to better grades. That being said, there is a greater number of premeds majoring in bio, and competition will be higher and more cutthroat here than in many other majors.
For the full analysis, including data of medical school acceptance rates by each major, check out: The Best Premed Major—Backed By Med School Acceptance Data.
Freshman Year
During the first half of your freshman year, don’t worry too much about extracurriculars and the other aspects of bolstering a strong medical school application. This should be when you establish your foundational habits, which will facilitate success moving forward as you begin to be pulled in multiple directions.
Dialing in your evidence-based study strategies, which we discuss extensively on this channel, is a great place to start. Set up a regular exercise routine, establish your social circle, and properly adjust to this new chapter in your life.
In the second half of your freshman year, begin seeking out relevant extracurriculars that are related to your interests in medicine. During the spring quarter of my freshman year, I began reaching out to PI’s at various labs studying inflammatory bowel disease, a disease process I was particularly interested in.
By securing a position early on, I had ample time to secure a publication and two abstracts before I applied to medical school. This is important. Research is unique because it’s the one standard extracurricular with the greatest potential to drastically improve your competitiveness as an applicant.
Sophomore Year
Either towards the end of freshman year or at the beginning of sophomore year, your focus should be on gaining clinical and research experience. Intentionally build relationships throughout your early years of college. This will be invaluable once it comes time to ask for letters of recommendation.
If you want to go straight from college to medical school without taking time off, then you’ll need to apply at the end of your junior year, with applications opening for submission in June. That way, you’ll be applying and completing the application cycle during senior year, allowing you to start in the fall right after graduating. If you want to take one year off between college and medical school, then you’ll be applying at the end of your senior year.
This is an important decision to make, as it dictates your strategy in taking the MCAT. There’s no right or wrong answer here. I have yet to meet a medical student or physician who regrets taking a year off. I personally went straight through, likely due in part to my impatience and overzealous ambition.
If you want to go straight through, I recommend you take the MCAT during the summer between your sophomore and junior year. Having dedicated summertime to focus on the MCAT without the added workload of classes can make a huge difference in your final MCAT score.
Many students ask if it’s still fine to take the MCAT without taking certain courses. I personally didn’t take biochemistry until after I took the test, and I was still able to secure a 99.9th percentile MCAT score. That being said, this is going to be more of a personal decision based on your own comfort level with the material.
Junior Year
If you’re taking a year off, it’s usually best to take the MCAT during the summer between your junior and senior year.
Applications open around the beginning of May each year, but you cannot submit your application until the end of May or early June. You will need to start the process of applying to medical school during your junior year to allow the application to be obtained and completed by the time June rolls around. Get the ball rolling on these by midway through junior year.
When you do apply, you’ll be using AMCAS, or the American Medical College Application Service, for most MD schools. Texas schools use TMDSAS, and osteopathic medical schools use AACOMAS. They’re all similar, but each application has slightly different nuances.
AMCAS vs. AACOMAS vs. TMDSAS Med School Application Differences
Senior Year
After you submit your primary application in June, you’ll begin to receive and write secondary applications, which are specific to each school. Complete them as soon as possible after they come in; ideally, within 2 weeks of receiving them.
You will conduct most of your interviews during the fall and early winter of your senior year. Medical school interviews are often in-person, meaning you must travel to the school’s campus. This is an amazing opportunity to experience the city and the program.
In October, medical schools begin sending acceptance letters. You may be contacted any time thereafter. You can hold multiple acceptances until mid-May, when you must commit to one school.
Follow our College Premed Timeline for Medical School Applications, which outlines an ideal schedule for freshman, sophomore, junior, and senior year.
Step 2 | Medical School
Medical schools in the US are generally 4 years in duration, and you’ll earn either an MD or a DO. The first two years are the preclinical years, where you are primarily learning in the classroom with limited clinical exposure. The final two years are the clinical years, where you spend more time in the hospital and clinic and less time in the classroom.
Your first year will be the most radical transition, and for many, it can be quite jarring. I go over how to make the adjustment as painless as possible in my Adjusting to Medical School 101 post.
During this time, if you want to have a semblance of a balanced life while also being a top performer, you should reassess and refine your study strategies, figure out your routines, and work to optimize your efficiency.
You’ll remember the middle and end of your first year as some of the best times in medical school. The stress is comparatively low to the later stages, you have more free time, you are bonding with new people, and solidifying lifelong friendships. You’ll be amazed by your classmates, as medical students are some of the most impressive and diverse people you’ll come across.
There are a total of three United States Medical Licensing Exams. During your second year, you’ll begin ramping up for USMLE Step 1. After taking Step 1 at the end of your second year, you’ll begin third year and transition to your clinical rotations.
Clinical rotations are particularly challenging because, for the first time in your life, you’re not just studying out of books and taking tests. You still have to do that, but most of your waking hours are now spent in the hospital or clinic, and your evaluations from your seniors hold tremendous weight in your overall grade. It’s a different game entirely. During your third year, you’ll complete various rotations, such as internal medicine, family medicine, neurology, and more.
USMLE Step 2 is usually taken at the end of the third year, although some push it into their fourth year. Rather than spending 6 months studying, 1 month will usually suffice.
You’ll start your fourth and final year of medical school with away rotations, also known as audition rotations, where you act as a sub-intern at institutions across the country.
You’ll usually do 2 or 3 away rotations, each lasting one month, at institutions you would like to ultimately match at for residency. Think of it as a month-long interview. If you’re going into a specialty with a suboptimal lifestyle, like surgery, expect long hours and high stress.
While doing a plastic surgery away rotation, I remember having three 19 hour days in a row, but I was graciously saved by 3 subsequent days of only 12-13 hours. That’s 95 hours in a single week, plus studying and preparing for the next day’s cases. Away rotations can be tough, but not all sub-internships are going to be this rigorous.
In September of your fourth year, you’ll apply to residency using the Electronic Residency Application Service, or ERAS for short. It’s analogous to the AMCAS experience when applying to medical school. Residency interviews will follow, occurring anywhere between October to February.
Read our comprehensive ERAS Residency Application Guide.
At the end of February, you submit your rank list to participate in the match process. In March, you’ll attend Match Day with your medical school classmates and open an envelope that informs you of the program you’ll be training at for the next 3-7 years.
Step 3 | Residency
Congratulations, you’re now a doctor with an MD or a DO after your name! You’ll begin your first year of residency, or intern year, on July 1st, and it’s going to be a long ride. In the first year of residency, you’ll do several rotations across various specialties, some of which aren’t all that relevant to the specialty you’ve chosen.
In your second and third years, however, you’ll be doing rotations that are more focused on your specialty, and you’ll even get options to choose electives to focus on your areas of interest within the specialty. If you’d like to specialize further, you can elect to do a fellowship after you complete residency.
Medical school and residency are both difficult, but for different reasons. Medical school is challenging because you must work hard to earn strong evaluations, and balancing clinical work with doing well on exams is taxing, to say the least. Think of it as multiple bursts of very high intensity. Residency is never as challenging on a short term scale, but it will test you in the form of an endurance race. You won’t have cutthroat competition or the pressure of getting top evaluations; however, you’ll have greater responsibility for your patients, hours are long, and it goes on for years.
Depending on your specialty, residency will last anywhere from 3-7 years. Fellowship is optional and can add another 1-3 years on top of that. But once you’re done, you’re an attending physician, and your training is complete! Just take the board exams for your specialty and you’ll be a board-certified doctor or surgeon.
Alternative Routes
A quick note about alternative routes. BS-MD programs combine college and medical school into a single application and begin immediately after high school. Rather than 4 years of college plus 4 years of medical school totaling 8 years, most BS-MD programs are only 6 or 7 years in duration.
If you’d like additional degrees in medical school, there are two main options. First, you can add a master’s degree for an additional 1 or 2 years, the most common of which are a master’s in public health or MBA. You can decide to do this once you’re already accepted to a traditional 4 year MD program. Second, you can get a PhD in addition to your MD, but that requires you to apply to MD/PhD programs upfront through the AMCAS application, not when you’re already enrolled in a medical school.
Premed Roadmap to Medical School Acceptance
If this all seems intimidating and complex, I get it. I was the first and only person in my family to pursue a career in medicine, and I definitely made some mistakes along the way.
I don’t want you to repeat my mistakes, and it’s for that reason that my team and I have created the Premed Roadmap to Medical School Acceptance course. We go into painstaking detail through each year of college and provide an adaptable blueprint that will help maximize your chances of getting into a top medical school. By following the practices in this course, I was able to achieve a 99.9th percentile MCAT score, get accepted to multiple top 5 medical schools, and got a full-tuition scholarship to my number one program.
Becoming a doctor is a long and tedious process, but by taking it one step at a time, you’ll be able to succeed. And we’re here to help you each step of the way, with tutoring, advising, and editing services for both premeds and medical students.
If you want me to cover anything else in particular regarding the medical training process, let me know with a comment down below.
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Great advice.