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 in becoming a doctor, and then 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 your bachelor’s degree. And no, an associate’s degree won’t cut it. Many students and their parents stress 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 certainly are 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 than many other majors. For the full analysis, including data of medical school acceptance rates by each major, check out my post on the best major for pre-meds.
During the first half of your freshman year, don’t worry too much about extracurriculars and other aspects of bolstering a strong medical school application. This should be the time where you establish your foundational habits that 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 of your life.
In the second half of your freshman year, begin seeking out relevant extracurriculars that are related to your interests and passion for 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 that I was particularly interested in for personal reasons. 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.
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 here. I have yet to meet a medical student or physician who regrets taking a year off. I personally went straight through, in part likely due 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.
If you’re going to be taking a year off, then usually it’s best to take the MCAT during the summer between your junior and senior 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.
You’ll submit your primary application in June. You’ll receive and write secondary applications, which are specific to each school, during the summer, and will conduct most of your interviews during the fall and early winter.
Step 2 | Medical School
Medical schools in the U.S. 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, you should reassess and refine your study strategies, figure out your routines, and work to optimize your efficiency if you want to have a semblance of a balanced life while also being a top performer.
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, and you are bonding with new people and solidifying life long 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 the dreaded USMLE Step 1. It’s the most important test for matching into residency, hence the high stress surrounding this exam. If you thought you studied hard for the MCAT, just wait until you get to 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. Rather, you still have to do that, but now most of your waking hours are 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 rotate on internal medicine, family medicine, general surgery, psychiatry, neurology, pediatrics, ob/gyn, and emergency medicine.
USMLE Step 2 is usually taken at the end of the third year, although some push it into their fourth year. It’s not nearly as important as Step 1, but it’s a great opportunity to make up for a lackluster Step 1 score. 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 used when applying to medical school. Interviews will follow, occurring anywhere between October to February. 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 as you must work hard to earn strong evaluations, the level of competition for Step 1 is next level, 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 from your preceptors. 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.
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.
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 Pre-Med Roadmap to Medical School Acceptance course. We go in 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 do it. And we’re to help you each step of the way.
If you want me to cover anything else in particular regarding the medical training process, let me know with a comment down below. Much love to you all!