Significant Points

• Many physicians and surgeons work long, irregular hours.
• Acceptance to medical school is highly competitive.
• Formal education and training requirements-typically 4 years of undergraduate school, 4 years of medical school, and 3 to 8 years of internship and residency-are among the most demanding of any occupation, but earnings are among the highest.
• Job opportunities should be very good, particularly in rural and low-income areas.

Nature of the Work

Physicians and surgeons diagnose illnesses and prescribe and administer treatment for people suffering from injury or disease. Physicians examine patients, obtain medical histories, and order, perform, and interpret diagnostic tests. They counsel patients on diet, hygiene, and preventive healthcare.

There are two types of physicians: M.D. (Medical Doctor) and D.O. (Doctor of Osteopathic Medicine). M.D.s also are known as allopathic physicians. While both M.D.s and D.O.s may use all accepted methods of treatment, including drugs and surgery, D.O.s place special emphasis on the body's musculoskeletal system, preventive medicine, and holistic patient care. D.O.s are most likely to be primary care specialists although they can be found in all specialties. About half of D.O.s practice general or family medicine, general internal medicine, or general pediatrics.

Physicians work in one or more of several specialties, including, but not limited to, anesthesiology, family and general medicine, general internal medicine, general pediatrics, obstetrics and gynecology, psychiatry, and surgery.

Anesthesiologists focus on the care of surgical patients and pain relief. Like other physicians, they evaluate and treat patients and direct the efforts of their staffs. Through continual monitoring and assessment, these critical care specialists are responsible for maintenance of the patient's vital life functions-heart rate, body temperature, blood pressure, breathing-during surgery. They also work outside of the operating room, providing pain relief in the intensive care unit, during labor and delivery, and for those who suffer from chronic pain. Anesthesiologists confer with other physicians and surgeons about appropriate treatments and procedures before, during, and after operations.

Family and general physicians often provide the first point of contact for people seeking healthcare, by acting as the traditional family physician. They assess and treat a wide range of conditions, from sinus and respiratory infections to broken bones. Family and general physician typically have a base of regular, long-term patients. These doctors refer patients with more serious conditions to specialists or other healthcare facilities for more intensive care.

General internists diagnose and provide nonsurgical treatment for a wide range of problems that affect internal organ systems, such as the stomach, kidneys, liver, and digestive tract. Internists use a variety of diagnostic techniques to treat patients through medication or hospitalization. Like general practitioners, general internists commonly act as primary care specialists. They treat patients referred from other specialists and, in turn, they refer patients to other specialists when more complex care is required.

General pediatricians care for the health of infants, children, teenagers, and young adults. They specialize in the diagnosis and treatment of a variety of ailments specific to young people and track patients' growth to adulthood. Like most physicians, pediatricians work with different healthcare workers, such as nurses and other physicians, to assess and treat children with various ailments. Most of the work of pediatricians involves treating day-to-day illnesses-minor injuries, infectious diseases, and immunizations-that are common to children, much as a general practitioner treats adults. Some pediatricians specialize in pediatric surgery or serious medical conditions, such as autoimmune disorders or serious chronic ailments.

Obstetricians and gynecologists (OB/GYNs) specialize in women's health. They are responsible for women's general medical care, and they also provide care related to pregnancy and the reproductive system. Like general practitioners, OB/GYNs attempt to prevent, diagnose, and treat general health problems, but they focus on ailments specific to the female anatomy, such as cancers of the breast or cervix, urinary tract and pelvic disorders, and hormonal disorders. OB/GYNs also specialize in childbirth, which includes treating and counseling women throughout their pregnancy, from giving prenatal diagnoses to assisting with delivery and providing postpartum care.

Psychiatrists are the primary mental healthcaregivers. They assess and treat mental illnesses through a combination of psychotherapy, psychoanalysis, hospitalization, and medication. Psychotherapy involves regular discussions with patients about their problems; the psychiatrist helps them find solutions through changes in their behavioral patterns, the exploration of their past experiences, or group and family therapy sessions. Psychoanalysis involves long-term psychotherapy and counseling for patients. In many cases, medications are administered to correct chemical imbalances that cause emotional problems.

Surgeons specialize in the treatment of injury, disease, and deformity through operations. Using a variety of instruments, and with patients under anesthesia, a surgeon corrects physical deformities, repairs bone and tissue after injuries, or performs preventive surgeries on patients with debilitating diseases or disorders. Although a large number perform general surgery, many surgeons choose to specialize in a specific area. One of the most prevalent specialties is orthopedic surgery: the treatment of the musculoskeletal system. Others include neurological surgery (treatment of the brain and nervous system), cardiovascular surgery, otolaryngology (treatment of the ear, nose, and throat), and plastic or reconstructive surgery. Like other physicians, surgeons also examine patients, perform and interpret diagnostic tests, and counsel patients on preventive healthcare.

Other physicians and surgeons work in a number of other medical and surgical specialists, including allergists, cardiologists, dermatologists, emergency physicians, gastroenterologists, ophthalmologists, pathologists, and radiologists.

Work environment. Many physicians-primarily general and family practitioners, general internists, pediatricians, OB/GYNs, and psychiatrists-work in small private offices or clinics, often assisted by a small staff of nurses and other administrative personnel. Increasingly, physicians are practicing in groups or healthcare organizations that provide backup coverage and allow for more time off. Physicians in a group practice or healthcare organization often work as part of a team that coordinates care for a number of patients; they are less independent than the solo practitioners of the past. Surgeons and anesthesiologists usually work in well-lighted, sterile environments while performing surgery and often stand for long periods. Most work in hospitals or in surgical outpatient centers.

Many physicians and surgeons work long, irregular hours. In 2008, 43 percent of all physicians and surgeons worked 50 or more hours a week. Nine percent of all physicians and surgeons worked part-time. Physicians and surgeons travel between office and hospital to care for their patients. While on call, a physician will deal with many patients' concerns over the phone and make emergency visits to hospitals or nursing homes.

Training, Other Qualifications, and Advancement

The common path to practicing as a physician requires 8 years of education beyond high school and 3 to 8 additional years of internship and residency. All States, the District of Columbia, and U.S. territories license physicians.

Education and training. Formal education and training requirements for physicians are among the most demanding of any occupation-4 years of undergraduate school, 4 years of medical school, and 3 to 8 years of internship and residency, depending on the specialty selected. A few medical schools offer combined undergraduate and medical school programs that last 6 or 7 years rather than the customary 8 years.

Premedical students must complete undergraduate work in physics, biology, mathematics, English, and inorganic and organic chemistry. Students also take courses in the humanities and the social sciences. Some students volunteer at local hospitals or clinics to gain practical experience in the health professions.

The minimum educational requirement for entry into medical school is 3 years of college; most applicants, however, have at least a bachelor's degree, and many have advanced degrees. In 2008, there were 129 medical schools accredited by the Liaison Committee on Medical Education (LCME). The LCME is the national accrediting body for M.D. medical education programs. The American Osteopathic Association accredits schools that award a D.O. degree; there were 25 schools accredited in 31 locations in 2008.

Acceptance to medical school is highly competitive. Most applicants must submit transcripts, scores from the Medical College Admission Test, and letters of recommendation. Schools also consider an applicant's character, personality, leadership qualities, and participation in extracurricular activities. Most schools require an interview with members of the admissions committee.

Students spend most of the first 2 years of medical school in laboratories and classrooms, taking courses such as anatomy, biochemistry, physiology, pharmacology, psychology, microbiology, pathology, medical ethics, and laws governing medicine. They also learn to take medical histories, examine patients, and diagnose illnesses. During their last 2 years, students work with patients under the supervision of experienced physicians in hospitals and clinics, learning acute, chronic, preventive, and rehabilitative care. Through rotations in internal medicine, family practice, obstetrics and gynecology, pediatrics, psychiatry, and surgery, they gain experience in the diagnosis and treatment of illness.

Following medical school, almost all M.D.s enter a residency-graduate medical education in a specialty that takes the form of paid on-the-job training, usually in a hospital. Most D.O.s serve a 12-month rotating internship after graduation and before entering a residency, which may last 2 to 6 years.

A physician's training is costly. According to the Association of American Medical Colleges, in 2007 85 percent of public medical school graduates and 86 percent of private medical school graduates were in debt for educational expenses.

Licensure and certification. To practice medicine as a physician, all States, the District of Columbia, and U.S. territories require licensing. All physicians and surgeons practicing in the United States must pass the United States Medical Licensing Examination (USMLE) or, for osteopathic physicians, the Comprehensive Osteopathic Medical Licensing Exam (COMLEX). To be eligible to take the USMLE or COMLEX, physicians must graduate from an accredited medical school. Although physicians licensed in one State usually can get a license to practice in another without further examination, some States limit reciprocity. Graduates of foreign medical schools generally can qualify for licensure after passing an examination and completing a U.S. residency. For specific information on licensing in a given State, contact that State's medical board.

M.D.s and D.O.s seeking board certification in a specialty may spend up to 7 years in residency training, depending on the specialty. A final examination immediately after residency or after 1 or 2 years of practice is also necessary for certification by a member board of the American Board of Medical Specialists (ABMS) or the American Osteopathic Association (AOA). The ABMS represents 24 boards related to medical specialties ranging from allergy and immunology to urology. The AOA has approved 18 specialty boards, ranging from anesthesiology to surgery. For certification in a subspecialty, physicians usually need another 1 to 2 years of residency.

Other qualifications. People who wish to become physicians must have a desire to serve patients, be self-motivated, and be able to survive the pressures and long hours of medical education and practice. Physicians also must have a good bedside manner, emotional stability, and the ability to make decisions in emergencies. Prospective physicians must be willing to study throughout their career to keep up with medical advances.

Advancement. Some physicians and surgeons advance by gaining expertise in specialties and subspecialties and by developing a reputation for excellence among their peers and patients. Physicians and surgeons may also start their own practice or join a group practice. Others teach residents and other new doctors, and some advance to supervisory and managerial roles in hospitals, clinics, and other settings.

Job Outlook

Employment is expected to grow much faster than the average for all occupations. Job opportunities should be very good, particularly in rural and low-income areas.

Employment change. Employment of physicians and surgeons is projected to grow 22 percent from 2008 to 2018, much faster than the average for all occupations. Job growth will occur because of continued expansion of healthcare-related industries. The growing and aging population will drive overall growth in the demand for physician services, as consumers continue to demand high levels of care using the latest technologies, diagnostic tests, and therapies. Many medical schools are increasing their enrollments based on perceived new demand for physicians.

Despite growing demand for physicians and surgeons, some factors will temper growth. For example, new technologies allow physicians to be more productive. This means physicians can diagnose and treat more patients in the same amount of time. The rising cost of healthcare can dramatically affect demand for physicians' services. Physician assistants and nurse practitioners, who can perform many of the routine duties of physicians at a fraction of the cost, may be increasingly used. Furthermore, demand for physicians' services is highly sensitive to changes in healthcare reimbursement policies. If changes to health coverage result in higher out-of-pocket costs for consumers, they may demand fewer physician services.

Job prospects. Opportunities for individuals interested in becoming physicians and surgeons are expected to be very good. In addition to job openings from employment growth, openings will result from the need to replace the relatively high number of physicians and surgeons expected to retire over the 2008-18 decade.

Job prospects should be particularly good for physicians willing to practice in rural and low-income areas because these medically underserved areas typically have difficulty attracting these workers. Job prospects will also be especially good for physicians in specialties that afflict the rapidly growing elderly population. Examples of such specialties are cardiology and radiology because the risks for heart disease and cancer increase as people age.