||This article needs to be wikified. (April 2009)|
Medicine is a very complex field. In the past, a doctor could learn almost all that we knew about medicine. Now that is impossible. So after finishing medical school, young doctors choose what kind of doctor they wish to be. After school, they usually do more years of training to learn about the kind of medical specialty they want to do.
Some doctors try to learn some about all of the different subjects of medicine and how to treat all patients. These kind of doctors are called 'primary care' doctors. Sometimes they are also called 'generalists' or even 'general practitioners.' In the United States these kind of doctors are called family practitioners or family medicine doctors. When a problem is strange or complex they give it to a specialist.
There are other doctors who are also 'primary care' doctors. Pediatricians are primary care doctors, but only for children. Internists are primary care doctors for adults. Some gynecologists do primary care, but for women only.
Other doctors are called 'specialists'. This means they have learned more about certain types of medical care. A dermatologist is a doctor who knows more about the skin and diseases of the skin. A psychiatrist is a doctor who knows more about thought and mood and mental illnesses like depression and schizophrenia. An orthopedic surgeon is a doctor who knows about bones and joints and fixes them when they are broken or diseased.
In the broadest meaning of 'medicine', there are many different specialties. However, within medical circles, there are two broad categories: "Medicine" and "Surgery." "Medicine" refers to the practice of non-operative medicine, and most subspecialties in this area require preliminary training in "Internal medicine." "Surgery" refers to the practice of operative medicine, and most subspecialties in this area require preliminary training in "General Surgery." There are some specialties of medicine that do not fit into either of these categories, such as radiology, pathology, anesthesia, etc.
In the U.S., all specialties must pass all three steps of the national medical board examinations (steps I and II during medical school and step III during intern year). After passing these exams, further board exams are given specific to each specialty, including both written and oral boards. After residency is completed and the doctor has been in practice for at least one year, and after all these exams have been passed, the doctor is considered to be board certified in that particular specialty. There are only a few training spots per specialty each year, and therefore some specialties can be very competitive. Some medical students do not obtain their first choice of specialty. Some specialties suffer from severe shortages of doctors (which can be due to a lack of applicants, an unanticipated need and therefore too few training spots, or high attrition rates), while other specialties have too many practicing doctors.
Surgical training requires a minimum of five years of residency after medical school. Sub-specialties of surgery often require seven or more years. In addition, fellowships can last an additional one to three years. Because post-residency fellowships can be competitive, many trainees devote two additional years to research. Thus in some cases surgical training will not finish until more than a decade after medical school. Furthermore, surgical training can be very difficult and time-consuming. A surgical resident's average work week is approximately 75 hours. Some subspecialties of surgery, such as neurosurgery, require even longer hours, and utilize an extension to the 80 hour regulated work week, allowing up to 88 hours per week. Many surgical programs still exceed this work hour limit. Attempts to limit the amount of hours worked has been difficult because of the large volume of patients who require surgical care, the limited amount of resources (including a shortage of people willing to enter into surgery as a career), the need to perform long operations and still provide care to all pre- and post-operative patients, and the need to provide constant coverage in the Operating Room (OR), Intensive Care Unit (ICU), and Emergency Room (ER).
Medical training, as opposed to surgical training, requires three years of residency training after medical school. This can then be followed by a one to two year fellowship in the subspecialties listed above. In general, resident work hours in medicine are much less than those in surgery.