Physicians and Surgeons

• Many physicians and surgeons work long, irregular hours; over one-third of full-time physicians worked 60 or more hours a week in 2004.
• Formal education and training requirements 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.
• New physicians are much less likely to enter solo practice and more likely to work as salaried employees of group medical practices, clinics, hospitals, or health networks.

Physicians and surgeons serve a fundamental role in our society and have an effect upon all our lives. They 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 health care.

There are two types of physicians: M.D.—Doctor of Medicine—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 more likely than M.D.s 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. Anesthesiologists focus on the care of surgical patients and pain relief. Like other physicians, they evaluate and treat patients and direct the efforts of those on their staffs. Anesthesiologists confer with other physicians and surgeons about appropriate treatments and procedures before, during, and after operations. These critical care specialists are responsible for maintenance of the patient’s vital life functions—heart rate, body temperature, blood pressure, breathing—through continual monitoring and assessment during surgery. They often 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.

Family and general practitioners. Family and general practitioners are often the first point of contact for people seeking health care, acting as the traditional family doctor. They assess and treat a wide range of conditions, ailments, and injuries, from sinus and respiratory infections to broken bones and scrapes. Family and general practitioners typically have a patient base of regular, long-term visitors. Patients with more serious conditions are referred to specialists or other health care facilities for more intensive care.

General internists. General internists diagnose and provide nonsurgical treatment for diseases and injuries of internal organ systems. They provide care mainly for adults who have a wide range of problems associated with the internal organs, 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 are commonly looked upon as primary care specialists. They have patients referred to them by other specialists, in turn referring patients to those and yet other specialists when more complex care is required.

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

Obstetricians and gynecologists. Obstetricians and gynecologists (ob/gyns) are specialists whose focus is women’s health. They are responsible for general medical care for women, but also provide care related to pregnancy and the reproductive system. Like general practitioners, ob/gyns are concerned with the prevention, diagnosis, and treatment of general health problems, but they focus on ailments specific to the female anatomy, such as breast and cervical cancer, urinary tract and pelvic disorders, and hormonal disorders. Ob/gyns also specialize in childbirth, treating and counseling women throughout their pregnancy, from giving prenatal diagnoses to delivery and postpartum care. Ob/gyns track the health of, and treat, both mother and fetus as the pregnancy progresses.

Psychiatrists. Psychiatrists are the primary caregivers in the area of mental health. 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, and 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 may be causing emotional problems. Psychiatrists may also administer electroconvulsive therapy to those of their patients who do not respond to, or who cannot take, medications.

Surgeons. Surgeons are physicians who specialize in the treatment of injury, disease, and deformity through operations. Using a variety of instruments, and with patients under general or local 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 primary care and other specialist physicians, surgeons also examine patients, perform and interpret diagnostic tests, and counsel patients on preventive health care.

A number of other medical specialists, including allergists, cardiologists, dermatologists, emergency physicians, gastroenterologists, ophthalmologists, pathologists, and radiologists, also work in clinics, hospitals, and private offices.

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 health care organizations that provide backup coverage and allow for more time off. These physicians often work as part of a team coordinating care for a population of patients; they are less independent than solo practitioners of the past.

Surgeons and anesthesiologists typically 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. Over one-third of full-time physicians and surgeons worked 60 hours or more a week in 2004. Only 8 percent of all physicians and surgeons worked part-time, compared with 16 percent for all occupations. Physicians and surgeons must travel frequently between office and hospital to care for their patients. Those who are on call deal with many patients’ concerns over the phone and may make emergency visits to hospitals or nursing homes.

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 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 a medical school is 3 years of college; most applicants, however, have at least a bachelor’s degree, and many have advanced degrees. There are 146 medical schools in the United States—126 teach allopathic medicine and award a Doctor of Medicine (M.D.) degree; 20 teach osteopathic medicine and award the Doctor of Osteopathic Medicine (D.O.) degree. Acceptance to medical school is highly competitive. 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.

All States, the District of Columbia, and U.S. territories license physicians. To be licensed, physicians must graduate from an accredited medical school, pass a licensing examination, and complete 1 to 7 years of graduate medical education. 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.

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 also is 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 specialty boards, 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.

A physician’s training is costly. According to the Association of American Medical Colleges, in 2004 more than 80 percent of medical school graduates were in debt for educational expenses.

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 in order to keep up with medical advances.

Physicians and surgeons held about 567,000 jobs in 2004; approximately 1 out of 7 was self-employed and not incorporated. About 60 percent of salaried physicians and surgeons were in office of physicians, and 16 percent were employed by private hospitals. Others practiced in Federal, State, and local governments, including hospitals, colleges, universities, and professional schools; private colleges, universities, and professional schools; and outpatient care centers.

According to the American Medical Association (AMA), in 2003 about 2 out 5 physicians in patient care were in primary care, but not in a subspecialty of primary care (table 1).

A growing number of physicians are partners or salaried employees of group practices. Organized as clinics or as associations of physicians, medical groups can afford expensive medical equipment and realize other business advantages.

According to the AMA, the New England and Middle Atlantic States have the highest ratio of physicians to population; the South Central and Mountain States have the lowest. D.O.s are more likely than M.D.s to practice in small cities and towns and in rural areas. M.D.s tend to locate in urban areas, close to hospital and education centers.

Employment of physicians and surgeons is projected to grow faster than average for all occupations through the year 2014 due to continued expansion of health care 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. In addition to employment growth, job openings will result from the need to replace physicians and surgeons who retire over the 2004-14 period.

Demand for physicians’ services is highly sensitive to changes in consumer preferences, health care reimbursement policies, and legislation. For example, if changes to health coverage result in consumers facing higher out-of-pocket costs, they may demand fewer physician services. Demand for physician services may also be tempered by patients relying more on other health care providers—such as physician assistants,, experienced physicians may work longer hours, delay retirement, or take measures to increase productivity, such as using more support staff to provide services. Opportunities should be particularly good in rural and low-income areas, because some physicians find these areas unattractive due to less control over work hours, isolation from medical colleagues, or other reasons.

Unlike their predecessors, newly trained physicians face radically different choices of where and how to practice. New physicians are much less likely to enter solo practice and more likely to take salaried jobs in group medical practices, clinics, and health networks.

Earnings of physicians and surgeons are among the highest of any occupation. According to the Medical Group Management Association’s Physician Compensation and Production Survey, median total compensation for physicians in 2004 varied by specialty, as shown in table 2. Total compensation for physicians reflects the amount reported as direct compensation for tax purposes, plus all voluntary salary reductions. Salary, bonus and/or incentive payments, research stipends, honoraria, and distribution of profits were included in total compensation.

Self-employed physicians—those who own or are part owners of their medical practice—generally have higher median incomes than salaried physicians. Earnings vary according to number of years in practice, geographic region, hours worked, and skill, personality, and professional reputation. Self-employed physicians and surgeons must provide for their own health insurance and retirement

Physicians work to prevent, diagnose, and treat diseases, disorders, and injuries. Other health care practitioners who need similar skills and who exercise critical judgment include chiropractors, dentists, optometrists, physician assistants, podiatrists, registered nurses, and veterinarians.

For a list of medical schools and residency programs, as well as general information on premedical education, financial aid, and medicine as a career, contact:

• Association of American Medical Colleges, Section for Student Services, 2450 N St. NW., Washington, DC 20037-1126. Internet: http://www.aamc.org/
• American Association of Colleges of Osteopathic Medicine, 5550 Friendship Blvd., Suite 310, Chevy Chase, MD 20815-7231. Internet: http://www.aacom.org/

For general information on physicians, contact:

• American Medical Association, 515 N. State St., Chicago, IL 60610. Internet: http://www.ama-assn.org/
• American Osteopathic Association, Division of Communications, 142 East Ontario St., Chicago, IL 60611. Internet: http://www.osteopathic.org/

For information about various medical specialties, contact:

• American Board of Medical Specialties, 1007 Church St., Suite 404, Evanston, IL 60201-5913. Internet: http://www.abms.org/
• American Society of Anesthesiologists, 520 N. Northwest Hwy., Park Ridge, IL 60068-2573. Internet: http://www.asahq.org/
• American Academy of Family Physicians, Resident Student Activities Department, 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2672. Internet: http://fmignet.aafp.org/
• American College of Physicians, 190 North Independence Mall West, Philadelphia, PA 19106. Internet: http://www.acponline.org/
• American College of Obstetricians and Gynecologists, 409 12th St. SW., P.O. Box 96920, Washington, DC 20090-6920. Internet: http://www.acog.org/
• American Academy of Pediatrics, 141 Northwest Point Blvd., Elk Grove Village, IL 60007-1098. Internet: http://www.aap.org/
• American Psychiatric Association, 1000 Wilson Blvd., Suite 1825, Arlington, VA 22209-3901. Internet: http://www.psych.org/
• American College of Surgeons, Division of Education, 633 North Saint Clair St., Chicago, IL 60611-3211. Internet: http://www.facs.org/

Information on Federal scholarships and loans is available from the directors of student financial aid at schools of medicine.

Information on licensing is available from State boards of examiners.

• Source: Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2006-07 Edition,