Notes from med school

It was 10:34 when the gentle tap from a rough hand startled me. I turned from my textbook to find a short, mostly bald man standing directly behind me. In a hushed voice he asked, "What are you studying?"

"Today it's viruses," I said. "I'm a medical student over at UCD."

"Oooooh great, great," he said. " So are you going to be a people doctor or an animal doctor?"

"A people doctor. Animal doctors go to veterinary school."

Then he added, "You know, my son wants to be a doctor. What exactly does he need to do?"

Realizing that this would not be a quick question, I offered him a seat and we chatted. Here is what I told him:

The first step is attending college. Any school. Any major. But you must include a full year of calculus, general chemistry, organic chemistry, physics, English and biology.

Medical schools expect students to be active beyond academics. This is not technically required — but it is a must. This usually includes involvement in student organizations, athletics, volunteer work and/or research.

There is no set path.

Some people take time off to volunteer, work or travel. Many medical students have taken several years off school or begun different careers before deciding on medicine. Some start medical school in their 40's. Anything is possible.

As it was once put to me: "Do what you like and you will excel at it. If that's research, then do research. But if you'd rather pursue rock climbing — then skip research and go be the best climber you can be." I was nervous, so I did both.

At the end of junior year you take the Medical College Admissions Test (MCAT). I won't lie. It was tough. I studied for the MCAT for several months in addition to my college classes. Back in my day the test was eight hours long and written. Now it's five hours and computerized (Geez, I sound old).

You apply to medical schools around the start of senior year. There's a primary application which requires a one-page personal statement, a detailed account of college activities and three letters of recommendation.

It took me 40 hours to summarize myself in one page.

The average applicant applies to 13 schools, but applying to more than 30 is not unheard of. With 130 or so medical schools in the United States and eight in California, it is a hard decision.

Schools decide if you qualify for a secondary application. These vary by school, but typically require multiple essays ("Why our school?" "What has been your greatest challenge in life?" etc.).

Of course there's a fee for the secondary — $50 to $125 per school. It can get expensive.

If a school likes your secondary, they offer you an interview. You buy plane tickets, find a place to stay and arrange transportation. Then you hope they don't yawn as you explain how you love to help people and are fascinated by the human body.

As the four years of college end, the four years of medical school begin (if you're lucky — only 42 percent make it; many end up reapplying). Average costs of attendance with living expenses can break $200,000 for four years at a private school. Public schools are generally cheaper (averaging $140,000).

My debt will be around $160,000 by graduation. Good times.

The first two years are classroom/lab based. Anatomy. Physiology. Histology. Biochemistry. Microbiology. Awesome workshops. Endocrinology. Cardiology. Lots of fun. Neurology. Hematology. Gastroenterology. (And every other -ology you can think of).

The two years culminate with step one of the national board exam (3 Steps total). An eight-hour computerized test with 350 clinical questions.

The third year involves eight-week rotations in the six core specialties: primary care, internal medicine, pediatrics, surgery, OB/GYN, and psychiatry. You finally get real patients (with real doctors watching over you). Everything is graded.

During the fourth year you do elective rotations. They can be in any specialty (family practice, emergency medicine, general surgery, urology, radiology, etc.). Typically, you tailor your fourth year to the specialty that you have decided to enter. It's also possible to do rotations at other hospitals or in other countries.

Fourth year also includes step two of the board exam. One part is a computerized exam on clinical knowledge. The other part tests your examination skills using standardized patients.

Once you graduate medical school you get an MD. But it's not over yet. You now must begin your residency (think Grey's Anatomy).

The residency length varies by specialty. Family or emergency medicine residencies are three years. Surgery and most specialties ending in -ology are six-to-seven years.

The first year you take Step 3 of the board exam. Passing gets you a license to prescribe medications. The last year you take a final certification test. This grants you "board certification". Now you're ready to be a doctor.

Here's a running total for someone who wants to become, say, a cardiologist:

Four years of college

Four years of medical school

Three years of internal medicine residency

Three-to-four years of cardiology training.

It's a long haul and at times it's tough, especially when your business-major friends are partying just because it's Thursday. But overall, it's extremely rewarding. It's the only field I can think of where people come to you with their most intimate secrets and trust you with their lives. It's both intellectually stimulating and extremely satisfying for those willing and able to put in the time.

The man chuckled and thanked me for my help. Then, as he turned and headed toward the door he muttered,"Man, wait until my kid hears this."

Ryan Whitted, of Woodbridge, is a third year student at University of California, Davis School of Medicine. Notes from Med School is his account of what it's like to become a doctor. If you have questions for Ryan Whitted, e-mail him at ryanw@lodinews.com.

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