Transcript The Profession of Medicine - Virginia Commonwealth University

THE PROFESSION OF
MEDICINE
Samantha Hudson MD MEng
Department of Internal Medicine
VCU School of Medicine
Based on a presentation by Rita M. Willett MD
Learning objectives
After this learning activity, you should be able to:
1.
Describe how physicians are trained.
2.
Discuss career paths of physicians.
3.
Discuss the layers of credentials for physicians.
4.
Describe the continuing education requirements for physicians.
5.
Discuss current challenges in medicine.
Physician Training - Overview
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Medical school (4 years)
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“The basics” for all physicians
Leads to professional degree
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Residency (3-7 years)
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Allopathic (MD)
Osteopathic (DO)
Supervised practice
Specific field of practice
Leads to specialty certification
Fellowship (1-5 years)
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Optional
Additional specialization
MD and DO Degrees
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MD degree = medical
doctor
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DO concepts
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Allopathic
~ 80% of medical
students are MD track
DO degree = doctor of
osteopathic medicine
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Osteopathic
Generally no difference
in privileges
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Patient-centered, holistic,
hands-on approach to
diagnosing and treating
illness and injury
Osteopathic manipulative
techniques
Help patients achieve a high
level of wellness by focusing
on health education, injury &
disease prevention.
http://www.aacom.org/about/osteomed/pages/default.aspx
Medical School (VCU SOM ’10-’11)
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Both years: Clinical Skills
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Year 2: Pathophysiology
Pharmacology
 Microbiology
 Hematology
 Endocrine
 Systems, such as Pulmonary,
Neurology and Cardiology
 Women’s health
 Behavioral health
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Year 1: Healthy Human
Population medicine
 Biochem, Genetics
 Anatomy & Physiology
 Human behavior
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Medical School (VCU SOM ’10-’11)

Year three – clinical
clerkships
 Internal
medicine
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Year four –
individualized
 Prepare
for specialty
 Pediatrics
 “Acting”
internship
 Family
 Critical
medicine
 Obstetrics
and
gynecology
 Surgery
 Psychiatry
 Neurology
care
 Electives
National Tests
While In Medical School
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USMLE Step 1
Generally basic science
 After 2nd year of med school
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USMLE Step 2 CK
(Clinical Knowledge)
Written exam based on clinical experience
 After 3rd year of med school
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USMLE Step 2 CS (Clinical Skills)
Observed, standardized patient encounters
 After 3rd year of med school
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COMLEX is a similar test for DO’s
Residency
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Supervised practice with increasing
autonomy
Specialization
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Internal Medicine
Pediatrics
Family Medicine
Surgery & subspecialties
Anesthesiology
Emergency medicine
Neurology
Psychiatry
Radiology
Pathology
Physical medicine / rehabilitation
Internal Medicine Residency
at VCU HS

PGY1 (Intern) year: “Learner”
 Begin
Continuity Clinics (Primary Care)
 Always under the supervision of a resident on Wards
and ICUs
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PGY2 year: “Manager”
 Given
more autonomy while still supervised
 Learn to manage patients before supervising interns
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PGY3 year: “Teacher”
 Continue
to develop autonomy while progressing into
teaching role
Fellowship
Added specialization in practice field
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Internal medicine
 Cardiology,
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Obstetrics and gynecology
 High
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oncology, endocrinology…
risk ob, oncology…
General Surgery
 Transplant,
oncology…
National Tests
In, and after, Residency
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USMLE Step 3
 Taken
during or after Intern year
 All physicians must take prior to
receiving medical license
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Boards for specialty
Boards for subspecialty, if
applicable, after Fellowship
Credentials &
Continuing Medical Education
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Licensure – state government
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Board certification – professional
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State law governs practice
Board of Medicine regulates
Degree, Steps 1 - 3, one year residency required
Continuing medical education (CME) for renewal
Does not designate specialty training
National specialty boards (i.e. pediatrics, surgery, psychiatry)
Requires residency completion and specialty exam
Re-certification on periodic basis
Hospital credentials and privileges
Career Paths of Physicians
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Community practice
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Ambulatory, hospital, long term care
Private, managed care, health center, VA
Academic medicine
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Clinician, educator, researcher
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Industry
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Government
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Policy
Public health
What do Physicians do?
Physician challenges:
Patient Care
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Time pressures
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Office visits
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Hospital length of stay
Aging population
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Multiple chronic illnesses
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Declining functional status
Care for under-served
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Rural and inner-city settings
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Uninsured and under-insured
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Limited mental health and dental care
Physician challenges
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Help from Pharmacy
 Insurance
formularies
 Medicare Part D complexity
 Prior authorizations
 Uninsured / under-insured patients
 Medication from multiple physicians
 Controlled substances
 New pharmaceuticals
Physician challenges
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Help from Health Psychology
 Mental
Health diagnoses
 Behavior change necessary to manage chronic diseases
Smoking cessation
 Sleep
 Obesity
 Many other medical problems
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 Motivational
Interviewing and Behavior Change Plan
Thank you!