Arne Vainio. Photo from Walking Into The Unknown / Vision Maker Media
What does it take to become a physician?
By Arne Vainio Tomorrow I talk to the first year medical students at the University of Minnesota, Duluth School of Medicine. I never really know for certain what I will tell them. I get to do this every year and usually in October. I generally start by showing “Walking into the Unknown” and use that as a launching point for further discussion. I vividly remember being a first year medical student and sitting in the front row, second seat from the right. When I first started medical school, I wasn’t even certain what each of the four years of schooling consisted of and much of it came as a surprise to me. It seemed all the other med students had a pre-existing knowledge of what was coming next and I didn’t want to show my ignorance by asking questions about things that seemed obvious to everyone else. It occurs to me that other students may have some of the same questions and it doesn’t seem like there’s always an easy place to get answers. This is a general overview of what it takes to become a physician: School through high school, then four years of college. The high school and college classes should have a heavy focus on writing, math and the sciences because they are preparation for the MCAT. This is the Medical College Admission Test and the scores from this test are sent to all the medical schools applied to. The MCAT is a one day standardized test and there are four sections overall. The test is very secure and the testing center needs photo ID, takes a digital photo, takes fingerprints and only allows pencils and scratch paper they supply. The scores from the test are one of the major criteria for being accepted into medical school. College transcripts are also important as is any previous experience related to medicine in some way. Another important part of the application is the personal statement. This is a written statement by the applicant and it tells their story and why they should be considered for admission. Reference letters are another part of the application and strong letters are important. Most students will apply to multiple medical schools to increase their chances of an interview. Schools can easily have over a thousand applications for a relatively few seats each year and they review the applications carefully. Being invited for an interview is a major step in the right direction. Some schools have multiple interviewers at the same time and some do the interviews one on one. My interviews were one on one. This is the opportunity to sell yourself as a future physician and this can be a difficult process for some students, especially if they come from a background where humility is a virtue. Once in medical school, the overall structure is four years, with the first two years almost entirely in the classroom. The courses are grueling and the credit load is usually 30 credits or more. At the end of the second year of medical school is the first USMLE (United States Medical Licensing Exam) board exam and passing this is necessary to go on to the 3rd and 4th years of medical school. The 3rd and 4th years are doing required medical rotations in the hospitals and also in exploring specialty rotations. There is some classroom time, but much of the time is actually spent learning medicine from a practical standpoint. At the end of the 4th year is the second USMLE examination and passing this is necessary to go on to residency after graduating from medical school. Applying to a residency program is a difficult process and it starts sometime in the 4th year of medical school. Residency is a minimum of 3 years and can be several more depending on specialties chosen. Residency programs applied to will want medical school transcripts, USMLE scores, a personal statement, letters of recommendation, medical school performance evaluations and a resume. Residency is actually working in the hospitals and the intern is a first year resident. Usually a 3rd or 4th year resident will be in charge of the team overall. Shifts can be 24 hours long and 80-hour workweeks are not uncommon in residency. Residents get paid, but mostly just enough to live on. On my very first day as a resident in Seattle, I was on a surgery rotation and at the end of the day; a quick game of rock, paper and scissors decided I was the resident to stay in the hospital. We had 33 patients on our service and I was constantly running up the stairwell from the Emergency Room to the post surgical ward on the sixth floor of the hospital. I took the stairs because waiting for the elevator simply took too long and there was too much work to do. I was wearing four pagers and all of them were going off constantly. I remember running up the stairs to the sixth floor to assess a post-operative patient with shortness of breath and my Emergency Room pager went off. I was totally overwhelmed, it was 3:30 AM and I remember thinking I know why people jump out of windows. Residency includes lots of clinic work and I saw patients at the Seattle Indian Health Board. I loved working there and I quickly developed strong ties to my patients and everyone I worked with. The second and 3rd years of residency bring more responsibility and are not as grueling as the first year. At the end of residency is the third and final USMLE exam. Passing that exam means it’s time to apply for a Physician’s license in the state of choice. Being a new physician is just like starting over and each step of the way felt the same way to me. As I was finishing my residency, I started to get calls and letters from recruiters. It was flattering to think so many places wanted me to work for them and the Seattle Indian Health Board very much wanted me to stay on as a physician. As tempting as that was, I had made a promise to an elder to come back to Minnesota and work for my people. I did that just a bit over eighteen years ago and I’ve been working on the Fond du Lac Reservation ever since. I’ve never looked back and I’ve never wished for anything else. Every single day I work with the smartest, most compassionate and caring people I’ve ever known. I come home almost every day knowing I changed something for almost every person who walked through our doors. I get to teach medical students and I get to guide students aiming for medical school in the right direction. Right now I’m working with five students who want to get into medical school. All of them are sincere and are looking at medicine for all the right reasons. I have had students come to spend time with me just long enough to get a letter of recommendation and I can spot those students from a mile away. What will I tell the first year medical school class tomorrow? Medicine has always been a calling and true happiness comes from a life of service. Watch out for those who want to do what you do, they won’t always announce themselves. Out of tragedy springs hope. As physicians, we are often the lighthouses in a sea of tragedy. We are trusted because we walk in the footsteps of those who came before us and others will one day walk in ours. Leave a clear trail. Arne Vainio, M.D. is an enrolled member of the Mille Lacs Band of Ojibwe and is a family practice physician on the Fond du Lac reservation in Cloquet, Minnesota. He can be contacted at firstname.lastname@example.org.
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