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Slide 2 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 Slide 3 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. Slide 4 Physician Training - Overview Medical school (4 years) The basics for all physicians Leads to professional degree Allopathic (MD) Osteopathic (DO) Residency (3-7 years) Supervised practice Specific field of practice Leads to specialty certification Fellowship (1-5 years) Optional Additional specialization Slide 5 MD and DO Degrees MD degree = medical doctor Allopathic ~ 80% of medical students are MD track DO degree = doctor of osteopathic medicine Osteopathic Generally no difference in privileges DO concepts 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 Slide 6 Medical School (VCU SOM 10-11) Both years: Clinical Skills Year 1: Healthy Human Population medicine Biochem, Genetics Anatomy & Physiology Human behavior Year 2: Pathophysiology Pharmacology Microbiology Hematology Endocrine Systems, such as Pulmonary, Neurology and Cardiology Womens health Behavioral health Slide 7 Medical School (VCU SOM 10-11) Year three clinical clerkships Internal medicine Pediatrics Family medicine Obstetrics and gynecology Surgery Psychiatry Neurology Year four individualized Prepare for specialty Acting internship Critical care Electives Slide 8 National Tests While In Medical School USMLE Step 1 Generally basic science After 2 nd year of med school USMLE Step 2 CK (Clinical Knowledge) Written exam based on clinical experience After 3 rd year of med school USMLE Step 2 CS (Clinical Skills) Observed, standardized patient encounters After 3 rd year of med school COMLEX is a similar test for DOs Slide 9 Residency Supervised practice with increasing autonomy Specialization Internal Medicine Pediatrics Family Medicine Surgery & subspecialties Anesthesiology Emergency medicine Neurology Psychiatry Radiology Pathology Physical medicine / rehabilitation Slide 10 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 PGY2 year: Manager Given more autonomy while still supervised Learn to manage patients before supervising interns PGY3 year: Teacher Continue to develop autonomy while progressing into teaching role Slide 11 Fellowship Added specialization in practice field Internal medicine Cardiology, oncology, endocrinology Obstetrics and gynecology High risk ob, oncology General Surgery Transplant, oncology Slide 12 National Tests In, and after, Residency USMLE Step 3 Taken during or after Intern year All physicians must take prior to receiving medical license Boards for specialty Boards for subspecialty, if applicable, after Fellowship Slide 13 Credentials & Continuing Medical Education Licensure state government 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 Board certification professional National specialty boards (i.e. pediatrics, surgery, psychiatry) Requires residency completion and specialty exam Re-certification on periodic basis Hospital credentials and privileges Slide 14 Career Paths of Physicians Community practice Ambulatory, hospital, long term care Private, managed care, health center, VA Academic medicine Clinician, educator, researcher Industry Government Policy Public health Slide 15 What do Physicians do? Slide 16 Physician challenges: Patient Care Time pressures Office visits Hospital length of stay Aging population Multiple chronic illnesses Declining functional status Care for under-served Rural and inner-city settings Uninsured and under-insured Limited mental health and dental care Slide 17 Physician challenges Help from Pharmacy Insurance formularies Medicare Part D complexity Prior authorizations Uninsured / under-insured patients Medication from multiple physicians Controlled substances New pharmaceuticals Slide 18 Physician challenges Help from Health Psychology Mental Health diagnoses Behavior change necessary to manage chronic diseases Smoking cessation Sleep Obesity Many other medical problems Motivational Interviewing and Behavior Change Plan Slide 19 Thank you!