What do physicians do? Physicians care for people at offices, hospitals, and other locations. They generally work some 50-60 hours a week and make $120,000 or more a year. They train for a minimum of 11 years after high school including 4 years of college, 4 years of medical school and 3 - 5 years of residency (get paid for these years). They must be willing to listen to and care for all types of patients. Physicians manage programs, clinics, labs, and research projects. One translation of the word "doctor" is teacher and a physician continually works to teach patients better health practices, to teach students medicine, and to teach people in the community how to improve the health care in the community. Remember that what you see on TV is only a small and dramatically distorted part of what medicine is about. Physicians are leaders in research, health care, and government.

Physicians receive special permission to literally become a part of people’s families and their lives. They share some of the greatest joys and our there to comfort people in their deepest sorrows. There is even more. Physicians become and shape the fabric of America.

Awareness and Future Physician Leaders - if you don't think that you have the finances or the grades etc, don't let this keep you from making the effort. America depends upon more lower income students gaining admission. This means that you might have to commit to such a career early and work harder, but you can make it, you have to make it!

What will physicians do differently in the future? There are many changes going on in medicine. Despite the increasing complexity of computers, doctors are unlikely to be replaced by them. Many medical decisions involve a knowledge of science, situations, and people that go far beyond the ability of programmable computers. Often the limitations are science where not all is known about a disease or condition or the particular individual with that disease or condition. Physicians have to deal with uncertainty and make the best decisions possible, often without all the information.

Physicians are becoming more and more employees and are less owners of their practices. This allows more time for patients, but presents certain challenges. When physicians saw the need to send a patient to a specialist in the past, they just did it. Now they must provide some evidence for the need for the referral and sometimes must insist on this! The population in America is changing and doctors will be doing more geriatric (elderly) care. They will also be doing more behavioral and mental health care.

The role of the physician is changing. No more are physicians lonely captains of the ship. They work with other types of health professionals in teams to care for patients. Physicians are doing more work with the community and groups of patients to identify sources of disease at the root level rather than wait to treat the diseases that result (alcohol, drugs, tobacco, fatty foods, lack of exercise, teen pregnancy, educational failure, mental health, parenting skills, sexually transmitted diseases, AIDS).

The more medicine advances, the more we realize that we rarely "cure" disease with new discoveries and other high tech stuff. Despite 30 years of the most amazing technological development, despite major improvements in cancer in children, and despite incredible methods to image cancer; 1996 was the first year that overall cancer mortality (people dying of cancer) declined. The big reason was smoking decreased in men 30 years before. Unfortunately cancer deaths continue to rise in women, because more teenage girls smoke. Stamping out smoking would be like winning $10,000 a year for life for all in the US. Smoking is not the only problem. If we did not have AIDS to treat we could give over 50 billion dollars in health care costs alone back to people. That would be like giving a check for $5000 each year to every person under age 35.

Medicine is about helping people to live their lives better, not stamping out disease. Advances in medicine in the future will depend more on communication and working with others than advances in the basic sciences. Medical education is also changing. Current students are likely to face a host of changes in the next decade.

What are the main challenges of being a physician?

It is difficult to be nice to patients when they are not nice to you or are very different than you, but despite these differences, a physician must do their best.

It is tough to find a balance between knowing enough to do the best care, and not getting overwhelmed by what all there is to know. Remember it is more important to know where patients can go for help, than caring for everything yourself.

Sometimes caring for people can even cause physical (sleep), emotional (problems too close to home), spiritual (different beliefs), or financial problems. It is also tough to keep medicine from being so fascinating that it absorbs your life, your family, etc. The best physicians learn how to balance their personal (and family) and professional lives. They learn how to delegate, utilize the skills and talents of others, and they know when to say no.

It is difficult to do painful procedures or ask invasive questions, even when you know it is in the patient’s best long term interest. It is tough to do self-examination to find out areas that you need to improve, and devote time to learning about these areas. Many worry about whether they can tolerate surgery, cadavers, or the sight of blood. The trick is getting yourself and others involved in problem-solving and helping people. That is the best way to not get overwhelmed at their problems.

The rewards of being a physician are often immediate, especially with children. Some of the best rewards often come later after you have withstood the challenges and your patients get the best treatment. Most times only the physician and the patient know when this happens; official recognition may never come. Rural doctors often have few obvious rewards, but a great deal of satisfaction knowing that he or she is contributing to the community in a special way. There is a special bond. Rural physicians that leave and go to the city to practice or teach often feel a bit lost because the roles are so uncertain and the sense of belonging and caring is just not there.

How do I become a physician? You must finish college and take certain science and other courses to qualify. Then you apply to a public medical school (state school), private medical school (Creighton, Baylor, Loma Linda), or osteopathic medical school (Des Moines, Kansas City, Kirksville). Remember that many do not get in their first year and some come to medical school after ten or more years of different work. Admission applications go up or down year to year, but 95% of public medical students come from the home state. Private medical schools are generally more competitive. Osteopathic medical school emphasizes primary care approach more and osteopathic graduates make just as good a physician with some advantages in the musculoskeletal and whole person areas. Both Osteopathic and Private schools have much higher tuition ($20-30,000 per year), but loans and scholarships are readily available and there is some advantage to being poor or oriented toward serving the underserved in order to obtain these. Doctors do well enough financially to pay off all debts, provided they don’t spend themselves greatly into debt during or after medical school. One of the increasing problems that folks have trying to get into and survive medical school, is already being in debt, particularly credit card debt. So avoid the use of plastic!!!

What are the types of physicians? Basically there are primary care physicians who see patients mostly in office settings, and specialist physicians who see patients with more specific problems such as heart disease, stomach trouble, brain tumors, cancer, etc. Primary care physicians include family physicians, general internists, and general pediatricians. Sometimes obstetrician-gynecologist doctors do primary care, but mostly on the women that they care for. Specialty physicians often work to do certain types of surgery or specialize in the care of a specific body organ. Other physicians have support roles. They assist other physicians with lab tests (pathologists), put surgical patients to sleep (anesthesia), or read x-rays (radiologists).

In recent years it has become more difficult to find jobs for specialists. Primary care physicians have seen increasing need and increasing salaries in recent years, especially those interested in rural health and geriatrics. There is a great need for psychiatrists and others skilled in mental health care (treating depression, behavior problems, substance abuse, and children’s mental health). Even the specialists have been able to find jobs, but some have a great deal of trouble. Another area of growth is the area of business and doctors who take business courses or earn business degrees are much in demand.

What do medical schools look for? Medical schools want responsible, academic types. Successful applicants have good grades, especially in the science courses. They also have good scores on the Medical College Admission Test (MCAT), but grades and MCAT scores are not the only qualifications. Applicants interview at the medical school and the application contains information about past experiences in life, health care, volunteer work, awards, accomplishments, and more. Some schools specifically ask questions about primary care and interest in rural practice. The major function of the interview is to determine the ability of the applicant to succeed in medical school. This involves bot academic ability as well as the ability to relate to others. Medical schools have begun to pursue applicants with varied backgrounds and interests such as experiences with other cultures or in other nations. Medical schools have been accepting older candidates over the past two decades because they value their maturity and dedication. Students interested in rural practice may find that their rural background, family practice interest, or being married to a rural spouse are factors that could influence admission in states where rural physicians are in demand.

Why don’t more rural people get into medical school? Some don’t think about health careers because they had little exposure in school or organizations. Others think that they are not quite good enough. Rural applicants often have more extracurricular activities, more awards, and more work experience, but they worry that their grades or scores are not good enough. Some start in other health professions, and then choose medicine later. Although this may cost them some loss of time in school, it is valuable in terms of what they later bring to medicine and patient care.

What if my grades or scores aren’t that great? Some students do poorly in their first year. Others have some problem with another year for various reasons. The interview will give you a chance to demonstrate improved performance in the later years as you settled down, applied better study habits, got more motivated, or whatever. Health experiences and job experience can count too. Another way to increase you chances is to be more diverse in needed areas, such as being fluent in spanish. Again the best advice is to prevent problems before they happen. Try not to take more than 15 or 16 hours a semester in the first year. If you have trouble adjusting to major change, 13-14 might be better the first time. In later years you can prove that you can handle the 20+ hour loads common in medical school. Be sure to seek advice from premed advisors sooner rather than later. If a family member is ill or other problems crop up, it may be better to decrease your load or lay out a semester rather than perform poorly.

What college should I pick? The most important thing about the college is that it be a good match with you and your needs. Some need a challenge, some need less distraction and fewer students around, some need to be closer to family. The college should have some form of premedical group and premedical majors. It should have strong science courses and hopefully a good track record for getting students accepted into medical school. I chose a college that was mostly a community college with good sciences (12000 students). It was about 2 hrs from home, important to me. It did not have 40000 students and lots of tempting entertainment, it also was not so academic that I would be stressed out all the time. This was a good fit for me, what about you?

What challenges do I face in medical school? Medical school is challenging educationally and emotionally. You must practice good study habits, learn to prioritize important areas despite lots of information, and keep a good balance in your physical and emotional needs (exercise, good food, friends, family, church, etc.). There is much new information. Even if you took a lot of biology and chemistry courses, you would still have new material. People from small towns also face adjustments as well (feeling safe, less friendly folks, folks who might take advantage of you in rent, purchases, etc.). Others find it difficult to be as involved as they were in college or high school.

Middle school - science fairs (check with state medical schools and science colleges), scouting awards, good books include Dear and Glorious Physician by Taylor Caldwell and books about Pasteur, Koch, Lister, Semmelweis, Osler, and more recent medical pioneers such as Papanicolaou. Some middle school students get opportunities to do church or medical missions.

High school - visits to local doctors, hospital volunteer work, Scouting awards and ranks such as Eagle, medical explorers, volunteer for Emergency squad, scholarships, leadership in clubs and team sports, community work, volunteer/leader in community organizations, foreign language courses or foreign exchange student, good movies include Gross Anatomy, The Doctor.

College - Make sure of good study habits. Show ability to manage challenging material and courses at the same time in one semester. Establish connections with premedical club and premed advisors. Do volunteer work as a leader (on campus, in groups, Habitat for Humanity, Christian missions, school or community organizations), Do a cultural immersion experience of one or more months. Take visits to medical school campuses, take medical school orientation or science course or do research or community project with the medical school. Prepare and take MCAT and take required medical school courses (check with your potential school). Another help is Get Into Medical School! A Guide For The Perplexed, If you are interested in flyers or more information, contact Galen Press, (520) 577-8363, PO Box 64400, Tucson, AZ 85728-4400.

Work - many work experiences tie in to medicine. My personal bias is in favor of waiters and waitresses and others who serve (and learn to put up with) people. Teachers and teaching are also needed. Medicine needs more social workers and those with mental health interest and experience.

Remember that medicine is about serving people. If you enjoy serving and learning and problem solving, you could not ask for a better opportunity.

Notes for teachers and professors - I hope that you have health career education programs going. Some colleges have annual high school career fairs. The Chadron State Health Career Fair attracts over 400 students with 80 parents and teachers from 4 states. Rural kids just do not have the health career exposures. They often don't think that they are good enough or they think it will cost too much.

Robert C. Bowman, M.D. UNMC Family Medicine Director of Rural Health Education and Research

983075 Nebraska Medical Center

Omaha, NE 68198-3075 (402) 559-8873 or fax at –8118

rbowman@unmc.edu

Checklist for Admission

Health Advisors

www.ruralmedicaleducation.org