Physicians and Surgeons
- Many physicians and surgeons work long, irregular hours; over
one-third of full-time physicians worked 60 or more hours a
week in 2004.
- Formal education and training requirements are among the most
demanding of any occupation, but earnings are among the highest.
- Job opportunities should be very good, particularly in rural
and low-income areas.
- New physicians are much less likely to enter solo practice
and more likely to work as salaried employees of group medical
practices, clinics, hospitals, or health networks.
Physicians and surgeons serve a fundamental role in our society
and have an effect upon all our lives. They diagnose illnesses
and prescribe and administer treatment for people suffering from
injury or disease. Physicians examine patients, obtain medical
histories, and order, perform, and interpret diagnostic tests.
They counsel patients on diet, hygiene, and preventive health
There are two types of physicians: M.D.—Doctor of Medicine—and
D.O.—Doctor of Osteopathic Medicine. M.D.s also are known as allopathic
physicians. While both M.D.s and D.O.s may use all accepted methods
of treatment, including drugs and surgery, D.O.s place special
emphasis on the body’s musculoskeletal system, preventive medicine,
and holistic patient care. D.O.s are more likely than M.D.s to
be primary care specialists although they can be found in all
specialties. About half of D.O.s practice general or family medicine,
general internal medicine, or general pediatrics.
Physicians work in one or more of several specialties, including,
but not limited to, anesthesiology, family and general medicine,
general internal medicine, general pediatrics, obstetrics and
gynecology, psychiatry, and surgery.
Anesthesiologists. Anesthesiologists focus on the care
of surgical patients and pain relief. Like other physicians, they
evaluate and treat patients and direct the efforts of those on
their staffs. Anesthesiologists confer with other physicians and
surgeons about appropriate treatments and procedures before, during,
and after operations. These critical care specialists are responsible
for maintenance of the patient’s vital life functions—heart rate,
body temperature, blood pressure, breathing—through continual
monitoring and assessment during surgery. They often work outside
of the operating room, providing pain relief in the intensive
care unit, during labor and delivery, and for those who suffer
from chronic pain.
Family and general practitioners. Family and general practitioners
are often the first point of contact for people seeking health
care, acting as the traditional family doctor. They assess and
treat a wide range of conditions, ailments, and injuries, from
sinus and respiratory infections to broken bones and scrapes.
Family and general practitioners typically have a patient base
of regular, long-term visitors. Patients with more serious conditions
are referred to specialists or other health care facilities for
more intensive care.
General internists. General internists diagnose and provide
nonsurgical treatment for diseases and injuries of internal organ
systems. They provide care mainly for adults who have a wide range
of problems associated with the internal organs, such as the stomach,
kidneys, liver, and digestive tract. Internists use a variety
of diagnostic techniques to treat patients through medication
or hospitalization. Like general practitioners, general internists
are commonly looked upon as primary care specialists. They have
patients referred to them by other specialists, in turn referring
patients to those and yet other specialists when more complex
care is required.
General pediatricians. Providing care from birth to early
adulthood, pediatricians are concerned with the health of infants,
children, and teenagers. They specialize in the diagnosis and
treatment of a variety of ailments specific to young people and
track their patients’ growth to adulthood. Like most physicians,
pediatricians work with different health care workers, such as
nurses and other physicians, to assess and treat children with
various ailments, such as muscular dystrophy. Most of the work
of pediatricians, however, involves treating day-to-day illnesses
that are common to children—minor injuries, infectious diseases,
and immunizations—much as a general practitioner treats adults.
Some pediatricians specialize in serious medical conditions and
pediatric surgery, treating autoimmune disorders or serious chronic
Obstetricians and gynecologists. Obstetricians and gynecologists
(ob/gyns) are specialists whose focus is women’s health. They
are responsible for general medical care for women, but also provide
care related to pregnancy and the reproductive system. Like general
practitioners, ob/gyns are concerned with the prevention, diagnosis,
and treatment of general health problems, but they focus on ailments
specific to the female anatomy, such as breast and cervical cancer,
urinary tract and pelvic disorders, and hormonal disorders. Ob/gyns
also specialize in childbirth, treating and counseling women throughout
their pregnancy, from giving prenatal diagnoses to delivery and
postpartum care. Ob/gyns track the health of, and treat, both
mother and fetus as the pregnancy progresses.
Psychiatrists. Psychiatrists are the primary caregivers
in the area of mental health. They assess and treat mental illnesses
through a combination of psychotherapy, psychoanalysis, hospitalization,
and medication. Psychotherapy involves regular discussions with
patients about their problems; the psychiatrist helps them find
solutions through changes in their behavioral patterns, the exploration
of their past experiences, and group and family therapy sessions.
Psychoanalysis involves long-term psychotherapy and counseling
for patients. In many cases, medications are administered to correct
chemical imbalances that may be causing emotional problems. Psychiatrists
may also administer electroconvulsive therapy to those of their
patients who do not respond to, or who cannot take, medications.
Surgeons. Surgeons are physicians who specialize in the
treatment of injury, disease, and deformity through operations.
Using a variety of instruments, and with patients under general
or local anesthesia, a surgeon corrects physical deformities,
repairs bone and tissue after injuries, or performs preventive
surgeries on patients with debilitating diseases or disorders.
Although a large number perform general surgery, many surgeons
choose to specialize in a specific area. One of the most prevalent
specialties is orthopedic surgery: the treatment of the musculoskeletal
system. Others include neurological surgery (treatment of the
brain and nervous system), cardiovascular surgery, otolaryngology
(treatment of the ear, nose, and throat), and plastic or reconstructive
surgery. Like primary care and other specialist physicians, surgeons
also examine patients, perform and interpret diagnostic tests,
and counsel patients on preventive health care.
A number of other medical specialists, including allergists,
cardiologists, dermatologists, emergency physicians, gastroenterologists,
ophthalmologists, pathologists, and radiologists, also work in
clinics, hospitals, and private offices.
Many physicians—primarily general and family practitioners, general
internists, pediatricians, ob/gyns, and psychiatrists—work in
small private offices or clinics, often assisted by a small staff
of nurses and other administrative personnel. Increasingly, physicians
are practicing in groups or health care organizations that provide
backup coverage and allow for more time off. These physicians
often work as part of a team coordinating care for a population
of patients; they are less independent than solo practitioners
of the past.
Surgeons and anesthesiologists typically work in well-lighted,
sterile environments while performing surgery and often stand
for long periods. Most work in hospitals or in surgical outpatient
centers. Many physicians and surgeons work long, irregular hours.
Over one-third of full-time physicians and surgeons worked 60
hours or more a week in 2004. Only 8 percent of all physicians
and surgeons worked part-time, compared with 16 percent for all
occupations. Physicians and surgeons must travel frequently between
office and hospital to care for their patients. Those who are
on call deal with many patients’ concerns over the phone and may
make emergency visits to hospitals or nursing homes.
|Training, Other Qualifications, and Advancement
Formal education and training requirements for physicians are
among the most demanding of any occupation—4 years of undergraduate
school, 4 years of medical school, and 3 to 8 years of internship
and residency, depending on the specialty selected. A few medical
schools offer combined undergraduate and medical school programs
that last 6 rather than the customary 8 years.
Premedical students must complete undergraduate work in physics,
biology, mathematics, English, and inorganic and organic chemistry.
Students also take courses in the humanities and the social sciences.
Some students volunteer at local hospitals or clinics to gain
practical experience in the health professions.
The minimum educational requirement for entry into a medical
school is 3 years of college; most applicants, however, have at
least a bachelor’s degree, and many have advanced degrees. There
are 146 medical schools in the United States—126 teach allopathic
medicine and award a Doctor of Medicine (M.D.) degree; 20 teach
osteopathic medicine and award the Doctor of Osteopathic Medicine
(D.O.) degree. Acceptance to medical school is highly competitive.
Applicants must submit transcripts, scores from the Medical College
Admission Test, and letters of recommendation. Schools also consider
an applicant’s character, personality, leadership qualities, and
participation in extracurricular activities. Most schools require
an interview with members of the admissions committee.
Students spend most of the first 2 years of medical school in
laboratories and classrooms, taking courses such as anatomy, biochemistry,
physiology, pharmacology, psychology, microbiology, pathology,
medical ethics, and laws governing medicine. They also learn to
take medical histories, examine patients, and diagnose illnesses.
During their last 2 years, students work with patients under the
supervision of experienced physicians in hospitals and clinics,
learning acute, chronic, preventive, and rehabilitative care.
Through rotations in internal medicine, family practice, obstetrics
and gynecology, pediatrics, psychiatry, and surgery, they gain
experience in the diagnosis and treatment of illness.
Following medical school, almost all M.D.s enter a residency—graduate
medical education in a specialty that takes the form of paid on-the-job
training, usually in a hospital. Most D.O.s serve a 12-month rotating
internship after graduation and before entering a residency, which
may last 2 to 6 years.
All States, the District of Columbia, and U.S. territories license
physicians. To be licensed, physicians must graduate from an accredited
medical school, pass a licensing examination, and complete 1 to
7 years of graduate medical education. Although physicians licensed
in one State usually can get a license to practice in another
without further examination, some States limit reciprocity. Graduates
of foreign medical schools generally can qualify for licensure
after passing an examination and completing a U.S. residency.
M.D.s and D.O.s seeking board certification in a specialty may
spend up to 7 years in residency training, depending on the specialty.
A final examination immediately after residency or after 1 or
2 years of practice also is necessary for certification by a member
board of the American Board of Medical Specialists (ABMS) or the
American Osteopathic Association (AOA). The ABMS represents 24
specialty boards, ranging from allergy and immunology to urology.
The AOA has approved 18 specialty boards, ranging from anesthesiology
to surgery. For certification in a subspecialty, physicians usually
need another 1 to 2 years of residency.
A physician’s training is costly. According to the Association
of American Medical Colleges, in 2004 more than 80 percent of
medical school graduates were in debt for educational expenses.
People who wish to become physicians must have a desire to serve
patients, be self-motivated, and be able to survive the pressures
and long hours of medical education and practice. Physicians also
must have a good bedside manner, emotional stability, and the
ability to make decisions in emergencies. Prospective physicians
must be willing to study throughout their career in order to keep
up with medical advances.
Physicians and surgeons held about 567,000 jobs in 2004; approximately
1 out of 7 was self-employed and not incorporated. About 60 percent
of salaried physicians and surgeons were in office of physicians,
and 16 percent were employed by private hospitals. Others practiced
in Federal, State, and local governments, including hospitals,
colleges, universities, and professional schools; private colleges,
universities, and professional schools; and outpatient care centers.
According to the American Medical Association (AMA), in 2003
about 2 out 5 physicians in patient care were in primary care,
but not in a subspecialty of primary care (table 1).
Table 1. Percent distribution
of physicians by specialty, 2003
Family medicine and general practice
Obstetrics & gynecology
Surgical specialties, selected
All other specialties
|SOURCE: American Medical Association, Physician
Characteristics and Distribution in the US, 2005.
A growing number of physicians are partners or salaried employees
of group practices. Organized as clinics or as associations of
physicians, medical groups can afford expensive medical equipment
and realize other business advantages.
According to the AMA, the New England and Middle Atlantic States
have the highest ratio of physicians to population; the South
Central and Mountain States have the lowest. D.O.s are more likely
than M.D.s to practice in small cities and towns and in rural
areas. M.D.s tend to locate in urban areas, close to hospital
and education centers.
Employment of physicians and surgeons is projected to grow faster
than average for all occupations through the year 2014 due to
continued expansion of health care industries. The growing and
aging population will drive overall growth in the demand for physician
services, as consumers continue to demand high levels of care
using the latest technologies, diagnostic tests, and therapies.
In addition to employment growth, job openings will result from
the need to replace physicians and surgeons who retire over the
Demand for physicians’ services is highly sensitive to changes
in consumer preferences, health care reimbursement policies, and
legislation. For example, if changes to health coverage result
in consumers facing higher out-of-pocket costs, they may demand
fewer physician services. Demand for physician services may also
be tempered by patients relying more on other health care providers—such
as physician assistants,, experienced
physicians may work longer hours, delay retirement, or take measures
to increase productivity, such as using more support staff to
provide services. Opportunities should be particularly good in
rural and low-income areas, because some physicians find these
areas unattractive due to less control over work hours, isolation
from medical colleagues, or other reasons.
Unlike their predecessors, newly trained physicians face radically
different choices of where and how to practice. New physicians
are much less likely to enter solo practice and more likely to
take salaried jobs in group medical practices, clinics, and health
Earnings of physicians and surgeons are among the highest of
any occupation. According to the Medical Group Management Association’s
Physician Compensation and Production Survey, median total compensation
for physicians in 2004 varied by specialty, as shown in table
2. Total compensation for physicians reflects the amount reported
as direct compensation for tax purposes, plus all voluntary salary
reductions. Salary, bonus and/or incentive payments, research
stipends, honoraria, and distribution of profits were included
in total compensation.
Table 2. Median total compensation
of physicians by specialty, 2004
||Less than two years in specialty
||Over one year in specialty
Internal medicine: General
Family practice (without obstetrics)
|SOURCE: Medical Group Management
Association, Physician Compensation and Production Report,
Self-employed physicians—those who own or are part owners of
their medical practice—generally have higher median incomes than
salaried physicians. Earnings vary according to number of years
in practice, geographic region, hours worked, and skill, personality,
and professional reputation. Self-employed physicians and surgeons
must provide for their own health insurance and retirement
Physicians work to prevent, diagnose, and treat diseases, disorders,
and injuries. Other health care practitioners who need similar
skills and who exercise critical judgment include chiropractors, dentists, optometrists, physician assistants, podiatrists,
registered nurses, and veterinarians.
|Sources of Additional Information
For a list of medical schools and residency programs, as well
as general information on premedical education, financial aid,
and medicine as a career, contact:
- Association of American Medical Colleges, Section for Student
Services, 2450 N St. NW., Washington, DC 20037-1126. Internet:
- American Association of Colleges of Osteopathic Medicine,
5550 Friendship Blvd., Suite 310, Chevy Chase, MD 20815-7231.
For general information on physicians, contact:
For information about various medical specialties, contact:
- American Board of Medical Specialties, 1007 Church St., Suite
404, Evanston, IL 60201-5913. Internet: http://www.abms.org/
- American Society of Anesthesiologists, 520 N. Northwest Hwy.,
Park Ridge, IL 60068-2573. Internet: http://www.asahq.org/
- American Academy of Family Physicians, Resident Student Activities
Department, 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2672.
- American College of Physicians, 190 North Independence Mall
West, Philadelphia, PA 19106. Internet: http://www.acponline.org/
- American College of Obstetricians and Gynecologists, 409 12th
St. SW., P.O. Box 96920, Washington, DC 20090-6920. Internet:
- American Academy of Pediatrics, 141 Northwest Point Blvd.,
Elk Grove Village, IL 60007-1098. Internet: http://www.aap.org/
- American Psychiatric Association, 1000 Wilson Blvd., Suite
1825, Arlington, VA 22209-3901. Internet: http://www.psych.org/
- American College of Surgeons, Division of Education, 633 North
Saint Clair St., Chicago, IL 60611-3211. Internet: http://www.facs.org/
Information on Federal scholarships and loans is available from
the directors of student financial aid at schools of medicine.
Information on licensing is available from State boards of examiners.
- Source: Bureau of Labor Statistics, U.S.
Department of Labor, Occupational Outlook Handbook,