Just how a practitioner qualifies as a specialist is a procedure not thoroughly understood by most people. First of all, he must be a physician, and to reach this goal he must acquire premedical and medical education followed by an internship.
The premedical training period is three to four years of college work devoted to basic subjects preparatory to medical training. In some cases three years of such training will suffice, but most medical schools now require four academic years of premedical training before admission. The candidate may then be accepted by a medical school.
All medical schools are of four years’ duration. The first two years are devoted to the basic sciences and the theories of medicine, and the latter two years are the clinical years where most of the teaching is practical application. Much of the time is spent on the wards of the teaching hospitals, working alongside the professors and their staffs.
After completing medical school, the degree Doctor of Medicine is awarded, and a 12 months internship in an approved hospital is required. A few states will license physicians without an internship, but most require it. The doctor then takes examinations from the medical associations of the state in which he will practice. After licensure he is legally qualified to practice all medical and surgical procedures in that state. He is a physician and surgeon.
The general practitioner need go no farther, but many of them have had one or two years’ further training. He may take a second internship or some training in a specialty.
The specialist goes through these same steps and after internship acquires a licensc to legally practice all phases of the medical field. There are no further steps he must take to legally limit his practice to a specialty, but he must, of course, attain advanced knowledge to be recognized as a specialist by his colleagues. This advanced knowledge may have been acquired in either of two ways. He may have acquired it from practical experience, as was the procedure when specialties were first beginning. Then he merely limited his practice to a certain field and devoted maximum time to it. This may have been supplemented by short courses in this specialty and other various training periods, but the majority of his advanced knowledge and skill came from practical experience and studying all the literature in that field.
Today, however, definite training programs are set up in various hospitals for advanced training in specialties. These are called Residency Training Programs. After completion of an internship the doctor becomes a resident physician of a hospital in his chosen specialty. In this capacity he works with the staff physicians on all cases in that specialty and has other patients of his own under the supervision of the teaching staff. This plan serves two purposes: it provides doctors in the hospital at all times to care for the patients and at the same time provides the resident physician with his special training. This is supplemented by formal teaching conferences and lectures.
The length of time spent in the residency training program depends on the specialty. Some are of two years’ duration; others are longer before training is considered complete. Of the medical specialties, dermatology and pediatrics are of two years’ duration, the remainder of three years’. Of the surgical specialties, anesthesiology is of two years’ duration, the remainder of three years’ except for thoracic surgery and neurosurgery, which are of five or more years’ duration. These are minimum figures, and many specialists have taken much longer training periods than are given here. Some are taken concurrently, such as neuropsychiatry or obstetrics-gynecology, which usually take three years.
Those specialists who acquired their special skills by many years of practical experience are, of course, just as well qualified as those who take the formal residency training. However, the former method is no longer practical, and to become an accepted specialist today the doctor must take residency training.
An exception to this method of becoming a specialist is the oral surgeon. He is a graduate of a dental school, with the degree Doctor of Dental Surgery (D.D.S.), rather than a medical school graduate. He then spends two years in a hospital approved for training in oral surgery.
This outline of training qualifications for specialists is applicable in the United States. Other countries have different methods of training specialists.