PEOPLE IN WHITE COATS
When we entered medical school, none of us thought that we would have to prove and confirm our medical craft all our lives, both professionally and on paper. "You may not be a doctor, but you must be a citizen," – so, paraphrasing the poet's words, our teacher of CPSU history told us, without specifying, however, which country's citizenship she meant. We were all citizens of one-sixth of the land. It seemed to us then: everything was ahead of us, both honor and glory, we were people in white coats, Botkins and Pirogovs, we would be awaited and accepted, and we would accomplish, discover, and prove.
Sometimes, however, a spark of doubt flickered, especially when we came across foreign students – from Africa, Latin America, Kuwait. Of course, we asked them, and even nervously awaited the answer: "And what then, when you finish the institute?" – "Then there will be 3 exams and 4 years of internship in England or America – to confirm the diploma." Really?
There are no more citizens, there are gentlemen. The curtain fell in our theater and exposed the citizen-actors running in all directions. All with specialist diplomas. And around them – rotten scenery.
"Are you a citizen of this country?" – asks me a black lady when hiring. And so clearly I remembered the CPSU history at medical school. "Unfortunately, not this one." – "Then go to another table. Do you have the right to work? No – take a walk." And already in the back: "And in general, do you have an American license to practice?" So much for the diploma! As if I had never studied, never worked as an anesthesiologist. So what to do?
COURSES
Once, about 40-50 years ago, an enterprising man named Kaplan, apparently also a newcomer and also having struggled, found himself, as they say now, sponsors at the Jewish community of New York City, and organized courses to prepare for exams for the notorious American medical license, as well as for other equally important exams. Once these courses were free, existed on donations. A kind of club where people communicate, exchange medical news, study exam tickets from previous years. These courses, in principle, assume a year, maximum 2 years of study, but you can study longer. But now these courses have practically outlived themselves: non-functional and not cheap ($1,000-2,000 per year).
One acquaintance of mine attended these courses for three years like a job. He knew practically all the questions for the first exam by heart, and even the correct answers, in English, of course. And seven times he could not pass the ill-fated exam! And he was not the last person in his homeland, he succeeded, saved... But here the cards did not fall – so he became a phlebotomist, taking blood from grandmothers and grandfathers. I think the lack of methodology and insufficient knowledge of the language played a role. And memorizing tickets by heart is ineffective for the American exam system.
What does a person need to take into account when preparing for the medical exam in America, called USMLE? First of all, realistically assess your strengths and understand whether it is really necessary or not. After all, in fact, no courses will put into your head either the English language or medical subjects. Yes, you once studied them – in Russian and Latin, but now you have English with its specific structure and rules.
So the most effective way is to answer questions independently with a book and a pen. For the entire course you will need 20-30 books, on average $25 each. "Kaplan" offers short courses on a number of subjects in the form of brochures. Their price is $10-15. They are good at the first stage of preparation: they refresh knowledge and provide good speed training. Further – more serious. You need folio books with a huge number of exam questions and answers. Discussing the pros and cons of these books in detail is not appropriate now – during the preparation process you will intuitively find "your" author. You can buy these books at America's largest store "Barnes & Noble." For the final stage of preparation, we can recommend "The Merck Manual" (General Medicine), a well-known book that has been reprinted for 100 years.
To pass the exam, you will need about a year and a half of intensive training. Moreover, if you wish, you can prepare for the exams without even leaving the country.
EXAMS
Personally, I like the American exam system. It is simple and consists of several stages of testing. You need to choose one answer out of five. There are many questions, and time is very limited. But this method allows an unbiased assessment of the student's knowledge.
The medical exam consists of three steps. The first includes 12-15 basic disciplines: biology, chemistry, histology, and so on. There are a total of 1,200 questions for the course. The exam includes 600 questions, you need to answer within 6 hours with a 30-minute break. The exam takes place on the same day throughout the United States, Canada, and a number of other countries. Examinees are distributed to rooms in various universities. Each sits alone at a table, monitors walk between rows. Everything is done on command: take booklets, open booklets, put down pens, time is up. If you do not put down your pen in time, you may be removed from the exam. And the exam is not cheap – $450 per attempt.
The second step consists of clinical disciplines in pure form (about 10 subjects). Surgery, therapy, neurology, and so on. Price and procedure are similar. Naturally, without passing the first step, the applicant is not allowed to the second. The results of each exam are valid for 7 years.
And finally, the third step, an exam, as a rule, with a slightly formal touch. This is mainly hospital management, ethics, deontology, simple legal aspects of the medical profession. The exam is usually taken at the end or in the middle of a four-year residency (price – the same $450). If the first two exams confirm your medical diploma, the third is an exam for a license, that is, for the right to private practice.
RESULTS
"Sobered up – shed tears." This is how they ironically speak about deplorable results, and that is usually how it happens. But some are lucky. Although here luck is the result of proper preparation. The paper with the result comes by mail. It clearly and visually, graphically informs how you passed, where your shortcomings are, what needs to be improved, what percentage of correct answers. This percentage should be at least 70, and the higher it is, the easier you will find a job.
Let's return to the situation when you have passed two exams. Next – finding a residency.
A four-year residency implies your regular work in your specialty. You are paid $30-35 thousand per year. A very serious certification is conducted annually. If you do not pass it – plus another year, like repeating a grade. If the hospital reduces staff – you are fired first. Again job search – and again from the beginning. The fact is that according to the rules, all four years of residency must be completed in one place.
After successfully completing the residency and passing the third exam, you will be awarded an American doctor's license, and then the search for a contract begins. Typical earnings – from 80 to 300 thousand per year, if you find a place. This is not easy: first, your license is not valid in all states (for example, a license issued in New York is valid in 29 states). And second, American doctors do not retire and do not stay on sick leave like ours. My friend, an American doctor, after gallbladder removal surgery was back on duty the day after...
That is, this is where the main difficulties and all sorts of delights of competition begin. But you, it seems, wanted this, didn't you?
"Zagranitsa" No. 15, 1999.