Monday, December 17, 2007

The Journey

People know that it takes a long time for a doctor to graduate, but they don't know about the whole process. I'll give you a brief description of how a clueless high school graduate ends up a doctor.

After high school, the lucky (or unlucky) ones get into medical school. In Jordan it's six years. The first year is "the general sciences" with chemistry, physics and biology. Years 2 and 3 include medical sciences with no clinical experience. During years 4,5,6 students rotate through different clinical rotations in clinical settings, and they sit for exams at the end of the year. It's during these years that a student decides on the speciality s/he's interested in.

In the US it's a bit different. Students do not go directly into medical school but they have to get a degree first in something like chemistry, biology, economics...etc and they spend as long as it takes to finish these studies before doing the MCAT exams. If they did well in college and scored well on the MCAT, they get an acceptance into medical school.
That's why thousnads of Jordanian high school graduates have joined the AUB to study medicine but those who actually graduated from its medical school are fewer than 50.

After graduation from medical school, these "doctors" are still not allowed to practise medicine in the US, while in Jordan they're allowed to open their private clinics or join the hospital of their choice under the title "general practitioner".

In the US, they have to go through residency. There are dozens of specialities. Residencies last between 3 to 7 years. Residents start as interns, then they progress to more senior residents. Residents in general do the most work and they are supervised by an attending physician (specialist). The most senior residents are almost completely independent and comfortable working without supervision , however they cannot get patients in or out of the hospital or make major decisions without their attending physician's approval, and they need to give him a daily update on the patient and discuss the treatment plan with them.

The residency system is not much different between Jordan and the US, and at the end doctors can practise on their own or choose to do something called "fellowship", or a sub-speciality. For example a doctor who specialized (did residency in internal medicine) can choose to to become an internist or do a sub speciality in lung or heart or kidney disease. A surgeon can choose to stay a general surgeon or specialize in heart surgery and so on.

In general people who decide to do fellowships spend extra years but at the end become the experts in a certain area they truly enjoy doing, and earn more money. In Jordan fellowships have very recently started to emerge but they were nonexistent when I left Jordan in 2004.

That is a very general idea on how it works.

I joined medical school in 1996, finished residency in 2002, did a year of "imtiaz" that was a total waster of time, started residency in internal medicine in 2004, finished residency in 2007, and started the fellowship in infectious diseases last July. I will be done with fellowship in June 2009. Although I currently have my own patients in the clinic that I follow, and I make most decisions on the ill patients I see in the hospital, I am still always under the supervision of a specialist and I can't even leave a note on a patient without his signature on it.

I started in 1996, will be done in 2009 !!
I was 16 that time, will be 29 when I'm done
..... 13 years
totally worth it.


Anonymous said...

Ghammed 3ein, fatte7 3ein, and 2009 is around the corner. Godspeed, and our well wishes are with you always Faris. I hope that you derrive satisfaction out of what you do in life. :)
Keep blogging and we'll keep reading buddy, and when I get my terminal illness, I am catching the first flight to Arizona so I can hear the bad news in a totally cynical and dry-wit manner straight from our favorite Karaki Resident! :)

Blogger said...

Don't listen to the ghammeth 3ein o fate7 3ein people! It's non sense, it is still a .... long time,and they are not the ones who would work for 15hrs/day and take all those agonizing tests and memorize some sick and weird names.

On the bright side, 16 months and you'll be the guy charging me JD35 (maybe 50 with the inflammation*) for a 5 min check! Actually don't remind me.

Good luck man, you deserve it, and you've worked hard for it, beats the guy who spent his college years in the saqaweers sipping Gahweh and watching the "gamameer"

*: Ok, this was a very brilliant and awesome play on words! You see, did he (me) mean that he got a bad inflammation "somewhere" and it would cost a lot by that time? Or he meant inflation, and he is making a political statement, that he is a rebel and an anarchist?Wow, wine does its magic again!

asoom said...


Another thing to add about the american way is that unlike the medschool-bound in jordan where the decision is pretty much based on your tawjihi score, in the US they're also looking for "well-roundedness" which can sometimes make the process look quite random. So no matter how perfect a GPA is and how high the MCAT score is, if there's not too much going in your resume they might tell you to try again next year. Also the other way around, one of my grad school colleagues had a sub 3.0 undergrad GPA and barely a 3.0 grad GPA and was accepted into the more competitive med school of the state. It was probably because he had such an impressive research resume, at 24 he had already published 3 times.

I was once on the pre-med school track, I took the pre-reqa, did the clinical volunteering, and even totally kicked the MCAT's ass. The first time around I was waitlisted and told to try again. The next year I had second thoughts and decided to hold off on applying and do a masters and see how I feel after. During that time I decided it's a life I definitely don't want for myself.

Had I gone through with it I would have started med school at 23 or 24, I can't imagine jumping into it at 18 like my cousin in jordan, I'd have no clue what I was doing.....but kudos to you guys!

Anonymous said...

Wow... sorry didn't mean to have my encouragement be construed as nonsense. :(

Anonymous said...

it is an agonizing trip isn't it?!! we start young and end up,well not old but let's say 'older':) medicine is really a life-long commitment...I am still at the footsteps of trying for residency and I know there is a long way ahead.
one person once tried to count how many exams we had during med school...he just gave up after the number 260!and for the record I think our system is better than the American because it is a bit more focused.
But as u say it is totally worth it!!!
Good luck hareega,I think u chose a great field...

Salamonti said...

totally worth it.
100% true ))
antom al sabikon doc wa na7no al
la7ikon ))

Anonymous said...

tyb a question..
at some point ..weren't you overwhelmed? too many dreams to achieve and too many ambitions..
and then u just decided to go for it and do it..
and were u actually thinking about being "infectious" specialist wella that's what u got and u didnt really mind?

Hareega said...

ziad d... wala yhimmak man i'm an expert in giving horrible news ! Salamtak

firas.... thanks man, take it ez on the wine.

asoom, that's exactly right , you don't wanna do medicine if you don't like it, there's a lot of sacrifice.

caroline... good luck zameeleh lol, 260 might be an underestimate, i still have a big ass exam in 2 years!


citizen n... thanks to jordan i didn't even know that speciality existed when i was in med school, we had no speciliasts in the whole hospital when i was a student there -there was one for pediatrics-, at the cancer center i realized there's one and i found it somewhat interesting, then during residency i started eliminating specialities one by one until i found ID the most interesting and the people working in it as the brightest and most knoweldgable. the specilaity is way more than disgusting bacteria floating around or looking under the microscope for germs, it's the core of many medical speciliaties

Anonymous said...

Faris! When I started I was young and happy... you could say naive... survived med schoold...survived internship...the doctor's version of the busboy... 1st year fellowhip...I love what I do, but I'm too tired to enjoy it. And it does not get better.
You'll never be able to spend every holiday with your family, ou'll probably get home after your kids go to bed... I think I worked 40 hours the week I was on vacation.

The Observer said...

Allah ye3teek al 3afieh!

Very tough long journey! Bravo!

Hareega said...

Atlanta... I understand my friend, the future will be different, we're still in the slavery stages now so we (or maybe just you!) got to suffer, but the future is brighter!

Observer... thanks bro, y3afeek

Isam said...

is anything worth 13 years ??

Good luck ...