Matter, Energy, and Life of Michaela A. Castello.

Leveling Up

If there’s anyone left still following along after all the extended silences and affirmative responses to the “are you still in school” question, it’s time to check in with what I’m doing now. While I did, in fact, graduate with some degrees a while back there’s still a long way to go on the path from “person with a degree” to…wherever it is I’m going. After the eight-year MD/PhD debacle I told myself “no more garbage hybrid programs,” so when I found out Child Neurology was kind of a combination of Pediatrics and Neurology, I immediately ran away decided to sign up. Algorithmic matchmaking subsequently placed me in the Child Neurology residency program at UCSD.

Now, I’ve put another year experience point into this whole doctor-doctor career, which is to say, I’ve been in San Diego for over twelve months now. How “real” of a doctor I am largely depends on perspective. While I’m no longer a student, as a resident I am not quite autonomous, making me something of an apprentice. Is a Padawan still a Jedi? They carry lightsabers…

Sitting in the hospital with a badge that says “MD” while having no idea what to do in the electronic medical record (EMR), writing orders that other, more experienced doctors are constantly checking, but still being the primary physician for the patient…is the essence of intern year, also known as the first year of residency. Accordingly, mine went by in a blur of hospital workrooms and progress notes, leaving behind miscellaneous projects-in-progress and about half a dozen unfinished posts.

In the breakdown of how the years of life are traded after medical school, medical degree, medical license, and medical specialty are all separate but related things. A medical degree is worth very little on its own, but is a prerequisite for the other two. A medical license is administrated by a state medical board and grants the ability to do things like write and sign prescriptions and see patients independently—essentially to “practice medicine” in the most general sense. Obtaining a license requires a medical degree, passing all of those Step exams I used to talk about, and completing some amount of clinical training working under someone else’s license, the specifics of which vary by state.

Every “type” of doctor you might have heard about is a specialty or subspecialty, and a license to practice medicine does not a specialist make. For that distinction one must trade additional years of life by completing a residency (the first year of which is called internship, just in case this all was making too much sense). Regardless of the licensing requirements, newly-minted medical school graduates are nearly always signed up to be in a residency for longer: Residencies have a variable length starting at three years and increasing from there. Those years qualify one to take the specialty boards of whatever residency was just completed: Family, Internal Medicine, etc. Then there’s subspecialties like Cardiology or Neurosurgery, which require more training called a fellowship and passing yet another exam, the subspecialty boards.

As for me personally, I passed the Steps, finished intern year, and the next, uh, step, is to apply for a medical license in the short term, and complete Child Neuro residency in the longer term—the specifics of which will require a wholly separate explanation.

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