Background Manajemen | Fakultas Ekonomi Universitas Maritim Raja Ali Haji 115.full

II. Background

Getting into medical school requires a bachelor’s degree from a four-year college or university. 5 While there has been some research regarding the effect of undergraduate education on physician specialty choice—see Ernst and Yett 1985—such work is not conclusive, and it seems likely that most students enter medical school undecided about their specialty, or at least receptive to new experience. Once in medical school, the first two years are devoted to the basic sciences: anatomy, physiology, biochemistry, pathology, and the rest. Clinics are usually deferred until the final two years of school and represent the student’s first prolonged contact with the various specialties of medicine. 6 Most schools require months in general surgery, internal medicine, pediatrics, family practice or ambulatory medi- cine, psychiatry, and obstetrics and gynecology. Students typically explore clinical electives, including subspecialties, during the fourth year. During the fourth year, students apply and interview for residency spots. For most students, a computerized algorithm assigns a residency position; this algorithm takes into account students’ stated preferences, as well as those of the residency programs. 7 Accepting the match means agreeing to at least a three-year commitment, depending on the specialty. Internship is the first year of residency. At the end of the internship year, a doctor completes all requirements for a license to practice medicine. Physicians with a license are legally enabled to practice general medicine, though few do. 8 Board certi- fication is more rigorous and requires completing both the residency program and testing by specialty boards. There are two routes to subspecialty training: completion of a residency program in a specialized branch of medicine, or completion of a subspecialty fellowship after fin- ishing a basic residency. Total training times, set by specialty boards, vary widely; for example, internal medicine and pediatrics take three years, radiology takes four years, and surgery takes at least five years. Fellowships in specialized fields, like cardiology or neurosurgery, can take many years after a basic residency like internal medicine or general surgery.

III. Empirical Model