To become a licensed medical doctor in the United States, a person must complete a multi-stage educational and training process requiring at least two distinct degrees. The path to becoming a practicing physician, whether a Doctor of Medicine (MD) or a Doctor of Osteopathic Medicine (DO), is long and involves extensive supervised clinical training. This rigorous sequence of education and examinations is mandatory for nearly all medical practice, ensuring every licensed physician possesses the comprehensive scientific knowledge and practical experience necessary to care for patients.
The Foundational Requirement: Undergraduate Education
The journey begins with the completion of a four-year undergraduate program culminating in a Bachelor’s degree. This degree is required for admission to virtually all US medical schools. While a Bachelor of Science (B.S.) is common, medical schools accept applicants with majors in any field, including humanities, social sciences, and the arts.
Regardless of the chosen major, prospective medical students must complete a specific set of prerequisite courses, often called the pre-med track, to demonstrate a foundational understanding of the sciences. These required courses typically include one year each of general biology, general chemistry, organic chemistry, and physics, all with corresponding laboratory work. Many schools also require biochemistry, English, statistics, or calculus. Successful completion of these courses is necessary because the scientific principles learned support the advanced medical concepts taught in medical school.
Earning the Professional Degree: Medical School
After obtaining a bachelor’s degree, the next step is four years of medical school, resulting in a professional doctoral degree: either a Doctor of Medicine (MD) or a Doctor of Osteopathic Medicine (DO). Both degrees grant the holder full practice rights, allowing them to practice medicine and surgery in all 50 states. The curriculum and training for both MD and DO students are largely similar, focusing on the diagnosis and treatment of disease using evidence-based medicine.
The four years are divided into two phases: pre-clinical and clinical. The first two years are dedicated to pre-clinical studies, focusing on foundational sciences, including anatomy with dissection, physiology, biochemistry, pathology, and pharmacology. This phase often utilizes an integrated, organ-system approach, teaching students about the body in a block-by-block format.
The third and fourth years are the clinical years, consisting of rotations (clerkships) where students gain hands-on experience under supervision in hospital and clinic settings. Core rotations include:
- Internal medicine
- Surgery
- Pediatrics
- Obstetrics and gynecology
- Psychiatry
- Family medicine
DO students receive additional training, typically around 200 hours, in Osteopathic Manipulative Treatment (OMT). OMT is a hands-on method for diagnosis and treatment related to the musculoskeletal system, reflecting the DO emphasis on holistic care.
The Essential Post-Graduate Training: Residency and Fellowship
Graduation from medical school is followed by residency, which is mandatory for state medical licensure and typically lasts between three and seven or more years. Residency is a paid, supervised clinical training program that allows the physician to specialize in a particular field, such as internal medicine, surgery, or pediatrics. The transition into this phase is managed through the National Resident Matching Program (NRMP), often called “The Match,” which uses a computer algorithm to pair graduating medical students with residency programs based on their ranked preferences.
The length of residency varies significantly by specialty; family medicine typically requires three years, while neurosurgery can require seven or more years. During residency, the physician, now referred to as a resident, assumes increasing responsibility for patient care under the guidance of attending physicians. After completing residency, some physicians pursue optional sub-specialized training through a fellowship. Fellowship training adds one to three years and provides in-depth expertise in a narrow area, such as cardiology or infectious disease.
Licensure and Board Certification
The ability to practice medicine independently requires state licensure, issued by state medical boards. This license is the minimum legal requirement to diagnose and treat patients in a given state. To qualify, the physician must have graduated from an accredited medical school, completed the required post-graduate training (residency), and successfully passed a comprehensive national medical licensing examination. MD students take the United States Medical Licensing Examination (USMLE), while DO students take the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA). Both are multi-part exams taken throughout medical school and residency.
Separate from licensure is Board Certification, a voluntary process that signifies a physician’s expertise within a specific specialty. This recognition is obtained by passing a rigorous examination administered by a specialty board. While not legally required to practice, many hospitals and employers strongly prefer or require physicians to be board-certified, and certification must be maintained through ongoing education and periodic re-examination.
The Total Time Commitment and Financial Investment
The educational timeline typically spans a minimum of 11 to 15 or more years following high school graduation: four years for the undergraduate degree, four years for medical school, and three to seven years for residency training. A physician who pursues a sub-specialty fellowship may spend up to 18 years in training before practicing independently.
The financial investment required is equally significant. The average cost of a four-year medical school education, including tuition, fees, and living expenses, is substantial. The median total cost ranges from approximately $286,000 for public schools to over $390,000 for private institutions. Most students rely on loans to finance this education, often graduating with debt well over $200,000. This does not include the cost of the undergraduate degree.
Related Healthcare Careers That Do Not Require an MD or DO
Individuals interested in patient care with a shorter educational path and different scope of practice may consider several related healthcare careers that do not require an MD or DO degree.
Physician Assistants (PAs)
PAs complete a graduate-level program, typically lasting two to three years, and earn a Master’s degree. PAs are trained to practice medicine on healthcare teams with physicians and surgeons, taking medical histories, diagnosing illnesses, and developing treatment plans under a physician’s supervision.
Nurse Practitioners (NPs)
NPs are advanced practice registered nurses who complete a graduate degree, generally a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP), taking two to four years. NPs focus on a holistic, patient-centered approach. Their scope of practice varies by state, with some states granting full independent practice authority. NPs and PAs have significantly fewer required clinical hours (500 to 750 hours) compared to the 12,000 to 16,000 hours completed by MDs and DOs through clinical rotations and residency.
Chiropractors
A Chiropractor earns a Doctor of Chiropractic (DC) degree, a professional doctorate focusing on the diagnosis and treatment of neuromuscular disorders through manual adjustment and manipulation of the spine. Chiropractors are not medical doctors, and their education and scope of practice are entirely separate from the allopathic and osteopathic medical models. The DC degree prepares them to practice a form of alternative or complementary medicine, focusing on non-surgical, non-pharmacological approaches to health.