The United States/ has more than one hundred twenty medical colleges. The American Association of Medical Colleges says/ these schools/ have about seventy thousand students.

How hard/ is it/ to get into one of the top medical schools, like for example/ the one/ at Yale University/ in Connecticut? Last year/ almost three thousand seven hundred students/ hoped to get accepted/ there. Only one hundred seventy-six -- or less than five percent -- were admitted.

More and more of the students/ getting accepted to medical schools/ are women. In fact, at Yale, those one hundred seventy-six first-year students/ included more women/ than men.

People/ who want to become medical doctors/ often study large amounts of biology, chemistry and other science. Some students/ work for a year or two/ in a medical or research job/ before they try to get accepted/ to medical school. Most people/ apply to more than one school. Some/ apply to as many as ten.

The Association of American Medical Colleges/ is changing the Medical College Admission Test, or MCAT. Starting in January, the MCAT/ will be offered/ as a computerized exam only -- no more paper-and-pencil test. The exam/ is given/ throughout North America/ and also in countries/ around the world.

The number of test dates/ will increase/ from two a year to twenty-two. And beginning/ in two thousand seven, the number of questions/ on the MCAT/ will be reduced/ by about one-third. So/ will the permitted testing time. Students/ may take the MCAT exam/ up to three times/ a year.

A medical education/ can be very costly, especially at a private school. One year/ at a private medical college/ can cost forty thousand dollars/ or more. The average/ at a public medical school/ is more than fifteen thousand dollars. Most students/ have to take out loans/ to pay for medical school. Many/ finish their education/ heavily in debt.

Doctors/ are among the highest paid professionals/ in the United States. Specialists/ in big cities/ are generally the highest paid. But there are also doctors/ who earn/ considerably less, including those/ in poor communities.

Medical students/ spend their first two years/ in classroom study. They learn/ about the body/ and all of its systems. And they begin studying diseases -- how to recognize and treat them.

By the third year, students -- guided by experienced doctors -- begin working/ with patients/ in hospitals. As the students/ watch and learn, they think/ about the kind of medicine/ they would like to practice/ as doctors.

During the fourth year, students begin applying/ to hospital programs/ for the additional training/ they will need/ after medical school. Competition/ for a residency/ at a top hospital/ can be fierce.

Medical residents/ treat patients/ under the supervision/ of professors and other experienced doctors. Most states/ require a person/ to complete at least one year of medical residency/ before taking examinations/ to work/ as a doctor. Doctors-in-training/ are usually called/ interns/ during their first year of residency.

Medical residents/ get experience/ in different kinds of care. Interns, for example, may work with children/ one month. Then/ the next month/ they may be in the operating room. How long a residency lasts/ depends on the chosen area of medicine.

There are many specialties. Some people/ become cardiologists/ and care for the heart. Others become oncologists/ and treat cancer patients. Still others/ become pediatricians/ and take care of children. And some doctors/ go into medical research, either at a university/ or a biotechnology company.

But whatever they choose, first/ they need training. Some doctors/ spend up to ten years/ serving in hospitals/ before they are fully trained/ in a specialty. Surgeons, for example, spend many years/ performing operations/ as residents.

A doctor in Chicago, Illinois, remembers/ that before his internship, he wanted to work/ in crisis medicine. But he lost that interest/ after he interned/ in a hospital emergency room.

He saw many patients/ who needed help immediately -- like accident victims/ and victims of gunshot wounds. One of the things/ he likes/ about the specialty he chose, surgery, is that he usually has more time/ to decide/ how to help his patients.

Medical residents/ do not get paid/ very much/ and have traditionally been expected/ to work long hours/ without much sleep. A young family doctor/ in the state of Virginia/ says/ she learned a lot/ as a resident. But she says/ she might have learned even more/ if she had not been so tired.

In nineteen ninety-nine, the Institute of Medicine of the National Academies/ published a report/ on medical mistakes/ in American hospitals. The report said/ preventable errors/ resulted in at least forty-four thousand/ and perhaps as many as ninety-eight thousand deaths/ each year.

In two thousand four, the New England Journal of Medicine/ published two government-financed studies/ of serious errors/ made by interns. The researchers found/ that the error rates/ in two intensive-care departments/ decreased/ when interns/ worked fewer hours. The interns/ made fewer mistakes/ when they had to prescribe medicines/ and identify conditions.

Some residents, however, say/ they need extended time/ with patients/ to observe changes/ in their condition. And some say/ residents/ need to work/ as much as they can/ so they can become good doctors.

But in two thousand three, the Accreditation Council for Graduate Medical Education/ reduced the hours/ that residents/ may work. The council/ supervises the training of residents. Some residents/ were spending one hundred or more hours/ a week/ at their hospitals. They were often on duty/ more than thirty-six hours/ at a time, with limited sleep.

The new rules/ limit residents/ to thirty hours of duty/ at a time. And a hospital/ is not supposed to require more than eighty hours of duty/ in a week. In addition, interns and residents/ must have one day off/ in every seven. But some residents say/ the new rules/ are not being followed/ by all hospitals.

Paul Rockey/ is a medical educator/ in Illinois/ who has worked for years/ with residents. He says/ residencies today/ are more difficult/ than before. Patients/ do not stay/ as long in the hospital/ as they once did. So Doctor Rockey says/ there is a lot of pressure/ on young doctors/ to learn quickly.

He says/ the difficulties of a medical education/ may be great. But, he adds, people/ also get great satisfaction/ seeing themselves/ gain the knowledge and skills/ to become good doctors.

We have talked about people/ who want to go to medical school/ in the United States. What about those/ who already have a medical education -- a foreign medical education -- and now want to work here/ as doctors? Traditionally/ this has not been easy. States/ require foreign doctors/ to pass tests/ and finish an approved residency/ or other medical program/ in the United States.

To be accepted for a residency, a person/ must meet the requirements/ of the Educational Commission for Foreign Medical Graduates. This certification/ process involves several tests/ before a person/ can receive a visa/ to stay in the United States/ for the training period.

Foreign medical graduates/ may be required to return to their own country/ for at least two years/ after they complete the training. But because of doctor shortages/ or other needs, some/ have been able to get visas/ without the required two-year stay/ in their home country.