How long does it take to make a doctor?

Our group of four family physicians had just recruited a fifth physician to join us. We knew him pretty well, having served as preceptors both for his inpatient medicine experience as well as a six-week rotation seeing our patients in our office. He was born and raised in the local community and already had longer-term relationships with some of our patients than we would ever have. The negotiations were complete, the papers were signed, and the five of us were celebrating over dinner.

Between dinner and dessert, our newest colleague asked, “When does it stop being scary? When will I feel like a doctor?”

The four of us, all more than 15 years out of residency at that point, were unanimous that the sense of being imposters who would shortly be discovered as incompetent had persisted well past medical school graduation, when the magic letters MD were appended to our names. Three years of residency taught us how much there was to know and did little to relieve our anxiety about our inadequacies. 

We agreed that for years we approaching every day as the day we would be undone, disgraced by a disease we could not diagnose, a treatment we had forgotten, a question we could not answer, or a procedure we botched. At some point, this had changed. What used to be discomforting because it was unfamiliar, was now interesting and rewarding because it was unfamiliar. Instead of dreading the unknown, we eagerly anticipated the challenge of a complex patient or a problem we had never seen. Instead of seeing the familiar as comforting, we saw the familiar as a hazard, a place where we could all too easily be lulled into missing something different and important, camouflaged by a superficial similarity to the routine. What had changed was not how much we knew, but an understanding of the border around what we know, a comfort with exploring the unknown, and an awareness of the fractal nature of the known, with its infinite levels of variation. 

Our youngest colleague interrupted our philosophical discussion of the nature of knowledge and stages of competence and asked again, “Seriously, guys. How long did it take before you felt comfortable with your stethoscopes and prescription pads?” 

We each wrote our personal answer on our paper napkin, and put them in the center of the table. When we turned them over, the answers were 5 years, 5 years, 5 years, and 4-6 years. (One of us is less concrete than the rest.)

I still don’t know how long it takes to make a doctor. In my own case, I’m still hard at work at it. But at least I have some sense as to how long it takes to feel like a doctor.



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