The road to becoming a specialist



You have just graduated from medical school and have chosen a specialty.  What’s next?  What hoops do you have to jump through in order to be a specialist in your chosen field?

Some of the necessary steps are obvious, but many are not.  Many also vary from specialty to specialty.  This article is intended only as an overview of what may be experienced as a complicated, long-drawn-out process.

U.S. Medical Licensing Examination

The Federation of State Medical Boards and the National Board of Medical Examiners sponsor the U.S. Medical Licensing Examination.  The Medical Licensing Examination consists of three parts (or steps).  If your medical school has been accredited by the Liaison Committee for Medical Education (the main accrediting body for U.S. and Canadian schools of medicine), then the first step is taken at the end of the second year in medical school and the second step is taken during the final year.  (Normally step one is taken first and step two second, but you may be able to reverse the order.)

Typically you would take step three during your first or second year of residency.  After completing the first Step (which may be step two rather than step one), the student has seven years to complete the other two parts.  It is uncommon to pass the exam the first time.  Over the next four or so years, you may take the exam three or four more times.  (In Kentucky, an applicant must pass the exam in four tries for each step.)

Medical Residency and Fellowships

Usually in your third year of medical school, you will become acquainted with multiple medical specialties.  Preliminary training in general surgery or internal medicine will be necessary to further your education.  This training is typically acquired during a residency at a hospital.  A residency in internal medicine takes a minimum of three years, often followed by a fellowship in a subspecialty that lasts from one through three years.  Residency for surgeons requires at least five years, with additional subspecialty training for at least seven years.

Graduating medical students generally apply for residency positions and fellowships with the assistance of the National Resident Matching Program, which links candidates with available openings.  In recent years, the number of graduating medical students equals or exceeds the number of available residency slots.

Medical Licensing

To continue training, the resident must at a point get licensed.  Each state has its own medical licensing requirements.  Kentucky applicants must have completed, among many other requirements, at least two years of post-graduate training before applying for a license.  Once you are licensed in your state, you will be required to obtain continuing medical education credits on a regular basis to maintain your license.

Specialty Certification       

Physicians may choose to be certified in their specialties through the American Board of Medical Specialties (ABMS) or other specialty boards.   The residency you pick will determine which board exam you may be eligible to take.

If you become certified, you will need to satisfy the board’s maintenance of certification (MOC) requirements in your specialty to keep up your certification.  MOC requirements are currently changing at many boards, related in part to recent changes at the Accreditation Council for Graduate Medical Education for residency programs.

A History of High Standards

Since 1933, the ABMS Member Boards have been certifying doctors to help assure patients as well as hospitals, health plans, insurers and the government that these doctors are qualified to provide expert healthcare in an ever-expanding number of medical specialties and subspecialties. With the guidance and support of ABMS, the 24 member board is responsible for developing and implementing the educational and professional standards for quality practice in a particular medical specialty or subspecialty, as well as for evaluating candidates for Board Certification.

Medicare Enrollment

When you start practicing (and, in some cases, while you are in residency), you will enroll in Medicare, which allows you or your employer to bill Medicare for your services.  You will be required to declare a specialty and a subspecialty when you enroll.  This declaration is for programmatic and claims processing purposes and may limit the services for which you will be paid.

For Medicare purposes, you do not need to be board certified in order to declare a specialty.  Certain physician may decide to opt out of Medicare, which has its own requirements and implications.

Hospital Privileging

To practice in a hospital, you will need to be credentialed at the hospital and receive privileges in your specialty.  Hospitals carefully review your education, residency, fellowship, recommendations and practical experience before granting you medical staff membership and privileges.

In short, becoming and staying a physician require passing a series of trials and assessments designed to test your competency to practice medicine.  It is a rewarding but demanding career.

Common Specialties

  • Allergy & Immunology
  • Anesthesiology
  • Colon & Rectal Surgery
  • Dermatology
  • Emergency Medicine
  • Family Medicine
  • Internal Medicine
  • Medical Genetics and Genomics
  • Neurological Surgery
  • Neurology/Child Neurology
  • Nuclear Medicine
  • Obstetrics & Gynecology
  • Ophthalmology
  • Orthopaedic Surgery
  • Otolaryngology
  • Pathology
  • Pediatrics
  • Physical Medicine & Rehabilitation
  • Plastic Surgery
  • Preventive Medicine
  • Psychiatry
  • Radiology
  • Surgery
  • Thoracic Surgery
  • Urology

For a complete listing of Board Certified specialties and subspecialties, visit

-David Lips is an attorney with Hall Render Killian Heath & Lyman.