From MCAT to board certification: navigating the 10+ year journey to becoming a physician
everything you need to know about exams, medical school, residency, and more
09/28/2026
If you were to compare the average length of schooling and training across all disciplines, you would find that the road to becoming a doctor far exceeds other career paths in length, exceeding that of dentists, veterinarians, and lawyers. Yet if you were to also rank careers by their median annual pay, you would also find that fields requiring an MD, whether that be a cardiologist, anesthesiologist, or radiologist, overwhelmingly sweep the top spots. As such, the field of medicine offers great reward but for an even greater amount of effort, bringing challengers down a path which on average takes about 11 to 16 years to complete. This is a path that deviates depending on the subspeciality, however to better elucidate what the road to an MD actually entails, herein we’ve discussed the full process from an undergraduate degree to the white coat ceremony, and finally to board certification.
a journey of 10+ years
bachelor's
degree
4 years
medical school
4 years
residency
3-7 years
fellowship
1-3 years
gap
year(s)
1-2 years
attending
physician
independent practice, CME programs
total time: 12 - 20 years
Herein, we’ll be discussing the traditional MD pipeline, as opposed to other options such as BS/MD programs or MD/PhD programs (for MD/PhD check out our other article: Decoding the Doctorate: the pathway to a PhD). This pipeline starts much like any other college degree, attending a four-year undergraduate institution. Notably, the actual major taken does not matter so long as students still take all necessary classes to fulfill medical school prerequisites, wherein common prerequisites include biology, general chemistry, organic chemistry, physics, biochemistry, math, and English. As there are a significant number of credits to attain before graduation, it's highly recommended that undergrads make the decision of medical school or not by their sophomore year, giving them around two years to compile all credits. Many STEM majors however do fulfill these credits as part of their overall degree (i.e. a biochemistry curriculum would hold significant overlap) and thus would require less additional time dedication. With the necessary credits in hand, students will traditionally then go on to apply to medical school in their senior year, after taking the MCAT in the spring/summer of junior year. Perhaps one of the most stereotypically associated parts of an MD, the MCAT is essential to medical school applications, with top competitive scores being around 512 and above. As a result, students are increasingly taking a one to two year gap year in order to build their resume and study for the MCAT. Likewise in terms of assembling as many extracurriculars as possible, this process doesn’t stop after high school. In fact, it intensifies as students try to build the most competitive profiles for medical school applications, with common extracurriculars being EMT or CNA work, physician shadowing, and wet lab research.
Once in medical school, students will find it is divided into two main sections between years 1-2 and years 3-4. The first two years, similar to the first couple of years of a PhD, largely consist of course curriculum as students are taken in-depth into the world of general medicine. The third and fourth years of medical school put this acquired knowledge to use, wherein students begin clinical rotations, also called clerkships, exposing them to the main fields of internal medicine, general surgery, pediatrics, OB/GYN, psychiatry, family medicine, and neurology. During this time, students are required to take and pass shelf exams as they go through each rotation. These exams are critical in class ranking and honors, influencing the highly competitive residency matching process. Accordingly, in the senior year of medical school, students begin residency applications. However, we’re first going to briefly introduce the United States Medical Licensing Examination (USMLE) Step Exams for some context. These three Step exams are taken throughout one’s medical journey, with passage of all three required to become a licensed physician, with steps 1 and 2 taken in medical school. The Step 1 exam is taken after the second year of medical school, a pass/fail exam which tests students on the medical concepts they should’ve learned those first two years of schooling including but not limited to in-depth anatomy, pathology, pharmacology, and physiology. The Step 2 exam is typically taken at the end of the third year in medical school, or the beginning of the fourth year, which tests on applied clinical knowledge in a supervised patient care setting. This exam score is especially
crucial to residency applications, which are done in the fourth year as well. Following the passing of all coursework, Step 1 and 2 exams, shelf exams, and all other credits necessary, students graduate medical school, earning a Doctor of Medicine (MD) degree.
Before moving on to residency and fellowships, we’re briefly going to cover the cost of this schooling relative to projected salaries post-licensing and board certification. Latest reports categorize the average medical school graduation debt as around $200,000 to $250,000. Due to this high cost however, financial aid is not uncommon, including resources such as federal loans, institutional grants, and external scholarships. Relative to salary, the average annual salary for doctors is $380,000, but this figure varies greatly depending on speciality, with high stakes positions such as neurosurgery or cardiology pulling in greater amounts.
Continuing where we left off, after medical school, students then go through the residency matching process. This process is conducted by an algorithm created by the National Residency Matching Program, which matches applicants to residency programs based upon a comprehensive analysis of the student’s profile. This profile includes prior experience, extracurricular activities, research publications, conference proceedings, a personal statement, academic transcripts, and letters of recommendation. In this application, students will also rank residency programs based upon preference, to which the algorithm will then go through to match students based on qualifications relative to the competition. This match is legally binding and once accepted into a residency program, students are unable to attend any other program.
Once in residency, during the first year, residents take the last of the Step exams, namely the Step 3 exam. The Step 3 exam is an assessment of the application of clinical knowledge similar to Step 2, however this time in an unsupervised patient care setting, focusing especially on the assessment of individual decision making. This is not only a crucial step in progressing through one’s residency, but also necessary to attain a medical license. It is worth noting that it is legal to practice medicine with only a license and no board certification, however this is heavily dissuaded as employment options are extremely restricted and insurance options are considerably worse. From there, residents will spend on average 3-7 years in residency, with the length of time once again highly dependent on their speciality wherein more technical and high-risk specialties such as surgery require a much longer time for training. Unlike medical school, during this time, residents do get paid a small stipend, average about $60,000 to $70,000 per year, although the salary does increase with each postgraduate year. Following this, residents then have the option to conduct a fellowship in an even more specific subspeciality (i.e. cardiac electrophysiology as a subspeciality to cardiology). These fellowships average about 1-3 years, with a similar stipend paid as in residency.
After this long journey spanning over a decade, physicians face their final test before entering into independent practice, which is passage of the board examination. While the medical license serves as a test for broader fields in medicine, the board exam is meant to rigorously test the knowledge of physicians in a specific subspeciality, as the final check for mastery. If passed, the physician is officially board certified and available to enter into
independent practice as an attending doctor! But before you think the schooling is officially over, contrary to popular belief, physicians still have to take schooling programs throughout their career. Called Continuing Medical Education (CME) programs, these programs, which vary by state, ensure doctors continue keeping up in their respective fields so as to prevent the usage of obsolete knowledge. Accordingly, practicing doctors are required to renew their licenses about every two years, with these CME programs being critical in renewals.
Thus, the process which we’ve highlighted here to not just earn an MD degree, but then go on to apply that knowledge to eventually become a practicing physician, is no doubt a long and non-trivial path, but at the end of the day is simply a reflection of the intent to produce the best healthcare providers in the world.
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As a result, for those that seek the challenge, find a true passion in medicine, and strive to help people, this path can be extremely rewarding and worthwhile.