Last year, delegates from the American Medical Association considered passing a ban on white coats for physicians in hospitals during their annual conference. They cited increased potential infection risk as their primary concern. A secondary concern is "white coat hypertension," which occurs when patients' anxiety levels increase at the sight of a white coat. An official ban was not passed but the topic remains open for debate.
As medical leaders are debating the presence of white coats, patients can benefit from understanding what the different coat lengths mean. Why are some coats longer than others?
White coat lengths correspond to the level of training a physician has received after completing requirements for medical school (typically a bachelor's degree and passing the MCAT exam.) The short white coat length indicates completion of medical school. The standard medical school curriculum lasts four years, with two years of basic sciences and two years of clinical rotations, where students begin to work with patients. The rotations expose students to various fields of medicine to help them determine which one they would like to pursue upon completion of medical school. Students who graduate from medical school receive an MD (medical doctor) or DO (doctor of osteopathy) degree. MD and DO training are very similar, and both degrees allow for licensing in all fifty states and hospital privileges.
After the completion of medical school, most new MDs or DOs complete a three- to seven-year residency program. The American Board of Specialties has a complete listing of all residency programs, also known as specialties, at www.abms.org. During this training, residents practice medicine under the supervision of fully licensed physicians, also known as attending physicians, in a private hospital or an academic medical center. Residents wear a mid-length white coat. First-year residents used to be known as interns, but now all residents are identified by postgraduate year: PGY-1, PGY-2, and PGY-3, etc.
Upon completion of residency, physicians have two options. The first is to become licensed and board certified and begin practicing as attending physicians (in the full-length white coat.) Board certification exams are very grueling, taking two to three days. Physicians must meet state requirements, including a licensing exam, to become licensed. All physicians must be licensed to practice medicine. Physicians without board certifications can be licensed, but they cannot obtain hospital privileges.
The second post-residency option is to pursue a subspecialty by completing a fellowship of at least one year. Subspecialties such as cardiology, oncology, and gastroenterology follow an internal medicine residency. In rare instances, subspecialists such as oncologists can become even more specialized by developing expertise in treating one particular form of cancer. Fellows must become board certified and licensed if they have not already done so after completing their residency. Specialties with corresponding subspecialties are listed at www.abms.org.
The white coat length for a fellow depends on whether she is an attending in her specialty (e.g., internal medicine) while training for a subspecialty (e.g., nephrology) or she is receiving training and not practicing as an attending. A fellow who is not an attending wears a mid-length white coat. But some physicians choose to forego the white coats altogether and wear scrub pants and tops for comfort and for less risk of spreading infection.
Wow, that's a lot to remember! So what are your thoughts? Do you prefer to see your physician in a white coat, or are you more comfortable seeing her in business attire or scrubs?