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?
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In reality, the white coat is supposed to similar to scrubs. It is supposed to used to protect the health care professional or provider from contaminates when doing a physical exam or procedures. This is not exclude to physicians. It can include PA's, NP's, and laboratory staff, etc., generally, but not always, who wear professional attire, but need environmental protection. The length is generally based on preference. There are medical and nursing traditions, but that doesn't necessarily transfer to real life practice. The white coat should not be worn outside of the clinical area, it should be removed before exiting the building and laundered appropriately, just like "scrubs". But often, you will see people in the public with these uniforms/jackets on. This can spread disease, so any health care professional should be aware of this concept.
September 23, 2017 - 8:46amThis Comment
Medical students wear short white coats.
August 31, 2017 - 8:40amResidents may wear long white coats with plastic or metal buttons.
Attending physicians are signified by long white coats with cloth buttons
Most all physicians enter a residency after medical school graduation but all physicians must complete a "one year rotating internship" before becoming licensed to work independently anywhere.
"General Practitioners" or GP are those that did not continue after internship to a specialty (i.e. FP, IM, OB, Surgery, etc). GPs are really a thing of the past.
A long white coat signifies an actual physician and the long difficult work it took to become one. No other type of clinical worker should be wearing one.
I have no idea what this author means by "a non-licensed" doctor can work but without hospital privileges. This article was grossly under researched.
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I hesitate to say that doctors are overpaid and over-valued, as they have put in a ton of time and effort to get where they are, but it's hard not to find the whole process of becoming a practicing doctor silly and inefficient.
Your input may be on point, but the culture you describe is part of what has made America's healthcare system so costly and inaccessible. Without even delving into the insurance side of things, our country needs way more nurses and NPs (who do 90+% of the regular work that doctors do) instead of more over-educated doctors who revel in the prestige of their "long white coats."
January 8, 2020 - 2:15amThis Comment
At my institutions (UT & UNC)
October 24, 2016 - 5:25pmMedical students get white coats at the start of their training: Short white coats, hitting right at the hip
Residents have mid-thigh length coats
Attendings & Fellows have just above the knee length
it seems nurses, lab techs, nutritionists, etc. wear whatever they want coat wise
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At Emory in Atlanta:
November 18, 2015 - 10:05amShort coat with arm badge - Medical Student
Short Coat without badge - First year Intern
Medium Coat - Resident 2-4
Long Coat- Chief Resident, Fellow or Attending.
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Medical Students wear short coats.
June 24, 2013 - 8:58amPhysicians (residents, fellows, and attendings) wear long coats; there isn't variation beyond short and long.
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