It all begins in highschool. Not that you have to "know" that you wish to be a physician then. Not hardly. But you must have a basic ability and desire to learn, ...and you must have applied yourself enough to at least be able to then enter undergraduate school and "do the pre-med work necessary" to prepare for taking the MCAT application exams. If one sluffs off early on...and doesn't get the basics down in junior high and high school,...it makes it very difficult, if not impossible, to prepare for attempting to be accepted into medical school later. At the same time, not everyone in medical school went the strict "premed" study route in college. If you are smart enough, and if you applied yourself in other study areas,...such that you end up knowing enough about physics, math, biology, chemistry, etc....to do well on the MCAT application exams....you too may apply and be accepted to med school. But, there's no getting around it, you must be willing to study hard and willing to put off many of the "fun things" until much much later. Discipline is key!
A physician can be promoted, but not exactly in the way that one might imagine a promotion. A physician can become the head of a medical facility by promotion or appointment. He or she might also become a member of certain medical societies where the physician might be promoted to president of the society.
Many local colleges and universities offer physician assistant training. Research schools in your area offering classes to become a certified physician assistant. There are a number of accredited programs in California that can help you become a physician assistant. Among these places, include the UC Davis School of Medicine, California Academy of Physician Assistants, and the USC Primary Care Physician Assistant Program.
The referring physician is usually your "Family physician". If you were having trouble sleeping for example, you usually would talk to your doctor who might recommend a sleep study. Your doctor would become the "referring physician" to the sleep study. If, during the sleep study, you appeared to have seizures, a neurologist might be called in as a "consulting physician".
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