Self-employed private physicians who charge a fee for each patient visit are the foundation of medical practice in the United States. Most physicians have a contract relationship with one or more hospitals in the community. They send their patients to this hospital, which usually charges patients according to the number of days they stay and the facilities(operating room, tests, medicines that they use). Some hospitals belong to a city, a state or, in the case of veteran's hospitals, a federal government agency. Others are operated by religious orders  or other non-profit groups. Some medical doctors are on salary. Salaried physicians may work as hospital staff members, or residents, who are often still in training. They may teach in medical schools, be hired by corporations to care for their workers or work for the federal government's Public Health Service. Physicians are among the best paid professionals in the United States. In the 1980s, it was not uncommon for medical doctors to earn incomes of more than $ 100 000 a year. Specialists, particularly surgeons, might earn several times that amount. Physicians list many reasons why they deserve to be so well rewarded for their work. One reason is the long and expensive preparation required to become a physician in the United States. Most would be physicians first attend college for four years, which can cost nearly $ 20 000 a year at one of the best private institutions. Prospective physicians then attend medical school for four years. Tuition alone can exceed $ 10 000 a year. By the time they have obtained their medical degrees, many young physicians are deeply in debt. They still face three to five years of residency  in a hospital, the first year as an apprentice physician. The hours are long and the pay is relatively low. Setting up a medical practice is expensive, too. Sometimes several physicians will decide to establish a group practice, so they can share the expense of maintaining an office and buying equipment. These physicians also take care of each other's patients in emergencies. Physicians work long hours and must accept a great deal of responsibility. Many medical procedures, even quite routine ones, involve risk. It is understandable that physicians want to be well rewarded for making decisions which can mean the difference between life and death. The expenses for becoming a doctor are spent on   _  .
schooling and retraining practice in a hospital facilities he or she uses education he or she receives