I recently read an article discussing “The Three-Year Medical School” as a solution to increasing debt for medical students, especially those going into family medicine. If you want, you can view that article here. Here is my take on it and why it is a horrible idea.
So basically some schools are starting to implement a fast-tracked version of medical school for those who know they want to go into family medicine. The idea is that by allowing these students to complete school faster, they will have one year less of debt, which is a good thing since doctors in family medicine tend to make less money than those who specialize and, thus, have a much harder time paying off their med school loans.
I think the idea is addressing an issue that definitely needs to be addressed. More and more doctors are not choosing primary care and instead are choosing to specialize. This is most likely due to several things. 1. Specialists make much more money than primary care physicians. 2. Specialists are often perceived as “more intelligent” than primary care physicians because they have trained longer and make more money. (Which is just not true.)
Anyway, the three-year med school is supposed to help with that. However, while it does decrease physician debt, I think it many ways it perpetuates the stereotype that primary care physicians aren’t as smart as specialists. By making them train for one year less, it sounds like you are saying that they don’t need to learn as much as specialists, which is the opposite of true.
For me, one reason I am so attracted to primary care, is the intellectual challenge that it involves. Primary care physicians need to know about anything and everything because they are generally the first ones to identify a problem. I think it is sad to think that a shorter version or a fast-tracked version of med school can prepare them as well to be good primary care physicians as a longer curriculum.
I know that med school seems like a long time and a lot of school, but believe me it isn’t. There is so much to learn to be a physician, and there is no room to make mistakes when you are dealing with human lives. I often feel like I wish I had one or two more years to learn it all. I have heard my professors say that they used to teach something but now there just isn’t room in the curriculum for it, and that makes me sad because sometimes the topics that are cut out are very important. Medical knowledge is increasing, not decreasing, so even though there have been times in the past where medical schools were shortened in cases of emergency, such as during WWII, I don’t think that it is ideal.
The fact is this is an issue that needs to be addressed. I can tell you from my own personal experience that med school debt is ridiculous. I owe so, so much money, and I worry every day about how I will pay it off. In the midst of health care reform, I can’t help but notice how little thought has been put into how to address the issue of physician shortages. Many physicians are afraid of working even more and getting paid even less. It is a scary time to become a doctor.
For what it’s worth, my own personal opinion is that the three-year med school is a bad idea. I wouldn’t want my own physician to have less training than the next. A better solution would be to look at government loans and interest rates. I know that I stress less about the actual amount of the loans I am borrowing and more about the interest rates. I wish I wouldn’t have to start accruing interest right off the bat. Why not wait until I am actually out of medical school? Or at least charge me a decent interest rate, instead of 6.4%!
It does cost a lot for a medical education. But, whatever the cost, I would gladly choose to pay it over the idea of short-changing my own education and my patients’ well-being.
my first patient 
Perhaps we need more well-trained vets. Oh, I’ll take a vet over an M.D. any day. They gotta be able to cure a lizard, a chicken, a pig, a frog – all on the same day.
Well thought out Emily, I agree with you.
Interesting post.
I interviewed at a three year med school and it was actually significantly more expensive than all the other schools I looked at. In Canada, there is a pretty big range of med school prices, but the one I looked at was something like 16,000 per year compared to the 6,800 I paid, with an average for other schools being around 12,000ish (I think). So, it really wasn’t decreasing debt for me.
I don’t think they get less training necessarily because they (the ones I know of) go through the summer and have fewer holidays and get more clinical stuff earlier on, but they do cut out some stuff that we “traditionally” learn and I think should keep.
Like you, I don’t think this would actually change the numbers of people doing family medicine or other specialties.
I agree with you that things need to change to allow physicians of all specialties to climb out of debt. I think a better solution would be to reduce the number of years in undergrad. Spending 4 years and tons of money, just so you get the privilege of doing the same thing the next 4 years is a bit much. It seem like half of the classes I took in undergrad were merely to get the degree and not relevant towards my major at all (I majored in biology). I like the idea of a 6 year medical program where a true undergrad program is completely avoided. In theory, that should save at least 2 years worth of debt, which can be $80,000+ in savings, depending where you went.
I definitely agree with you. If years need to be cut, it should be in undergrad vs med school. And I also felt like a lot of my classes were worthless, or, like biochem and anatomy, you take them again. The six-year program works well in other countries.
I’m in a six-year undergrad program in South Africa. I think it works way better than cutting actual med school years. I’ve wished sometimes that I could have done an undergrad first, like in the US/Canada, but also came to the conclusion that it would be waaaaay too expensive.
And, I agree with your opinion re: family physicians. I think that is the worst situation to cut training time – they really do need to know everything.
I heard that in China, they have some fast tracks, such as training some people to JUST do appendicectomies every. single. day. I don’t know if that’s true, though.
That’s really interesting that your primary care docs are paid less than hospital docs.. over here (UK) it is the other way round, with GPs (our version of family medicine) often earning much, much more than hospital doctors and working much better hours as well. A “GP-only” degree was suggested here a couple of years ago as well, to remove the mandatory year of hospital training after we qualify, but that was shot down pretty quick as well.
Just so you know, Pres. Phelps is actually looking into and working towards setting up a 3 year program here at KCOM (probably several years out).
I understand your argument of how it can alter people’s perception, but I feel it doesn’t in any way cheapen the degree. What is 4th year made up of? Honestly, auditions, interviews, a couple sub-i’s, some filler rotations to kill time until graduation? I think for people pursuing primary care, this knocks out a lot of wasted time, saves money, and allows them to really jump into what they love. While I’m only an M2, based on my interactions with 4th years, interns, and residents, much of 4th year is really not necessary.
I definitely see where you’re coming from. A lot of people agree, and I am not in any position to say what is best. I am not a fourth year yet, but it does seem to be perceived as a “blow off year” of sorts, but I think that is also up to each student. Fourth year is largely up to each student to schedule and decide what rotations they want to do. I see it as an opportunity to explore some specialties that I don’t plan on going into, but would like to look more closely at. The more experience I get in each specialty, the better I will be at primary care. I still think that medical knowledge is increasing so much that even a 4-year education doesn’t seem like enough time to learn it all. A lot of people like the idea that many European countries have in place, that involves a 6-year program that kind of combines undergrad and medical school, which seems like a better solution to me. Instead of taking anatomy twice and biochem twice and never really learning it well, why not take it once and go slower and integrate it better, etc. That is just my opinion. But I appreciate the comment! There are pros and cons for sure.