How long does it take to become a doctor? Some medical schools shaving off a year of training
For Travis Hill, it was an offer too good to refuse. Last year when
the 30-year-old neuroscientist was admitted to a new program at New York
University that would allow him to complete medical school in only
three years and guarantee him a spot in its neurosurgery residency, he
seized it. Not only would Hill save about $70,000 -- the cost of tuition
and living expenses for the fourth year of medical school -- he would
also shave a year off the training that will consume the next decade of
his life.
"I'm not interested in being in school forever," said Hill, who
earned a PhD from the University of California at Davis last June and
started med school in Manhattan a few weeks later. "Just knowing where
you're going to be for residency is huge."
So is Hill's student loan debt: about $200,000, dating back to his undergraduate days at the University of Massachusetts.
And he won't begin practicing until he is 40.
The chance to finish medical school early is attracting increased
attention from students burdened with six-figure education loans: The
median debt for medical school graduates in 2013 was $175,000, according
to the Association of American Medical Colleges. This year, the
combined cost of tuition and fees for a first-year medical student
ranges from just over $12,000 to more than $82,000.
Need For More Primary Care Doctors
Some medical school administrators and policymakers see three-year
programs as a way to produce physicians, particularly primary-care
doctors, faster as the new health-care law funnels millions of
previously uninsured patients into the medical system. Enormous student
loans are cited as one reason some newly minted doctors choose lucrative
specialties such as radiology or dermatology, which pay twice as much as pediatrics or family medicine.
But debt and the shortage of primary-care doctors are not the only factors fueling interest in accelerated programs.
Some influential experts are raising questions about the length of
medical school in part because much of the fourth year is devoted to
electives and applying for a residency, a process that typically takes
months. (Similar questions are being raised about the third year of law school.)
In a piece published in the Journal of the American Medical Association
in 2012, University of Pennsylvania Vice Provost Ezekiel Emanuel and
Stanford economist Victor Fuchs proposed that a year of medical school
could be eliminated "without adversely affecting academic performance."
The overall time it takes to train physicians, they wrote, is an example
of waste in medical education and could be shortened without affecting
patient care or eroding clinical skills; students could be assessed on
"core competencies rather than on time served."
A 2010 report by the Carnegie Foundation recommended that fast-tracking be considered.
So far, fewer than a dozen of the nation's 124 medical schools are
offering or actively considering three-year programs, which typically
involve the elimination of electives, attendance at summer classes and
the provisional guarantee of a residency -- offered because three-year
graduates might be at a disadvantage compared with other applicants.
NYU launched its program
in September with Hill and 15 other students chosen from a pool of 50
applicants -- nearly a third of the medical school's 160-member class.
Texas Tech University Health Sciences Center in Lubbock graduated its
first three-year class in 2013; its nine students are training in
family medicine. Fifteen more students started this fall.
In September, Columbia University's College of Physicians and Surgeons launched a "fast track MD" for candidates who already hold doctorates in biology; there were 40 applicants for four slots.
Despite the growing popularity of such programs, critics question the
wisdom of jettisoning the fourth year of medical school, which they say
plays a crucial role in preparing doctors for residency and subsequent
practice.
Some note that the three-year track was offered by a few dozen
medical schools in the late 1970s but subsequently abandoned, largely
because of student burnout from trying to cram too much into three
years.
Supporters of the three-year option say that contemporary medical
school programs are different from 1970s curricula, which relied more
heavily on rote memorization, and that the new programs have been
designed to minimize burnout.
"This has been tried before, and it was a miserable failure," said
Stanley Goldfarb, associate dean for curriculum at the University of
Pennsylvania's Perelman School of Medicine, who co-authored an essay opposing three-year programs in a recent New England Journal of Medicine.
"Since the 1970s things have gotten so much more complex in
medicine," he said. The more relaxed fourth year, he said, gives
students the chance to pick the field that best suits them and to
carefully evaluate residencies. More than three-fourths of students, he
said, enter medical school uncertain about their eventual specialty.
Goldfarb said he favors enhancing the fourth year, not eliminating it.
Medical students have mixed feelings about three-year programs, said Nida Degesys, president of the Reston-based American Medical Student Association.
While many are eager to reduce their debt, they are also concerned
about missing opportunities; fourth-year electives can include
ophthalmology, critical care and emergency medicine.
"I personally changed my mind" during med school, Degesys said. "In
the first year I thought I was going to do OB-GYN, but I later found
that emergency medicine is truly the right fit for me."
Century Old System
For more than a century, medical schools have largely designed their
programs around a template: two years of preclinical or classroom work
in basic medical science, followed by two years of clinical rotations,
mostly in hospitals.
After med school, students continue their training in residencies
lasting from three to seven years, which increasingly is followed by a
fellowship of one year or more.
"There have always been some individuals who wondered about the
length of medical school," said John Prescott, former dean of the
medical school at West Virginia University and chief academic officer at
the Association of American Medical Colleges.
To speed the production of doctors, medical training during World War II was shortened to three years with no ill effect, he said.
Prescott calls the current three-year programs "well-designed
experiments" that may provide models about how to prepare students "in
the most cost-effective way." But he doubts they will supplant the
conventional four-year track for most students.
Steven B. Abramson, vice dean of NYU's medical school, agrees, but he
said he expects three-year programs to multiply over the next five
years.
NYU's accelerated program, he said, is best suited for highly
qualified students who are typically older, more mature and certain of
their choice of specialty. Because three-year students take the same
core courses as their classmates, they will be equally well prepared, he
said. And Abramson noted the proliferation of dual-degree programs:
students who earn an MD along with a graduate degree in science,
business administration or public health.
"The core content we deliver is rigorous, comprehensive and very well
monitored," he said. To stay in the three-year program, students must
remain in the upper half of the class; they retain the option of
switching to the four-year track if they find it too taxing. First-year
students are also assigned mentors in their intended residency.
While students at NYU can designate a variety of specialties, the three-year Family Medicine Accelerated Track at Texas Tech is limited to those who intend to pursue that specialty.
"There weren't enough primary-care doctors before the Affordable Care
Act," said Texas Tech medical school dean Steven Berk, who trained as a
family physician. "There are lots of towns in Texas with 25,000 people
and no doctor. And it's the primary-care physicians who find the small
breast mass or control patients' blood pressure. They are essential to
the functioning of the health-care system."
Many students who chose the three-year course have committed to
primary care based on their previous work experience. "We have students
who have been PAs, EMTs and RNs," he said, referring to physician
assistants, emergency medical technicians and registered nurses.
Texas Tech students are awarded a $15,000 full tuition scholarship to
cover the first year. When they graduate, their average debt for
tuition and living expenses totals about $60,000, Berk said. Like the
NYU program, students have the option of switching to the four-year
track -- none has so far -- and are granted a residency spot when they
enter med school.
Fears that they will not perform as well as their four-year
counterparts have not been validated, Berk said. Scores on licensing
exams are equivalent, and burnout has not been a problem.
Charles Willnauer, 30, a graduate of Texas Tech's first three-year class, said the accelerated program worked well for him.
The promise of a residency in family medicine, a specialty that "fits
with my values and goals," was enticing, as was the lower price tag.
"A lot of people have to apply to 30 or more residency programs,"
said Willnauer, now a first-year resident. "That's a very large cost and
a lot of time."
It was also a bonus in other ways. Married and the father of two
toddlers born while he was in medical school, Willnauer, age 30, said,
"I bought a house and knew I wouldn't have to uproot my family."
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