Health Policy$ense

Does American Medical Education Have to be Endless?

Aspiring Med Student Challenges The Current System

[cross-posted from the Health Cents blog on Philly.com]

“So you’ll be how old when this is all done?”

Between mouthfuls of rice, I go through the math. “Four years of undergrad plus three gap years plus four years of medical school plus three years of residency plus three more for fellowship puts me at 35 to be an independently practicing doctor.”

My mother looks up and raises an eyebrow, wearing an expression of disbelief. “I say take the consulting job and be done with it,” she quips. 

As seniors in college aspiring to become doctors, my peers and I are painfully aware of the long, draining journeys we have ahead of us to become physicians in the United States. Though the rewards, including a fulfilling occupation, stable job, and high earning potential are appealing, the costs of pursuing a medical career can make any prospective doctor think twice.

In the US and Canada, medical students must have a four-year baccalaureate degree. Most medical schools require applicants to have completed several basic science courses during their undergraduate years. Once admitted, medical students typically spend two years in classroom study followed by two years of clinical education. Applicants graduate with a medical degree, either an MD or DO (Doctor of Osteopathy), that qualifies them to practice medicine, albeit with significant supervision.

In contrast, students in the United Kingdom, India, and most European countries can be admitted to medical programs immediately after high school. In the UK, applicants must have completed basic science requirements at the high school level and received certain minimum scores on the standardized examinations. The medical programs last only five or six years, including two to three years of pre-clinical training and two years of clinical education. Graduates receive a Bachelor’s in Medicine or Surgery.

As Denise Grady has noted in The New York Times, many physicians and educators agree that the four-year medical school model based on the 1910 Flexner Report must be revised and condensed. Most recommendations involve the shortening of medical school itself. However, the years spent simply getting to medical school represent a significant portion of the education period and perhaps it is time that the track from high school to medical school be reexamined as well.

Integrated undergraduate/medical school programs in the US offer a faster track to obtaining a medical degree, but differ from medical education programs in the UK. Students in six- or seven-year integrated programs commit to completing both an undergraduate and medical degree consecutively at one institution. This involves an extremely rigorous, stressful academic schedule that eliminates the summer breaks and demands more time and effort of American students to achieve the same certification as their counterparts in the UK and Europe.

Why, then, does the US require students to complete undergraduate degrees to practice medicine while the UK and Europe do not? The argument in the United States has been that a well-rounded liberal arts education provides students in any field the intellectual base needed to become a scholar. However, it is unclear why this requirement is applied so strictly to doctors when prospective nurses, engineers, and business students, along with many other professionals are allowed to study in a targeted manner immediately after high school.

In fact, the extended duration of American medical education is bound to deter college students from pursuing careers as doctors. Successful college graduates face a choice between forgoing income and paying to attend medical school or taking a high-paying job in a sector like finance or engineering. With private medical school costing over $50,000 annually, the prospect of attending can be very discouraging to all but the wealthiest candidates.

Shortening the duration from eight years to five or six would significantly lessen the financial burden, making a medical career far more attractive to top students without regard to their socioeconomic backgrounds. It could also help to increase the presence of underrepresented ethnic minorities in medicine by lowering the financial barriers that prevent lower-income individuals from becoming doctors. Additionally, allowing doctors to begin their careers sooner will promote the presence of women in medicine by offering the chance for a better work-life balance at a younger age.

US medical students graduate with an average of $176,000 in loans. The staggering amount of debt puts young doctors under immense pressure to take only the most lucrative specialty positions, despite an estimated shortfall of up to 31,100 primary care providers in the United States by 2025. Shortening the education period would help reduce the debt burden carried by graduates and might encourage more young doctors to pursue primary care.

The conventional 8-year program may still have its place in American medical education. Students who are unsure of their interest in medicine, or those who aspire to health careers outside of clinical practice may benefit from a four-year undergraduate degree that gives them time to explore their interests.

However, it should no longer be the only choice for those who are firmly committed to practicing medicine. These students would be better served by a system that allows them to earn medical degrees without completing an undergraduate education that they cannot afford, will not use, and may not want.

Madhavi Muralidharan is a senior at the University of Pennsylvania pursuing a dual degree in Health and Societies and Healthcare Management. She hopes to attend medical school in the future.