News & Commentary

Med School in 3? Let Debate Begin

“Young doctor” could be considered a contradictory term because by the time physicians-to-be finish med school, residency, and a year of fellowship, they are not so young anymore. And they are saddled with debt.

To address those problems plus the physician shortage, some medical schools have eliminated the fourth year. Doing so will not only speed up the process but also, theoretically, increase the ranks of primary care physicians.

Those making this argument often cite an article in the March 21, 2012, issue of JAMA ( by Ezekiel J. Emanuel, MD, PhD, and Victor R. Fuchs, PhD. Emanuel and Fuchs write, “[T]here is substantial waste in the education and training of U.S. physicians. Years of training have been added without evidence that they enhance clinical skills or the quality of care. This waste adds to the financial burden of young physicians and increases health care costs. The average length of medical training could be reduced by about 30% without compromising physician competence or quality of care.”

Paying off those enormous student loans might be one reason why aspiring doctors choose to be specialists, where they can make more money.

Not everybody likes this idea. Writing in the Sept. 19, 2013, issue of the New England Journal of Medicine, Stanley Goldfarb, MD, and Gail Morrison, MD, state that a similar effort was attempted in the 1970s for the same reasons: to reduce medical school costs and to increase the number of PCPs. It failed.

“The hope that students would opt for primary care careers was not consistently borne out,” they write. “Students enrolling in some accelerated BA–MD programs in community-based medical schools tended to enter careers in family medicine in higher numbers than did those from standard MD programs, but even those numbers were nowhere near the hoped-for 60% to 75%; and overall, these programs did not consistently boost the number of students choosing primary care careers.”

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