Medical School Too Long For Poor Students?

[ParkerSmith]

"The current system has costs beyond making doctors expensive and rare. The long process doesn’t just weed out the incompetent and the lazy from the potential pool of physicians—it deters students who can’t pay for so many years of education or who need to make money quickly to support their families. That introduces a significant class bias into the physician population, depriving a large proportion of the population of doctors who understand their background, values, and challenges".

What do you think?

http://www.slate.com/articles/healt...tage_should_we_shorten_medical_education.html

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[Goro]

This is why loans exist. If your family is so badly off that you need to be working, then med school isn't in the cards. Then again, there are scholarships out there. Serving your country is one honorable way of doing it.

Cruelly, there are plenty of other qualified applicants out there.

Class bias has existed in this country for, oh, >300 years.

And yes, life's unfair.

BTW, we don't have a physician shortage, but a misdistribution.

"The current system has costs beyond making doctors expensive and rare. The long process doesn’t just weed out the incompetent and the lazy from the potential pool of physicians—it deters students who can’t pay for so many years of education or who need to make money quickly to support their families. That introduces a significant class bias into the physician population, depriving a large proportion of the population of doctors who understand their background, values, and challenges".

What do you think?

http://www.slate.com/articles/healt...tage_should_we_shorten_medical_education.html

 

[futuredoc331]

They're right. This is a problem that encompasses many areas of life though. I think the best answer is a universal basic income.

 

[NeuResurgens]

I'm pretty sure student loans are available to most medical students, so I don't think that's an issue. The statement about making money quickly is more pertinent - some students from underserved populations need to make money quickly to help support their families.

However, we can't just shorten the length of education substantially. The years are required to put in to ensure that students become competent in the capacity of high responsibility they will carry.

I don't think healthcare absolutely needs doctors who grew up in underserved populations in order to be sensitive to the needs of those populations. Premeds are greatly encouraged to work with these groups early in their education, and medical school carricula are emphasizing these values as well. If any one group amongst the wealthy has more experience with the plight of the poor than doctors, I don't know who they are.

 

[Cavs5284]

Well, we could do away with the requirement that applicants finish a useless bachelor's degree before applying to medical school like every other developed country in the world. Or make 6 year programs where the pre-med requirements are taught in years 1 and 2.

 

[resiroth]

Yeah and also eliminate all those useless courses that emphasize things like "critical thinking"! That's not on the step!

 

[AlbinoHawk DO]

"The current system has costs beyond making doctors expensive and rare. The long process doesn’t just weed out the incompetent and the lazy from the potential pool of physicians—it deters students who can’t pay for so many years of education or who need to make money quickly to support their families. That introduces a significant class bias into the physician population, depriving a large proportion of the population of doctors who understand their background, values, and challenges".

What do you think?

http://www.slate.com/articles/healt...tage_should_we_shorten_medical_education.html

As someone in the bottom bracket with no support at all, I can say this is patently false. Anyone that wants an education in this country can get it if they are willing to take out loans. Start at a community college (free in California for poor people and loans available), transfer (loans), medical school (loans) and then residency (get paid).

 

[Law2Doc]

I am constantly humbled by how little I don't know, never learned. Med school is actually quite short considering the amount if knowledge one ought to subsequently possess as a physician. You could probably even justify adding a year -- administrators are already making judicious cuts of the curriculum that leave big gaps in your education.

As Goro said, there's no physician shortage. Its more about everyone wanting to be a plastic surgeon in NY or LA and nobody wanting to do FM in Oklahoma. You don't fix that with more people, you fix it by picking different people and maybe incentivizing them differently. And even if there was a shortage, you couldn't fix that at the med student level anyhow -- the residencies slots are the bottleneck. There was just a National news article that US med school deans are worried all their grads won't find residency slots as is -- the fix isn't to shorten the pipeline and make this shortfall happen quicker.

 

[Mad Jack]

The current system has costs beyond making doctors expensive and rare. The long process doesn’t just weed out the incompetent and the lazy from the potential pool of physicians—it deters students who can’t pay for so many years of education or who need to make money quickly to support their families. That introduces a significant class bias into the physician population, depriving a large proportion of the population of doctors who understand their background, values, and challenges.

The average medical school CoL loan is far higher than the pay of full time minimum wage jobs. This is literally the dumbest reason to shorten medical education I've ever read.

One solution is to simply lop off a few years from the process. Writing in the Journal of the American Medical Association in 2012, bioethicist Ezekiel Emanuel (one of those Emanuels) and economist Victor Fuchs recommended shortening each stage by about 30 percent. Four years of premedical training shouldn’t be a requirement for those who don’t want it or can’t afford it, they argued. The fourth year of medical school is largely a breeze, and a few progressive medical schools are now offering three-year programs to reflect that reality.

An American physician spends an average of 14 years training for the job: four years of college, four years of medical school, and residencies and fellowships that last between three and eight years. This medical education system wasn’t handed down to us by God or Galen—it was the result of a reform movement that began in the late 19th century and was largely finished more than 100 years ago. That was the last time we seriously considered the structure of medical education in the United States.

The medical school curriculum was 4 years over 100 years ago, and yet we've infinitely increased the knowledge base required to be a competent physician. If anything, medical school should be longer, not shorter, as there is simply too much information to cover in a mere 4 years. We just hope we pick up all the missed bits in residency and through indepenedent study post-graduation.

In recent years, however, studies have shown that reductions to working hours during residency have harmed neither patients nor doctors-in-training. We need to subject assumptions about duration of training to the most rigorous scientific assessment possible. It’s time for doctors to turn the microscopes on themselves and their own training, and accept that the system that produced them may be imperfect. It’s nothing against you, Doctor, it’s just a scientific inquiry.

If the same quality of care is being provided, but in lower quantity, it has, in fact, harmed patients via a reduction of available providers.

As for postgraduate training, Emanuel and Fuchs attacked the increasingly common requirement that residents and fellows complete laboratory or clinical research projects. They don’t buy the popular ideal that every doctor must be a “physician-scientist.” Referring specifically to surgeons, they wrote, “The most important factor in becoming a competent surgeon is high volume—performing specific procedures many times over. A research year does not add to surgical volume and skills building.”

I love when liberal economists insist they know what is best practice for scientists. He may be content with an army of mediocre physicians, but I'd prefer a legion of competent ones. Quality should supercede quantity when lives are at stake.

 

[titanmoon]

I did a search and this seems like pretty standard length of time for doctor training across all developed countries. However 1 major difference is, almost all other countries admit students directly into medical school after high school. Their med school is a year or two longer, but they don't have to do undergrad first before applying to med school. For example, to become a doctor in:

The UK (10-15 years):
After A level (HS, age 18), 5 years med school, 2 Foundation years (begin receiving stipend), 3 years general training, plus 1-5 years for specialty

France (9 to 11 years):
After Baccalaureate(HS, I think), 6 years med school (in last 3 years receive stipend), 3 years general medicine residency, plus 1-2 more for specialty.

Australia (11-14 years):
After HS, 5-6 years med school, 1 year intern, 1+ year resident, 4-6 years registrar(specialty)

Ireland (6-16 years):
After A level, 5 years med school, 1 year intern, 2-8 years specialty training

Japan (13 year-14 years):
After HS, 6 years med school, 2 years intern, 5-6 years specialty training

However, in developing countries where there's acute shortage of doctors, the training is much shorter, for e.g.
India (5 1/2 years):
4 1/2 years of med school, 1 year intern

So the real difference is 5-6 years of med school compared to our 8 (4 yrs undergrad+4 yrs med school). Also these other countries do not require their med school students and residents to do research. Their med school and residencies are primarily for hands on training, which allows them to shorten the time for both as proposed by this article.

 

[WingedOx]

Well, we could do away with the requirement that applicants finish a useless bachelor's degree before applying to medical school like every other developed country in the world. Or make 6 year programs where the pre-med requirements are taught in years 1 and 2.

pre-med-like typing detected.

Let's think about the demographics of the people who actually apply and are accepted to said programs... It ain't the poor kids.

 

[Law2Doc]

I did a search and this seems like pretty standard length of time for doctor training across all developed countries. However 1 major difference is, almost all other countries admit students directly into medical school after high school. Their med school is a year or two longer, but they don't have to do undergrad first before applying to med school. For example, to become a doctor in:

The UK (10-15 years):
After A level (HS, age 18), 5 years med school, 2 Foundation years (begin receiving stipend), 3 years general training, plus 1-5 years for specialty

France (9 to 11 years):
After Baccalaureate(HS, I think), 6 years med school (in last 3 years receive stipend), 3 years general medicine residency, plus 1-2 more for specialty.

Australia (11-14 years):
After HS, 5-6 years med school, 1 year intern, 1+ year resident, 4-6 years registrar(specialty)

Ireland (6-16 years):
After A level, 5 years med school, 1 year intern, 2-8 years specialty training

Japan (13 year-14 years):
After HS, 6 years med school, 2 years intern, 5-6 years specialty training

However, in developing countries where there's acute shortage of doctors, the training is much shorter, for e.g.
India (5 1/2 years):
4 1/2 years of med school, 1 year intern

So the real difference is 5-6 years of med school compared to our 8 (4 yrs undergrad+4 yrs med school). Also these other countries do not require their med school students and residents to do research. Their med school and residencies are primarily for hands on training, which allows them to shorten the time for both as proposed by this article.

To be fair our med school is only 4 years long, with the equivalent of about a year of prereqs you need in college before that. So our med schooling is really 5 years to their 5-6. Only difference is that we expect a bit more maturity and liberal arts background before you get to start. Which most people in the field don't consider a negative.

 

[titanmoon]

I think there are pros and cons to both approaches. Admitting high school students directly into med school could probably save a 2-3 years of schooling and weeding later on, but a lot of 17, 18 year olds who want to be doctors change their mind after while. What happens to these kids? They'd have to reapply to college, wasting a few years of med school. The good thing about making everyone get an undergrad degree first is it allows kids to mature and make sure med school is really what they want, and it also helps weed out those who are less qualified. I wouldn't be comfortable being treated by a doctor who looks like he just graduated from high school, which is how old many of the medical interns will look in some of these countries.

Most professional services firms(accounting, law, management consulting) that have partnership tracks also require about 8-11 years before a college grad can make partner. Before then they toil away as associates for years making low salary and working long hours. In accounting it's 11 years after your bachelor's so you make junior partner at 33, another 10 years before senior partner (about $400-$500k in large accounting firms). In law that's often 8-11 years after law school, so you make partner around 33-36(assuming you go to law school right after college, $400k to >$1M in large national law firms). In MC it takes about 8-9 years after your MBA, around 34-35 (assuming 2 years work experience before MBA school). All have harsh "up or out" cultures that weed out the majority before they make partner. As a doctor you can start practicing in IM at age 30, or latest as a neurosurgeon at 33? Unless you're a bad doctor no one can weed you out.

 

[PhillyMed777]

Wow! Excellent responses on this thread.

 

[NeuResurgens]

I would definitely say that, based on my experience out of the country, the quality of our medical education is great. With a few exceptions, we produce very good physicians. As was stated above, a lot of the problem is not a pure physician shortage, just maldistribution of our physician resources. Many schools specifically recruit in-staters with an implicit expectation for them to remain in state, but you can't really remove people's autonomy if they decide the greats is greener elsewhere.

Most other countries seem to do the integrated medical school approach, with students entering from high school. There are positives and negatives to this model. I personally feel that high school students aren't usually ready to commit to the demands that medicine requires - especially because we don't encourage job specialization until college, whereas in many countries this begins in high school. I don't think changing medical education to a direct-from-high school model would really benefit underserved populations - at least some of those kids get to set themselves apart as undergrads, whereas in underserved high schools it can be much more difficult to reach top programs.