Should High Schoolers Directly Start Medical Schools as an Approach to Addressing Physician Shortage and the URM Gap?

[Nontrad_FL_LGBT]

There's more to life than studying and being a doctor and "min-maxing" the efficiency of your career path. Being a 17-18 yo starting a medical program really prunes a lot of branches on the tree of your life, not the least because most people at that point are still doing exactly what their parents tell them. Many European med programs have a high attrition since a lot of kids realize they're not cut out or just not interested, and they're not forced to pay back hundreds of thousands in loans. I'd wager the dropout rate here would be way higher if it wouldn't incur a life-ending debt.

I'll hopefully be starting as a 30 yo next year, 10-11 years after graduating (I started at 16 and graduated at 19 and would've been qualified for a BSMD program at the time had I known they existed). After working in sales and hospitality, game design, project management, software engineering, and teaching software before clinical work, I know what I want.

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[EdgeTrimmer]

But not everyone needs additional years to figure out their path and adcoms shouldn’t be prioritizing them.

 

[EdgeTrimmer]

Personally, I think 4 years of undergrad really gave me a chance to explore my interests and figure out if this is truly what I want. Considering how many people I knew started out committed to premed and then ending up switching to something else, I don’t think it’s good to have more high schoolers commit to a whole career path with minimal experience and exploration. You really do so much in college and I think it’s a valuable time to figure yourself out.

BSMD programs also require clinical and non clinical volunteering and some research experience and getting into them is tougher than MD. My issue is most kids need connections to get those opportunities given age restrictions and also high cost of these programs. Yes, attrition rate is slightly higher (I think around 5% from small number) but parents are willing to take that risk ☺️

 

[LizzyM]

True. But the point is that they went to medical school right out of high school and they come over here , successfully complete residency and practice without any issues.

It is exceptionally difficult to get that residency spot as an IMG and those chosen are the best of the best. I see many IMG who come to the States and never match thus never achieving licensure in the US. If someone is "practicing without any issues" it is because they jumped through multiple hoops and are often far older than their residency peers who graduated from US schools.

 

[EdgeTrimmer]

It is exceptionally difficult to get that residency spot as an IMG and those chosen are the best of the best. I see many IMG who come to the States and never match thus never achieving licensure in the US. If someone is "practicing without any issues" it is because they jumped through multiple hoops and are often far older than their residency peers who graduated from US schools.

I know several kids who went to India after HS to do medicine and got residencies (primary care ) with out going thru too many hoops. They finished in medical school in 5.5 years and spent year or so for USMLE prep, got US clinical experience and got residency. Total yeas after HS is 7-8 years. Few of them started fellowship this month. Most of them chose to take that because they were afraid of gap years here. They probably spent around $250k which is much cheaper than doing UG+medial school in US. Again it comes down to the students and there are different paths to become a doctor .

 

[Angus Avagadro]

If they wanted to do FM, could have gone to a DO school and be done in 8 yrs

I know several kids who went to India after HS to do medicine and got residencies (primary care ) with out going thru too many hoops. They finished in medical school in 5.5 years and spent year or so for USMLE prep, got US clinical experience and got residency. Total yeas after HS is 7-8 years. Few of them started fellowship this month. Most of them chose to take that because they were afraid of gap years here.

Could have done the same thing by going to DO school in the states and not have to be so far from home. Now I don't know the cost of med school in India and that could be a factor. 5.5 yrs, a yr for USMLE prep, so 6.5 yrs or longer as you mentioned. 8 yrs to be a DO, so your saving what, 18 months tops? I again, don't understand the rush.

 

[EdgeTrimmer]

If they wanted to do FM, could have gone to a DO school and be done in 8 yrs

Could have done the same thing by going to DO school in the states and not have to be so far from home. Now I don't know the cost of med school in India and that could be a factor. 5.5 yrs, a yr for USMLE prep, so 6.5 yrs or longer as you mentioned. 8 yrs to be a DO, so your saving what, 18 months tops? I again, don't understand the rush.

Actually with USMLE prep, getting some US clinical experience and residency start date it ends up being 8 years. I do agree they could have done DO in US and that’s my recommendation to anyone who asks , but these are risk averse parents (just like BSMD parents) with kids willing to go to India. Cost comes to $250-$300k but you are saving on UG cost. Comparatively schools my child chose for UG/Med have combined sticker price of $650k+

 

[senecca]

But not everyone needs additional years to figure out their path and adcoms shouldn’t be prioritizing them.

Couldn’t have said it better.

 

[gonnif]

I am a little late to this thread, but I wanted to clarify some things both here in the USA, and in the UK
1) most medical students in the UK, as indeed, most university students do not enter college immediately after high school. Many have a year of preparatory often referred to as the matriculation year, essentially grade 13

2) university/medical school can last 4 to 6 years ( this is where the discussion is cutting for five year to four years).

3) this is followed by two years of foundation, clinical training, roughly equivalent, to internship or PGY 1/2. They are house staff.

4) this is followed by three years of what we would refer to as residency just to become a general practitioner, which is very roughly equivalent, to family practice

5) specialist, training, or what we would call residency is now being proposed to follow directly after the foundation years in a minimum of two or three additional years.

6) to become a consultant physician in which is roughly equivalent to a fellowship actually requires 2 to 3 years additional clinical, and usually 2 to 3 years additional research thesis, essentially getting a PhD in addition to the MD. Many students choose to do this right after medical school proper.

In sum, at best, it’s four years of medical school, two years of foundation, training, and three years of residency. That’s nine years minimum. At that point you are a general internist or a general surgeon. Anything else requires another 2 to 7 years.

It also should be pointed out that the two main reasons that the UK is having a physicians shortage is firstly that the national health service pays like crap. Unless you go for the training to become a consultant position (fellowship level specialist) where you can open your own cashed based practice, you are in a very bloated, corporate government organization. Secondly, many of the European Union countries paid their doctors worse, and therefore many went to the UK. But of course, with Brexit, the pathway is more difficult.

One last note, in the US schools, the attrition rate has been steady at 3% for decades. However, the worst attrition rate is by BS/MD students at nearly 5%. And these other students who have formally been excepted and started medical school. We don’t know how many have dropped out in the BS phase.

 

[gonnif]

Just to add to an earlier comment by @LizzyM . The number of physicians is not limited by medical school seats, but rather by residency slots, Since the founding of the republic the United States has always relied on foreign born/educated physicians, which now make up about a quarter of the total physician workforce in the US. While there has been an increase of about 40% total first year medical seats since 2009 across MD/DO, there has been much less growth and pipeline residency slots. While medical schools may oversee the training and residency, the GME slots are based on a complicated formula for Medicare, and assigned them to the hospitals. Indeed, the slots are owned by the hospitals that are used in arrangement with medical schools for residency training. In short, there’s a disconnect between the medical school seats and the residency slots. And for those of you who at least have even a passing note of the political scene, ain’t nothing gonna get done by Congress to increase these slots anytime soon.

 

[gonnif]

There is not a physician shortage, just a maldistribution. People just don't feel like practicing in, say, Jonesboro, AR or Kalispell, MT.

I will disagree with my right honorable colleague from West of St. Louis on this particular point. It was considered dogma by the AMA was a formal report in 1980 that we were going to have too many physicians. This is why between 1980 and 2000 only one allopathic medical school opened in the US. Several osteopathic schools expanded during this time frame. It wasn’t until about 2000 at the AMA decided as premise of too many physicians was false, which is why between 2009–19, first year MD seats, increased by 30%. Number first your osteopathic seeds approximately doubled, so roughly since 2010 we have increased the overall number for first year medical school seats by 40%.

The maldistribution, both geographically and medical specialty, is certainly a major factor in the overall physicians shortage. And I would also argue that the reimbursement structure for primary care also limits the distribution. The insurance cost for some specialties and certainly now the political climate for some also limits care.

And now madame speaker, I yield the floor

 

[chicandtoughness]

(Gonna be honest, as a non-trad starting med school, I would not trust a high school graduate to enter med school right away. Is this a "get off my lawn" granny take? Possibly. But seeing some of these folks with full blown bachelors degrees still struggle with common sense and professionalism makes me nervous to have anyone younger in med training.)

 

[EdgeTrimmer]

(Gonna be honest, as a non-trad starting med school, I would not trust a high school graduate to enter med school right away. Is this a "get off my lawn" granny take? Possibly. But seeing some of these folks with full blown bachelors degrees still struggle with common sense and professionalism makes me nervous to have anyone younger in med training.)

People mature at different ages.

 

[chicandtoughness]

People mature at different ages.

Unfortunately, thanks to the limitations of biology, no one's prefrontal cortex is fully developed by age 17.

 

[senecca]

Unfortunately, thanks to the limitations of biology, no one's prefrontal cortex is fully developed by age 17.

We don’t have to hold off the train until every passenger made up their mind. Just publish the schedule and stick to the schedule. People who want more time to make up their mind, can take more time. There are students who wanted to become doctors at 10, never wavered and got into med schools.

I am hearing that the attrition rate for medical schools is 5%. So, if we need to train 1000 doctors per year, just increase the total seats by 5%.

 

[LizzyM]

Unfortunately, thanks to the limitations of biology, no one's prefrontal cortex is fully developed by age 17.

Furthermore, there are things taught in medical school that we should not be subjecting minors to. We start instructing students on taking medical histories in M1 year. Should we be asking minors to ask adults about their sexual behaviors and other aspects of social history and to make assessments of risk based on the responses? It seems like we would be requiring activities that they are not emotionally prepared to handle.

 

[LizzyM]

We don’t have to hold off the train until every passenger made up their mind. Just publish the schedule and stick to the schedule. People who want more time to make up their mind, can take more time. There are students who wanted to become doctors at 10, never wavered and got into med schools.

I am hearing that the attrition rate for medical schools is 5%. So, if we need to train 1000 doctors per year, just increase the total seats by 5%.

Part of the reason that the attrition rate is so low is because the ticket price is so high. Once you sign that first student loan note, you almost have to go through with it all the way to licensure because there is almost no other way to pay off the loans.

We've been doing the 4 years of college, 4 years of medical school thing for >100 years (since the Flexner Report ushered in the modern era of medical education). We've toyed with 2+4 and 3+4 plans and found them to be of benefit to the undergrad institution that attracts high flyers but a detriment to the medical school for a variety of reasons.

Other countries do it differently but they also finance education differently, finance health care differently, and pay physicians far less. And, if the number of physicians attempting to immigrate is any indication, many educate more physicians than they have the ability to support as attendings.

The original question suggested that we could increase the number of URM physicians by taking kids right out of HS but our past experience with <8 year paths did not attract that demographic. It also overlooks the bottleneck of residency slots. Overall, it is a big "no" anyway you look at it in terms of increasing the population of URM physicians practicing in the US.

 

[chicandtoughness]

We don’t have to hold off the train until every passenger made up their mind. Just publish the schedule and stick to the schedule. People who want more time to make up their mind, can take more time. There are students who wanted to become doctors at 10, never wavered and got into med schools.

Reread my previous post for comprehension. I said nothing about deciding to attend or even desire to attend. I don’t care if little Jimmy wants to have a drink when he’s 13; the legal drinking age is still 21 and that’s for a reason.

I specifically referenced the ability to make responsible, ethical decisions based on the bare minimum of neurological development. That said, plenty of people with fully developed brains still struggle with maturity, as I’m seeing with some of my classmates. If a significant portion of 23-year-olds are still struggling with being respectful and appropriate, I hate to see what standardizing the entry age to 17 (or lower) would do.

 

[gonnif]

We don’t have to hold off the train until every passenger made up their mind. Just publish the schedule and stick to the schedule. People who want more time to make up their mind, can take more time. There are students who wanted to become doctors at 10, never wavered and got into med schools.

I am hearing that the attrition rate for medical schools is 5%. So, if we need to train 1000 doctors per year, just increase the total seats by 5%.

The overall graduation rate is 97% and that has been stable for decades. It is the direct (and presumably younger) students in BS/MD programs who have a 5% attrition rate once they start medical school. And likely there is significant attrition in the three years prior in premed. So we graduate 97% of US MD students and I think the DO rate is at 96%. In both groups graduate medical education (GME or residency) placement rates are in excess of 99% when counting all the systems (NRMP, SOAP, military, SF Match, Urology, etc)

In addition to slow rate of growth in residency programs and slots, it should also be noted that there is a dearth of clinical sites for medical students. You cannot simply throw medical students into without clinical supervision, attending physicians, and agreements between the hospitals and the medical schools. Two or three generations ago. Every doctor assumed that they would be supervising certainly residents if not medical students. Many do not want the added burden. Additionally, many hospitals would rather use PAs/NP’s on staff than rely on residents.

 

[Nontrad_FL_LGBT]

Two or three generations ago. Every doctor assumed that they would be supervising certainly residents if not medical students. Many do not want the added burden. Additionally, many hospitals would rather use PAs/NP’s on staff than rely on residents.

Totally off-topic, but this is a disgrace on behalf of the profession and a poison I see in my own non-medical profession as well. Integrity and keeping the door open for new generations is so important; do not enter a profession where teaching is an expectation if you can't be bothered to extend that same grace to others that your seniors did to you.

 

[gonnif]

Has made it very difficult Totally off-topic, but this is a disgrace on behalf of the profession and a poison I see in my own non-medical profession as well. Integrity and keeping the door open for new generations is so important; do not enter a profession where teaching is an expectation if you can't be bothered to extend that same grace to others that your seniors did to you.

The growing burden of extreme administrative duties that the last few generations of physicians have had placed upon their shoulders for both medical record, keeping, and insurance has made it very difficult to find time as well as the loss of income to be teaching. This of course is now being exacerbated by the corporatization of medicine. Large health systems associated with medical school have teaching as part of their culture. other health systems do not, and have less incentive to do so

 

[Nontrad_FL_LGBT]

The growing burden of extreme administrative duties that the last few generations of physicians have had placed upon their shoulders for both medical record, keeping, and insurance has made it very difficult to find time as well as the loss of income to be teaching. This of course is now being exacerbated by the corporatization of medicine. Large health systems associated with medical school have teaching as part of their culture. other health systems do not, and have less incentive to do so

Yeah, I understand it's a broad systemic issue. Doesn't mean it's not shameful. There's a lot that the current American medical-health insurance complex has to answer for. I am hopeful that the tide begins to change as unions seem to be coming back into fashion in wider society and even residents. I suppose we'll see how things go.

 

[Mr.Smile12]

Yeah, I understand it's a broad systemic issue. Doesn't mean it's not shameful. There's a lot that the current American medical-health insurance complex has to answer for. I am hopeful that the tide begins to change as unions seem to be coming back into fashion in wider society and even residents. I suppose we'll see how things go.

AI's gonna make it so much better.

 

[LizzyM]

The growing burden of extreme administrative duties that the last few generations of physicians have had placed upon their shoulders for both medical record, keeping, and insurance has made it very difficult to find time as well as the loss of income to be teaching. This of course is now being exacerbated by the corporatization of medicine. Large health systems associated with medical school have teaching as part of their culture. other health systems do not, and have less incentive to do so

And don't get me started on medical centers "selling" training slots for medical students to off-shore schools, making fewer slots available for students from US schools. This is truly a disgrace!

 

[gyngyn]

It appears that everyone has had their say.