U.S. model vs foreign models of medical education

[Reformer]

In most other countries, you can attend medical school directly (or almost directly) from secondary school. Instead of 8 years (for UG and med school), it is only around 5 years. It is also usually heavily subsidized if not outright free.

The drawback of course is that in return for subsidized education, these countries have government controlled health care systems like the British NHS or single payer systems like in Canada. You are therefore either a direct govt employee or are paid at govt regulated uniform rates. Incomes are not as high as in the U.S and therefore prestige is not as high although they are still reasonably well paid.

Still the advantages might outweigh the drawbacks. There is less schooling and almost no debt which is a huge plus. Furthermore while incomes are not as high, there is no huge debt to service. Liability insurance costs are also kept under control in these other countries much better than here.

And making potential pay not as exorbitant weeds out people who are motivated almost completely by the high pay rather than a true desire to practice medicine. And these other countries don't suffer from a lack of highly trained physicians despite the lack of potentially exorbitant pay.

I sometimes wonder if the foreign system of medical education is better than the U.S. model. I realize of course that this system would turn off potential medical students that are in it for the money. But OTOH, this system would attract students to the field who would consider medicine if not for the exorbitant debt and are willing to do it for lesser (but still good pay) which would more than balance out.

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[dilated]

And making potential pay not as exorbitant weeds out people who are motivated almost completely by the high pay rather than a true desire to practice medicine.

I think you need to reform your use of the term "exorbitant". 250k a year after spending the better part of your life in school is not "exorbitant" in a country with NBA stars and banking executives.

High pay -> high prestige profession -> high quality people. Thankfully, nobody is even considering any of the things you suggest in your post so I don't have to worry about my younger colleagues being a bunch of *******es (but so altruistic, they try hard but all the bright ones went into banking!).

 

[Reformer]

I think you need to reform your use of the term "exorbitant". 250k a year after spending the better part of your life in school is not "exorbitant" in a country with NBA stars and banking executives.

High pay -> high prestige profession -> high quality people. Thankfully, nobody is even considering any of the things you suggest in your post so I don't have to worry about my younger colleagues being a bunch of *******es (but so altruistic, they try hard but all the bright ones went into banking!).

These are lots of other professions that require as much education as being a physician over the course of a lifetime. Most of them don't make 250k a year. And the system that I suggest is already the case in virtually all other countries with the exception of the U.S. These other countries hardly have a bunch of "*******es" for physicians.

 

[greatnt249]

And making potential pay not as exorbitant weeds out people who are motivated almost completely by the high pay rather than a true desire to practice medicine.

Great, another premed who feels that doctors should take a hit for doing what they do.

You say this as if there are boatloads of people who go into medicine just for the pay. In reality, if I ever ran into one of those premeds or students who stated this as the reason they went into medicine, I would laugh right in their faces; you're a sucker if you think you're going to get rich in medicine these days.

 

[texahn]

These are lots of other professions that require as much education as being a physician over the course of a lifetime. Most of them don't make 250k a year. And the system that I suggest is already the case in virtually all other countries with the exception of the U.S. These other countries hardly have a bunch of "*******es" for physicians.

How many of these other professions require someone to pay tuition as high as medical schools while spending much of his/her 20s in intense training while under constant threat of lawsuits?

 

[45408]

These are lots of other professions that require as much education as being a physician over the course of a lifetime. Most of them don't make 250k a year. And the system that I suggest is already the case in virtually all other countries with the exception of the U.S. These other countries hardly have a bunch of "*******es" for physicians.

I'm planning on being a surgeon. I'm applying now for a 5-year residency, with 80 hour weeks for most of that duration. Let's throw in a year of research and a one year fellowship. That's over 25,000 hours, which would amount to 12-13 years at a normal job, in addition to the 8 years I already put in for med school and college. Other than something like a PhD/post-doc, what other profession has anywhere near that level of training?


And that's not even close to the upper limit. There's a peds CT surgeon here that started college in 1982 and finished her last fellowship in 2004.

 

[turkeyjerky]

Leaving aside the issue of pay (although it always puzzles me that there are people out there who argue they should be paid less), I do think that medical education could do with a good reform.

The way I see it, they could easily cut premed down to two years of humanities and basic sciences, with automatic volunteering/clinical experiences thrown in. Then, you take the mcat and, if you're score is sufficient and you pass a quick interview, you move on to med school proper at the school that is affiliated with your undergrad. That way you get your md after 6, rather than 8, years.

 

[MilkmanAl]

I'm planning on being a surgeon. I'm applying now for a 5-year residency, with 80 hour weeks for most of that duration. Let's throw in a year of research and a one year fellowship. That's over 25,000 hours, which would amount to 12-13 years at a normal job, in addition to the 8 years I already put in for med school and college. Other than something like a PhD/post-doc, what other profession has anywhere near that level of training?


And that's not even close to the upper limit. There's a peds CT surgeon here that started college in 1982 and finished her last fellowship in 2004.

This was my initial reaction. If anything, I'd argue that physician salaries are too low, not "exorbitant." That goes double for primary care docs. I'm not in this profession solely for pay, but there's not a chance in hell I'd be on this path if my maximum earning potential was in the $150k range or less. I would've taken my physics degree and run to the nearest engineering firm or business in need of an analyst and settled down.

The way I see it, they could easily cut premed down to two years of humanities and basic sciences, with automatic volunteering/clinical experiences thrown in. Then, you take the mcat and, if you're score is sufficient and you pass a quick interview, you move on to med school proper at the school that is affiliated with your undergrad. That way you get your md after 6, rather than 8, years.

That sounds pretty reasonable to me. In my mind, there's no question that the pre-med curriculum needs drastic reworking to be more applicable to med school.

 

[HurricaneKatt]

This was my initial reaction. If anything, I'd argue that physician salaries are too low, not "exorbitant." That goes double for primary care docs. I'm not in this profession solely for pay, but there's not a chance in hell I'd be on this path if my maximum earning potential was in the $150k range or less. I would've taken my physics degree and run to the nearest engineering firm or business in need of an analyst and settled down.

That sounds pretty reasonable to me. In my mind, there's no question that the pre-med curriculum needs drastic reworking to be more applicable to med school.

I have to agree. I am not in Medicine for the money (In my opinion, that is one of the worst things you could do) but I would like to be compensated for the very large chunk of my life I am losing. After spending 8+ years in school, and shelling out enough money to raise two or three families and being so deep in debt I will literally be swimming in it...and then spending several more years in Residency making little to nothing and working more than most sane people would ever even consider working.... Well, I'd better make some decent money or I will never ever be free of debt!!!! And living in debt is not something I want to do for my whole life. That said, I really do want to help people and have always been fascinated by medicine and bodies - in elementary school I was drawing skeletons to help me learn more about body form! haha

I also think that the whole idea of Premed is a little skewed. The idea, in my opinion, is to complete several things before entering Med school:
to filter those who can't handle a very heavy work load, through the MCAT they test retention of what you learn not so much what you learned itself because they will reteach it to you the way they want you to know it, and to get a chance to build a well-rounded foundation before entering a fairly one-track career.
However, because people focus so much on the sciences and preparing for Med school, the well rounded part is often lost. I don't really have any brilliant ideas about how Medical Education should change, but I do agree it should change - not too much though I'm not really into the idea of socialized medicine or anything like that.

 

[rwe4me]

High pay -> high prestige profession -> high quality people

This is a troubling statement. I don't see the correlation between high pay and high quality people. Quality of an individual isn't measured by how much money they make/have. I know a few docs (and a few non docs) with jillions of $$ that I think are low class @$$es. $$ ≠ quality. Can't stand a doc who thinks the world owes him obeisance because of his degree.

 

[HurricaneKatt]

This is a troubling statement. I don't see the correlation between high pay and high quality people. Quality of an individual isn't measured by how much money they make/have. I know a few docs (and a few non docs) with jillions of $$ that I think are low class @$$es. $$ ≠ quality. Can't stand a doc who thinks the world owes him obeisance because of his degree.

I agree. Money and a good job does NOT make a good, or "high-quality" person. In fact, some of the poorest people I know are the most "High-quality" that I know. I think in some (but not ALL) cases high pay-> higher education, which is good. But other than that...

 

[psipsina]

I'm planning on being a surgeon. I'm applying now for a 5-year residency, with 80 hour weeks for most of that duration. Let's throw in a year of research and a one year fellowship. That's over 25,000 hours, which would amount to 12-13 years at a normal job, in addition to the 8 years I already put in for med school and college. Other than something like a PhD/post-doc, what other profession has anywhere near that level of training?


And that's not even close to the upper limit. There's a peds CT surgeon here that started college in 1982 and finished her last fellowship in 2004.

Agreed. If I'm going to put all these years in while accumulating/not paying down my debt I need a guarantee that I'll be able to make up for that later. The idea of doing this just to end up drowning in debt, struggling to send my kids to college and save for retirement is just absurd. I don't need to roll in a bently and bathe in champagne but there needs to be a guarantee of financial safety at the end of this road. I'm fine being broke now and staring down those scary statements from my loan people and working my tail off for free/minimum wage as long as that promise of a good future is there. To do what I love the years of struggle are worth it as long as I know that my family will be taken care of in the end.

 

[dilated]

This is a troubling statement. I don't see the correlation between high pay and high quality people. Quality of an individual isn't measured by how much money they make/have.

You skipped the middle part of it. Just following money doesn't always bring the best people into a field. But American society associates prestige with pay, and like it or not prestige is a huge factor in what field the top achievers decide to pursue. Teach For America was started because none of the top college graduates in the country were going into teaching because it was viewed as low prestige.

Maybe in twenty years with people like the OP pushing doctors pay and status down, we can get Operate For America where Harvard graduates can spend a few years doing cardiac surgery before going on to Wall Street to make their fortunes!

 

[MilkmanAl]

You skipped the middle part of it.

It's still a false connection. Prestige doesn't make you a good or "high quality" person, no matter how much all the socially-incompetent and/or insanely egotistical med students might wish otherwise.

 

[HurricaneKatt]

Agreed. If I'm going to put all these years in while accumulating/not paying down my debt I need a guarantee that I'll be able to make up for that later. The idea of doing this just to end up drowning in debt, struggling to send my kids to college and save for retirement is just absurd. I don't need to roll in a bently and bathe in champagne but there needs to be a guarantee of financial safety at the end of this road. I'm fine being broke now and staring down those scary statements from my loan people and working my tail off for free/minimum wage as long as that promise of a good future is there. To do what I love the years of struggle are worth it as long as I know that my family will be taken care of in the end.

Exactly.

 

[lisichka]

And that's not even close to the upper limit. There's a peds CT surgeon here that started college in 1982 and finished her last fellowship in 2004.

this is called legalized slavery. i want foreign education module. much simpler. and as effective.

 

[45408]

(although it always puzzles me that there are people out there who argue they should be paid less)

Especially when "those people" are pre-meds on SDN. Stick up for yourself and your future salary - if you don't, why would anyone else stick up for you?

 

[VincentAdultman]

These are lots of other professions that require as much education as being a physician over the course of a lifetime. Most of them don't make 250k a year. And the system that I suggest is already the case in virtually all other countries with the exception of the U.S. These other countries hardly have a bunch of "*******es" for physicians.

I wonder how many other professions are made to feel bad about how much money they make.

 

[Reformer]

It appears that many people have missed my point entirely.

Right now medical education is very long and arduous and the money that is spent on it is a small fortune. And residency training is especially tough because of super long hours for low pay while carrying a huge debt burden. Because of this sacrifice, it is only worth it if you can get a big payday to make up for these sacrifices. The point I am making is that it doesn't have to be this way because this is not how other countries do it.

For example, you could make it like this:
1. Medical education can be made to be available post-HS. So make it 5 years instead of 8 years post-HS, same as is the case for the MBBS. Upon graduation you become a junior physician.

2. Subsidize medical education so that the loan burden is small and easily manageable.

3. Improve pay and working hours for graduate medical education (GME). Make it so that junior physicians are like PAs except once you finish the requisite GME, you become a full fledged physician. The problem of too-long hours for doctors has largely been addressed in Europe, where the European Union restricts physicians' shifts to 13 hours and their workweeks to 48 hours. In France, doctors work a maximum of 52.5 hours a week, and in Denmark, only 37 hours. Weekly work-hour limits in the United Kingdom range from 56 to 64 hours.


Now the catch though is that since the govt subsidizes medical education and training, you'd have to work for a govt health care system where your pay is determined by that system. In these systems, the pay is still good and the jobs secure but the pay is less than is the case in the U.S. Still there are no huge student debts to be burdened with so it evens out somewhat. Also no dealing with overhead and malpractice and crap like that. The govt deals with all this and you can just focus on actually practicing medicine as a govt employee.

Would some people be willing to work under a national health care system where student debt is non-existent, length of post-secondary education is shorter, junior physicians have okay pay with good work hours during residency training with the drawback that you make good pay but less than in the U.S.?

 

[psy]

If we can take care of the overhead and malpractice, most doctors would agree. However, these aren't politically feasible. And politics rule medicine...and about to rule even more of medicine

 

[lee9786]

Sometimes I wonder how people come up with these decisions. The educational requirements/costs are all increasing in healthcare-related professions. At the same time the compensation for these professions are threatened. 250k/ year is not a lot compared to a big shot health insurance CEO making a couple million a year. The last thing that should be wanted is potential healthcare workers saying it's not worth it and choosing a nonhealthcare related path. It seems that this fact is getting overlooked.

 

[HurricaneKatt]

I think a lot of things are getting overlooked...

 

[Peter Benders]

i agree with hurricane. there are a lot of things being overlooked. i think foreign models and u.s models are equally good in their own aspects.

 

[turkeyjerky]

Especially when "those people" are pre-meds on SDN. Stick up for yourself and your future salary - if you don't, why would anyone else stick up for you?

C'mon man--premeds aren't people.

 

[Dr.Millisevert]

Incomes are not as high as in the U.S and therefore prestige is not as high although they are still reasonably well paid.

In Australia residents (doctors in training) are usually paid "at least" double if not more than double than what US doctors get paid as residents.

Also, even in the US you have quite a few medical schools which have 6-7 year programs for students out of high school which is no different than many other places around the world. Medical school in most places in Europe is 6-8 years long too.. they simply usually choose their students straight from high school rather than make all of them complete a science degree beforehand.

In Australia there is a mix of med schools.. half of them are 6 years long and the other half are 4 years and require a pervious degree. (same as in the states).

... at the end of the day.. all medical schools educate their students to the same level of medical knowledge and competence. If you're able to complete your exams and obtain a medical license.. you're no less qualified to be a doctor than anyone else.

However, I do agree with you that governments should subsidize medical education to a higher degree.

 

[Thomasss]

For example, you could make it like this:
1. Medical education can be made to be available post-HS. So make it 5 years instead of 8 years post-HS, same as is the case for the MBBS. Upon graduation you become a junior physician.

2. Subsidize medical education so that the loan burden is small and easily manageable.

3. Improve pay and working hours for graduate medical education (GME). Make it so that junior physicians are like PAs except once you finish the requisite GME, you become a full fledged physician. The problem of too-long hours for doctors has largely been addressed in Europe, where the European Union restricts physicians' shifts to 13 hours and their workweeks to 48 hours. In France, doctors work a maximum of 52.5 hours a week, and in Denmark, only 37 hours. Weekly work-hour limits in the United Kingdom range from 56 to 64 hours.

I would think that option 1 would make a lot of sense,although it will never happen. I don't understand why so many professional degrees (teachers, doctors, lawyers) require an undergraduate degree. If well-roundedness is a concern, make it the first year of the Med degree, just like that's supposed to be the first year of your undergraduate degree. I would think the requirement of an additional 4 year degree is detrimental to the time and cost to the individual, and the society as a whole. Even if the total price of the undergrad degree is negligible compared to the Med degree, the 4 additional sucked-up years from the doctor's working years costs both the doctor, and the healthcare system in total.
As for subsidies: you're going to have a hard time coming up with the money for that anytime soon.
And as for changing working conditions, there are a lot of cultural barriers to that, and I'm not sure its as fundamental to fixing the system at this point.

 

[RGMSU]

Wait until you get into med school, if you do... then you'll see why nobody would do it for less than physicians currently get paid. Trust me - NOBODY would do it! $150-250,000 debt, 4 years of working non-stop and then additional years of residency at the same pace - don't tell me everybody else in every other career does this. I just spent all labor day weekend studying for an end of block med school exam while I listened to everybody else outside at the pool all weekend. Doesn't sound like we're all doing the same thing to me. With all due respect, wait until you have experienced the medical school education in America before you choose to comment about something you know nothing about. Plus, we could never shorten the duration of medical education in this country. American colleges must spend four years teaching undergraduates everything they didn't learn in the public high school system. Now, the government paying for medical education - there's a bright idea! Just make it retroactive for the rest of us. There IS a correlation between potential income and the quality of the talent you attract. Don't be so naive as to think there isn't. Learn how the real world works. The duration and rigor of medical school education IS appropriate. At the end of it, your responsibilities are great, the stakes are high, and you need all the preparation you can get. If you don't understand that, you have no business accepting responsibility for other peoples' healthcare. My prediction is that physician salaries won't change that much because supply/demand will dictate that salaries not fall below a certain level. Specialist salaries likely will go down a bit due to cost control efforts. As far as shorter methods of education for getting into healthcare, keep in mind that there are options for being non-physician providers. If 11 or 12 years of education spooks you, PA training, NP training, etc, may be a better option.