Do we really need greater numbers of lesser trained physicians?

My Swedish medical school curriculum was 5 1/2 years, but I remember during a third-year class trip to the Soviet Union hearing that some doctors over there had a much shorter education. My classmates and I were at first surprised to see physicians staffing ill equipped ambulances, riding the streets of Moscow with critically ill patients and no equipment to deliver care. We concluded that physician labor was cheap and medical equipment expensive.

In today’s American health care debate, the duration of medical education has cropped up as a solution to the physician shortage dilemma. A recent article in the New York Times by Dr. Pauline Chen describes the final year of medical school as a year of laid back electives and extended vacations. This was certainly not the case with years four and five when I went to medical school, and it helps me understand the difficulties I have seen many of my younger, American-trained colleagues have over the years.

In primary care, much of what we see falls into what American medical education treats as somewhat elective. You can get a medical degree without knowing a whole lot about ophthalmology, for example, but if you are fast-forwarded through medical school and residency to fill staffing needs in an underserved rural community, and a patient walks in with acute angle closure glaucoma or an iritis, will you know what to do? Will you recognize an emergency when you see it? And without spending time both in the psychiatric ward and in psychiatrists’ offices, how equipped will you be to assume the role of sole mental health provider for a small town population?

Abbreviated medical education may be a way for government to produce better health care workforce statistics, and it may help drive physician salaries down even more. But, really, we already have two kinds of medical providers with a shorter education — nurse practitioners and physician assistants. Do we need a third, at the expense of patients and health care organizations who have counted on improved primary care in these times of patient centered medical homes and the like?

In an era where medical information continues to expand, and the complexity of health care continues to grow, do we really need greater numbers of lesser trained clinicians, or should we look at reforming the four year medical curriculum to better prepare doctors for the realities of practice where we need them most?

“A Country Doctor” is a family physician who blogs at A Country Doctor Writes:.

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  • PoliticallyIncorrectMD

    Agree with your argument in general, though would have few corrections:

    1. In the former Soviet Union the length of medical education was the longest (6 full years before internship) – this did not necessarily create “better” doctors. Much of this was an “academic” knowledge without real life applications.

    2. In the US system, medical school is not where you learn to practice medicine, the residency is. It might not be unreasonable to cut few years from the premed and med scholl education and, instead, increase the length of residency and lift bogus restrictions on residents hours to allow for more hands on training.

    • rbthe4th2

      What would you think of the English or Indian (India) model? Do you think that going from high school to med school would be the deal?

      • ninguem

        We have had programs like that in the USA for decades, fifty years, maybe more. If they were a particular advantage they would have proliferated. A handful continue to operate.

        • rbthe4th2

          In medicine, hierarchy and the way things are done could stand in the way of that issue.

  • Steven Reznick

    I could not agree with you more. The return of the rotating internship or a mandatory year in a general training public health national service program before you can specialize would go a long way toward broadening the horizons of our physicians and giving them a better perspective of the problems and decision making required in other areas of medicine

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Seems the Russians are trying to address the same “problem” we are, with similar tools – less education, or make believe education http://blogs.bmj.com/bmj/2013/02/11/vasiliy-vlassov-the-destruction-of-medical-education-in-russia/