Don’t shorten medical school: Shorten undergraduate training instead

Should medical school be shortened to three years?

I say, “no.”

Here’s why.

There is way too much to learn in 3 years. Unless medical education is radically changed, it will be impossible for students to memorize all the unnecessary stuff they still have to memorize, complete all their clerkships, and move onto the next phase — residency training.

I do not see how medical students can choose a career path before they have had experience with rotations in all of the major specialties. I have had numerous queries from students in four-year schools who do not know what they want to specialize in even by the first part of their fourth year.

Yes, the fourth year of medical school currently is not productive. However, the amount of time needed for students to choose their specialties and interview at 15 or more different residency programs could not possibly be squeezed into the third year of a three-year program.

Some have said that shortening medical school to three years would increase the number of doctors produced. That would be true for one year when schools would graduate two classes, the three-year and four-year groups. But after that year, the same number of students would graduate from school as did so when the length of time was four years.

By the way, that year with the double graduating classes would be difficult to manage because there is already a predicted shortage of residency positions by 2015. This is due to the federal government’s cap on the funding of resident positions. Graduating more than 40,000 medical students at the same time when only about 25,000 residency slots are available would be chaotic.

Here’s a better solution.

The length of time it takes to become a doctor could be shortened by simply not mandating that every medical student have a four-year undergraduate degree before starting medical school.

Who says that medical students need to have a bachelor’s degree in anything? If for some reason that is still desired, students could attend college through the summers to pick up enough credits for a degree.

A few medical schools in the United States have had accelerated programs in place for many years. For example, a program jointly run by Penn State University and Jefferson Medical College graduates doctors with both BS and MD degrees in six or seven years. It’s been around since 1964. A longitudinal study over 26 years showed that doctors who completed that accelerated program performed at a level indistinguishable from traditional eight-year graduates.

A recent compilation lists several colleges/medical schools (of 140 or so MD-granting medical schools in the US) with similar accelerated programs.

Several European countries use similar models and seem to have healthy citizens.

Shortening or accelerating the undergraduate experience would save a year or two of tuition expense, accomplish the desired saving of time, and not disrupt the four-year medical school cycle.

“Skeptical Scalpel” is a surgeon blogs at his self-titled site, Skeptical Scalpel.

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  • Dr. Drake Ramoray

    I agree 100%. I hope that this idea continues to gain traction as I think it is the best way to shorten the length of training.

  • JR

    I think Bachelors degrees in general should be cut to three years with a bunch of electives cut out.

  • NPPCP

    Nothing is better than monitored experience. My years (lots of years) as an RN in many different fields are invaluable to me in my clinic. I think this is a good idea as well.

    • Skeptical Scalpel

      I don’t believe that any state in the US allows med school graduates to practice without at least one year of residency training and in many states, it’s two years.

      The definition of “general practice” stated above is not one I have ever heard. Family practitioners used to be called GPs. They still are in the UK.

      • http://www.chrisjohnsonmd.com/ Chris Johnson

        In my father’s (and grandfather’s) day — both were rural physicians in MN — a GP was someone who had completed a 1 year rotating internship and then went out and hung out their shingle. That hasn’t really been done since the early 1960s.

        The emergence of family practice as a specialty with a 3 year residency came out of the late 1960s.

  • PCPMD

    If anything, PCP’s need more training, not less. The idea of a 4th year medical student waking up the morning after graduation as an independently practicing primary care physphysician is truely terrifying. GP’s were great when medicine was signifanctly simpler. They have no place in modern Medicine, IMO.

    • Patient Kit

      This may be a stupid question, but what exactly is a General Practitioner compared to Family Medicine or Internal Medicine docs?

      • PCPMD

        A GP, or “general practitioner”is a physician without any additional training beyond medical school.

        By comparison, FP’s and Internists have completed a minimum of three additional years of primary care training, where they actually learn how to practice medicine.

        Most states will no longer grant a license to practice medicine without this additional training (grandfathered GP’s not withstanding)

        • Patient Kit

          Ah!, thank you for explaining. So, GPs start practicing medicine as soon as they graduate from med school? No residency at all? I don’t remember actually coming across any GPs but, now, if I ever do, I’ll know what it means. I have to admit, I wouldn’t be comfortable seeing a doc who “only” went to med school.

          • EmilyAnon

            I didn’t know that either. I think I’ve used ‘GP’ loosely around my internist who I know has 4 years of residency under his belt. Better be more careful.

          • querywoman

            Oh, how I love the vanishing GPs. I have often found a little bit of knowledge to be dangerous in a doctor.
            GPs learned on the job.
            I see mostly specialists now, excellent ones, but I still like the instincts of a lesser trained good GP.

          • Skeptical Scalpel

            Sorry to repeat but my comment elsewhere may not have been noticed.

            I don’t believe that any state in the US allows med school graduates
            to practice without at least one year of residency training and in many
            states, it’s two years.

            The definition of “general practice” stated above is not one I have
            ever heard. Family practitioners used to be called GPs. They still are
            in the UK.

          • T H

            For nearly every state in the union, a physician cannot practice or hold a medical license without completing at least an internship.

        • buzzkillerjsmith

          not quite right see my reply to pt kit

          • PCPMD

            Thank you, I stand corrected.

      • buzzkillerjsmith

        GPs, a vanishing breed, have one year of training after med school. You can’t get a license to practice medicine without a year of residency, at least in WA or CA. FPs and IMs and pediatricians have 3 years of training after med school.

        You can’t get privileges to admit to a hospital as a GP. You can’t get a job where the other docs speak English very well. But you are well-qualified to commit Medicare fraud.

        • Patient Kit

          Thanks for your descriptive explanation. I don’t think I’m likely to run into any GPs. But now I have a better idea of what one is, in case I do come across one. BTW, you forgot to tell me that there are no stupid questions. ;-). I know, I know. There ARE plenty of stupid questions. :-p

  • Dave

    Agreed. Shortening medical school is not the answer, especially as medical science continue to advance at such a fast pace. We’re just at the beginning of an era when understanding of the basic science behind medicine will be more important than ever before. And with regards to fourth year, while some students treat it like a vacation, some really do suck the marrow out of it and are better doctors because of it.

  • guest

    I agree. I went to high school in Europe. When my friends from high school were finishing med school I was just completing my 1st year. They could not and still do not understand why a college degree was needed. On the other hand my 1st two years of college here were a repetition of what I learned in a European high school. Their med school is 6 years. I would improve our high schools, eliminate college and make last few years od med school more meaningful, such as with more responsibility, seeing patients with practicing physicians, learn more. I think 4 or 5 years is enough for med school if the focus changes to actual learning in the last few years instead of shadowing without communication, slaving away for the residents and mostly just waiting around for the whole experience to be over before starting residency. However, considering that recent study where interns were shown to spend only 12% of their time with patients residency may not be the ideal learning experience either. Make learning and teaching a priority and med school could last 6 years and you could produce something closer to an actual physician at that point.

    • Skeptical Scalpel

      Yes. Medical education needs an overhaul too.

  • Dr. Cap

    Agree 110%. I thought the seven year program students were immature. Well, most still lived at home, so, there’s that.

  • Skeptical Scalpel

    I agree. If it does happen, it will take years and years to accomplish.

  • T H

    Submit a plan: what would you cut out from 1st and 2nd year curriculum? I submit that pharm, path, and physiology need to be expanded, not contracted. Same for immunology, genetics, micro, etc.

    And don’t discount ‘life experience’ and ‘time to mature,’ they have a value all their own for up-and-coming MDs/DOs.

    Cutting down on a Bachelor’s? I’m fine with that.

  • T H

    Don’t discount college experiences: even learning what NOT to do can be valuable later on in life… but shortening undergrad would be fine, especially now that ‘traditional’ students are a dying breed..

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