Earning an MD Degree in Six Years to Reduce the Debt-Load of Medical Students

I was admitted to medical school without an undergraduate degree nearly 50 years ago. I had completed the obligatory courses for admission and the University of Michigan Medical School accepted me. Medical schools and professional medical associations are now under pressure to reduce the number of years required to obtain an M.D. because of the increasing debt-load of newly graduating physicians (see: AMA Looks to Put Brakes on Debt Load of Med Students). Below is an excerpt from this article with boldface emphasis mine:

Medical students who went into debt could figure on owing $126,714 in 2007 on average, up from $88,331 in 2000, according to the Association of American Medical Colleges. You can figure the debt tab has only gone up since then. Such statistics are being cited by American Medical Association as docs prepare for their [upcoming] confab in Chicago next week....Suggestions under consideration would take approval by powers greater than the AMA. They include providing tax deductibility for tuition and loans, and expanding state and federal scholarship opportunities. But another cost-cutting approach is investigating ways to reduce the length of medical schooling—perhaps through competency-based curriculums, or through combined B.A./M.D. programs. Some schools already offer a variety of such combination programs, though only a handful actually shorten the total length of training. For those that normally don’t worry about the school loans carried by docs, remember that the med school debt load can have broader implications. It’s one of the most common reasons given for problems like the shortage of physicians and the skewing of medical professionals toward specialty practices.

How about consideration of programs to reduce the number of years required to obtain an M.D.? I personally believe that developing a combined B.A./M.D. degree programs is the wrong approach. This was attempted in the past at the University of Michigan Medical School -- the six-year program was called Inteflex and was ultimately abandoned (see: Be flexible -- Eliminating Inteflex would limit students' options). One of the reasons for its demise was that the 18-year-olds admitted to the program were being guaranteed admission to medical school after completion of their undergraduate courses. For many and because the pressure for admission to medical school was eliminated, they decided to take it easy, often receiving their degrees in eight or more years. Many also decided belatedly that the medical career path was not suitable for them.

Here's my modest proposal for shortening the number of years to earn an M.D. without spending a dime and without burdening medical school deans and curriculum committees with additional work. In order to understand this proposal, you need to understand that for most medical schools, the fourth year studies are comprised mainly, or even totally, of electives rather than mandatory courses.

• Medical schools should begin to accept students, as in former years, after three years if they have fulfilled all of their undergraduate course requirements. If this is impossible given the number of such prerequisites, this number should be reduced such that it is possible for most applicants to quality for the new program.
• On a selective basis, medical school should allow some students to skip their fourth year and graduate in three. This should only be an option for the most mature students who have amply demonstrated their ability to function well as they pursue their post-graduate medical training.

The likelihood of such a plan being adopted is probably slim. It will require minimal planning and, after all, medical school deans are compensated for their curricular planning expertise. The deans and presidents of undergraduate institutions would also probably oppose such a plan as they did when I pursued it many years ago. They will argue that physicians need the broader liberal arts background. However, I am not convinced that one more year of undergraduate studies will achieve this goal.

Comments

[Ajit Alles]

Maybe we should adopt the system in the British Commonwealth. Students go into medical school straight from high school. They receive an MBBS or MBChB(equivalent of the MD) in about 4 years. I went through such a program in Sri Lanka. The only catch is that High School is very intensive and more focused. I think that many FMG's practicing in this country are from former British Colonies and have a similar training. The training is similar to US Medical schools in terms of course content. I have felt no lack of education compared to my US colleagues.

[Brian Jackson]

Bruce,

Another idea -- I'm basing this on a proposal published in JAMIA a few years back by Bill Stead. Create a 2 or 3 year track for nurses and PA's to earn full medical degrees. The curriculum could be streamlined since these folks already have a lot of clinical knowledge. But keep the academic bar for admission about where it currently is for medical schools. I remember a med school classmate -- former nurse -- who was both extremely bright and extremely clinically experienced. It was stupid and wasteful to make her do all the same coursework the rest of us had done.

For this approach to be really effective, this country would have to figure out how to markedly increase the number of slots for nursing and PA schools -- but we should do this anyway.

This track would help potential doctors from being scared off by med school debt, since they could first get decent-paying jobs as nurses or PA's and then entertain finishing up the medical degree later on.

[Karl Robstad]

Hmmm, interesting.

As a graduate from a combined college/med school program myself, I feel like I have some insight to share on this.

Where I went to med school they had 3 combined programs, mine was 8yrs, and there was a 7yr and a 6yr program as well. IMHO, those kids who had only 2yrs of college, while they may have been very bright, some of them were wayyyyy to immature for medicine (one of them had a breakdown, actually, and dropped out). Having said that, however, to pick medical student to graduate early based on their 'maturity' is way vague and subjective and, I think, ultimately not fair. The issue of debt from education is undeniable, and GP is suffering as a result, for sure. And while I think cutting years is a clever approach, I just don't think it's the answer. Personally, I think the direct approach is the best here. Can ANYONE explain to me why med school was $55,000 a year for me? Sure ppl always say. "well, you'll be good for it in 8 years" or whatever, but that's really not ok. My med school was one building, with quite a finite list of teachers and services, yet it cost twice as much as college and didn't come with room or board! During my tenure as a medical student, we actually approached our dean about the outrageousness of the tuition (I think we were 3rd in the country for most expensive med school at the time), and the fact that it was continuing to go up. Well, he sat our whole class down and showed us a 100-foot pie chart of our expenses. And with that, we had our answer. Now, I'm not 100% sure I'm recalling this EXACTLY, but if memory serves me: 30% of our tuition went to float the hospital's pro-bono work. Is this true elsewhere? I was outraged, we all were. In addition to this we also had to pay a multi-thousand dollar 'national security fee' or something of like. Unreal. In the end we all just sucked it up, but it's not ok. Things need to be fixed or the system will collapse in on itself.

Nobody likes people that complain and then don't offer an alternative, so here are my ideas:
1. My medical school is as expensive as it is because we have one of the WORST endowments in the country. There should be more focus on giving back, in the form of alumni office activity, and also, you attendings out there should do your parts!!

2. If I go to med school, I should be paying for my education and not ER work for ppl without healthcare. I suppose this could be fixed by adopting a nationalized health care system, but I'm not about to open that can of worms. Again, I'm not sure if this situation is recapitulated elsewhere in the country, but there must be some shenannigans to justify $55,000 a year.

3. Go to a state school or live in a country outside the US. Many of my co-residents have ZERO debt because medical school is paid for by the government in their country. Now that's all good and what not, but in all seriousness, programs like this DO exist in the United States. First of all, there are the Armed Forces. Also, there are various programs (most of them in Family Practice, I believe) that will pay for medical school with a X-year contract to practice in underserved areas. I think these could be some valid alternatives to signing away your soul to some people.

Just some food for thought :) What do you think?

-Karl