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The three-year doctor: Good or Bad?

January 14, 2013

Wow.  I am falling down on the job here.  How could I have missed the New York Times article in december of 2012 that talked about how NYU and a few other medical schools are shortening their curriculum to three years?  This is the sort of discussion I luuuuurve!

Medical school takes a long time and is very expensive.  NYU, in case you missed it like I did, is offering a three-year track to a small number of students who can only remain in the program if they keep up a certain grade standard, and do class work before first year of med school and during summers. A few other schools have done this as well.  In Canada there are some schools that have been doing this for years.  Brown University used to have a 6-year combined undergrad-med school track.  The British system does a six-year track system as well.  The article in the times drew 350 comments, many of them frankly combative about this subject both pro and con.

Historically, before the civil war anyone who wanted to be a doctor just apprenticed himself to someone who was already a practicing physician.  Or you could just declare yourself one.  The first medical schools didn’t start until around 1770, and required 1 year of lectures and an apprenticeship.  These requirements gradually expanded as medical knowledge became more scientifically-based.  The reason medical school is now 4 years in this country is unclear.  In many other countries undergraduate school and medical school are in some way combined.

Here are some of the arguments AGAINST shortening medical school

1. You have to pay to play.  The docs saying this say the medicine is a calling and a privilege, it comes with money and prestige, and you pay with your time, money, and sleepless nights to pay for the right to call yourself “doctor”.

2. Cramming.  These folks think all 4 years of medical school are crammed with knowledge every minute.

3. Dumbing down.  People of this opinion think that shorter medical school would be “medicine lite” and would be less valid and produce poor and uneducated doctors.

4. You’re too young for this ride.  One of the reasons Brown did away with it’s 6-year program is that it was graduating 21 and 22-year-old doctors, deemed immature and unable to deal with what was then a punishing clinical training regime.

Here are some arguments FOR shortening medical school.

1. You don’t become a better doctor by suffering more or paying more.  Those who think you do are talking more about residency, which is in my opinion where you actually learn to be a doctor.  No one is suggesting shortening that experience.

2. People who have gone through law school are generally of the opinion that the L3 year is a waste of time.  Medical school is the same.  All the years are not created equal.  The last year is spent interviewing for residency, padding your resume with electives, sleeping in, and drinking.

3. A medical degree is a piece of paper.  It’s presence or absence does not necessarily mean you are a good or  a bad medical practitioner.

4.  Absolutely, some 22 year olds are too young for residency.  Six-year programs require that high school students know they want to be doctors from a very young age and doesn’t let them off the ride once its started.  Some people can handle it, some can’t.

5. It’s one year cheaper.  ‘Nuf said.

How about this?  Make the fourth year of medical school also the internship year.  I can envision an hybrid year in which heavy clinical emphasis is placed and courses are linked to practice.  Call it a sub-internship, call it an internship, call it med school, whatever.  Just make it count experientially.  You don’t learn how to be a doctor in medical school.  You don’t.  You learn it in residency, by doing it and watching other people do it and seeing the same things over and over so you recognize diseases and complications when you see them.  It doesn’t matter how much time you spend learning the theoreticals.

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2 Comments
  1. The only way I can really see shortening the med school curriculum would be to create specialty tracks. For example, if you want to do surgery your rotations are geared specifically toward this and you don’t have to “waste” time doing as many medicine rotations. However, I think this would have a number of drawbacks. 1) We would be forcing students to pick their track early and as we know most people end up switching what field of medicine they want to practice 2) We would be producing less well rounded doctors. As a surgery resident I need to know internal medicine as well, I wouldn’t want to miss out on this.

    Survivor D.O.
    Survivinggrays.com

    • Survivor – Like “The Duke School of Surgery”, or the “Connecticut School of Primary Care”? Interesting idea. You’re right, it’s really too early to ask young people to choose a specialty before they’ve seen all branches, and the quality of each rotation figures strongly in what students choose. I think well-rounded is important as well, but not everyone is willing to use that broad education. Anybody who spends 5 minutes on the orthopedic service knows that anything that smells of medicine immediately gets a medicine consult at the least and a medicine admission at the worst. That’s because you may learn it in med school that that doesn’t mean you can function in any useful capacity with that knowledge. That is what residency is for. I would shorten med school by making the 4th year the internship year.

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