NYU and Other Medical Schools Offer Shorter Course in Training, for Less Tuition
nytimes.com
nytimes.com
To be honest, it's really residency training programs that have become too long. You pretty much know what you need to know to become a PCP after two years of residency training in primary care. And I'm not sure if you really need 6 years of post medical school training to become a cardiologist or gastroenterologist. Seems like 4 would be enough. But the people who make these decisions, like the American Board of Medical Specialties, won't hear of this. In an era of rising tuition rates and declining reimbursements, they need to reconsider what not only makes for a reliable practitioner, but also one that isn't drowning in debt for years. Otherwise many of our best and brightest will mostly pursue other professions.
This is true, but it would also be a good idea to move toward a more European-style system that creates an alternate path to the M.D. by making the first two years of med school equivalent to an undergrad major. So a student at, say, the University of Washington could do their first two years of med school from 20 – 22, their second two from 22 – 24, and a three-year residency afterwards, leaving them with less debt (because they'd pay undergrad tuition) and with a faster path to an actual career.
This sort of thing is hugely important to me because I wrote an essay called "Why you should become a nurse or physicians assistant instead of a doctor: the underrated perils of medical school" (http://jseliger.wordpress.com/2012/10/20/why-you-should-beco...) which explains what numerous med students, residents, and doctors say they wish someone had told them.
Part of the essay includes this:
Once I realized how nasty the residency match process is and how fundamentally unfair the labor market for residents is, I was shocked: residency programs have formed a cartel designed to control cost and reduce employee autonomy, and hence salaries. I only went to law school for a year, by accident, but even I know enough law and history to recognize a very clear situation of the sort that anti-trust laws are supposed to address in order to protect workers. When my friend entered the match process like a mouse into a snake’s mouth, I became curious, because the system’s cruelty, exploitation, and unfairness to residents is an obvious example of employers banding together to harm employees. Lawyers often get a bad rap in our society, and sometimes for good reasons, but a case like this looked ripe to me.
It turns out that I’m not a legal genius and that lawyers have noticed this anti-trust violation. So an anti-trust lawsuit was filed. You can read about it in the NYTimes, including a grimly hilarious line about how “The defendants say the Match is intended to help students and performs a valuable service.” Ha! A valuable service to employers, since employees effectively can’t quit or negotiate with individual employers. Yes, indeed, curtailing employee power by distorting markets is a valuable service. The article also noted this bit of regulatory capture:
Fourth year is relatively flexible because students must travel for interviews, and there is an insane amount of vacation and 'slack' rotations available to help this.
The whole damned fourth year is a ripoff, and become more so each year the 'match' become more competitive.
I'd bet lawyers are to blame here. At least partially. Sure you can wax conspiratorial about lawyers in cahoots with doctors or something ... but malpractice. I'm sure there's a case somewhere that a plaintiff's lawyer attempted to go after a doctor's training institution as well as the doctor.
Residency (and the 4th year of med school?) is cheap labor for American hospitals, coupled with brutal working conditions - ACGME's 80 hour work week restrictions were winked at throughout my training, and I suspect still are a lot. Making decisions after being on your feet 30+ hours is pretty much like making decisions drunk - not sure that four years of that was optimal for anybody, particularly patients.
And yeah, we had "protected time" for didactics in residency - it was there that most of us developed the ability to fall asleep instantly.
Don't think combining that year with others would be hard at all. On the other hand I don't necessarily agree that residencies necessarily need to be shorter ( as someone else commented here ) At least, im not sure to what advantage it would serve.
Residency is a matter of real life on-the-job experience. You can start graduating people early but then you are just graduating less experienced people. It's hard to compress the same work experience in a shorter amount of time, at least with the hours restrictions that are in place. And unlike my 4th year of medical school, my residency had much less downtime.
My specialist physician friends say that they basically restarted their training in residency. In particular, I have pathologist friends who say they almost never use knowledge from their clinical rotations in medical school, and might as well just not have done them.
True, but the really radical shift would come from another direction, as I wrote in a separate comment:
It would also be a good idea to move toward a more European-style system that creates an alternate path to the M.D. by making the first two years of med school equivalent to an undergrad major. So a student at, say, the University of Washington could do their first two years of med school from 20 – 22, their second two from 22 – 24, and a three-year residency afterwards, leaving them with less debt (because they'd pay undergrad tuition) and with a faster path to an actual career.
This sort of thing is hugely important to me because I wrote an essay called "Why you should become a nurse or physicians assistant instead of a doctor: the underrated perils of medical school" (http://jseliger.wordpress.com/2012/10/20/why-you-should-beco...) which explains what numerous med students, residents, and doctors say they wish someone had told them.