Med school on the fast track: A 3-year degree
■ Some schools offer an accelerated approach to a medical degree by adjusting curricula and training, a move that could boost primary care.
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In response to concerns about nationwide shortages of primary care physicians and rising student debts, several U.S. medical schools are experimenting with programs that allow students to obtain a degree in three years instead of four.
These programs, which are geared for primary care, would be significantly less costly for students, who in practice can expect to earn less than other specialities.
The medical schools condense their courses of study by eliminating breaks and electives and allowing students to begin clerkship training in their second year, a year earlier than the traditional four-year curriculum.
Many students in traditional programs spend their fourth year primarily doing specialty rotations and interviewing for residency positions. Students who know they want to go into family medicine from the start don’t necessarily need that fourth year, said Robert Pallay, MD, professor and chair of the Dept. of Family Medicine at Mercer University School of Medicine’s campus in Savannah, Ga.
“There are many of us in medical education who wonder about the need for the fourth year of medical school,” he said. “The issue here is, ‘What does society need?’ What our society needs right now is a significant increase in the number of family physicians.”
In the last five years, at least four schools have initiated or are developing three-year programs:
- Mercer will begin its three-year track at its Savannah campus in June.
- Lake Erie College of Osteopathic Medicine in Erie, Pa., started its program in 2007 and launched a second three-year track in July 2011 for certified physician assistants who want to become doctors.
- Texas Tech University Health Sciences Center School of Medicine in Lubbock began its three-year program with nine students in 2011.
- Louisiana State University School of Medicine is developing a three-year program at its campus in Lafayette. The first class is projected to start in 2014 or 2015, said Sam McClugage, PhD, the medical school’s associate dean for admissions.
“The focus of the program would be to train primary care physicians in an accelerated curriculum designed to encourage more physicians to go into primary care and then hopefully into more underserved areas, such as rural communities, to practice medicine,” McClugage said.
Now a consortium of six schools, including Texas Tech, Mercer and LSU, has applied for $23 million in federal grants from the Center for Medicare and Medicaid Innovation to expand the three-year model to more campuses. Other schools in the consortium are Indiana University School of Medicine, East Tennessee State University Quillen College of Medicine and the University of Kentucky College of Medicine, said Ronald Cook, DO, chair of Texas Tech’s Family and Community Medicine Dept. The innovation center is expected to announce grant recipients soon.
Although the schools may follow some similar approaches, each will implement its program differently, Dr. Cook said. “You can’t just have a blanket curriculum,” he said. “Every school’s curriculum is a bit different.”
Not a new model
The traditional four-year design has been in place at least since educator Abraham Flexner published his influential report on medical education in 1910. It called for students to have two years of basic sciences and two years of clinical training.
Though most medical schools have followed that model, three-year programs are not new. Some schools, including the Medical College of Virginia, offered three-year programs during World War II. In the 1980s and 1990s, about a dozen schools offered accelerated programs that allowed students to begin residency training while finishing their fourth year of medical school.
In Canada, the University of Calgary Faculty of Medicine and McMaster University Michael G. DeGroote School of Medicine have had a three-year curriculum for all students for years, said Dan Hunt, MD, co-secretary of the Liaison Committee on Medical Education, which accredits allopathic schools in the U.S. and Canada.
Some argue that U.S. students should be trained in less than four years. A March 21 article in The Journal of the American Medical Association called for medical education nationwide to be shortened 30% by 2020.
“In an era when unnecessary medical services are being intensely examined to reduce costs, similar critical attention should be applied to eliminating waste from medical training,” wrote the article’s authors, Ezekiel J. Emanuel, MD, PhD, and Victor R. Fuchs, PhD.
An answer to physician shortages?
Nationwide physician shortages are projected to reach 91,500 physicians by 2020, including 45,000 primary care doctors, according to the Assn. of American Medical Colleges.
“The major impetus was the recognition that one of the major issues in the health care system is the shortage of primary care physicians and the imbalance between primary care physicians and specialists,” said Steven Berk, MD, dean of Texas Tech’s medical school. “We believe that medical schools need to take part of the responsibility for that imbalance.”
The Texas Tech program condenses its medical school curriculum into three years and eliminates eight contact weeks of study. Four-year students get 160 contact weeks, and three-year students get 152. The LCME requires allopathic medical schools to include a minimum of 130 contact weeks.
Texas Tech student Clay Buchanan decided to go to medical school after a career as a lawyer and was trying to decide between family medicine and pediatrics. The chance to be part of the first class of the Family Medicine Accelerated Track helped him make the choice.
As a father of three children, he saw that taking part in the program means a lighter student debt load and the ability to begin working again sooner to support his family.
He said faculty members ask for feedback from students regularly. “They’re very supportive and very interested in what we have to say,” Buchanan said. “They say we’re the guinea pigs.”
In addition to not having a fourth year of medical school, students in Texas Tech’s F-MAT program are given a scholarship in their first year.
At Pennsylvania’s LECOM, it’s projected that students will save more than $50,000, including tuition and living expenses, said Richard Ortoski, DO, chair of the Dept. of Primary Care Education at the osteopathic medical school. There has been a lot of interest, with more than 30 students applying each year.
“It takes a more mature person to go through this pathway, and go through rotations earlier and more quickly,” Dr. Ortoski said.
The new Accelerated Physician Assistant Pathway is approved for up to 12 students, including six positions designated for students who commit to primary care, said Mark Kauffman, DO, PA, LECOM assistant dean of graduate studies. Students work as PAs an average of six years before entering the program.
“They’re not going to be disillusioned by what medicine is really like to practice. They know what they’re getting into, and they want it,” Dr. Kauffman said.
But accelerated degree programs aren’t for everyone. Perry Pugno, MD, MPH, vice president of medical education for the American Academy of Family Physicians, said many medical students aren’t prepared to start clerkships in their second year.
“I’m concerned about pushing students into clinical training before they become sufficiently mature from life lessons to lend context and perspective to those experiences,” he said.
The LCME also is concerned about what happens to students who decide midway through a program that primary care isn’t for them. Students have to be given the chance to opt out if they decide to pursue a different career path, Dr. Hunt said.
For example, students in Mercer’s three-year program who decide midway through that family medicine is no longer for them would be integrated into the traditional four-year degree track, Dr. Pallay said.
“We’re not proponents of three-year medical school for everybody,” Texas Tech’s Dr. Berk said. “There are a lot of medical students definitely who need that fourth year to decide what they’re going to do. If everyone were to do this, it would defeat the purpose of why we’re doing this, and that is to make primary care more attractive.”