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Will a Three-Year Medical School Curriculum Increase the Supply of Primary Care Physicians?

Posted Apr 21 2010 12:00am

I think that it would be very feasible for some percentage of medical students to complete their required course work in three years. I also think that pre-medical undergraduate course requirements could also be completed in three years by some students. These two changes could lead to the an M.D. degree in six years. KevinMD, a noted physician blogger, recently wrote about a three-year medical curriculum at Texas Tech, linking the proposal to the need for more primary care physicians and student debt-load reduction. Below is an excerpt from his note (see: (see: Primary care and the three year medical student ):

It’s well documented on this blog that the primary care shortage will only worsen once most of America has access to affordable health insurance. As I wrote in a recent op-ed. not only will there a shortage of primary care physicians, but nurse practitioners and physician assistants won’t alleviate the problem either, mostly because they are also enticed by the lucrative allure of specialty practice. Enter the three-year primary care physician. Texas Tech University is experimenting with such a program. Apparently, the fourth year of medical school was deemed expendable
The program was designed out of the conviction that most of the fourth year of medical school was focused on electives in various medical specialties—programs that are important for those considering specialized residencies, but that may not be necessary for those committed to primary care. Texas Tech believes that, with a few adjustments, it can provide those who plan careers in family medicine with the necessary parts of the fourth year earlier—and free up the year.
....I can see how medical students can be enticed by a year less of medical school. For some, that can both shave off $50,000 or more in medical school tuition and bring them a real-world physician salary earlier.But that would also lock the student in a primary care track early on. The fourth year is where students taste the various medical specialties that ultimately influence their residency decisions. Maybe that’s the point. Perhaps shielding them from the lifestyle advantages, not to mention the financial benefits and relative lack of bureaucratic hassles, of specialty practice is one way to convince more to choose primary care as a career.

I have posted a previous note about reducing the time for physician training (see: Earning an MD Degree in Six Years to Reduce the Debt-Load of Medical Students ). I agree with most of the points made above including the observation that much of the fourth year for medical students is occupied with the selection of a medical specialty. This is accomplished, in part, by " audition or away rotations " so that students' favored residency programs can get a close look at them and vice-versa. However, I don't think that it's realistic to lock medical students into primary care by reducing medical school by one year and altering the curriculum for such students. It might work in the short-run but these are bright high-achievers. Many in primary care practice will soon become disillusioned with their practices. Armed with an M.D. degree, they will seek advanced specialty training at some later time. I do part ways with Kevin on one major point -- I think that most of the the primary care positions in the future will be filled by physician assistants and nurse practitioners.

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