It's time to change medical school curriculum...

[Splenda88]

Seen a lot disappointments on social media after the match on Monday. I think it is time to make some changes in med school curriculum. I think we should do what many countries do... Instead of having a 4th year that is somewhat useless for the most part. Should we call and structure 4th year like an internship (outside of the match) and lobby state legislatures to allow everyone to apply for licensure (GP license) upon passing step3 if they wish. That at least will give people an option to be able to use their medical degree. The match, however, can stay as it is except that everything will be categorical (no advanced positions).

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[Goro]

Tell that to the HMOs.

Also, knowing the students who fail to match at my school, no amount of change in medical school curriculum will remediate lazy, unrealistic, clueless, unteachable or sociopathic individuals.

 

[Redpancreas]

I wholeheartedly agree. Currently there is a clinical path but it needs to be streamlined.

In my state, in order to qualify to be a licensed physician, you need to have completed two years of residency and passed Step 3 and shell out $500 for a licensing fee. It’s really rare for a resident to leave after getting credit for two years of training already so I’m not sure who in their right mind wouldn’t just finish their residency and prefer to go the unboarded, licensed GP route.

For those who don’t even match, there is no job option as a majority of states require at least completion of 1 year of a residency. I suppose there are preliminary positions but those are hardly resume builders but I suppose they’re better than nothing.

I think medical schools need to be held accountable to ensure their graduates can actually practice medicine. Most are now playing hot potato with ticking time bombs who aren’t knowledgeable enough or lack the skills to execute in residency. You passed 2 standardized multiple choice exams, passed the standardized multiple choice exams and didn’t get flagged in clerkship where no one is watching you closely? OK, our job is done. Off to residency.

By the end of year 1/2, students should be able to get Step 1 done, by the end of year 3 Step 2 should be done, and year 4 needs to stop being so “elective heavy” and have actual responsibilities. Besides the SubI month, 4th year is pretty light. One excuse for that is schools needed to make time for interviews but now we can go virtual this shouldn’t be as much of an issue. I think passage of 3 in a medical school issue. Why are we studying ancillary board in residency? I get that a year of internship helps but that year should be incorporated into fourth year.

In general there will be fault and resistance on both ends. Medical schools will see it as too much and residencies will be forced to actually start paying attention to medical students. The two agencies really need to become more integrated because right now we’re setting a small, but not insignificant number of medical students to fail in residency. If you don’t care about that group and characterize them as misfits/sociopaths, then at least acknowledge that the medical knowledge and competency of students entering residency on average is pretty bad.

 

[Ho0v-man]

I wholeheartedly agree. Currently there is a clinical path but it needs to be streamlined.

In my state, in order to qualify to be a licensed physician, you need to have completed two years of residency and passed Step 3 and shell out $500 for a licensing fee. It’s really rare for a resident to leave after getting credit for two years of training already so I’m not sure who in their right mind wouldn’t just finish their residency and prefer to go the unboarded, licensed GP route.

For those who don’t even match, there is no job option as a majority of states require at least completion of 1 year of a residency. I suppose there are preliminary positions but those are hardly resume builders but I suppose they’re better than nothing.

I think medical schools need to be held accountable to ensure their graduates can actually practice medicine. Most are now playing hot potato with ticking time bombs who aren’t knowledgeable enough or lack the skills to execute in residency. You passed 2 standardized multiple choice exams, passed the standardized multiple choice exams and didn’t get flagged in clerkship where no one is watching you closely? OK, our job is done. Off to residency.

By the end of year 1/2, students should be able to get Step 1 done, by the end of year 3 Step 2 should be done, and year 4 needs to stop being so “elective heavy” and have actual responsibilities. Besides the SubI month, 4th year is pretty light. One excuse for that is schools needed to make time for interviews but now we can go virtual this shouldn’t be as much of an issue. I think passage of 3 in a medical school issue. Why are we studying ancillary board in residency? I get that a year of internship helps but that year should be incorporated into fourth year.

In general there will be fault and resistance on both ends. Medical schools will see it as too much and residencies will be forced to actually start paying attention to medical students. The two agencies really need to become more integrated because right now we’re setting a small, but not insignificant number of medical students to fail in residency. If you don’t care about that group and characterize them as misfits/sociopaths, then at least acknowledge that the medical knowledge and competency of students entering residency on average is pretty bad.

Lol will never happen. Med schools only care about collecting a check in 4th year and reluctantly pushing paper around. COVID has forced my school to kind of try to provide a semblance of an education this year since they can’t make us do aways and you’d swear we were asking them to die for all of our sins.

 

[Redpancreas]

Lol will never happen. Med schools only care about collecting a check in 4th year and reluctantly pushing paper around. COVID has forced my school to kind of try to provide a semblance of an education this year since they can’t make us do aways and you’d swear we were asking them to die for all of our sins.

Yeah. This is inexcusable. There needs to be a massive upheaval in the paradigm of medical education.

 

[Ho0v-man]

Yeah. This is inexcusable. There needs to be a massive upheaval in the paradigm of medical education.

Absolutely agree. Either help me learn to become a physician (ya know...the point of med school) or let me graduate. Personally, I’d love a system where we matched before the new year and spent the rest of med school transitioning to our field.

 

[SurfingDoctor]

Absolutely agree. Either help me learn to become a physician (ya know...the point of med school) or let me graduate. Personally, I’d love a system where we matched before the new year and spent the rest of med school transitioning to our field.

That 4th year spring Rads elective tho...

Honestly, 4th year was the most expensive vacation I think I've ever had... and that includes Disneyland where a churro requires a downpayment (though they are kinda amazing).

 

[Redpancreas]

Absolutely agree. Either help me learn to become a physician (ya know...the point of med school) or let me graduate. Personally, I’d love a system where we matched before the new year and spent the rest of med school transitioning to our field.

No. Instead you shall pay 50K per year to allow professors to teach you biochemistry and shadow doctors in the hospital because residencies have bigger priorities than medical education.

 

[Redpancreas]

Absolutely agree. Either help me learn to become a physician (ya know...the point of med school) or let me graduate. Personally, I’d love a system where we matched before the new year and spent the rest of med school transitioning to our field.

That’s another alternative. Those 6 months could be spent as a prolonged subI and you could knock Step 3 out.

 

[Splenda88]

Yeah. This is inexcusable. There needs to be a massive upheaval in the paradigm of medical education.

The problem is that we are not cohesive group... You will find someone here who will come up with his/her anecdote that 4th yr was helpful while ignoring what the other 90%+ students are saying.

Look at CS, only a bad pandemic could force these people to suspend it. A test that ~100% students and even administrators agree was too expensive and useless.

 

[Redpancreas]

The problem is that we are not cohesive group... You will find someone here who will come up with his/her anecdote that 4th yr was helpful while ignoring what the other 90%+ students are saying.

Look at CS, only a bad pandemic could force these people to suspend it. A test that ~100% students and even administrators agree was too expensive and useless.

Post of the thread.

 

[IMG69]

I'll play devils advocate for fun;

What would happen if the US adopted a UK style system post med school, lets say you apply to a state (any state) certain states would be more competitive etc which is why grades etc matter. You then find out which state you matched to, then you apply to specific 'residency-like' positions in the hospitals within that state, e.g in the UK you're required to do 1 surgical field, 1 internal med field and then a 3rd field of your choice. So for example you would essentially be a 1st year resident of Nephrology, Gen surgery and whatever you choose (so you rotate like you did in med school basically), these again are competitive as more people might be interested in a certain fields than others etc and this might differ by which state you matched to.

Then you either do this process again for PGY-2 like the UK or you then apply to specialty training after that (which ever you think would be best)

Would this remove some of the midlevels? because those that didn't match into a specialty after PGY1 (or PGY2 depending on the sentence above) could stay on in the hospitals as basically senior residents allowing them to further build their CV to apply next year or whatever.

Thoughts on how this would work? Salaries wouldn't need to be dropped to UK levels, in fact if this did remove mid levels then doctors might even get a pay rise overall?

Anyone care to entertain this idea for fun?

 

[VA Hopeful Dr]

The problem is that we are not cohesive group... You will find someone here who will come up with his/her anecdote that 4th yr was helpful while ignoring what the other 90%+ students are saying.

Look at CS, only a bad pandemic could force these people to suspend it. A test that ~100% students and even administrators agree was too expensive and useless.

I know you and I go back and forth on this a good bit, but I'd rather see 4th year become universally useful as opposed to throwing it away completely. You'd still need some easy months for interviews but it shouldn't be hard to have valuable rotations as well that make that last year actually worth doing (which even I'll admit for most people as it is now, its not really worthwhile).

CS was a bad idea 15 years ago that didn't get better with time. 4th year (and 3rd year in many places sadly) seems to be getting worse over time.

 

[Splenda88]

I know you and I go back and forth on this a good bit, but I'd rather see 4th year become universally useful as opposed to throwing it away completely. You'd still need some easy months for interviews but it shouldn't be hard to have valuable rotations as well that make that last year actually worth doing (which even I'll admit for most people as it is now, its not really worthwhile).

CS was a bad idea 15 years ago that didn't get better with time. 4th year (and 3rd year in many places sadly) seems to be getting worse over time.

Interviews are done virtually now... and it has worked this year. I know a few students who decided to visit programs on their own since they were their 'top' choices.

After seeing so many bad stories on Monday after the match, I slightly change my stance about 4th year. Have med schools make it a truly internship year, so every everyone is a GP after graduation and upon passing step3. Keep residency as it is with no advanced positions.

It's like that in many countries. That will prepare med students better for residency.

 

[VA Hopeful Dr]

Interviews are done virtually now... and it has worked this year. I know a few students who decided to visit programs on their own since they were their 'top' choices.

After seeing so many bad stories on Monday after the match, I slightly change my stance about 4th year. Have med schools make it a truly internship year, so every everyone is a GP after graduation and upon passing step3. Keep residency as it is with no advanced positions.

It's like that in many countries. That will prepare med students better for residency.

You'd have to get buy in from 50 different states which is very unlikely. We know most schools aren't going to do away with 4th year and I'd be shocked if states agreed with your idea. So the push given those 2 things should be to improve 4th year so the students at least get some value from the money they have to pay in.

 

[Maimonides1]

I referred to a possible reform in other thread..!

Post in: 'Do you actually enjoy medical school?'
Do you actually enjoy medical school?

 

[Splenda88]

You'd have to get buy in from 50 different states which is very unlikely. We know most schools aren't going to do away with 4th year and I'd be shocked if states agreed with your idea. So the push given those 2 things should be to improve 4th year so the students at least get some value from the money they have to pay in.

I don't think states have to be involved. If LCME put that in the curriculum and call it intern year and that year is ACGME approved... it fulfills the requirements of more than 34 states for licensure.

 

[VA Hopeful Dr]

I don't think states have to be involved. If LCME put that in the curriculum and call it intern year and that year is ACGME approved... it fulfills the requirements of more than 34 states for licensure.

Of course the states do, they make the rules regarding licensure.

You really think if they just renamed 4th year of med school to "internship" and threw step 3 in that the states wouldn't notice and very probably change their rules?

 

[VA Hopeful Dr]

I referred to a possible reform in other thread..!

Post in: 'Do you actually enjoy medical school?'
Do you actually enjoy medical school?

That's a massive overhaul of both college and med school. No way that happens anytime soon.

 

[Lawpy]

Seen a lot disappointments on social media after the match on Monday. I think it is time to make some changes in med school curriculum. I think we should do what many countries do... Instead of having a 4th year that is somewhat useless for the most part. Should we call and structure 4th year like an internship (outside of the match) and lobby state legislatures to allow everyone to apply for licensure (GP license) upon passing step3 if they wish. That at least will give people an option to be able to use their medical degree. The match, however, can stay as it is except that everything will be categorical (no advanced positions).

All we need to do is reduce preclinical everywhere to 1 year and stop making clinical years look like glorified shadowing

 

[Maimonides1]

That's a massive overhaul of both college and med school. No way that happens anytime soon.

I didn’t say soon..,
I agree, It’s comprehensive and ambitious.. but we can start from somewhere now..!

 

[Splenda88]

Of course the states do, they make the rules regarding licensure.

You really think if they just renamed 4th year of med school to "internship" and threw step 3 in that the states wouldn't notice and very probably change their rules?

Licensure requirements are completion of med school with at least 1 yr of ACGME accredited training...

Make it happens so we can save the 2-3% med students who have trouble matching. It's wrong to have a useless degree after all that training if you don't match.

 

[Splenda88]

All we need to do is reduce preclinical everywhere to 1 year and stop making clinical years look like glorified shadowing

I agree with that but that won't solve issues with the match... Do it like most countries. Everyone is a GP upon graduation, then you can specialize if you want.

 

[Lawpy]

I agree with that but that won't solve issues with the match... Do it like most countries. Everyone is a GP upon graduation, then you can specialize if you want.

Isn't that a glorified medicine prelim?

I don't think surgery bound MS4s will enjoy working in IM/FM at all. What we need to improve the match is to force reasonable application caps.

 

[Splenda88]

Isn't that a glorified medicine prelim?

I don't think surgery bound MS4s will enjoy working in IM/FM at all. What we need to improve the match is to force reasonable application caps.

It happens in most countries... Med students will accept anything since they have accepted step2 CS

 

[Splenda88]

That's a massive overhaul of both college and med school. No way that happens anytime soon.

So let's keep the status quo...

 

[GoSpursGo]

I know you and I go back and forth on this a good bit, but I'd rather see 4th year become universally useful as opposed to throwing it away completely. You'd still need some easy months for interviews but it shouldn't be hard to have valuable rotations as well that make that last year actually worth doing (which even I'll admit for most people as it is now, its not really worthwhile).

CS was a bad idea 15 years ago that didn't get better with time. 4th year (and 3rd year in many places sadly) seems to be getting worse over time.

Basically I agree with this... I feel like I'm seeing a proliferation of arguments that medical education needs to be overhauled, and that it's feasible "because look, CS got canceled!" In reality, CS was a singularly stupid test that needed to get killed, and that doesn't really have anything to do with the requests for "change" that I see regularly.

Medical education isn't perfect. There is probably some number of US MD and DO grads who fail to match through no fault of their own. But I also think it's false to quote this 2-3% who go unmatched, when we all know a decent number of those are people who applied for a surgical subspecialty/derm/whatever when they realistically had no business doing so.

 

[VA Hopeful Dr]

So let's keep the status quo...

I know you and I go back and forth on this a good bit, but I'd rather see 4th year become universally useful as opposed to throwing it away completely. You'd still need some easy months for interviews but it shouldn't be hard to have valuable rotations as well that make that last year actually worth doing (which even I'll admit for most people as it is now, its not really worthwhile).

CS was a bad idea 15 years ago that didn't get better with time. 4th year (and 3rd year in many places sadly) seems to be getting worse over time.

Yep, totally status quo.

 

[VA Hopeful Dr]

I didn’t say soon..,
I agree, It’s comprehensive and ambitious.. but we can start from somewhere now..!

Sure, like working to make 4th year worth the money you're paying for it (which I suggested earlier) and making tuition lower than the stupid rates we're seeing now (that I've been saying for at least 2 years now).

 

[NotAProgDirector]

I realize that many other countries have medical school + 1 year required internship = GP.

I also realize that our interns, although smart and good at their jobs, would not be very good GP's. I just don't think it's enough experience. Maybe if we made the internship fully outpatient and then limited their scope of practice, but even with that I don't think it's enough experience. But I guess it depends how good you want your physicians to be.

 

[SurfingDoctor]

You’re gonna need a lot of momentum to overcome the inertia. Realizing that the MATCH system works for a vast majority of applicants (>96% in 2020) and programs, you’d need for all of them to be impacted as well, and rather severely, for there to be any change. I’m not trying to be Debbie Downer, that’s just the reality.

 

[Lem0nz]

Interviews are done virtually now... and it has worked this year. I know a few students who decided to visit programs on their own since they were their 'top' choices.

After seeing so many bad stories on Monday after the match, I slightly change my stance about 4th year. Have med schools make it a truly internship year, so every everyone is a GP after graduation and upon passing step3. Keep residency as it is with no advanced positions.

It's like that in many countries. That will prepare med students better for residency.

I’m confused. What are you defining a GP as? A primary care doc? If that’s the case why do we have three year FM residencies? If not a primary care doc than what?

That isn’t a paradigm shift for fourth year. That’s a paradigm shift for all of American medicine. And quite frankly it’s never going to happen, or if it does it’s going to blow holes into primary care, internal medicine, and billing/reimbursement which will make the system completely unrecognizable, and not necessarily better. Just different.

Not to be a jerk, but your four years of undergrad are not helpful at all for being a doctor. So if you toss that out, and toss out a years worth of Biochem which is *very targeted* and of limited utility in being a ‘GP’, at that point what difference is there between you and a midlevel? Beside the fact you cost way more.

I’m normally on the opposite side of this coin but what you’re proposing will make more midlevels with inadequate training except their alphabet soup will have MD or DO somewhere in it. It’s either that, or you’re accepting that 2-3 years of practical training is enough in which case, again, why don’t we use midlevels who are dramatically cheaper?

Capitalism and the supply/demand of American medicine will simply never support this route, at all.

 

[Splenda88]

I’m confused. What are you defining a GP as? A primary care doc? If that’s the case why do we have three year FM residencies? If not a primary care doc than what?

That isn’t a paradigm shift for fourth year. That’s a paradigm shift for all of American medicine. And quite frankly it’s never going to happen, or if it does it’s going to blow holes into primary care, internal medicine, and billing/reimbursement which will make the system completely unrecognizable, and not necessarily better. Just different.

Not to be a jerk, but your four years of undergrad are not helpful at all for being a doctor. So if you toss that out, and toss out a years worth of Biochem which is *very targeted* and of limited utility in being a ‘GP’, at that point what difference is there between you and a midlevel? Beside the fact you cost way more.

I’m normally on the opposite side of this coin but what you’re proposing will make more midlevels with inadequate training except their alphabet soup will have MD or DO somewhere in it. It’s either that, or you’re accepting that 2-3 years of practical training is enough in which case, again, why don’t we use midlevels who are dramatically cheaper?

Capitalism and the supply/demand of American medicine will simply never support this route, at all.

We still have GP (not FM/IM) practicing now in IHS, state prison, county health departments, even clinics (a lot of them in south FL)... It was a thing 30+ years ago.

It's not the only the # of years of training that differentiate us from NP... I am not advocating to do away with the prereqs, but an undergrad degree is not needed. Most FMG do not have a undergrad degree.

 

[Matthew9Thirtyfive]

We still have GP (not FM/IM) practicing now in IHS, state prison, county health departments, even clinics (a lot of them in south FL)... It was a thing 30+ years ago.

It's not the only the # of years of training that differentiate us from NP... I am not advocating to do away with the prereqs, but an undergrad degree is not needed. Most FMG do not have a undergrad degree.

Just because it’s a thing doesn’t mean it should be. I agree that a full bachelors in music theory or interpretive dance is completely irrelevant and unnecessary. I enjoyed my math degree, but I didn’t need to get it to succeed in medical school or become a good doctor.

 

[VA Hopeful Dr]

Just because it’s a thing doesn’t mean it should be. I agree that a full bachelors in music theory or interpretive dance is completely irrelevant and unnecessary. I enjoyed my math degree, but I didn’t need to get it to succeed in medical school or become a good doctor.

I don't really like the 6 year BS/MD programs, but I'll admit they are a decent option for those who don't find value in a 4 year undergrad degree.

 

[LunaOri]

For those of you who are complaining that 4th year is a waste, what would stop you from making better use of it (doing a full year of subI's and electives that are relevant to your preferred specialty)?
And are you all assuming that everyone entering medical school should know what specialty they are intending to enter, right from the beginning? I know quite a few people in my time who didn't decide until 4th year; is it different now?

 

[SurfingDoctor]

I don't really like the 6 year BS/MD programs, but I'll admit they are a decent option for those who don't find value in a 4 year undergrad degree.

I would disagree in that I have encountered a handful of 6 year BS/MD, and while they are brighter than an age matched control, they are incredibly immature and almost painful to interact with.

Yes, undergrad is too expensive AND the education you receive is mostly useless but people need that to frankly grow up.

I do think colleges should require finance and money management classes though instead of the history of Germanic fairytales.

 

[VA Hopeful Dr]

I would disagree in that I have encountered a handful of 6 year BS/MD, and while they are brighter than an age matched control, they are incredibly immature and almost painful to interact with.

Yes, undergrad is too expensive AND the education you receive is mostly useless but people need that to frankly grow up.

I do think colleges should require finance and money management classes though instead of the history of Germanic fairytales.

This has also been my experience, but my anecdotes to my mind aren't enough to say something we already have some be done away with.

 

[Med Ed]

For those of you who are complaining that 4th year is a waste, what would stop you from making better use of it (doing a full year of subI's and electives that are relevant to your preferred specialty)?

Fortnite.

 

[Lem0nz]

A more thoughtful and useful discussion is probably the opportunity/cost of our current lengthy training and a realistic assessment of if it’s good enough or if it needs to be reduced.

Surgeons, for example, in general on the traditional path will be minted in 15 years in average from completion of high school. Assumes either a 7 year residency or 5+2 of fellowship which is a reasonable assumption I think. It can of course take longer.

Is it reasonable that you can’t start being an attending surgeon until 33? Assuming you go straight through. Do you need that long to learn and mature to be a surgeon?

My personal opinion is a hard no. I think it can be cut down to 28-30. But if we do that, where is the highest yield to cut with the least loss of quality and maturity, and where the system can absorb the impact of the cuts? To me that would be undergrad. But I’m interested to hear other’s opinions. Even for a family Med doc the fastest we churn them out (traditionally) is age 29 at 4+4+3. It seems like we can probably bring that down closer to 25-26 but I don’t know. Maybe it is better that doctors aren’t entering the work force until their 30s.

But there is no question the biggest complaints from my generation of trainees and docs is that our 20s are ‘wasted’ making ‘no money’ with ‘unsustainable debt’. And there is really no argument that at least two of those are dramatically worse than even a decade ago. So at a high level, what is the solution?

My proposal is that the entire pathway can be trimmed and made shorter giving you back 3-5 years of additional attending salary by entering the work force faster and 3-5 years less debt. Avoids the residency salary issue and cutting residency down.

What do you guys think?

 

[VA Hopeful Dr]

A more thoughtful and useful discussion is probably the opportunity/cost of our current lengthy training and a realistic assessment of if it’s good enough or if it needs to be reduced.

Surgeons, for example, in general on the traditional path will be minted in 15 years in average from completion of high school. Assumes either a 7 year residency or 5+2 of fellowship which is a reasonable assumption I think. It can of course take longer.

Is it reasonable that you can’t start being an attending surgeon until 33? Assuming you go straight through. Do you need that long to learn and mature to be a surgeon?

My personal opinion is a hard no. I think it can be cut down to 28-30. But if we do that, where is the highest yield to cut with the least loss of quality and maturity, and where the system can absorb the impact of the cuts? To me that would be undergrad. But I’m interested to hear other’s opinions. Even for a family Med doc the fastest we churn them out (traditionally) is age 29 at 4+4+3. It seems like we can probably bring that down closer to 25-26 but I don’t know. Maybe it is better that doctors aren’t entering the work force until their 30s.

But there is no question the biggest complaints from my generation of trainees and docs is that our 20s are ‘wasted’ making ‘no money’ with ‘unsustainable debt’. And there is really no argument that at least two of those are dramatically worse than even a decade ago. So at a high level, what is the solution?

My proposal is that the entire pathway can be trimmed and made shorter giving you back 3-5 years of additional attending salary by entering the work force faster and 3-5 years less debt. Avoids the residency salary issue and cutting residency down.

What do you guys think?

Or just cut tuition

 

[eteshoe]

Or just cut tuition

lol so simple and elegant

 

[SurfingDoctor]

Or just cut tuition

But that's administrator's office is sooo beautiful! And have you seen the chocolate fountain next to the Cap'N Crunch in the cafeteria?! Devine....

Worth every taxpayer funded Stafford loan penny...

 

[Splenda88]

A more thoughtful and useful discussion is probably the opportunity/cost of our current lengthy training and a realistic assessment of if it’s good enough or if it needs to be reduced.

Surgeons, for example, in general on the traditional path will be minted in 15 years in average from completion of high school. Assumes either a 7 year residency or 5+2 of fellowship which is a reasonable assumption I think. It can of course take longer.

Is it reasonable that you can’t start being an attending surgeon until 33? Assuming you go straight through. Do you need that long to learn and mature to be a surgeon?

My personal opinion is a hard no. I think it can be cut down to 28-30. But if we do that, where is the highest yield to cut with the least loss of quality and maturity, and where the system can absorb the impact of the cuts? To me that would be undergrad. But I’m interested to hear other’s opinions. Even for a family Med doc the fastest we churn them out (traditionally) is age 29 at 4+4+3. It seems like we can probably bring that down closer to 25-26 but I don’t know. Maybe it is better that doctors aren’t entering the work force until their 30s.

But there is no question the biggest complaints from my generation of trainees and docs is that our 20s are ‘wasted’ making ‘no money’ with ‘unsustainable debt’. And there is really no argument that at least two of those are dramatically worse than even a decade ago. So at a high level, what is the solution?

My proposal is that the entire pathway can be trimmed and made shorter giving you back 3-5 years of additional attending salary by entering the work force faster and 3-5 years less debt. Avoids the residency salary issue and cutting residency down.

What do you guys think?

Totally doable. Prereqs only, which can be 2-3 yrs plus 3-year of med school and 2-6 yrs residency (total 8-12 yrs). The system will force them to do it at one point, but it might take 20+ yrs.

 

[Splenda88]

I am glad some state legislatures are doing something for these unmatched FMG/IMG...

Assistant Physicians — State by State Progress for Assistant Physicians and Associate Physicians — Association of Medical Doctor Assistant Physicians

News For AP's

assistantphysicianassociation.com

 

[Future_HeartMD]

Here’s a novel idea. How about we just you know...expand the number of residency spots and shut down this idea that we need 7 new DO schools over the next 5 years?

 

[Ho0v-man]

Here’s a novel idea. How about we just you know...expand the number of residency spots and shut down this idea that we need 7 new DO schools over the next 5 years?

Big no to an expansion of slots. But absolutely stop expanding/opening med schools! We shouldn’t have as many med students as we currently do.

 

[VA Hopeful Dr]

Big no to an expansion of slots. But absolutely stop expanding/opening med schools! We shouldn’t have as many med students as we currently do.

Agreed. Many of the new residency programs seem of questionable quality as is. If an existing program was another slot or two, that's likely not a problem though.

 

[Isoval]

Tell that to the HMOs.

Also, knowing the students who fail to match at my school, no amount of change in medical school curriculum will remediate lazy, unrealistic, clueless, unteachable or sociopathic individuals.

Wait but...but I'm lazy...

*chuckles*
I'm in danger.

 

[operaman]

If a Med school decided to make their 4th year curriculum more standardized and rigorous, social media would explode with posts about how thats abusive and unnecessary and they’d be calling for the dean’s head on a spike. As it is, we seem to have people calling to abolish the fourth year because most students don’t make much use of it. Seems to me that’s isn’t so much a school problem as a student problem. There’s nothing stopping students from crafting a 4th year schedule that’s actually beneficial.

Despite the fact students have been neutered by EMRs and school policies against scut work, there’s still much to learn. If I’m honest, my day to day practice hasn’t changed that much from student to resident to now. I get up early, chart round on my patients, go to the hospital and see patients. I write notes on my inpatients. I go to clinic and see patients. Often I have to present them to other consultants and colleagues. I write clinic notes. Some days I go to the OR instead of clinic, though obviously my role there has evolved over the last 10 years. Even so, if I’m with a resident I’m generally just holding retractors while watching them like a hawk - not terribly different from my student days! So I would argue there’s much that can be learned during the fourth year and it’s not a school’s fault if students elect to use that time less productively.

I don’t think creating half-arsed MDs is the answer to match failures. Most unmatched applicants I know have not surprised me by their failure to match. Sure, some are amazing people just reaching for hyper competitive fields, but the majority have some major red flags and i sure as shootin wouldn’t want to train them. I also have zero sympathy for IMGs who were stupid enough to go that route despite overwhelming evidence. Play stupid games, win stupid prizes.