One hears a good deal these days about the shortage of physicians in the United States. Part of the problem is one of distribution. M.D.‘s like to live in big cities more than they do in rural communities or small towns. So Boston probably has a little more than its fair share of doctors while others go wanting. But beyond that, the issue is also complicated by our changing demographics. As the baby boomers get older they need more care, and when they get more care they live longer and need more care.
For a long time the issues were insufficiently recognized, and in fact, medical schools were discouraged from growing by their professional organizations. If we had a momentary shortfall in doctors, we addressed it by importing talent from other countries, frequently from the third world, and we continue to do this with doctors and nurses even now. This gave Americans more medical care but deprived other nations of their best and brightest talent.
But over the past five years, as the facts of distribution and demographics have become more robustly evident, American medical schools have been encouraged to expand, and several new medical schools opened or are on the drawing board. As you can imagine, the start up time between deciding to establish a medical school and doing so is extensive, and it is not cheap. There are great capital costs for buildings and laboratories, and there are also human-resource issues; you have to find the professors and other professional staff. So one can only ask, what are we to do?
When I was a young dean at Boston University, a pilot program was funded by the Macy Foundation to see if it actually took eight years to make a doctor. Four years of pre-medical education leading to a B.A. or B.S. degree, and four more years to earn the M.D. was conventional. We found that perfectly wonderful doctors, talented and capable in all possible ways, could be educated in seven years, and a combined B.A./M.D. degree program has been successfully in place at BU at least since the 1960s.
When I came to George Washington University in 1988, I proposed that a comparable accelerated joint degree program be established, but was told by the medical school that it was impossible. It took some persuading to induce my colleagues at GW to try a novel initiative but they did, and we’ve had the B.A./M.D. degree program at GW for well over a decade and a half, with success that parallels that at BU.
The graduates of these programs are indistinguishable from their classmates who take a full additional year to receive their training; they go on to postgraduate internships and residencies with comparable competence, and there seems to be no evidence to suggest they are in any way less able or committed physicians for their slightly abbreviated experience.
This makes one wonder why the seven-year program hasn’t become generalized. If the job can be done in seven rather than eight years, why do the longer programs persist? Particularly when we need to enhance the supply of medical personnel, and when we recognize that it is bad public policy to be depriving poorer nations of their indigenous physicians.
The December 2007 issue of Academic Medicine, published by the Association of American Medical Colleges, is devoted to the question of “addressing physician shortages” and describes innovative models under way in Arizona, California, New Mexico, and Oregon, among other states. Surely this is a question that should be high on the roster of the next president of the United States and particularly his or her secretary of health and human services and secretary of education. Indeed it ought to be thought about in all the 50 state capitals.
Some time ago I asked the late Jean Mayer, then the president of Tufts University, why it took four years to go through medical school when Abraham Flexner was studying American medical education, and many years later, when surely there was a great deal more to know, it still took four years. He replied, “Stephen, we don’t educate doctors in four years, we socialize them. It takes about four years to turn a civilian into a physician.” Perhaps that is true.
But it is clear that in seven years we can take outstanding high-school seniors and put them through an academic experience during which they earn a joint B.A. and M.D. and are qualified to sit for their medical boards. Three years of Arts & Sciences are devoted to complete the pre-medical requirements and provide the students a range of classes in the humanities and social sciences, with first-year medical studies beginning with the fourth year. We don’t want to cheat the students of a general liberal-arts experience; we need to see if there are courses that concurrently fulfill both B.A. and M.D. basic-science requirements and yes, probably use one of the summer vacations to round them out.
We know this can be done: We can eliminate redundant course offerings; save every medical student in America a year, which is no small matter in both time and money; and graduate more physicians without dramatic new budgetary expenditures by taxpayers, students, and students’ parents.
Is this perhaps an idea that needs to go from the experimental to the general?
