ACE-PC in the news
The Drawn-Out Medical Degree
Aug. 1, 2014,
Should medical education be shorter?
The answer is yes, at least according to administrators at many of America’s leading medical schools. The idea may conjure up images of clueless residents Googling symptoms on their smartphones at the patient’s bedside, but advocates insist that time spent in school can be trimmed without shortchanging education or compromising quality of care. And they say there are compelling reasons to speed up the process: to reduce the crushing debt many face by eliminating a year’s tuition and allowing doctors to start careers, and earn money, earlier.
The traditional four-year medical curriculum — two years of academic study and two years on the wards — is based on recommendations made in 1910 in a study called the Flexner Report and, many educators say, it’s time to rethink the program.
A recent, unpublished survey of 120 medical schools, conducted by the New York University School of Medicine, found that 30 percent were considering or already planning to start three-year programs, according to Dr. Steven B. Abramson, the senior vice president and vice dean for education, faculty and academic affairs. N.Y.U. enrolled its first three-year medical students a year ago. A handful of other pioneers include the medical schools at Mercer University in Savannah, Ga.; Texas Tech in Lubbock; the University of California, Davis; and Lake Erie College of Osteopathic Medicine.
The American Medical Association is among those urging changes in the way doctors are taught. Last year, it awarded $11 million to medical schools to spur innovative approaches. One emphasis is competency-based programs, in which students’ pace is determined by how well they perform a task, not by the number of years spent in school. Such programs in other fields have shortened the education process by about 20 percent, said Dr. Susan E. Skochelak, the association’s group vice president for medical education.
More than a dozen medical schools already have programs to move students more quickly from the classroom to the clinic, but by shortening premedical studies rather than medical school. Among them are Albany Medical College, Northeast Ohio Medical University and the medical schools at Boston University, Drexel, George Washington, Howard, Jefferson, Meharry and Northwestern. Gifted high school seniors or early college students are guaranteed admission to medical school if they perform well during freshman year of college. Combined bachelors/M.D. programs have been around for half a century, but these students complete both degrees in six or seven years instead of the usual eight.
“I absolutely think it’s doable,” said Dr. Charles G. Prober, senior associate dean for medical education at Stanford School of Medicine, which is considering such a program. Well-designed programs to accelerate doctors’ training “don’t send them out prematurely, but send them out with adequate tools, recognizing that they will grow,” said Dr. Prober, who writes and speaks extensively on medical education reform. “Real learning begins when you are actually beginning to take care of patients, doing what you were trained to do.”
While research is scant, a few studies show promising results. Comparisons of graduates of three-year programs at the University of Calgary and McMaster University to graduates of four-year Canadian medical schools found “equivalent performance.” And a small study at Marshall University in the 1990s, which for almost a decade incorporated fourth-year requirements with the first year of residency in family practice, declared it a success for “carefully selected candidates.”
Indeed, educators make clear that not all students can handle the accelerated curriculum. Dr. Prober notes that with the explosion of medical information, students more than ever must learn to work smart, figuring out what they need to memorize and how to find out the rest. Part of the education process today is learning to collaborate and tap the expertise of others.
That point — that there is too much to learn — is often cited to explain the failure of fast-track efforts in the 1970s amid student and faculty burnout and what some worried was inadequate preparation. An essay published on Sept. 19 in The New England Journal of Medicine called it “unwise” to eliminate the fourth year of medical school. The authors, Dr. Stanley Goldfarb and Dr. Gail Morrison, professors and administrators at the University of Pennsylvania’s medical school, argued that students needed more experience taking care of patients, not less, and would miss out on opportunities like the chance to work in other countries and to delve more deeply into topics like medical ethics, patient safety and health policy.
One counterargument is that training simply drags on too long. Residencies and fellowships after medical school have lengthened over the years, taking up productive working years.
An article co-authored by Dr. Abramson, also in the Sept. 19 issue of The New England Journal of Medicine, reported that the average age of newly minted doctors had increased. Since 1975, the percentage of doctors younger than 35 had declined from 28 percent to 15 percent
The article also noted that in 2011, 64 percent of medical students owed $100,000 or more. The enormous costs have insidious effects: Indebtedness drives students to pick lucrative specialties that will help pay off loans sooner, like orthopedics and dermatology, instead of fields like internal medicine and geriatrics, where physicians are greatly needed. Cutting time off medical school saves $30,000 to $50,000 a year.
The N.Y.U. School of Medicine enrolled 16 students (out of a class of 150) in its first three-year M.D. program last summer. The curriculum is identical to that of the rest of the class, except that the fourth year is missing. And the three-year applicants must know what type of physician they wish to become. Unlike students in traditional programs, who study, rotate through various specialties and then decide on one, three-year students must pick a specialty up front, are assigned mentors in that field and given opportunities to go on rounds, observe in the operating room and participate in research.
“If you want to be a certain kind of physician, you need to find out what it’s like,” Dr. Abramson said. Traditionally, students spend much of their fourth year applying for residencies and visiting programs all over the country, sometimes spending $20,000 just on travel for interviews.
“There’s an abrupt break, no continuum,” between medical school and residency, Dr. Abramson said. “There shouldn’t be abrupt breaks.”
Three-year students, on the other hand, will be guaranteed residencies at N.Y.U. “They’ll be secure, and they won’t have to worry about matching and interviewing.” He added: “Our approach is about being able to pursue personalized pathways.”
Right now, 15 percent of traditional N.Y.U. medical students actually take a fifth year, often to get a master’s in public health or business. (Dr. Prober, too, said that, typically, Stanford medical students stay on for nearly five years to take advantage of scholarly opportunities.) At N.Y.U., 10 percent coming in prefer a three-year program.
Devon Ryan, 24, plans to become an orthopedic surgeon. The program appealed to him, he said, because of “the opportunity to accelerate your career, given how long it is with med school plus residency and fellowship,” but also because of the chance to get to know people in the orthopedics department and become involved in patient care and research.
Amy Ou, 22, entered the program with plans to be a gastroenterologist, and welcomed the chance to bypass a year, which she estimated would save her and her family $70,000.
“One of the things I strongly believe in is that education is not the same for everybody,” Ms. Ou said. “For me, it’s not to regurgitate facts, but to learn to solve problems. I value being efficient with my time, so it makes sense for me to do it in three years.”
By Denise Grady, The New York Times
UC Davis is trailblazer in three-year medical school model
Monday, July 28, 2014 | Sacramento, CA |
A handful of UC Davis students are trailblazers in a new medical school model that has won the approval of Californian Governor Jerry Brown. Brown signed legislation that will allow doctors to practice with three years of medical school instead of four.
It’s Ngabo Nzigira’s sixth week of medical school, and he’s already interacting with patients.
“So we have the norco, you still taking that?" he asks.
Nzigira is being trained by a doctor at Kaiser Permanente in South Sacramento. Normally he wouldn’t be in a clinic until his third year. In this accelerated program, students can shave sixty thousand dollars off their medical school debt. But Nzigira had hesitations.
“I thought, 'Oh man, you want me to put the intensity and stress that is medical school in four years, you want me to condense it down to three years. I’m not sure about that,'” he says.
The UC Davis program is designed for students who know they want to be a primary care physician. It cuts out summer vacations and electives to get them into the field faster.
“There’s a huge problem, a huge shortage of primary care physicians," says Dr. Tonya Fancher who directs the program.
UC Davis says it’s meant to increase the supply of family doctors under the Affordable Care act.
“It seems like students come into medical school and they’re passionate about patients, passionate about primary care, part of it is the debt that they accrue, and part of it is the models of primary care that they’re exposed to," says Fancher.
One patient says he’s not concerned about shortened medical school - as long as students meet the same standards as other doctors.
Governor Brown Signs Bonilla Bill to Create New Pathway for More Physicians in California
July 18, 2014
SACRAMENTO – Assemblywoman Bonilla’s AB 1838, which allows graduates of accelerated and fully accredited medical education programs to become licensed physicians in California, was signed into law today by Governor Brown. This bill will allow more physicians to practice in California and help doctors incur less student debt.
“Currently California faces an extreme shortage of trained medical residents and physicians,” said Assemblywoman Susan A. Bonilla (D-Concord). “AB 1838 is an innovative step towards addressing this problem and meeting the needs of our communities, without diminishing the quality of patient care.”
Accelerated programs differ from traditional programs as they focus on the individuals’ skills and academic achievements, as opposed to the length of time they are in school. Accelerated programs do not replace current programs, they are offered as a separate track. Only students who have demonstrated a high level of scientific and medical understanding are eligible for the accelerated track.
This bill, which is co-sponsored by the Medical Board of California and the University of California, will be effective January, 2015.
“The Medical Board of California is pleased that Governor Brown signed AB 1838 into law,” said Executive Director, Kimberly Kirchmeyer. “This bill will help meet the needs of applicants applying for licensure, who have graduated from accelerated medical school programs, and will also assist in reducing student debt. The passage of the bill will further the Medical Board’s mission of promoting access to care while continuing to protect consumers.”
“We want to thank Assemblymember Susan A. Bonilla and the Medical Board of California for their leadership on this important and timely legislation,” said Dr. Cathryn Nation, UC Associate Vice President, Health Sciences. “UC is proud that its School of Medicine at Davis, in partnership with Kaiser Permanente, developed the first accelerated medical education program in California, enrolling its first class of six students in June 2014. Now, future graduates from not only this primary-care focused program – but also other accelerated programs – will have a clear path to medical practice in California.”
Assemblywoman Bonilla’s legislation, AB 1838, is also expected to enable California’s graduate medical education or residency training programs to recruit graduates of accelerated medical education programs operated by other accredited medical schools to complete their specialty training, become licensed, and enter practice in the state. Not only do accelerated programs address the clear need for more physicians while reducing student debt, they do so without affecting the quality of healthcare that patients deserve.
AB 1838 Press Release from Assemblymember's Office
ACE-PC story, Sacramento Business Journal
Six Sacramento students are pioneers in a three-year, accelerated medical school program with a focus on primary care.
Classes started June 16. The program is testing one way to address the primary-care shortage in California: getting physicians in the workforce sooner.
Legislation is winding its way through the state Capitol that would allow these students to become licensed doctors in three years instead of the usual four. The new pathway doesn’t try to cut corners, but it could cut student debt
The UC Davis School of Medicine is one of 11 medical schools selected nationwide last year by the American Medical Association to receive $1 million to develop new programs to train future doctors. Kaiser Permanenteis partnering with UC Davis to allow students to simultaneously perform primary-care residencies at Kaiser for a net total of six years of training.
The idea is to immerse students in Kaiser’s health-care system for seamless integration between medical education and medical practice. The focus is on treating chronic conditions like diabetes and chronic obstructive pulmonary disease. Students will have three full years with the same mentor at the same Kaiser clinic, no matter what other rotation or classes they are taking, said Dr. who runs the Kaiser side of the program. “And they will have a group of patients at the clinic they will be following over time. Medical students don’t usually have that ability.”
Impetus for the program comes from economic issues related to student debt and how new doctors find their career path. “Why is there a shortage and what can we do about it?” posed Dr. Tonya Fancher ,director of the UC Davis part of the program.
Far more students come to medical school wanting to be primary-care physicians than leave school with the same mind set, Fancher said. One of the barriers is medical school debt. An accelerated schedule can ease that burden.
In addition, experience in Kaiser’s approach to primary care — considered a model for the nation — boosts the value of the program, Fancher added.
Assembly Bill 1838 by Democratic Assemblywoman Susan Bonilla from Concord creates a shorter pathway to licensure through accelerated programs approved by national accreditation agencies. It is sponsored by the University of California — which operates six medical schools in the state — and the Medical Board of California ,which regulates, licenses and disciplines doctors.
The legislation comes at a time when demand for primary-care doctors is high due to federal health reform. AB 1838 has sailed through the Legislature without opposition. It was on the Senate floor at press time.
- Dennis McCoy - Sacramento Business Journal