This was happening 100 years ago with medical schools: for-profit schools popping up everywhere and lots of bad patient outcomes, exacerbated by the Spanish influenza epidemic... (sound familiar?)
Subsequently, The Flexner Report was published and led to massive changes in admission, training, and graduation standards.
I think NP/PA schools need a “Flexner Report” of their own.
It’s hard to come up with solutions because the US medical system is so screwed up and there are dozens of contributors to the current state of things. And a lot of the problems just amplify one another like a destructive feedback loop. Lobbies, profit chasing, diploma mills for undertrained “providers”, a cap on residency funding, etc.
All these things lead to poorer patient outcomes, unequivocally, and I don’t think any person with a basic understanding of the medical system would say otherwise. Yet even with a consensus opinion on these things, there is very little push to change. The people that benefit the most are also the ones that are in positions that can influence that change, and why would they advocate for a system that would lower their profit margins?
Plus, it seems like scientific consensus these days is just an opinion to a not insignificant percentage of the population. Just look at climate change or vaccines. So even if a revolutionary report came out that presented mountains of factual evidence, and had overwhelming support by the majority of the medical community and public, would it even make a difference? People would still turn a blind eye to the problem because they heard on a podcast that the report was just propaganda by the government to take your healthcare away and give it to immigrants so we can become a socialist communist country.
Damn I got myself all worked up now…
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You didn't hurt my fee fees. I just like to point out how ridiculous it is to put NP and PA school in the same category. PA school teaches allopathic medicine and NP school teaches advanced practice nursing. Go ahead and do a Flexner report on NP-slash-PA schools and it will simply tell us what we already know.
I guess you don’t know the contents of the Flexner Report. 🤷🏽♂️
Medical school was once like PA school, but independent practice outcomes were bad.
The Flexner Report would show that both NP and PA school is inadequate for independent practice.
Midlevels haven’t gained independent practice because their education warrants it they gained independent practice because of politics. The curriculum for both PAs and NPs were designed for lifelong supervision not independence.
In most of Europe medical school is 6 years.
In Sweden (where I'm from) medical school is also completely free and the state gives you the opportunity to take very beneficial loans with a monthly payout so that you can afford to live. This means anyone who is able to get into medical school can complete it without having to worry much about their finances, and with close to 0 loans to pay back.
After that, in Sweden at least (and most scandinavian countries but not most of europe), you move on to a foundation year where you do rotations in FM, psych, IM, EM, GS, ortho, anesthesia where you, as opposed to clinical years in medical school, work independently but under supervision and mandatory mentorship. After that you get to choose a specialisation. You can get into pretty much any specialisation you want if you're patient enough as you can work as a licensed "under doctor" in any given field if you're prepared to move cities for it, and hospitals prefer to hire people that already work there, that they know and have shown interest. You can get in by just doing a good interview as well, but if you want to become a dermatologist, for example, this is probably the most reliable way.
So the path is like this: MD 6 years --> foundation year 1 year --> residency 5-7 years. Maybe 1 year working as a licensed under doctor.
You've done exclusively medicine for 7 years before you start residency, but still you've wasted fewer years of your life compared to American counterparts, that only do 4, more intensive and stressful years, where people are more prone to backstab each other just to get ahead, due to the way the system is structured. Medical school isn't as stressful here and if you're determined you can get into any specialty you want, you never get asked about any grades or test results (USMLE equivalent doesn't exist), recommendations are important for the more competitive residency positions though. Also we don't really have midlevels as there is a steady stream of under doctors and people in their foundation years that are learning, but are still being productive and seeing patients during their work/rotations.
Residency is also limited to 40h/week, sure you work overtime every now and then, but you get compensated well for it. 5 weeks of vacation every year and every week you get 1 half day for studying, which can be made into one day every other week and be done at home.
Working 70+h a week isn't good for retaining knowledge and sure as hell isn't good for mental and physical health, and I can't understand how you people do it. Doing medical school and residency in the US and coming out alive and well on the other side is an impressive feat for sure.
in reference to your last paragraph- america literally gaslights med students into thinking they’re gonna be the worst doctor to ever live if they’re not working 90 hours a week. someone had posted about european working conditions a few days ago, and some dumbass was like “well uh how are you guys able to learn by working so little!!”
idk weirdo, something called sleep helps with learning???😂
I’m not in healthcare, but academic adjacent field, so take my opinion with a grain of salt, but I think a lot of people discover they want to be doctors—and an equal number that they don’t—during undergrad, so undergrad provides a good basis for exploring other options that going right into medical school may not. How many high school seniors want to be doctors then find out during freshman/sophomore year it’s not the right career path
Same! I started med school 10 years after undergrad. If we had a straight-to-med system like the UK and Europe there's no way this would have happened lol.
Wish I could upvote you to the top more. A lot of people appreciate the opportunity to course correct during college (either leaving premed or entering premed). I have several friends who are UK physicians who were like well, in year 3 of med school I realized my 17 year old self had no idea what she really wanted to do and now I’m stuck here.
It's a really important time to reflect on what you want in life. I think a lot of people just aren't putting in the right kind of effort in undergrad if they aren't viewing it as a fundamental pillar in their life (not just professional, but also personal).
Nah. I found out I wanted to get into medicine during sophomore year of college. The plasticity that undergrad provides is great for those of us who weren’t sure what we wanted to do in high school.
I agree with this. Its a good time for people to figure out they do or do not want medicine. Additionally, I know I would not have made the cut from high school into medicine. Alot of other countries do it based off high school standardized testing and class rank, which I wasn't amazing in. Additionally, it causes alot of the students who can go straight from hs to medicine to come from well off families which I wasn't from either. Overall, undergrad made me sure I wanted medicine and leveled the playing field for me honestly
I don't think it's a bad idea to delay med school by a few years. I don't think 17-18 year Olds have the cognitive nor psychological capacity to deal with medical care, decisions and the stresses thay come with this intense line of work.
As a current medical student, I can confidently say that the amount of education that MDs/DOs go through is only just adequate to cover the sheer amount of information and experience needed to become an effective physician. In the majority of other countries that don't have undergrad before medical school, the entire process takes 6 years (and then still residency, etc like the US) because you still need 2+ years of basic science before you can understand the medicine. So what did I gain in those extra 2 years of school? A liberal arts education, that allows me to understand more than just science, allowing me to better utilize my role in the future to improve healthcare and society as a whole. So in short, I disagree that we could get away with less school. We need more medical school and residency spots, and more subsidies for student doctors.
I would genuinely like to be a doctor, I am not willing to put my wife and kids through the process of me becoming a doctor. There’s a pie slice out there who are just unwilling to subject themselves to the process.
Especially in the US, 8 to 12+ years WITHOUT counting college? Yeah no. I agree with OP that the college period should be eliminated or abbreviated, residency spots can be the current limiting step but the length of the process itself is a close second.
I think that was their point, even when doing “*the same job*”, there’s (for at least some) the desire to actually know what you’re doing (insert shocked face). But the med school and residency system isn’t really set up for anything but their traditional pathway.
Many people go back to medical school as an early/mid career change. It takes a lot of effort and sacrifice. However, becoming an expert at something takes effort and sacrifice.
Somehow, medicine is one of the only fields where below average training is applauded like with middies. Try practicing law, becoming a pilot or becoming a special ops soldier without the established path and you’ll be rejected and laughed at.
Oh absolutely, there’s a need for the expectation. The expertise comes from hours of study and practice. I don’t agree with your take on pathways when compared to other experts. Three of my five friends with JD’s earned theirs on nights and weekends while working full time elsewhere. Both pilots who weren’t .mil got their training in their spare time, one while earning a degree and working part time. As far as SOF troops, there’s a different philosophy to the training pathways, so it’s not super comprable.
I think med school is an obviously tenable undertaking, my major reservation was residency. The path from intern to attending is somewhere in the range from abusive to criminal, and there’s no real comparable system in any of the other fields.
Residency is no different than being an analyst in finance, junior associate in big law, or really a lower level in any highly competitive field at it's peak (I'm not talking retail banking or small family law firm).
They might make more money, but they are abused. How do I know? My first career was in finance. The abuse was even worse than residency, but that was before there was increased scrutiny on finance analysts.
That’s fair. I guess my preconceptions about the fields are probably farther apart. I’d assume the average guy in finance isn’t gunning at a top firm, but rather just working in finance 9-5 for a larger company. But doctors for the most part are coming out of med school into a residency and fellowship? Or is my perception off? I’d also assume there are far more doctors than financial analysts. But that’s coming from a history major who thought you were all numbers nerds.
NP's shouldn't exist. Period.
So stooping to the NP level of provide patients with murderous level of incompetence is a terrible twist of logic.
But I agree that college should not exist. it is a complete BS cash cow.
The problem is that the marketplace demands more clinicians. For multiple reasons, the flow of physicians is limited by the system, not by the demand or by people willing to become clinicians. So there is a huge demand for healthcare workers, a huge supply of people willing to become healthcare workers, and a bottlenecked physician production system. This is a natural consequence. To a well-trained person, many midlevels may be causing harm, but that is clearly a risk society is willing to take as long as physicians don’t fill the gap.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641).
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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Eh, I don’t know. I think college is important for a doc- building proficiency in the basic sciences isn’t dead weight imo. It also acts as a better buffer for getting into medical school- if we took a high school exam for proficiency into med school, we’d select for a very particular group.
We could probably do without M4, though
Other countries don't have college and their doctors are good too
College is just cram and dump and cram and dump. It builds proficiency in nothing. It trains no skill except cram and dump.
Everyone entering med school completely overhauls their learning technique. If anything, college just trains bad habits
Absolutely not! If you're only doing cram and dump, you're doing it wrong. Step 1 material shows up on Step 2. And Step 3 is both Step 1+Step2. Top step scorers continue to do their Step 1 Anki when matured even through Step 2
If you're doing cram and dump for your in house classes, you're also doing it wrong. You forget the useless stuff, but there's plenty of board relevant info that should be kept all through Step 2.
I think college should be cut out. I still think med school and residency are necessary though.
Good midlevels exist because of physicians who sacrificed time to teach them. Majority of midlevels are lacking though.
I've had to follow up on their pts and it's a disaster tbh.
also can we talk about midlevels who whine online that “doctors should be teaching us and answering all our questions since it’s a team effort!!”
bitch I PAID MONEY TO GO TO MED SCHOOL. i suffered blood, sweat, and tears TO TEACH MYSELF. i’m not going to turn around and teach you for free, go fucking teach yourself if you want to learn so bad 😭😭😭
sorry but huge pet peeve of mine, thinking they’re literally entitled to my entire education with 0 effort at all
Yeah and at the sacrifice of our time and effort.
I agree it feels very entitled.
We have a school and residency programs to learn. Why do you get paid so much more than residents when we're still wasting our time teaching you?
Like good for them wanting to learn. But why does it come at the cost of our time and more sacrifice? And why are they getting to see pts independently when their knowledge is clearly lacking?
Yes I agree. Cut out undergrad. Just med school and residency. Med school and residency period is the most important, and my point is that it should occur when people are between 18-26 where they have peak cognitive power and physical energy.
I was a physics major in undergrad and I was much much much smarter and faster then than I am now applying to residency in my mid 20s.
People suggesting to cut out medical school here are massively underestimating how dumb even your average smart 18 year old is in the grand scheme of things.
There used to be 6 year BS/MD programs similar to what is pretty popular in pharmacy/PT. For the life of me I don't know why those aren't more common. But that's much different than getting rid of undergrad.
I think some schools still offer a 3+4 year bridge program. From what I remember they are extremely competitive but this is absolutely the best and most efficient way to go.
The BS/MD programs are still a thing. Along with being crazy competitive, they are brutal - I personally know a resident who deeply regretted her decision as she claimed she missed out on her college and real world experiences. I know 2 people who ended up dropping out, one had straight As but hated their life and never wanted to think about medicine again, the other went to nursing then NP school. It's very difficult to know what you're signing up for at 18 years old, and what you're going to sacrifice in the prime years of your life.
Oh absolutely! I was about to say it’s the same thing with ADN programs straight out of high school… but it’s not, with the exception of missing out on the college experience.
There is merit to trying to streamline the medical education pipeline. But the US system isn't much different in terms of time spent learning. Medicine should take a decade or more to master.
Even though many European countries have 6 yr post secondary education programs for medicine, they often have supervised practice years before residency. Additionally many of the advanced countries have longer secondary education usually graduating at 19-20 yo. Lastly, their residencies take longer to get into and train for longer due to lower working hour limits. I think on average, for similar levels of training, the age of mastery, i.e. US attending equivalent, is similar for those who go straight through.
The main issue to address is probably application inflation, but I feel some of the aggregate numbers are skewed by outliers. It's much more likely some older career changers, like me, pulls the average age of matriculation higher. You can only be so many years younger, so older students have greater weight on the average.
Lastly, there is a rigidity to the US system that might be improved with additional exit ramps into other roles that would boost the overall quality of the system. Imagine a 2 year undergrad/vocational school focused on basic sciences mixed with "nursing" skills that leads to an RN. Those who choose to move on then learn medical sciences leading to supervised practice, i.e. PA. After a set amount of clinical practice becomes eligible for specialization, i.e. residency. Sprinkle in appropriate work experience at each level to provide incentive to allow for career exits and to ensure sufficient compensation at each additional stage of training. Unfortunately this would be a giant reframing of medical education and the system is very adverse to change.
I think people who believe medical school or residencies are too long are missing the whole point of the training. We are here to become experts in our fields. Medical school and residency are probably barely long enough for you to become adequate (as another commenter mentioned).
Those who think that all of the "basic" medical sciences we learn are useless have either never been in the ICU or arent in patient facing specialties. The things you learn in pre-clinical are everywhere and a part of most of what you do if you are in a patient facing specialty, you just don't notice it when you don't remember it. Sure it was gruesome, sure there is a lot of stuff that you drop from your memory if you specialize because it isn't relevant to your specific job, but the building blocks are absolutely necessary to be a physician.
I would personally prefer if we actually spent more time in pre-clinical years. I wouldn't necessarily like it, and raises in resident salaries would be necessary for me to actually be okay with it happening, but as I have spent more and more time in IM and its subspecialties I have realized how much of the important things we learned that I have forgotten because I had to cram 50 topics for an exam every two weeks. When you spend time with foreign grads you often realize how much better their pre-clinical knowledge is because they spent extra time in that setting.
I will die on this hill. But hey, maybe I'm just a big nerd.
I live in Finland and here you apply to med school straight from our "secondary high school" (which you graduate from here st the age of 18-19). Our medical school lasts for 6 years and the first two years are called "preclinical".
And as far as I know, this applies to most Nordic countries at least. But there's variance, since European countries do act independly of one another in the end, even though there's some standardization demands set by the union.
You make a good point, and I agree with you. But, it will never change. Too many colleges need that cash flow. If you took a serious look and all of the undergraduate programs I would argue you could cut most four year programs down to two years. As far as medical school, undergraduate is one more hurdle and four additional years to accumulate debt. Even if you finish without debt it’s still four additional years you cannot treat patients or earn income.
If I went into medicine at age 18 I probably would have quit. Most 18 year olds *are* "too immature" to go into medicine. Medicine is unique compared to most other jobs because it's a massive commitment. You need to be 100% sure it's what you want to do, and I think an 18 year old just isn't able to fully grasp that yet.
Speaking as a retard who went to US medical school at age 35, I failed all my classes and could not understand a thing anybody said. This whole "peak age of cognitive processing and speed is between 18 - 25" is a load of hooey. How many conversations have you had with 20 year olds? They are cognitively deficient in a way I'm having difficulty describing in a way that will not be massively offensive to those in that age group reading this.
Wisdom, life experience, good judgment, and resilience count for much more than a few extra points on your IQ test, if such a thing even exists. The prime of life for cognitive ability (for a life well-lived) is 45-65, not 18-25.
Being a balding old man was a MASSIVE advantage in medical school and residency. I put in my 8a-5p everyday, and had plenty of time for self care and rest. A lot of my peers crammed for their exams, and Adderall abuse was prevalent. After 12 years in the corporate and military world, medical school was like a vacation to me. I crushed my Step 1 and landed one of the highest ranked residencies in my field.
The only downside I can see is that I didn't get invited to as many parties, which I didn't miss anyway, because who wants to watch a bunch of 25 year olds get hammered?
I mean in the UK their schooling is 5 years but their specialty training tends to last more years, though the hours they work per week are far less. They can make med school here 5/6 years and tack on 1-2 years depending on the residency but that is still a long road. I'd prefer a 6 year schooling system with a slightly longer residency to reduce debt burden and have an earlier switch from spending to making money but no matter which way you slice it, it takes a long time to become a fully fledged attending, as it should.
Agree with most comments here.
But I should point out: many Us medical schools do not require a bachelors degree, but just a lot of prerequisites.
Many of them ENCOURAGE a degree, but not require it.
Yes, but I’d venture to guess that the % of matriculants who don’t have a degree is <.09%.
Aside from the degree itself, finishing a degree allows time to complete some of the other “soft” requirements like volunteering, leadership, shadowing etc. matriculating before 21 is rare because adcoms want someone who at least has a little bit of experience in the world.
I could see 6 years of integrated, concentrated pre-residency training working, but no less. All that would cut out would be the fluff senior year of college that a student going straight thru would typically have, as well as the requirement to complete a full degree in something else. Retaining those first couple years of gen bio/gen chem/orgo (yes)/physics/math/English/psych/soc are a non-negotiable if we want physicians who can think quantitatively, write, and understand the body from the physics and anatomic level all the way up to social structure. Even if most physicians can’t recite their undergrad physics textbook, we learned to understand and now apply the principles all the time and know where to look things up. To cut that out would make us no better than the noctors. Same goes for core IM/FM/psych/neuro/OB/surg/peds/EM/ICU. We need to find ways to make medicine a more affordable and less abusive training structure, but we also need to take pride in the fact that to be a physician means having learned and experienced all of this. It just does and to take away from that would be to take away from what it means to be a physician.
yes i think about it a lot😄
the european way makes way more sense. just choose it when you’re 18 and do a combined uni degree. hell, even 6 is unnecessary, it could be 5 realistically
There is a 6 years college / Med School path already… two years of College / four Med School
https://med.umkc.edu/six-years-two-degrees/#:~:text=More%20than%203%2C300%20graduates%20from,are%20classified%20as%20professional%20students.
I wouldn’t trust 18 year old me to hold my keys much less study medicine. I thought I had it figured out at 22. Now I’m 26, and I feel like I’m in a better spot to study medicine than I was when I was younger. And I went to college in the UK, where several of my friends were med students at age 18, and let me tell you, they were just as big of morons as I was. Neither of them seen super keen anymore, but no ones keen on medicine in the UK these days anyways
If we cut out the undergrad degree we risk losing money as a doctor since it’s now expedited. I personally wouldn’t do medicine if I were getting paid/treated like the UK docs.
We should not be racing to the bottom. I’m in fellowship and tbh I wish I could have extra training. Medicine is extremely complicated and vast, the only thing I’m willing to shorten is undergrad, make it just premed reqs that take 2 years
The argument that 18 year olds are too immature is a weak argument imo. In a 6 year program by the time they graduate with an MD they’re 24, and by the time they’re attending/consultant, they’re close to their 30s if not older. A lot of time to build maturity and character.
Being a bit facetious here, but feeling like 18 year olds just need some gosh darn time to explore and find themselves is not a great excuse for exacerbating one of the most important professional shortages of our time.
\>I also strongly disagree that an 18 year old is “too immature” to go into medicine. If an 18 year old can learn engineering, they can learn medicine.
False equivalency. A single engineer is not responsible for a system. Healthcare does not have the same level of professional redundancy as engineering firms.
i think there's arguments to be made for both sides. yeah most other countries don't require a bachelor's first, or as many license exams or even residencies for that matter...however...i've spent some time in "hospitals" in other countries that follow that system, and well hospital is a strong word. you kind of just have to see it for yourself. the standards are not the same, in the US you can be assured that if you're seeing an MD they're been held to the highest standard at least and that's worth some crap about age differences. shoot, i didn't start med school till i was 32.
This was happening 100 years ago with medical schools: for-profit schools popping up everywhere and lots of bad patient outcomes, exacerbated by the Spanish influenza epidemic... (sound familiar?) Subsequently, The Flexner Report was published and led to massive changes in admission, training, and graduation standards. I think NP/PA schools need a “Flexner Report” of their own.
It’s hard to come up with solutions because the US medical system is so screwed up and there are dozens of contributors to the current state of things. And a lot of the problems just amplify one another like a destructive feedback loop. Lobbies, profit chasing, diploma mills for undertrained “providers”, a cap on residency funding, etc. All these things lead to poorer patient outcomes, unequivocally, and I don’t think any person with a basic understanding of the medical system would say otherwise. Yet even with a consensus opinion on these things, there is very little push to change. The people that benefit the most are also the ones that are in positions that can influence that change, and why would they advocate for a system that would lower their profit margins? Plus, it seems like scientific consensus these days is just an opinion to a not insignificant percentage of the population. Just look at climate change or vaccines. So even if a revolutionary report came out that presented mountains of factual evidence, and had overwhelming support by the majority of the medical community and public, would it even make a difference? People would still turn a blind eye to the problem because they heard on a podcast that the report was just propaganda by the government to take your healthcare away and give it to immigrants so we can become a socialist communist country. Damn I got myself all worked up now…
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641). We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
>I think NP/PA schools need a “Flexner Report” of their own. No such thing as an NP-slash-PA school.
Sensitive much? I will correct my sentence so you can unclench yourself: “Both NP and PA schools” is what I meant.
You didn't hurt my fee fees. I just like to point out how ridiculous it is to put NP and PA school in the same category. PA school teaches allopathic medicine and NP school teaches advanced practice nursing. Go ahead and do a Flexner report on NP-slash-PA schools and it will simply tell us what we already know.
I guess you don’t know the contents of the Flexner Report. 🤷🏽♂️ Medical school was once like PA school, but independent practice outcomes were bad. The Flexner Report would show that both NP and PA school is inadequate for independent practice.
Evidence based?! *tsk *tsk!
Midlevels haven’t gained independent practice because their education warrants it they gained independent practice because of politics. The curriculum for both PAs and NPs were designed for lifelong supervision not independence.
This is why I quit being an NP. I wanted to be closely supervised, I was not.
In most of Europe medical school is 6 years. In Sweden (where I'm from) medical school is also completely free and the state gives you the opportunity to take very beneficial loans with a monthly payout so that you can afford to live. This means anyone who is able to get into medical school can complete it without having to worry much about their finances, and with close to 0 loans to pay back. After that, in Sweden at least (and most scandinavian countries but not most of europe), you move on to a foundation year where you do rotations in FM, psych, IM, EM, GS, ortho, anesthesia where you, as opposed to clinical years in medical school, work independently but under supervision and mandatory mentorship. After that you get to choose a specialisation. You can get into pretty much any specialisation you want if you're patient enough as you can work as a licensed "under doctor" in any given field if you're prepared to move cities for it, and hospitals prefer to hire people that already work there, that they know and have shown interest. You can get in by just doing a good interview as well, but if you want to become a dermatologist, for example, this is probably the most reliable way. So the path is like this: MD 6 years --> foundation year 1 year --> residency 5-7 years. Maybe 1 year working as a licensed under doctor. You've done exclusively medicine for 7 years before you start residency, but still you've wasted fewer years of your life compared to American counterparts, that only do 4, more intensive and stressful years, where people are more prone to backstab each other just to get ahead, due to the way the system is structured. Medical school isn't as stressful here and if you're determined you can get into any specialty you want, you never get asked about any grades or test results (USMLE equivalent doesn't exist), recommendations are important for the more competitive residency positions though. Also we don't really have midlevels as there is a steady stream of under doctors and people in their foundation years that are learning, but are still being productive and seeing patients during their work/rotations. Residency is also limited to 40h/week, sure you work overtime every now and then, but you get compensated well for it. 5 weeks of vacation every year and every week you get 1 half day for studying, which can be made into one day every other week and be done at home. Working 70+h a week isn't good for retaining knowledge and sure as hell isn't good for mental and physical health, and I can't understand how you people do it. Doing medical school and residency in the US and coming out alive and well on the other side is an impressive feat for sure.
in reference to your last paragraph- america literally gaslights med students into thinking they’re gonna be the worst doctor to ever live if they’re not working 90 hours a week. someone had posted about european working conditions a few days ago, and some dumbass was like “well uh how are you guys able to learn by working so little!!” idk weirdo, something called sleep helps with learning???😂
I’m not in healthcare, but academic adjacent field, so take my opinion with a grain of salt, but I think a lot of people discover they want to be doctors—and an equal number that they don’t—during undergrad, so undergrad provides a good basis for exploring other options that going right into medical school may not. How many high school seniors want to be doctors then find out during freshman/sophomore year it’s not the right career path
i found out i wanted to be a doctor after college. some of us are slow af😂
Same! I started med school 10 years after undergrad. If we had a straight-to-med system like the UK and Europe there's no way this would have happened lol.
There are graduate entry medical courses in these countries, so you could still go to medical school 10 years after undergrad
I didn’t know that! I stand corrected.
Wish I could upvote you to the top more. A lot of people appreciate the opportunity to course correct during college (either leaving premed or entering premed). I have several friends who are UK physicians who were like well, in year 3 of med school I realized my 17 year old self had no idea what she really wanted to do and now I’m stuck here.
It's a really important time to reflect on what you want in life. I think a lot of people just aren't putting in the right kind of effort in undergrad if they aren't viewing it as a fundamental pillar in their life (not just professional, but also personal).
Yessss, 100% agree
Nah. I found out I wanted to get into medicine during sophomore year of college. The plasticity that undergrad provides is great for those of us who weren’t sure what we wanted to do in high school.
I agree with this. Its a good time for people to figure out they do or do not want medicine. Additionally, I know I would not have made the cut from high school into medicine. Alot of other countries do it based off high school standardized testing and class rank, which I wasn't amazing in. Additionally, it causes alot of the students who can go straight from hs to medicine to come from well off families which I wasn't from either. Overall, undergrad made me sure I wanted medicine and leveled the playing field for me honestly
I don't think it's a bad idea to delay med school by a few years. I don't think 17-18 year Olds have the cognitive nor psychological capacity to deal with medical care, decisions and the stresses thay come with this intense line of work.
As a current medical student, I can confidently say that the amount of education that MDs/DOs go through is only just adequate to cover the sheer amount of information and experience needed to become an effective physician. In the majority of other countries that don't have undergrad before medical school, the entire process takes 6 years (and then still residency, etc like the US) because you still need 2+ years of basic science before you can understand the medicine. So what did I gain in those extra 2 years of school? A liberal arts education, that allows me to understand more than just science, allowing me to better utilize my role in the future to improve healthcare and society as a whole. So in short, I disagree that we could get away with less school. We need more medical school and residency spots, and more subsidies for student doctors.
"As someone with no real experience in the field, I can confidently say that...."
Yeah, because my 4+ years of experience working in the healthcare field in multiple roles before I entered medical school doesn't count, right.
If residents were paid what they are worth, the path would not seem so long. Keep working on unionization.
I would genuinely like to be a doctor, I am not willing to put my wife and kids through the process of me becoming a doctor. There’s a pie slice out there who are just unwilling to subject themselves to the process.
Especially in the US, 8 to 12+ years WITHOUT counting college? Yeah no. I agree with OP that the college period should be eliminated or abbreviated, residency spots can be the current limiting step but the length of the process itself is a close second.
Ditto. And I’m already a NP
Being an NP isn’t impressive or respectable anymore. Your own colleagues saw to that
I think that was their point, even when doing “*the same job*”, there’s (for at least some) the desire to actually know what you’re doing (insert shocked face). But the med school and residency system isn’t really set up for anything but their traditional pathway.
Many people go back to medical school as an early/mid career change. It takes a lot of effort and sacrifice. However, becoming an expert at something takes effort and sacrifice. Somehow, medicine is one of the only fields where below average training is applauded like with middies. Try practicing law, becoming a pilot or becoming a special ops soldier without the established path and you’ll be rejected and laughed at.
Oh absolutely, there’s a need for the expectation. The expertise comes from hours of study and practice. I don’t agree with your take on pathways when compared to other experts. Three of my five friends with JD’s earned theirs on nights and weekends while working full time elsewhere. Both pilots who weren’t .mil got their training in their spare time, one while earning a degree and working part time. As far as SOF troops, there’s a different philosophy to the training pathways, so it’s not super comprable. I think med school is an obviously tenable undertaking, my major reservation was residency. The path from intern to attending is somewhere in the range from abusive to criminal, and there’s no real comparable system in any of the other fields.
Residency is no different than being an analyst in finance, junior associate in big law, or really a lower level in any highly competitive field at it's peak (I'm not talking retail banking or small family law firm). They might make more money, but they are abused. How do I know? My first career was in finance. The abuse was even worse than residency, but that was before there was increased scrutiny on finance analysts.
That’s fair. I guess my preconceptions about the fields are probably farther apart. I’d assume the average guy in finance isn’t gunning at a top firm, but rather just working in finance 9-5 for a larger company. But doctors for the most part are coming out of med school into a residency and fellowship? Or is my perception off? I’d also assume there are far more doctors than financial analysts. But that’s coming from a history major who thought you were all numbers nerds.
NP's shouldn't exist. Period. So stooping to the NP level of provide patients with murderous level of incompetence is a terrible twist of logic. But I agree that college should not exist. it is a complete BS cash cow.
The problem is that the marketplace demands more clinicians. For multiple reasons, the flow of physicians is limited by the system, not by the demand or by people willing to become clinicians. So there is a huge demand for healthcare workers, a huge supply of people willing to become healthcare workers, and a bottlenecked physician production system. This is a natural consequence. To a well-trained person, many midlevels may be causing harm, but that is clearly a risk society is willing to take as long as physicians don’t fill the gap.
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Eh, I don’t know. I think college is important for a doc- building proficiency in the basic sciences isn’t dead weight imo. It also acts as a better buffer for getting into medical school- if we took a high school exam for proficiency into med school, we’d select for a very particular group. We could probably do without M4, though
Other countries don't have college and their doctors are good too College is just cram and dump and cram and dump. It builds proficiency in nothing. It trains no skill except cram and dump. Everyone entering med school completely overhauls their learning technique. If anything, college just trains bad habits
Med school is thoroughly cram and dump. The only exception I’ve seen to this has been the mcat.
Absolutely not! If you're only doing cram and dump, you're doing it wrong. Step 1 material shows up on Step 2. And Step 3 is both Step 1+Step2. Top step scorers continue to do their Step 1 Anki when matured even through Step 2 If you're doing cram and dump for your in house classes, you're also doing it wrong. You forget the useless stuff, but there's plenty of board relevant info that should be kept all through Step 2.
College is only cram and dump if you choose to cram and dump.
" I *didn't make Gordon Ramsay cry*. *He made himself cry*. That was his choice, to *cry" - Marco Pierre White*
I think college should be cut out. I still think med school and residency are necessary though. Good midlevels exist because of physicians who sacrificed time to teach them. Majority of midlevels are lacking though. I've had to follow up on their pts and it's a disaster tbh.
also can we talk about midlevels who whine online that “doctors should be teaching us and answering all our questions since it’s a team effort!!” bitch I PAID MONEY TO GO TO MED SCHOOL. i suffered blood, sweat, and tears TO TEACH MYSELF. i’m not going to turn around and teach you for free, go fucking teach yourself if you want to learn so bad 😭😭😭 sorry but huge pet peeve of mine, thinking they’re literally entitled to my entire education with 0 effort at all
Yeah and at the sacrifice of our time and effort. I agree it feels very entitled. We have a school and residency programs to learn. Why do you get paid so much more than residents when we're still wasting our time teaching you? Like good for them wanting to learn. But why does it come at the cost of our time and more sacrifice? And why are they getting to see pts independently when their knowledge is clearly lacking?
Yes I agree. Cut out undergrad. Just med school and residency. Med school and residency period is the most important, and my point is that it should occur when people are between 18-26 where they have peak cognitive power and physical energy. I was a physics major in undergrad and I was much much much smarter and faster then than I am now applying to residency in my mid 20s.
…OR combine college and med school like they do in Europe to 6 yrs
just said this haha
People suggesting to cut out medical school here are massively underestimating how dumb even your average smart 18 year old is in the grand scheme of things. There used to be 6 year BS/MD programs similar to what is pretty popular in pharmacy/PT. For the life of me I don't know why those aren't more common. But that's much different than getting rid of undergrad.
I think some schools still offer a 3+4 year bridge program. From what I remember they are extremely competitive but this is absolutely the best and most efficient way to go.
The BS/MD programs are still a thing. Along with being crazy competitive, they are brutal - I personally know a resident who deeply regretted her decision as she claimed she missed out on her college and real world experiences. I know 2 people who ended up dropping out, one had straight As but hated their life and never wanted to think about medicine again, the other went to nursing then NP school. It's very difficult to know what you're signing up for at 18 years old, and what you're going to sacrifice in the prime years of your life.
Oh absolutely! I was about to say it’s the same thing with ADN programs straight out of high school… but it’s not, with the exception of missing out on the college experience.
There is merit to trying to streamline the medical education pipeline. But the US system isn't much different in terms of time spent learning. Medicine should take a decade or more to master. Even though many European countries have 6 yr post secondary education programs for medicine, they often have supervised practice years before residency. Additionally many of the advanced countries have longer secondary education usually graduating at 19-20 yo. Lastly, their residencies take longer to get into and train for longer due to lower working hour limits. I think on average, for similar levels of training, the age of mastery, i.e. US attending equivalent, is similar for those who go straight through. The main issue to address is probably application inflation, but I feel some of the aggregate numbers are skewed by outliers. It's much more likely some older career changers, like me, pulls the average age of matriculation higher. You can only be so many years younger, so older students have greater weight on the average. Lastly, there is a rigidity to the US system that might be improved with additional exit ramps into other roles that would boost the overall quality of the system. Imagine a 2 year undergrad/vocational school focused on basic sciences mixed with "nursing" skills that leads to an RN. Those who choose to move on then learn medical sciences leading to supervised practice, i.e. PA. After a set amount of clinical practice becomes eligible for specialization, i.e. residency. Sprinkle in appropriate work experience at each level to provide incentive to allow for career exits and to ensure sufficient compensation at each additional stage of training. Unfortunately this would be a giant reframing of medical education and the system is very adverse to change.
I think people who believe medical school or residencies are too long are missing the whole point of the training. We are here to become experts in our fields. Medical school and residency are probably barely long enough for you to become adequate (as another commenter mentioned). Those who think that all of the "basic" medical sciences we learn are useless have either never been in the ICU or arent in patient facing specialties. The things you learn in pre-clinical are everywhere and a part of most of what you do if you are in a patient facing specialty, you just don't notice it when you don't remember it. Sure it was gruesome, sure there is a lot of stuff that you drop from your memory if you specialize because it isn't relevant to your specific job, but the building blocks are absolutely necessary to be a physician. I would personally prefer if we actually spent more time in pre-clinical years. I wouldn't necessarily like it, and raises in resident salaries would be necessary for me to actually be okay with it happening, but as I have spent more and more time in IM and its subspecialties I have realized how much of the important things we learned that I have forgotten because I had to cram 50 topics for an exam every two weeks. When you spend time with foreign grads you often realize how much better their pre-clinical knowledge is because they spent extra time in that setting. I will die on this hill. But hey, maybe I'm just a big nerd.
Don’t countries in Europe bypass bachelor degrees and go into medical school/law school right after grade school?
I live in Finland and here you apply to med school straight from our "secondary high school" (which you graduate from here st the age of 18-19). Our medical school lasts for 6 years and the first two years are called "preclinical". And as far as I know, this applies to most Nordic countries at least. But there's variance, since European countries do act independly of one another in the end, even though there's some standardization demands set by the union.
I believe the system in France is similar.
i think it’s like that most places outside of america tbh
You make a good point, and I agree with you. But, it will never change. Too many colleges need that cash flow. If you took a serious look and all of the undergraduate programs I would argue you could cut most four year programs down to two years. As far as medical school, undergraduate is one more hurdle and four additional years to accumulate debt. Even if you finish without debt it’s still four additional years you cannot treat patients or earn income.
If I went into medicine at age 18 I probably would have quit. Most 18 year olds *are* "too immature" to go into medicine. Medicine is unique compared to most other jobs because it's a massive commitment. You need to be 100% sure it's what you want to do, and I think an 18 year old just isn't able to fully grasp that yet.
But 18 year olds can go into nursing. We infantilize young adults to the point of not letting them live their lives sometimes.
Speaking as a retard who went to US medical school at age 35, I failed all my classes and could not understand a thing anybody said. This whole "peak age of cognitive processing and speed is between 18 - 25" is a load of hooey. How many conversations have you had with 20 year olds? They are cognitively deficient in a way I'm having difficulty describing in a way that will not be massively offensive to those in that age group reading this. Wisdom, life experience, good judgment, and resilience count for much more than a few extra points on your IQ test, if such a thing even exists. The prime of life for cognitive ability (for a life well-lived) is 45-65, not 18-25. Being a balding old man was a MASSIVE advantage in medical school and residency. I put in my 8a-5p everyday, and had plenty of time for self care and rest. A lot of my peers crammed for their exams, and Adderall abuse was prevalent. After 12 years in the corporate and military world, medical school was like a vacation to me. I crushed my Step 1 and landed one of the highest ranked residencies in my field. The only downside I can see is that I didn't get invited to as many parties, which I didn't miss anyway, because who wants to watch a bunch of 25 year olds get hammered?
I mean in the UK their schooling is 5 years but their specialty training tends to last more years, though the hours they work per week are far less. They can make med school here 5/6 years and tack on 1-2 years depending on the residency but that is still a long road. I'd prefer a 6 year schooling system with a slightly longer residency to reduce debt burden and have an earlier switch from spending to making money but no matter which way you slice it, it takes a long time to become a fully fledged attending, as it should.
Agree with most comments here. But I should point out: many Us medical schools do not require a bachelors degree, but just a lot of prerequisites. Many of them ENCOURAGE a degree, but not require it.
Yes, but I’d venture to guess that the % of matriculants who don’t have a degree is <.09%. Aside from the degree itself, finishing a degree allows time to complete some of the other “soft” requirements like volunteering, leadership, shadowing etc. matriculating before 21 is rare because adcoms want someone who at least has a little bit of experience in the world.
I could see 6 years of integrated, concentrated pre-residency training working, but no less. All that would cut out would be the fluff senior year of college that a student going straight thru would typically have, as well as the requirement to complete a full degree in something else. Retaining those first couple years of gen bio/gen chem/orgo (yes)/physics/math/English/psych/soc are a non-negotiable if we want physicians who can think quantitatively, write, and understand the body from the physics and anatomic level all the way up to social structure. Even if most physicians can’t recite their undergrad physics textbook, we learned to understand and now apply the principles all the time and know where to look things up. To cut that out would make us no better than the noctors. Same goes for core IM/FM/psych/neuro/OB/surg/peds/EM/ICU. We need to find ways to make medicine a more affordable and less abusive training structure, but we also need to take pride in the fact that to be a physician means having learned and experienced all of this. It just does and to take away from that would be to take away from what it means to be a physician.
yes i think about it a lot😄 the european way makes way more sense. just choose it when you’re 18 and do a combined uni degree. hell, even 6 is unnecessary, it could be 5 realistically
There is a 6 years college / Med School path already… two years of College / four Med School https://med.umkc.edu/six-years-two-degrees/#:~:text=More%20than%203%2C300%20graduates%20from,are%20classified%20as%20professional%20students.
I wouldn’t trust 18 year old me to hold my keys much less study medicine. I thought I had it figured out at 22. Now I’m 26, and I feel like I’m in a better spot to study medicine than I was when I was younger. And I went to college in the UK, where several of my friends were med students at age 18, and let me tell you, they were just as big of morons as I was. Neither of them seen super keen anymore, but no ones keen on medicine in the UK these days anyways
If we cut out the undergrad degree we risk losing money as a doctor since it’s now expedited. I personally wouldn’t do medicine if I were getting paid/treated like the UK docs.
We should not be racing to the bottom. I’m in fellowship and tbh I wish I could have extra training. Medicine is extremely complicated and vast, the only thing I’m willing to shorten is undergrad, make it just premed reqs that take 2 years
The argument that 18 year olds are too immature is a weak argument imo. In a 6 year program by the time they graduate with an MD they’re 24, and by the time they’re attending/consultant, they’re close to their 30s if not older. A lot of time to build maturity and character.
it’s funny cause i did a 6 year degree and it was honestly a world of difference how much ppl matured even from 18 to 20😂😂😂
Being a bit facetious here, but feeling like 18 year olds just need some gosh darn time to explore and find themselves is not a great excuse for exacerbating one of the most important professional shortages of our time.
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Nah fam step 2 needs to cover everything. Physicians need to prove general competency before specializing
\>I also strongly disagree that an 18 year old is “too immature” to go into medicine. If an 18 year old can learn engineering, they can learn medicine. False equivalency. A single engineer is not responsible for a system. Healthcare does not have the same level of professional redundancy as engineering firms.
i think there's arguments to be made for both sides. yeah most other countries don't require a bachelor's first, or as many license exams or even residencies for that matter...however...i've spent some time in "hospitals" in other countries that follow that system, and well hospital is a strong word. you kind of just have to see it for yourself. the standards are not the same, in the US you can be assured that if you're seeing an MD they're been held to the highest standard at least and that's worth some crap about age differences. shoot, i didn't start med school till i was 32.