Is a Shortened Medical School Program the Cure for the Physician Shortage?

The U.S. has been experiencing a shortage of primary care physicians (family medicine, pediatricians, geriatricians) as medical school graduates go after specialties that pay more. According to the American Academy of Pediatrics, last year, 252 pediatric residency slots out of 3139 were not filled (around 8%) and family medicine programs had 636 vacancies out of 5231 (12%). The Association of American Medical Colleges has forecast a shortage of primary care doctors of between 20,200 and 40,000 by 2036.

The way doctors are trained is changing to meet this shortage in primary care through an accelerated MD program that trains doctors for three years instead of the customary four. General medicine fields don’t need specialty training required to treat more complex cases or to perform invasive procedures or surgeries; therefore, medical students who are committed to going into primary care from the outset can get out of school a year early, saving them tuition and getting them into practice sooner. The average yearly tuition and fees for medical school are about $60,000, not counting housing and other costs.

There are currently 33 programs nationwide that offer accelerated pathways through a three-year medical school or a combination BS/MD in seven years. The programs, which focus on general medicine, offer the same core curriculum as four-year programs that students need to enter the field, but enable them to do so more quickly and with less debt.

Benefits to Rural Communities

Urban and wealthy suburban areas typically have generous access to primary and specialty health care. The medical landscape in rural America is quite different, and rural and disadvantaged communities stand the most to gain from getting more primary care doctors to serve their healthcare needs. According to the National Rural Health Association:

• The patient-to-primary care physician ratio in rural areas is only 39.8 physicians per 100,000 people, compared to 53.3 physicians per 100,000 in urban areas, which affects the health of the population.
• Family physicians comprise only 15% of the U.S. outpatient physician workforce nationwide but provide 42% of the care in rural areas.

The upside to the public is that some of the fast-track programs were established with the specific goal of addressing physician shortages in rural communities.

One Physician-Attorney’s Take on Accelerated Medical School

Armand Leone, M.D., Esq., co-founder of Britcher, Leone & Sergio, LLC, has some thoughts about this matter. In addition to being a medical malpractice attorney, he is also a board-certified diagnostic radiologist.

“Given the fragmentation within medical care, a significant amount of training in medical school ends up being outside of the physician’s ultimate practice area that is arguably irrelevant and just withers away,” says Leone.  “If someone starts medical school committed to general practice, courses in pathology and histology could be dramatically shortened; the same goes for third- and fourth-year specialty rotations. So, those students on a general practitioner path could reduce time in school to three years.”

He adds that “If shortened med school means getting more doctors into primary care, especially in underserved areas of the country, that’s a good solution to that problem.”

The Downsides of Accelerated Medical School

While an accelerated degree costs less in time and money, primary care practitioners who go through a shorter program will not have the depth of knowledge nor the financial burden from four years of medical school and several years of residency specialty training. In addition, the accelerated program will put limits on the complexity of healthcare problems these physicians can handle. Just as with physician assistants and nurse practitioners, practice guidelines need to be in place to make sure that more complex cases are referred to higher-level providers. Failure to escalate care is a potential problem for patients and potential cause for malpractice claims.

Shorter medical school enrollment and residency for primary care may help alleviate the more limited access to care in underserved rural areas. That is a good thing. However, the lack of easy access to specialty care may push those practitioners to the limits of their competency and result in patient injury.  These factors need to be addressed to prevent injury from misdiagnosis and/or incorrect treatment.