I recently read that New York University (N.Y.U.) requested its Medical School seniors to graduate early to join the war against the corona-virus, and more than half of the students volunteered. On one hand, I felt so proud of these students for what they are doing. On the other, it almost felt like a wartime draft of our young. It also highlights a critical problem we face in the US — a shortage of doctors (According to a 2019 study by American Association of Medical Colleges (A.A.M.C.), the shortage is projected at 122,000 physicians across primary and specialty care by 2032). The problem may be compounded by the pandemic, and the glaring gaps in the healthcare infrastructure that it has exposed.
My wife is a physician, and my son is a junior in high school with aspirations of becoming a physician. As we explore the pathways for our son, this is what we have learned so far:
- He can pursue a four-year undergraduate degree at any of the colleges as a Pre-Med student, take the Medical College Admission Test (M.C.A.T.), and then apply to Medical School, which is another 4 years. At best, he will start his residency in 8 years. Looking at public colleges, that comes to a minimum of $400,000 in expenses without aid. At private colleges- $700,000. Invested at 5% rate of return over 20 years, that ranges from $1.05 Million to $1.85 Million. A lot of them won’t save that much over their lifetime. Realistically speaking, most students take 1–2 gap years between the two programs to work and minimize student debt.
- The other option he has to apply to a combined BS/MD program. There are approximately 60+ programs in the US where you have the option of getting guaranteed admission into the medical school after completion of the undergraduate degree. However, the acceptance rate in these programs is less than 1%, and even these programs come in different flavors: Some can be completed in 6 years, others in 7, most in 8 years. Some do not require M.C.A.T. to graduate into Medical School, others do. And others give you the option to apply to Medical School only in the second year of your undergraduate education.With so many inconsistencies, the only metric we have to decide on how to choose a school is based on investment needed — because there is no difference in the credentials of students graduating in 6 years versus 8+ years.
- If he decides to pursue his undergraduate education outside of the US — which he wanted, it will severely hamper his chances of getting admitted into the medical school in the US. For example, if he pursues his BS in the UK — which is a 3-year program, he is required to pursue at least a year of undergrad in the US to qualify for taking the M.C.A.T. Even if he went to a few of the universities in Canada that are recognized by A.A.M.C., only select medical schools in the US would consider his application. If he wants to study abroad, his best option is to complete medical school there and then apply for a residency program in the US as a foreign medical graduate. His path will then be akin to what my wife took — she finished her Bachelor of Medicine and Bachelor of Surgery (M.B.B.S.) in India ( a 5-year program), cleared the US Medical Licensing Exam (U.S.M.L.E.), and then pursued her residency in the US. The advantage of following the same path — he will finish medical school in 5 years. That is the primary model of medical education across the world and will save quite a few dollars. The disadvantage — he will have limited access to some of the more sought-after residencies, for example, surgery, anesthesiology, or orthopedics. One thing that will work in his favor versus other foreign medical graduates (F.M.G.) though is that he is a US citizen and he won’t have to worry about the immigration vortex a lot of F.M.Gs. find themselves in.
The bottom line, the most likely scenario for our son, and most aspiring physicians is at-least 8 years of medical school at a significant cost. Combine that with no increase in the number of spots available to train physicians even with the changing demographics, the shortage of physicians will become even more acute.
I applaud N.Y.U. (I am a proud alum of its business school) for being the first medical school in the country to make medical school free. A few others have followed suit. That is a great first step — a financial incentive to encourage and train a new generation of physicians, and an investment is the county’s economic future.
The current crisis will undoubtedly disrupt the status quo and create new opportunities for training future physicians and for the practice of medicine. We will have to evaluate our models of care delivery, find the right balance between centralization versus decentralization of care, even evaluate the current, procedure-driven business models. We will see increased use of technology — telemedicine, artificial intelligence in clinical decision support, and remote care. To prepare future-ready physicians, we should evaluate a few additional options:
- Increase the number of combined BS/MD programs — and standardize the curriculum, to reduce variability in the choice that benefits some over others.
- Reassess if we can reduce the duration of training from 8 years to 5 years without compromising on quality. Looking globally, there is clear evidence that 5 years of medical school works. The only justification for 8 years seems to be financial.
- Embed learning about new technologies — from telemedicine to artificial intelligence — in the medical curriculum — to train physicians that could enable a more efficient and effective health system.
Disclaimer: This is my personal opinion and not meant as disrespect or challenge to the status quo. Instead, it is to highlight a situation, solving which may benefit our society at large.