When talking about improving medical education, many experts comment on reducing time spent in college, reorganizing pre-med courses, restructuring medical school to emphasize the clinical learning, or even the shortening of medical education to 3 years. The nuances are endless, and several medical schools have adopted their own models to improve the practice of future physicians.
But what if we think even bigger about a completely different structure? Imagine a world where all Physicians/DOs begin their medical education with a Physician Assistant/Associate (PA) degree. Then, after 24 months of intense, clinically focused training, each Physician Assistant must work for 12 months in a primary care setting (family medicine, internal medicine, pediatrics or obstetrics and gynecology). During this time, the PA would take the Physician Assistant National Certification Examination (PANCE) and then apply to 2-year medical school where she would earn an MD/DO degree.
In this abbreviated 2-year medical school, the PA would first undergo 6 months of more in-depth didactic learning in pathophysiology. Then the PA would experience traditional core medical student rotations such as: Internal Medicine, Surgery, Obstetrics/Gynecology, Psychiatry, Neurology, Family Medicine, Pediatrics, and Emergency Medicine for 12 months. During all these rotations, the PA should operate at the level of a trainee. Finally, the PA would spend 6 months in electives to broaden their medical experience. Upon completion of this 2-year medical school, the PA would graduate with an MD/DO degree and be able to practice full primary care medicine without supervision as long as he passes the United States Medical Licensing Examination (USMLE).
If doctors decide to specialize further, they will apply for residency. However, they would not have to complete an internship year and could apply directly to any specialty and spend the next 3-7 years learning that field through residency. As with the traditional approach to current medical education, fellowship opportunities would exist once residency is completed and the physician becomes eligible/board certified.
I love being a doctor, I wouldn’t trade it for any other job in or outside of healthcare. I’m grateful for the process I’ve been through and for all the teachers and patients I’ve had along the way who have helped me learn and grow. Our training is arduous and necessary because clinical medicine is not black and white and it takes time, effort and perseverance to learn the nuances that save patients’ lives in the most difficult situations. Additionally, clinical judgment, leadership, and confidence that evoke change are characteristics that develop through experience and on-the-job training.
So why propose such a radical change in medical education? The main reasons are twofold: the worsening shortage of primary care physicians and the issue of the “all or nothing” conundrum.
Shortage of primary care physicians: We always hear about it, but what are we really doing about it? According to The Complexities of Physician Supply and Demand: Projections From 2018 to 2033, by the Association of American Medical Colleges (AAMC), the United States will likely be short of 21,400 to 55,200 primary care physicians by 2033. This proposed new model of medical education would address the shortage on two fronts. Since all potential MD/DO candidates would complete a year in primary care as a PA, some may decide to stay and practice as a PA due to their exposure to the field. Additionally, if they decide to continue to complete their MD/DO degree, they will be able to practice full primary care medicine immediately upon completing medical school, as students would have practiced at the resident level throughout their clinical rotations. . This would save the 3 years of residency it currently takes to practice primary care.
All or nothing puzzle: According to the American Medical Association, 92.8% of American medical seniors and 89.1% of American seniors in 2021. The average medical school debt is $215,900, before adding other medical school debt. studies. Imagine going through at least 8 years of study and then being told that you cannot practice clinical medicine, even though you have met the requirements and passed the board exams required to obtain a medical degree. It was the story of over 2,000 unparalleled physicians in 2021, left with the burden of debt but no clinical careers to show for their efforts. This proposed new model of medical training solves this problem. Potential candidates can practice as a PA early on and make a career out of it if they choose. If they wish to continue their studies, they can pursue MD/DO and immediately practice as a general practitioner thereafter. The candidate would only have to continue his residency if he wishes to specialize further. Equally important, this alternative system allows exit ramps for applicants at multiple points in time, which is important because people’s life situations or interests may change. During the process of medical education, students may start a family or face life-changing responsibilities, such as personal illnesses or death in the family. These events may not be conducive with the current “all or nothing” training process required to become a physician; thus, this new system may also help alleviate burnout and create more flexible pathways in medicine.
The United States has been a leader in medical innovation for generations, but our medical education process has evolved less rapidly. Paradigm shifts on this scale may sound like science fiction, but with vision and our American ingenuity, we can overcome these modern challenges and achieve the impossible.
Rafid Rahman, MD, is an incoming physical medicine and rehabilitation resident at the University of Missouri School of Medicine. He is a member of MedPage todaythis is the lab.