The Flexner Report, a 1910 study of medical education across North America, encouraged American medical schools to enact higher admission and graduation standards. For its author, Abraham Flexner, conveying knowledge of scientific advances was the primary criterion for a medical school education. He recommended the standardization of medical school research through two years each of scientific and clinical training, a formula found in many medical schools to this day. However, due to high skyrocketing costs in medical education and the aging of medical school matriculants, the medical community is challenging Flexner's educational standard.
In a New England Journal of Medicine article, a team of doctors opined that the length of medical school could be shortened by a year without diminishing a physicians' competency, especially considering the underutilization of the fourth year. The authors hoped that the curtailing of medical school education would counter the rising average age of medical students, the massive debts they incur and their pursuit of lucrative specialty fields over primary care.
Yet a rebuttal printed in the same issue noted that medical schools have attempted to shorten the total time to complete the curriculum since the 1970s, mostly by combining baccalaureate and medical education into a six or seven year experience. Many such programs have since been discontinued, primarily due to student and faculty's discontent at condensing the scientific and clinical material. Such compression may place these students at a disadvantage when taking the United States Medical Licensing Examination Step I, one of the most important components of a medical student's residency application. Even in the remaining six or seven programs, the four-year medical school curricula stays intact, as most of the time in training is reduced in the B.A. portion of the curriculum. Furthermore, the rebuttal stated that the programs did not consistently boost the number of students choosing primary care careers.
I recently interviewed a '12 currently in his first year of medical school. He expressed relief that medical schools are thinking about how to streamline the process of training physicians, but pointed out that they really must remove the "mostly superfluous" requirements imposed on applicants and let them begin their medical education at a reasonable time.
For instance, it is increasingly common to delay applying to medical school until after college graduation due to the competitive nature of the admissions process. In 2012, only 43 percent of original applicants matriculated to an M.D.-granting institution. To maximize their chances, many students choose to take time off to complete a large set of prerequisites, such as taking required courses, preparing for the MCAT and doing research and clinical work to bolster their application. The result is age creep among students and, consequently, new doctors.
Medical schools throughout the U.S. could address an aging matriculating pool by decreasing the number of required prerequisite courses or by streamlining the time frame of the application process. For instance, more medical schools could enact early admissions programs for more students. Geisel School of Medicine's early assurance program, which provides binding acceptance to the medical school for up to five current Dartmouth students during their junior year, is one such example. Geisel should consider expanding this program to ensure that quality applicants can take advantage of bypassing the time-consuming and costly admissions process.
Furthermore, in order to increase the number of people going into primary fields, programs such as the National Health Service corps already give a wide range of health providers the opportunity to have their student loans repaid while serving in communities with limited access to care. As such, rather than focusing on providing a short-term discount, more focus should be given to increasing compensation for primary care fields in the long-term. There is no simple solution, but considering these policy options could help make a lasting impact to ensure that the standards of education for primary care physicians remain on par with those going into more competitive specialties.
