kitchen table math, the sequel: physician training in the U.S.

Sunday, August 1, 2010

physician training in the U.S.

re: lawyers without law school

A friend sends the educational requirements for physicians:
Four years of college
then four years of medical school (during those last two years, you do a
bunch of rotations through whatever teaching hospital your medical
school is connected to).
Then residency -- which has varying lengths.
I believe the standard residency is 3 years, but can be much longer
(surgery is much longer -- 5 years).
After residency, you might choose a subspecialty, which would require a
fellowship (of varying length).

My husband’s pre-career training went something like this
4 years at xxxx undergraduate in engineering
4 years xxxx Medical school
3 years residency at xxxx in general pediatrics
3 years fellowship at xxxx in ped cardiology
so about 14 years of training and he was in his early 30s when he got
his first job.

Surgery is much longer. Not only is the residency longer, but if you
chose a subspecialty as well (such as cardio-thoracic) the surgery
fellowship is much longer.


palisadesk said...

There's some variability here. If anyone is interested in the "problem-based learning: approach in medical education (as opposed to the usual lectures, seminars etc.) see my comments in a post over at D-ed Reckoning:
inquiry based medical education

There are 3 comments there that elaborate on the system. I didn't know until recently there was such a thing as an inquiry-based approach in medical school, but it has excellent results -- with a very selective student body I might add.

ChemProf said...

There's also a market piece here that we shouldn't forget. Med schools could take students with less than a BA, but why should they do so when there are so many candidates with a BA? Pharmacy schools used to take students with two years of pre-pharmacy, without a BA, but have gotten more selective so less likely to do so in the last decade or so. So, similarly, the medical board could let you practice without a residency, but why should they when hospitals won't hire doctors who don't have it.

In the 70's, the same process made a postdoc (in chemistry) go from rare to required for academic jobs. In my field, Ph.D.'s used to commonly start as professors right out the gate, in their mid-20's. Then in the 70's, there was a glut of chemists, and so a postdoc lost its stigma (as in the 60's it was something only weak candidates would ever take). Now suddenly, academic institutions preferred candidates with postdoc experience.

As palisadesk notes, you can buck this trend if you have a great model but it also often requires a very well selected student body. I could teach chemistry as an inquiry-based course if all of my students had a great AP course, but where I teach, I'd have 2-3 clients a year!

Allison said...

Here's the issue:

so many students apply. You might as well take the very top of the top, no exceptions, and you might as well make the system as long and grueling as possible.

And I ask you: do YOU want a pediatric cardiologist who didn't have 14 years training when you could get one who did?

But this system couldn't be in place if costs weren't born by a 3rd party. This is the same problem as the academy offers: if students themselves had to bear the cost of their tuition, would they spend this many years learning some marginal amount rather than working? If doctors believe that they won't get paid to make up for these 14 years, will they go into it? If patients had to bear the full cost of 14 years of training, would they?

If you want to control costs, you need to create a system where the endusers pay for services not through 3rd parties, like federal student loan, vouchers, insurance companies, etc.

momof4 said...

One of the provisions of the new healthcare act is to seek "diversity" in medical (and other healthcare fields)admissions, as if that hasn't been happening for at least 20 years. Of course, the National Boards and the various specialty board exams must be passed, thank Heaven.

Allison said...

As I said on another thread, disparate impact is coming! It's already come to firefighting and policing. Soon it will come to science and engineering grad student placements and professorships. Can't wait til it's here for medicine!

Anonymous said...

I understand that there is a wide disparity in bar exam passage between those students admitted under affirmative action vs. the other students, at a number of law schools and am wondering about National Board pass rates across med school grads. Has anyone heard?

Crimson Wife said...

"if students themselves had to bear the cost of their tuition, would they spend this many years learning some marginal amount rather than working?

The short answer is, increasingly they don't. My DH's cousin who is interested in primary care pediatrics decided to attend a nurse practitioner program rather than getting her M.D. She'll make less (~$100k vs. ~$145k) but only a fraction of the student loans & time spent out of the workforce or in very-low-paid residency.

momof4 said...

I have found several studies that found strong correlations between undergrad science GPAs, MCAT scores and eventual National Board scores and one that includes eventual passage of the ACOG specialty board. In all of these, blacks and Hispanics who were admitted with lesser scores had much lower scores/pass rates. Those admitted with the same scores as whites and Asians had the same pass rates as whites and Asians. At least 15 years ago, I remember reading an article - in the Washington Post, I think - by a black professional whose primary doctor had retired. He researched the issue and came to the sad conclusion that he would limit his new-doctor search to white or Asian males or anyone over 50 (would be at least 65 today). Very, very sad.

Bostonian said...

Regarding the effects of medical school tuition, note that in India, tuition at government medical colleges is pretty low, even compared to Indian salaries. Competition for spots is fierce. A substantial fraction of doctors trained in those colleges end up practising abroad, in the U.S. or U.K. So in India, one finishes medical school at 23, with little debt, while in the U.S. one finishes at about 26, with hundreds of thousands of dollars of debt. That partly explains lots of doctors in the U.S. were trained in India or other countries.

It's well past time to create faster (and thus cheaper) routes to the M.D. in the U.S. There are a few year 6-year medical programs, but I think there should be more.

palisadesk said...

The McMaster Medical School program (see link in my comment above) is effectively a 6-year program: 3 years of university followed by 3 years of medical school. The McMaster program is very highly regarded and Harvard Medical School has adopted many features of its program.

ChemProf said...

Is it still 3 years of university? You have to be careful with Canadian programs because until recently Ontario high schools went up to 13th grade. I think in Quebec you still graduate from 11th grade, go to "college" for two years, and then go to university for three. So some of the numbers don't quite add up the way we think they do.

We had a Singaporan student whose family made use of this to graduate young. They finished high school at 16, then came to the US for college. In Singapore, they'd go to college/university for 5 years, but here they could graduate in 4.