I know very little about medical education, but it does strike me my ignorant mind as somewhat…excessive.
So, from what I have read, here are the post-secondary education requirements (does not include examinations or board certifications):
Undergraduate Degree – 4 yrs
Medical School – 4 yrs
Residency – 3-7 yrs
Fellowship – 1-3 yrs (for certain specialties)
The most basic run of the mill GP will require at least 11 years of post-secondary training. I suppose this makes sense to me.
However, if the doctor wants to get into a specialty*, it can be 14-18 years in total. This doctor will “begin” their career at 32-36 years old!
Have other ways been proposed to shorten this system**? How do other countries’ processes differ?
Apparently this is more common than ever in the US.
** Maybe it is stupid to think that there is a better way, but it is not uncommon for “better ways” to not be used. Tradition, politics, money, etc all come into play.
Well, remember that you are a real, live, practicing doctor before you begin a residency. It’s on-the-job training, not schooling, by that point. You get paid and everything.
In that respect, it’s not much different than other careers that require postgraduate training but offer opportunities for hyperspecialization with many years of experience. But medicine does it in a very formal way that other professions (like law) do not.
Some schools, including my alma mater, have six-year BS/MD programs. I knew someone in that program at my school, though, and it’s intense, with classes over the summer as well as during the year.
The doctor begins a career after medical school but might not be highly specialized until later.
Also, to my mind, if a doctor is going to be cutting into my brain, I’d feel more at ease knowing there was a decade or more of on-the-job training in neurosurgery involved.
From what I understand, you get paid a fraction of a normal doctor’s salary (like 40-50K) for working long, grueling hours. It is more like being a badly paid intern than on-the-job-training.
My friend the doctor says that internships and residencies used to be separate things, with a one-year internship typically preceding a residency, but now most of the time the two are combined into a single, longer residency period.
Yes, the pay blows serious chunks from what I understand. The employer holds all the cards in this relationship; you have an MD but need a residency to get certified in a specialty. If a hospital will take you, you basically have to do whatever they say.
I don’t understand why it’s acceptable to allow a resident who hasn’t slept in 16-30 hours or so to work on me. I wouldn’t get on a plane if the pilot was on the ass end of a 36-hour shift. Hell, I wouldn’t get in the car and drive myself if I haven’t slept in a couple days. Actually, I’m pretty worthless at the 18-hour mark. I really don’t understand why sleep deprivation is part of the medical training system. Or why we, as patients, are okay with that.
Or was ER exaggerating/outdated and medical residents don’t have to work more than a 12-hour stretch at a time?
A 36-hour shift doesn’t mean you’re working for 36 hours straight. It means you’re at the hospital for 36 hours, ready to respond to emergencies. You are expected to spend a reasonable time sleeping during the shift, but obviously that might not always happen if your city gets blown up or something.
Iirc, some countries have had schools where Medicine is an undergraduate major, so one can become a doctor by getting a BMed or something like that straight out of high school. Are there any countries that still do this?
I believe some residency programs were considering redesigning the training programs to eliminate the 24- or 36-hour shifts. But, as I remember, the older doctors viewed that time as a right of passage. And those long shifts help the doctors get experience.
There seems to be a general inflation in academic requirements for professions. In my parents’ generation, you could become a public school teacher with just a bachelor’s degree. Nowadays, it’s difficult (in a de facto sense), but not impossible (in a de jure sense), to teach with just a BS or BA and you are more or less practically required to complete a master’s degree if you want to be a somebody or hope to keep your job in the long term. I wouldn’t be surprised if the formal, de jure requirements get raised to a master’s degree in the next few years. In my great-grandparents day, you could become a teacher with a trade-school diploma that took two years beyond basic high school.
One remnant of the older ways may be that the schoolteachers’ credit union that I am a member of has their policies written such that anyone with a bachelor’s degree from the nearby university (my alma mater) automatically qualifies for membership by virtue of that degree, regardless of whether they hold a teaching license or ever intend to apply for one.
Pathology residency training actually was shortened from five years (when I did it) to four years for most pathologists-in-training awhile back. Most people still do a fifth year in some kind of fellowship, which is of more practical benefit, and job competition leads to many doing additional fellowships, so the total length of training probably has worked out to about the same. British pathologists reportedly do five to five and a half years of residency training.
Let’s see - four years of college, six years of enjoyable work for bad pay with terrible hours, then a couple years of grad school, four years of med school, five of residency, one year of fellowship - I started making a decent income when I was 36.
As for residency pay, it’s improved a lot from, say, the 1930s, when you were fortunate to be paid a few hundred dollars for your internship year (in some places, all you got was room and board).
Contary to the OP I believe the USA follows the same model as Canada, which was this (back in the 1970’s, still valid today I believe)
Undergraduate science “pre-med” 2 years possibly 3. (latter will get you a 3-year BSc)
You can keep trying, but if they have not admitted you after 2 tries, odds are they will not admit you.
IRCC Isaac Asimov in his autobiography mentions he failed to get into med school. When he applied for a post-graduate admission (MSc in Chem, late 1930’s or early 1940’s I think) they gave him a hard time because the faculty was suspicious he was just marking time to take another run at med school admission.
Never heard of 7-year internship, from what I heard of the guys in my college, 3 years was the norm.
In those days, it was a given that in the minds of real doctors, until you were a fully qualified doctor (i.e. during internship) you were lower than dirt (but higher than nurses) therefore you had no right to complain about 36-hour on-shift-on-call - they went through it, why should they worry about you? I recall some news about that changing in Canada.
One fellow started a year after me. Nine years later I met him, he was into his anaesthetist specialist training and still had 2 years to go (so, 11 years when he’d be done). however, he was already a real doctor, married to a classmate fellow doctor, so they could afford nice things already. That’s not a horrible timeline, since the guy watching me breathing and keeping me alive during an operation better be really really good.
Yes, the selection process was brutal at my college. Aspiring doctors (and dentists) disappeared into their room for 2 years to study and never came out except for class.
There was a story about one organic chem class where the assignment was “figure out what this is and purify it”. they marked the stock solution with C14 tracer, and found that a significant number of the class (whose mothers were pushing them to be doctors) cheated by diluting their sample with pure stock solution to improve their result. In organic and bio classes, rumors of experiment sabotage were common, since the pressure was simple - the ones with best grades got in, therefore screw thy neighbour’s marks.
They tried switching it to a “plus interview” procedure, but the general outcry was that was simply an excuse to weed out the Chinese students who were brilliant but lacked english communication skills. Not sure where it ended up.
that’s the purpose of the 2 to 4 years pre-med - how do you find the people able to be doctors? They select a few hundred from a year’s graduates of high school; so these are the study tools who get 95% to 99% consistently and are not in the aspergers’ stunned category. Plus, it’s an extra year or two to mature, so the admissions people can judge how they cope ina university environment (very different from high school), study habits, self direction, more mature, etc. - you’re judging 20/21 year olds, not 18 year olds. The extra 2 or 3 years also gives the student the chance to see what med school will be like (more of the same) qnd whether it’s for them.
Whether the rest of the course can be shortened? There’s an AWFUL LOT to cover. Perhaps we should have more “medical practitioners” or advanced nurses permitted to do elementary medical treatment; but for the full doctors, there’s no easy way to shorten the curriculum I assume.
As a side note, that fellow I knew mentioned several people who had difficulty and even flunked in medical school. they were allowed to repeat rather than being turfed, the theory being - they’d already taken a chance on you, invested a lot in yor education, they were willing to give you several chances.
After all, they’re only following the Golden Rule of School and Work - Do One to Others Before they can Do One to You.
I’ve thought that something like this might be a meaningful solution to bring down healthcare costs. Like you could have a “Diabetes Care Specialist” who isn’t a full medical doctor but has the legal ability and knowledge to manage most forms of regular diabetes care and can prescribe applicable drugs. They would refer complex cases to a full MD, but there could be a reduction in MD “office vists” just to get another prescription or get a referral when you have “textbook cases” that aren’t complex. Likewise, you could have a “Blood Pressure Practitioner” who knows a lot about BP and how to fix problems with it and can manage chronic hypertension patients on a regular basis (e.g. writing another refill prescription for HBP pills).
There are two big problems with this. One is defining just how much education and training will be required. For example, can you challenge licensure exams based on prior learning picked up wherever (nursing school, the Straight Dope, Uncle Bill, too much time at the library, etc.) or do you have to attend X classes? If you have to take classes, does it have to be in an “official” Diabetes Care Specialist program or can you substitute classes from med school or nursing school? E.g. Bill the Med Student decides that he doesn’t want to finish med school but has enough credits to qualify to take the test for Diabetes Care Specialist. The second problem is the likely resistance from “establishment” doctors, etc. who don’t want some upstart practitioner cutting into their bottom line.
