The medical education process for physicians is a very long and challenging endeavor, one that, while necessary, is also incredibly inefficient.  The current structure for medical education is an outdated system that causes a variety of issues, from a worsening doctor shortage, to a hostile working and learning environment for both students and graduated physicians, to an ever-increasing class gap within the field. However, many of these problems can be easily fixed or significantly lessened by simply shortening the process, namely the undergraduate education requirements. As by doing so the position of physician can become a more feasibly obtainable career option and would lessen the strain on both students and their families.  

The requirements for becoming a doctor in the United states varies from school to school, however for the most part student’s go thought a similar process. First, students must complete a four-year undergraduate degree, then spend four years in medical school, and finally spend three to seven more years in residency training. Lastly, if a student wishes to specialize, as most do, they must complete additional years of training and residency according to their specific specialty program. This totals to an overall average in America of fourteen years spent on medical training. (Mowery 6) 

While most might assume that this system is takes so long because doctors simply need to know a lot, but this isn’t quiet the case. The medical education process is the way it is due to a reform movement that began in the late nineteenth century, due to an over production of undertrained practitioners at the time. This reform was designed to weed out the less competent by giving better more in-depth training and to reduce the number of graduating doctors so that fewer go on to practice medicine. However, this structure of medical education was last revised nearly over a hundred years ago and while societal circumstances have long since changed, the ways in which we educate physicians have not.  (Palmer 7)

From the reform, education only continued to become longer, as there was more material to teach, and the field slowly became more exclusive and competitive. In 1889 the John Hopkins Hospital made college education a required prerequisite, changed its medical school time from two to four years, and implemented additional training programs (--12--). From there many other hospitals and schools followed suit. Over the years more and more has been added on to the list of required education, from hours of volunteer work and shadowing to longer and longer residency and specialty training. The world of medical education is now one that thrives on extreme standards, high stress, and high competition.

This has caused many deep seeded problems that affect the entire health care system today. The most prominent of these problems being the current doctor shortage crisis. The American Association of Medical Colleges estimated the United States is currently short 60,000 practicing physicians. This shortage is only expected to raise in the coming years, at the current rate it is estimated to eventually become a shortage of up to 130,600 doctors by 2025 (--13--). With an increasing and longer living population more doctors are needed, but because for so many becoming a doctor is simply not an available career choice the existing ones are instead forced to do the work of many. This has created a work environment of stressed, overworked physicians and has led the field to being ranked as one of the highest rated careers for risk of suicide. Nearly three to four hundred, or an entire graduating class, taking their lives each year due to the stress of work (Wozniczka 11). This overload also affects patients, as doctors are forced to spread themselves thinner, spending less time with each individual in order to cram in more patients, causing an increase of misdiagnosis, as well as unintentional medical malpractices. (Snyder 7). 

However, stressful work environment isn’t the only issue brought on by medical education. Education is expensive. Most people who plan to attend higher education in the United States also expect to take out at least some student loans in hopes of going on to use their education to get a job that pays well enough for them to pay it back. For those who wish to peruse medicine this idea of taking out loans and paying it back is far more daunting and unreasonable considering the sheer amount of money that is needed to pay for medical education. 

On average four years of college costs an upward of $35,000. (“What's the Price..”  10) in tuition alone, not to mention things such as books and living expenses like rent or food. And for larger university’s such the University of South Carolina, that number is nearly doubled just for a four-year bachelor’s degree (CollegeSimply 3). Medical school gets far worse, according to the AAMC, the cost averages for in-state students around $35,000 per single year. Raking in an average of over $165,000 in total expected medical school debt, this dose not include the original undergraduate loans or any other fees such as travel, books, living expenses, and student loan interest. These numbers make the idea of medical school less and less practical for the average middle class American (Kristof 5). Thus, the mere idea of the expected price is more than enough to deter a huge portion of potential students who come from lower income backgrounds, simply because they cannot afford to try. 

This also introduces a significant class gap into the field as only higher income families tend to be able to afford to send their kids to school and support them during their education. This class gap in health care brings in its own number of problems as lessening diversity in any field causes stagnation of ideas and innovation as well as puts it at higher risk of corruption. This elitism also can lead to biased medical treatments on both systematic and personal levels as doctors who do not come from similar backgrounds as the large proportion of their patients simply don’t understand their patients own background or challenges, which can impact how they view and treat them. (Palmer 7)       

Overall, due to this stress to see more patients in less time and the skyrocketing costs and debts left from education most medical physicians are left dissatisfied with their job, regarding it as the “Million Dollar Mistake” (Kristof 5). All of this due to an education structure deigned to repel students. These are all problems that can be fixed or helped at least somewhat by shortening medical education, allowing it to be more assessable, and opening the field up for more graduating physicians. However, “It is a perpetual dilemma that has become more severe, because there is now more to know.” (Palmer 7). In other words, doctors do still need to know quite a bit, so it is important to know where to cut what education from.

Doctors Emanuel and Fuchs state that “The average length of medical training could be reduced by about 30% without compromising physician competence or quality of care” as many of the years added to medical training show no evidence of enhancing clinical skills. This amounts to just over four years being considered completely unnecessary. The four years primarily add up from the ‘premedical’ or undergraduate education portion, however the article “Shortening Medical Training by 30%” dose suggest cutting time from both medical school and residency training as well (Emanuel 4). 

 One way to accomplish this goal is by “fast-track programs”, but like the ones used in the United Kingdom and Europe. (Emanuel 4) These programs usually consist of six years of medical school training directly after high school, making the medical school training longer but cutting out the bachelor degree pre-requisite all together. This has shown to be an effective method as one study that followed 659 physicians, who had been trained using said fast track programs, for 26 years though their careers and found that these types of accelerated programs compared favorably with the standard medical students. It was stated that accelerated students “graduate as younger physicians able to perform well in postgraduate training, and go on to highly productive careers in medicine.” (Callahan 1). 

Despite this such programs are still rare in the United States and show little promise of changing anytime in the near future. “Accelerating Medical Education: A Survey of Deans and Program Directors.” Is a study that surveyed deans and program directors of medical school across the United States in order to obtain an understanding of what the current views are on the idea of three-year pathway programs. The idea of these pathway programs is to shorten medical school down to three years rather than four, due to the lack of any educational value from the fourth year. From the survey it was found that, while many would consider the possibility, the majority felt that it was not for the best. The consensus among these programs directors was that while it would reduce certainly debt it would also reduce readiness of graduating students to enter the work force. (Cangiarella 2) 

However, this only looks into the idea of shortening medical school itself without considering undergraduate education or residency training. There are generally four years of medical school, however fourth year of med school is often perceived as “pointless” as little is accomplished during this year in terms of academics (Emanuel 4). However, the consensus among educators seem to be that the time is still vital to gaining clinical experience, applying for residencies, and deciding on specialty (Cangiarella 2). One former chairman of surgery and residency program director shares the belief that medical school should not be shortened to three years, they see the fourth year of medical school, while has is not as productive in terms of education, to still be necessary. Yet unlike the survey of deans, they also agree that the medical education process overall should be shortened. To accomplish this, they propose that instead of shortening medical school itself, undergraduate education should instead be taken out or at least combined with medical school in way of faster summer programs. (Skeptical Scalpel 8). While both seem reasonable, summer is often a time people use to either gain experience and check off other requirements such as volunteer work, as well as one of student’s few chances to work on paying of student loans they already are acquiring without their time spent working potentially affecting their academics. 

Shortening or cutting undergraduate education entirely appears to be one of the most favorable options of shortening the medical education process. Treating medical education as a trade rather than an extra graduate program by allowing high school graduated go directly into medical programs to earn a medical degree, skipping the bachelor degree program entirely has both been proven to work both in other countries (Emanuel 4) as well as proven to have no negative effect of quality of doctor care (Callahan 1). This may be largely due to the fact that it is only there to help build competition among students. And while there is a requirement in most places for a bachelors rarely is there a requirement for any specific type of degree. “You can major in underwater basket weaving if you wanted to” (--xx--). This means that not only dose having a bachelor’s not affect physician medical knowledge or capability, it doesn’t necessarily even have to pertain to their field to begin with. Thus, if a doctor decided to major in a non-health science related degree they would have spend nearly a third of their medical education on something entirely unrelated to medicine. 

In conclusion “The long process doesn’t just weed out the incompetent and the lazy from the potential pool of physicians—it deters students” (Palmer 7). Medical education is simply to long, to costly, and to inefficient. The current model is clogging the health care system and causing a variety of problems that affect all levels of health care. It needs to be reformed and unnecessary parts that waste time simply have no place in a highly specialized field like medicine. 
