A significant 34% of physicians believe medical training should be shorter, according to a Doximity poll of 3,411 physicians. This perspective is contrasted by 50% who feel that the current training length is appropriate, and 16% who would like longer training periods.
Reducing the length of medical training could potentially address issues such as student-loan debt and clinician shortages. U.S. medical tuition and fees have outpaced inflation, and the average medical school debt is more than $200,000, not including undergraduate debt. This debt often catches up to trainees once they graduate, and has been shown to deter graduates from pursuing lower paying specialties like primary care, where physician shortages are most extreme.
Nonsurgical specialists and PCPs show a substantial preference for shorter training, with 35% of nonsurgical specialists and 32% of PCPs in favor. Surgeons, however, are less inclined toward shorter training, with only 28% voting for it. Furthermore, 21% of surgeons support extending training, compared to just 14% of PCPs. Despite these differences, a significant portion of all specialties, including nonsurgical specialists, PCPs, and surgeons, believe that the current training length is about the right length, with figures ranging from 49% to 55%.
Specialty-specific needs play a crucial role in determining the appropriate length of medical education. Family medicine physicians are the most satisfied with the current training duration, with 62% believing it is about right. Similarly, a majority of ophthalmologists (60%), emergency medicine physicians (59%), dermatologists (57%), and psychiatrists (57%) hold this view. However, other specialties polled closer to or below 50% satisfaction.
Among those favoring a change in training length, nephrologists and orthopaedic surgeons are nearly split between longer and shorter training. Cardiologists, gastroenterologists, radiologists, physical medicine and rehabilitation (PM&R) physicians, and internal medicine physicians lean heavily toward shorter training. For instance, 47% of gastroenterologists and 44% of PM&R physicians prefer shorter training over maintaining the current duration (43% and 39%, respectively). In contrast, ob/gyn is the only specialty where more physicians favor lengthening training (28%) than shortening it (23%).
Worldwide, the length of medical training ranges from 5-8 years. In the U.S., reform of medical education has been discussed and actually implemented before. Accelerated programs were initiated during World War II in order to more quickly matriculate physicians for war efforts. Four year programs were cut to three by eliminating summer breaks to maintain educational standards without condensing course content. This led to financial burdens on both medical students, who were working during summers, and the schools, due to faculty being taken away from their research and clinical duties to teach on a more intensive schedule. In time, these fast tracks fizzled out.
Modern accelerated medical programs employ a different approach. Electives and breaks get trimmed, while clinical experiences begin even earlier. These accelerated programs also tend to offer, per an article on the AAMC website, “no more than a few specialty options, choosing to focus on shortage areas like family medicine.” Time will tell if this is an appropriate solution for minimizing student debt and addressing the physician shortages.
Younger physicians, particularly those aged 29 and below, show a strong preference for shorter training (53%), with only 5% supporting longer training and 42% finding the current duration appropriate. Older physicians are less inclined to favor reducing training length: 46% of those aged 30 to 39 support shortening training, while 45% prefer the existing length. This trend continues with age, with diminishing support for shorter training and increasing support for both longer training and maintaining the current duration. Physicians aged 70 and older exhibit the least enthusiasm for shorter training, with only 23% advocating for it, while a majority (57%) believe the current length is appropriate. Recency bias in relation to training and work experience likely influences these preferences.
Implications and Future Considerations
When researchers consider tuition cuts and an extra year of salary that may occur from shortening the length of medical training, they calculate a lifetime savings of around $250,000. These savings would be especially meaningful for students from historically underrepresented low-income backgrounds, which may make the largest impact on the communities facing the most extreme physician shortages. According to recent reporting from Vox, the physician shortage is not actually a shortage of physicians, but a misallocation of physicians. “Physicians tend to practice in communities similar in density and socioeconomic status to where they grew up…” says author Dylan Scott, “...and between 2010 and 2017, while large urban counties added 10 doctors per 100,000 people on average, rural counties lost three.” A nationwide shift to shorter, more accessible medical programs could make medical education more accessible and allow for more diverse students from various backgrounds including rural and low-income areas to become doctors, possibly allowing for better distribution of doctors.
On the other hand, the prospect of shortening medical training raises concerns for many about the possibility of lowered educational and training standards and subsequent decline in quality of patient care. Additionally, implementing longer training periods could enhance students’ clinical exposure and allow for more specialization.
While there's a divide among physicians regarding the ideal length of medical training, altering its duration either way could have a significant impact on access to medical education.
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