Medical School Might Get Shorter

A group of medical-school executives recommends course work based on competency, not length of time, to solve U.S. doctor shortage.

Katie Prather, a medical student at Georgetown University, holds her dog Elie during a rally on Monday morning. 
National Journal
Clara Ritger
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Clara Ritger
Nov. 4, 2013, 11 a.m.

Modi­fic­a­tions to med­ic­al-school cur­riculum could al­low stu­dents to gradu­ate in five—rather than sev­en—years.

A group of med­ic­al-school ex­ec­ut­ives penned an art­icle in the Novem­ber is­sue of Health Af­fairs, a health policy journ­al, re­com­mend­ing in­nov­a­tions in os­teo­path­ic edu­ca­tion to ad­dress the U.S. doc­tor short­age.

“Demon­stra­tion of key com­pet­ency rather than the pas­sage of a spe­cif­ic amount of time” would drive edu­ca­tion, said Steph­en Shan­non, pres­id­ent and CEO of the Amer­ic­an As­so­ci­ation of Col­leges of Os­teo­path­ic Medi­cine and a coau­thor of the re­com­mend­a­tions.

With the Af­ford­able Care Act provid­ing mil­lions of Amer­ic­ans with a path­way to health in­sur­ance, in­dustry ex­ec­ut­ives are wor­ried that health pro­viders could not handle the spike in con­sumers seek­ing care. Some 32 mil­lion con­sumers are ex­pec­ted to enter the health care sys­tem in 2014, ac­cord­ing to data from the As­so­ci­ation of Amer­ic­an Med­ic­al Col­leges.

By 2025, the AAMC es­tim­ates that the United States will face a short­age of 130,000 phys­i­cians. Roughly half of the de­mand will be con­cen­trated in the primary-care field. Today, one in five os­teo­path­ic—in­tern­al medi­cine—gradu­ates plan to enter the primary-care field, the Journ­al of the Amer­ic­an Med­ic­al As­so­ci­ation finds.

“There are a num­ber of schools that are already im­ple­ment­ing cer­tain cur­riculum modi­fic­a­tions,” Shan­non said. “But pi­lot pro­grams could be up and run­ning with­in a year or two.”

Among the cur­riculum changes pro­posed by Shan­non and his col­leagues is the in­tro­duc­tion of clin­ic­al ex­per­i­ences in the first year of study and a fo­cus on team-based and pa­tient-centered care to drive suc­cess­ful care out­comes. Stu­dents who show a mas­tery of course ma­ter­i­al can move for­ward in their edu­ca­tion, rather than be bound by a spe­cif­ic time frame of study. The goal is to re­duce the cost of med­ic­al school and make primary care more at­tract­ive to med­ic­al stu­dents, said Marc Hahn, pres­id­ent and CEO of the Kan­sas City Uni­versity of Medi­cine and Bios­ciences.

“Stu­dent debt is still an is­sue,” Hahn said, “and if we could de­vel­op a com­pet­ency based sys­tem—where stu­dents ad­vance based on their aca­dem­ic and clin­ic­al per­form­ance—we be­lieve we can re­duce stu­dent debt and make it easi­er for the stu­dent to pur­sue … primary care.”

One of the biggest hurdles the pi­lot pro­grams will have to over­come is ac­cred­it­a­tion. Shan­non said the re­com­mend­a­tions were presen­ted to col­lege ac­cred­it­ing groups, and there was “a sig­ni­fic­ant amount of in­terest and dia­logue” about ree­valu­at­ing doc­tor-train­ing pro­grams.

“Cer­tainly there’s no de­sire to push any­thing that will pro­duce less-qual­i­fied phys­i­cians,” Shan­non said. “But if the same re­quire­ments are there on both the un­der­gradu­ate and gradu­ate cur­riculum, there’s the po­ten­tial to con­dense.”

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