OPINION: Turning Doctors Into Technicians Won’t Enhance Workforce Or Reduce Costs
In a Feb. 2018 Mercatus Center report on potential paths to improve the American health provider workforce, former Dean of Harvard Medical School Jeffrey Flier and Dartmouth research project manager Jared Rhoads suggest that the U.S. medical education system should embrace combined BS/ MD programs.
The authors argue that reducing the number of years would lower overall debt, and encourage more students to pursue careers in medicine.
The accelerated model is common outside the United States. In the U.K. and British Commonwealth nations (such as Australia, India, and South Africa), graduating high school students enroll in a five- or six-year First Professional degree called MBBCh or MBBS (Bachelor of Medicine, Bachelor of Surgery).
The curriculum and professional qualifications are equivalent to that of an American MD, which means that these students skip the traditional U.S. undergraduate program.
Policy analysts Chris Pope and Tim Rice build on the Mercatus report recommendation by asserting that most undergraduate courses have “little to do” with clinical practice, merely prolonging the medical training process. This contention reveals an impoverished understanding of the practice of medicine and the state of American secondary education.
First, a doctor is not a technician of human pathology. Medicine is the art and science of healing, where empathy, emotional-mental stamina, critical reasoning, and communication play an integral role. None of these skills are taught in medical school, explaining the high dropout rate in countries where eighteen-year olds begin medical studies.
Analyses in the U.K. found that the average dropout rates over a ten-year period were between 11 and 14 percent. The average attrition rate from 2008 to 2014 for commencing Australian medical students was 14.3 percent (link: pages 60-62).
Contributing factors include an inability to cope with stress, low emotional intelligence (EQ), questionable motivations such as parental/ familial pressure, and natural changes in one’s personality and interests during early adulthood. In contrast, American medical schools that require a prior undergraduate degree have a 1–2 percent attrition rate.
According to the American Association of Medical Colleges, the four-year graduation rate for MD-only students in the 2013 class was 81 percent with 98 percent completing by the eighth year.
Second, falling public school standards, along with the geographic isolation and global cultural dominance of the US, contribute to insufficient preparedness for professional studies and adulthood. The average American high school senior is not likely to be well versed in organic chemistry, advanced calculus, Elizabethan drama or a foreign language.
An undergraduate education provides valuable opportunities for American students to complete core curriculum courses in the humanities, writing, and social sciences, regardless of the field in which they major.
In comparison, European high schools, for example, incorporate advanced liberal arts, which better positions their graduates to choose between professional and vocational studies at the college level.
Well-rounded knowledge imparts maturity, enabling students to decide if they are indeed willing and equipped for years of rigorous professional study, punishing hours of work, and a lifetime of serving the sick. Importantly, high EQ shields medical students and physicians from burning out – a trait of particular significance given that the United States is experiencing an epidemic of physician burnout.
A recent JAMA study shows that replacing an existing physician can cost up to $1 million. We cannot afford to lose current and future physicians to mental and emotional exhaustion.
Higher rates of burnout would cripple the American health provider workforce and offset any reduction in healthcare costs, potentially gained by speeding through medical education. The promise of cost-effectiveness does not warrant overhauling US medical education in favor of accelerated training programs that emulate the MBBS degree.
Meg Hansen trained in medicine (MBBS) and is the executive director of a Vermont-based health policy nonprofit.
The views and opinions expressed in this commentary are those of the author and do not reflect the official position of The Daily Caller.