The US is facing a healthcare catastrophe. With physicians retiring at record rates, a consequence of an aging workforce and pandemic related trauma, the AAMC predicts that by 2034 we will see doctor shortages of 40,000–125,000.[i],[ii] Changes in medical training practices are imperative, yet current standards do everything but incentivize increases in new doctors. By contrast, aspiring physicians have been strung out to dry. Financially, mentally, physically. To be clear, this isn’t a crisis of the existing workforce but of the pre-medical drop-out. And without a careful re-evaluation of medical training standards, with specific emphasis on students’ financial needs and mental health, pre-meds will continue to drop out of the track at rates unsustainable for our healthcare system.
As a pre-med, I, too, am reaching a breaking point.
I entered college as a wide-eyed freshman with dreams of becoming a physician. My decade long experience as a children’s hospital patient had, as I so frequently explained, “ignited a passion for medicine.” Flashforward nearly two years later and I am fully entrenched in the pre-medical program. I’ve completed almost all the laborious med-school prerequisites, I volunteer with the hospital, I’m an undergraduate researcher, the whole nine yards. I’ve committed the majority of my undergraduate education to medicine and yet, after years of work, I am closer than ever to dropping the track altogether. What was once a vibrant dream has slowly crumbled under the crushing weight of a sobering reality.
So how did I reach this point? And why do over 80% of freshmen who enter university declared as pre-med eventually come to the same conclusion?[iii]
The reality is this:
The track to becoming a physician will cost about $350,000, taking anywhere from 11 to 14 years of schooling.[iv],[v],[vi] Students will encounter multiple bottlenecks, from med-school applications (41% national average acceptance rate) to residency placement (~93% placement rate) to actually finding a job once you’re professionally licensed to practice.[vii],[viii] Med-students see rates of depression up to 3x the national average with these statistics continuing into residency as they are asked to work close to 80hr weeks.[ix],[x] ,[xi] For pre-meds, the future is incredibly uncertain, with no guarantee of success yet inevitable tribulation. Thus, when confronted with the incredible barriers to becoming a physician, the path drives many away.
So what can be done?
Firstly, we should take a good look at what purpose the pre-med undergraduate education is actually serving. Most US medical schools require 8 classes to be taken to be considered for admittance.[xii] Not only could these courses be condensed into a two-year plan, but many of the “required concepts” serve little practical significance to the profession itself. I, for one, have certainly struggled to connect my coursework in electromagnetism or angular momentum to the human body and surgery. Condensing content has been attempted with six-year, accelerated programs, offered at Howard, Cal-Northstate, and Mizzou.[xiii] Yet, since enrolled students must keep pace with those pursuing a traditional 8-year path, these programs often are too intense.[xiv] Indeed, a widespread consolidation of undergraduate course material is needed to shorten this undergraduate training component.
Limiting the price of med-school is another must, especially for students coming from lower socioeconomic backgrounds. For these students, the extreme cost is a major deterrent, resulting in most doctors hailing from families in the top two income quintiles.[xv] Further, in offsetting their debt, students opt to specialize, creating a notable shortage of primary care doctors.[xvi] Top med-schools like Duke and NYU believe that reducing med-school to 3 years is a viable possibility, saving $150,000 per-student and placing doctors into the field a year earlier.[xvii] Alternatively, the pandemic has exposed virtual lecture sharing between institutions as a practical mechanism to produce a cost-effective education.[xviii]
Lastly, throughout the process, universities and hospitals must place greater emphasis on curving high rates of mental illness amongst aspiring physicians.[xix] Within med-school itself, simple measures such as pass/fail grading, cuts in curriculum hours, and routine mental health check-ins have been demonstrated to boost student morale and well-being.[xx] Into residency, hospitals should also consider implementing these mental health check-ins in tandem with reductions in residency hours. In Europe, for instance, residency students are routinely limited to 48hr weeks, without observed reductions in the quality of education or training.[xxi]
Physicians are at the heart of our healthcare system. When they suffer, we all feel the consequences. And so, if medical training programs stick to their archaic and unreasonable standards, the pre-med drop-out will be here to stay, stretching even thinner the capacities of an already strained system.
Nathan Strang (PPS ’24) is a Public Policy Undergraduate at Duke University’s Sanford School of Public Policy. This piece was submitted as an op-ed in the Spring ’22 PUBPOL 301 course. This content does not represent the official or unofficial views of the Sanford School, Polis, Duke University, or any entity or individual other than the author.
[ii] Christine Vestal. (2021, March 15). ‘Why Do I Put My Life On the Line?’ Pandemic Trauma Haunts Health Workers. | The Pew Charitable Trusts. Retrieved April 18, 2022, from https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2021/03/15/why-do-i-put-my-life-on-the-line-pandemic-trauma-haunts-health-workers
[iii] Charlene ZhangID*, Nathan R. Kuncel, Paul R. Sackett. The process of attrition in pre-medical studies: A large-scale analysis across 102 schools. PLoS ONE 15(12): e0243546. December 28, 2020
[v] Hanson, Melanie. “Average Cost of Medical School” EducationData.org, October 11, 2021, https://educationdata.org/average-cost-of-medical-school
[vi] Indeed Editorial Team. (2021, October 4). How long does it take to become a doctor? Indeed Career Guide. Retrieved April 18, 2022, from https://www.indeed.com/career-advice/finding-a-job/how-long-does-it-take-to-become-a-doctor#:~:text=Doctors%20must%20complete%20a%20four,become%20a%20fully%20licensed%20doctor.
[vii] The Princeton Review. (2022). How many MED schools should you apply to? Retrieved April 18, 2022, from https://www.princetonreview.com/med-school-advice/how-many-med-schools-should-you-apply-to#:~:text=Med%20School%20Acceptance%20Rates,overall%20acceptance%20rate%20of%2041%25
[viii] Basen, R. (2021, March 19). Residency matching rates down this year. Medical News. Retrieved April 18, 2022, from https://www.medpagetoday.com/special-reports/exclusives/91731#:~:text=The%20percentage%20of%204th%2Dyear,from%2090.7%25%20to%2089.1%25
[ix] Yao, J. (2018, April 6). The unintended meaning behind medical schools’ pass-fail system. KevinMD.com. Retrieved April 18, 2022, from https://www.kevinmd.com/2018/04/unintended-meaning-behind-medical-schools-pass-fail-system.html
[x] Miriyala, S. (2018). Pass/fail grading systems in medical school. Retrieved April 18, 2022, from https://anatomy.org/AAA/News-Journals/Newsletter-Articles/Pass-Fail-Grading-Systems-in-Medical-School.aspx?_zs=iinWO1&_zl=T5PT5#:~:text=The%20pass%2Ffail%2C%20two%2D,schools%20across%20the%20United%20States.
[xi] Park, R. (2017, March 16). Why so many young doctors work such awful hours. The Atlantic. Retrieved April 18, 2022, from https://www.theatlantic.com/business/archive/2017/02/doctors-long-hours-schedules/516639/
[xii] Shemmassian, S. (2022, February 14). Medical School Requirements in 2022: The Definitive Guide. Retrieved April 18, 2022, from https://www.shemmassianconsulting.com/blog/medical-school-requirements#medical-school-course-requirements
[xiii] Sundquist, K. (2017, January 27). A complete introduction to BS/MD Programs. Retrieved April 18, 2022, from https://blog.collegevine.com/a-complete-introduction-to-bsmd-programs/
[xv] Zhang, A. (2021, January 27). Do Individuals from Low-Income Families Belong in Medicine? (Yes!). Retrieved April 18, 2022, from https://in-housestaff.org/do-individuals-from-low-income-families-belong-in-medicine-yes-1903
[xvi] Frazee, G. (2018, August 21). The U.S. needs more doctors. is Free Medical School the Answer? PBS News Hour. Retrieved April 18, 2022, from https://www.pbs.org/newshour/economy/the-u-s-needs-more-doctors-is-free-medical-school-the-answer
[xvii] Asch, D., Grischkan, J., & Nicholson, S. (2020, July 21). Lower the cost of producing doctors, not just the price of going to medical school. STAT First Opinion. Retrieved April 18, 2022, from https://www.statnews.com/2020/07/21/lower-cost-producing-doctors-not-just-price-medical-school/
[xix] Rotenstein, L. S., Ramos, M. A., Torre, M., Segal, J. B., Peluso, M. J., Guille, C., Sen, S., & Mata, D. A. (2016). Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA, 316(21), 2214–2236. https://doi.org/10.1001/jama.2016.17324
[xx][xx][xx] Paturel, A. (2020, January 21). Healing the very youngest healers. AAMC News. Retrieved April 18, 2022, from https://www.aamc.org/news-insights/healing-very-youngest-healers
[xxi] Park, R. (2017, March 16). Why so many young doctors work such awful hours. The Atlantic. Retrieved April 18, 2022, from https://www.theatlantic.com/business/archive/2017/02/doctors-long-hours-schedules/516639/