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The future of med school

A major concern with health care reform is that it could mean a flood of newly insured patients into doctors' offices, and therefore, a doctor shortage. Depending on how you look at it, it might be a good problem to have. But it's still a problem, and it'll most likely require creative solutions.

The bill itself provides some potential solutions, like increased funding for community clinics and greater use of nurses and doctor's assistants.

But long-term, what's required is extra incentives for people to become doctors, specifically primary care physicians.

A new program at Texas Tech University could be a sign of things to come. Yesterday, the school announced the Family Medicine Accelerated Track (FMAT) -- the first three-year nationally-accredited medical degree. It's half the cost of a traditional medical degree. The chairman of the department Michael Ragain describes it:

"The high cost of medical school and resulting debt are major challenges for many prospective medical students," Ragain said. "Our program addresses debt on two levels, first by shortening the program from four to three years, and second, by providing scholarships to all qualifying students. Training primary care physicians is a national issue that targets both rural and urban areas. With programs such as this, we can double the number of primary care physicians available to care for the U.S. population."

The school says the fourth year of med school is primarily devoted to specializing in a certain area and that the three-year degree will fully prepare students for being primary care doctors.

I remember doing a series many years ago about the shortage of doctors in rural areas, and one thing that stuck with me is that it's not all about economic incentives. Being a primary care physician is tough, especially in a rural setting. There's high burnout. It's also a rewarding job, but the rewards aren't financial compared to being a specialist.

It'll be interesting to see if cutting a medical degree's expense in half and shaving off a year of intense studying can actually double the number of primary care physicians.

We'll explore this further on Marketplace tonight, but what do you think of this idea?

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I recently returned to school to refresh my science coursework, because I want to take the MCAT. Attending medical school has been my lifelong dream, however, the cost of a medical education is one of the biggest reasons I am hesitant to actually pursue it. Noted flaws of the shortened curriculum and lack of residency or internship aside, the idea that ANY medical school is willing to admit that the COST of the education may be turning some of the brightest students away from the profession, I see as a superb realization, and I can only hope that other schools follow suit. Graduating from a 4 year medical school with hundreds of thousands of dollars of debt isn't exactly anyone's dream.

Taken together the comments reveal that there are ineluctable tradeoffs involved in attempts to reduce costs in a health care system driven by market mechanisms. Distortions are created because costs are shifted. One stakeholder's profit is another's cost. That's the nature of the current system and the nature of Obama's tepid reforms.

Until market mechanisms (profits) are eliminated from the health care system and value to the patient at its center there will always be gross inequities that reflect the gross inequities and inefficiences in the society generally.

Like any company hawking a service or product, Texas Tech is trying to beat their competition by reducing the cost and as a few commentators argue probably reducing quality as well. A tight market for loans and lower amounts in the Great Recession could be an advantage. Will this provoke a race to the bottom in quality as we’ve seen so often in other industries?

I think its is a ridiculous idea.

This stems from the notion that Primary care is the "absence of speciality". This is not only ignorant but demeaning towards PCP.

Primary care is a very challenging job without any compensation. A well trained PCP is the patients best friend best shot at cost containment. There has been a pattern in ACGME to under train PCPs already so as to keep lucrative practices reserved for the specialist. Contrary to the suggestion, at least four should be committed for FP/PCP residency in addition to 4-5 year medical school otherwise we will continue to produce "specialist fan club PCP" who lack the intellectual capacity to keep specialist on the straight and narrow.

Not sure that three years would cut it. A lot of the 4th year is spent (for primary care folks) doing electives in radiology, emergency medicine, rural health, international health, dermatology (skin complaints are common), and such. Losing all that experience could be very detrimental long term. Why not just support their education financially when guaranteed they will apply to family medicine residency ONLY for post medical school training? Having gone through med school, having over $400k in debt by the time I started residency (making only $45k a year for 4 yrs), I felt the need to pick a specialty in which I could pay it off.

Scott ,
This is a great idea. There are many of us who consider primary care, only to be dissuaded by the lack of financial incentives and the workload which is unappreciated by many laymen. There are even fewer of us who hail from rural areas and so would be apt to return to such a setting. What Texas Tech Medical School is doing is admirable and should be commended. In addition, compensation for an entire line of services provided by these physicians should be increased to attract strong medical students. Otherwise, individuals like myself will continue to specialize.

Regards,
Scott Carter, MD

I think it's a great idea. A lot of times when people are sick or have minor ailments, they don't need a full-blown doctor to see them. However, that's what they usually get. This is almost like a 'tweener.

Hmmm. What's the difference between this 3 year degree and a Physician's Assistant (PA)? Aren't we just dumbing down health care now?

Although I have to admit if a doctor is only going to need 3 years of school instead of 4 maybe they should have their pay cut by 25% too.

If they go into primary care, it's cut by more than that.

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