It’s three weeks into my first year of medical school (and one weekend away from my first exam!), and amidst meeting new people, readjusting to life back in Boston, and remembering how to be a full-time student again, I’ve been thinking a lot about this whole experience. You know, that whole med school thing. Medicine is a demanding career to pursue in any country—to become a doctor generally requires many years of education, intense on-the-job training, and lifelong self-education. I was curious about how other countries train their doctors, so I decided to do some research. The following comes from a mishmash of Internet research and information from friends.
You may already know that the American system for educating physicians is different: medicine in the US is a graduate degree program, whereas in the rest of the world, the most common pathway to medicine starts in undergrad. Most (probably all?) countries have options to switch to medicine for people who already have degrees in other subjects, although in most cases this is not a separate or accelerated curriculum but a waiver for the first one or two years of that country’s conventional path. I guess it is most comparable to not having to take the college premedical prerequisites.
How it works in the United States:
The most conventional path includes 4-5 years of college, 4-5 years of medical school, 3-5 years of residency training, and possibly 1-3 years of fellowship for those who want to pursue subspecialty training. Residency and fellowship are both on-the-job, supervised clinical training experiences, but only residency is required for a license to practice medicine. Fellowship is where future gastroenterologists and urologists and the like get their training, although there are also fellowships in areas such as preventive medicine or public health. If one is really on top of everything and chooses to practice as a generalist, the minimum amount of time from college to the end is 11 years. However, a plurality, if not a majority, of med school hopefuls now take one to two years off after college, and it is increasingly difficult for students to finish college in four years, so the average length of time it takes to train a new American doctor is probably closer to 12 or 13 years. Eek.
In the UK:
In the most conventional path, students go through 5-6 years of undergraduate and medical education. Then they do the Foundation Programme, which is 2 years long and very roughly analogous to the last two years of American medical school, except by this time they’ve already got their degrees. “Specialty training” takes 3-7 years—this is like residency. So to be a GP (general practitioner), if I’ve got this right, takes a full 12 years of education and training after high school.
Canada’s system is very similar to the American system, although there may be more possibilities (relatively speaking) to go to medical school without first earning an undergraduate degree. In Quebec, students only need two years of college to apply to medical school.
In New Zealand, students need 6 years of medical education at the undergraduate level and 3 years of clinical training to become a GP. Nine years in all.
France requires three stages of training. The whole scheme seems way too complicated to me. First there are two years of PCEM, which is kind of like college. The first year courses—biological and physical sciences, statistics, etc—are open to everyone. Starting in the second year, there is competition for places. The ministries of education and health set a quota each year for the number of places for medical students nationally, and each medical school is assigned a number of places (presumably proportional to population). Between 10 and 15% of students from year 1 make it to the next stage. This first year is also a launching point for other health careers such as nursing and pharmacy. The second year of PCEM offers more science coursework and some clinical experience. French medical students are required to learn medical English.
In stage two, students go through 4 years of medical school, more or less. It’s called DCEM. Students still learn some biomedical sciences, but there are substantially more clinical experiences. This is when they actually learn about medical science. Now get this: how well they do on the exam for residency determines whether they can become specialist or a lowly GP.
Stage three is the Internat, or residency. Interestingly, French medical students are students until they finish residency—no MD until the very end! The Internat takes 3 years for a GP (5-6 for a specialist). If you haven’t been keeping track, that’s a total of 9 years to train as a GP in France.
For another interesting fact that I came across in my research: We American premeds often complain about how hard it is to get into medical school. (Yes, I did, too, at one point.) But guess what? According to the AAMC, in 2009, 43.5% of applicants to allopathic medical schools were accepted. Only 26.1% of Canadian med school hopefuls made it in 2006 (source: Association of Faculties of Medicine of Canada).
And yet, we still have a shortage of doctors and sky-high health care costs.
In three weeks, I will get a white coat and be officially inducted into the profession of medicine (sort of, it’s really mostly symbolic). I feel incredibly privileged to be where I am right now. But doctors aren’t privileged just because people trust them. Medicine, for a number of reasons, is an incredibly inaccessible career for the poor. I’m willing to bet that this is true across the world, but my data here come from the AAMC, collected via the annual Matriculating Student Questionnaire. People who actually make it through the application process and matriculate come from pretty wealthy families. The median parental income of 2009 matriculants at American medical schools was $110,000. Almost 60% (60!!) had parents earning a gross income of >$100,000. Only 16.1% had parents who earned less than $50,000.
The economics of medical care has been a hot topic in the news because of health care reform. When will we have a serious discussion about the economics of medical education?
