Meet Your New Doctor: The Three-Year Medical Student

Last week it was revealed that for the first time in years, there's been an increase in young doctors going into primary care. That may have a lot to do with new scholarships for students interested in that field. (One of the reasons young doctors tend to shy away from primary care is that four years of medical school can cost an awful lot of money—cash that's hard to pay back if your salary is in the mid-$100,000s, compared with the $400,000-something a doc can make as a specialist.) But, as we noted, scholarships alone won't drive enough students into primary care to prevent a shortage of those doctors in the near future. We need more incentives, and innovative ones.

In that light, the news that Texas Tech University is starting a three-year medical-school track—one that's designed to nudge students toward primary care—sounds promising:

Steven Berk, vice president for medical affairs and medical school dean at Texas Tech, said that the program was designed out of the conviction that most of the fourth year of medical school was focused on electives in various medical specialties—programs that are important for those considering specialized residencies, but that may not be necessary for those committed to primary care. Texas Tech believes that, with a few adjustments, it can provide those who plan careers in family medicine with the necessary parts of the fourth year earlier—and free up the year . . . He also said that the emphasis in the fourth year on specialized electives "absolutely" draws students away from primary care . . . Then there is the financial incentive. Tuition and fees are about $13,000 a year for Texas residents, more for non-residents. Three-year students will be spared a year of tuition and living expenses, and will start earning a salary a year earlier.

Texas Tech isn’t the only institution thinking this way. The Carnegie Foundation for the Advancement of Teaching is planning to release a study in June suggesting that all medical schools offer (or at least consider offering) a three-year track.

This is an interesting way to deal with the primary-care crisis, but I'm not convinced that a lot of medical students will go for it. During the reporting for my piece on the primary-care crisis a few weeks ago, I talked to a kid named Jamie Saltsman, who is a first-year medical student at Tufts University. Specifically, Saltsman is on the "Maine Track," a (four-year) program that focuses on primary care. Was he sure he wanted to go into that field, I asked him? "It's still pretty early," he said. "Coming in, I really do see myself going into primary care, but I haven't found out if I want to be a brain surgeon yet."

That’s the thing about the fourth year: it's what lets you find out if you want to be a brain surgeon instead of a primary-care doc. (Yes, medical students do rotations earlier than that, but these are often short, one- or two-month gigs that don't provide a complete feel for what a field is like.) A three-year track will appeal to students who go into medical school knowing without a doubt that they want to do primary care. But how many of those are there?

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