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Association of American Medical Colleges Tomorrow's Doctors, Tomorrow's Cures®

New Three-Year Track Seeks to Boost Family Medicine, Reduce Student Debt

AAMC Reporter: October 2012

—By Leigh Page, special to the Reporter

A new three-year track at two U.S. medical schools is dangling a big carrot in front of entering students: If you commit to family medicine now, you will graduate in three years, shed at least one year of tuition payments, and ultimately start practicing a year earlier.

According to officials at two schools, a dozen or so other schools, many in the South, are considering similar programs. The goal is to increase the number of practicing primary care physicians as quickly as possible to alleviate an expected shortage. By 2020, the nation will face a shortage of 45,000 primary care doctors, according to the AAMC’s Center for Workforce Studies.

Texas Tech School of Medicine began the first three-year program in 2010, with nine students. In addition to finishing one year early, students receive a scholarship in the second year, for a total of $26,000 in tuition savings. Students are allowed to switch to the standard four-year program, but their scholarship converts to a loan.

Clay Buchanan, a member of the first cohort, said he appreciates the tuition savings, but the chief draw is graduating a year earlier. As a 48-year-old attorney, Buchanan is eager to start a second career and has a keen interest in primary care.

Steven Berk, M.D., the dean of Texas Tech, said students from small towns and other health care professions will flourish in the new track. He hopes the new program will eventually double the number—now about a dozen—of Texas Tech graduates who pursue family medicine.

Interest in family medicine tends to wane during medical school, but the new track never lets students lose sight of it. Family medicine is prominent during an introductory summer program at the end of the first year and a longitudinal clerkship throughout the second year.

Mercer University School of Medicine opened a similar program at its Savannah, Ga., campus in 2011. Cutting the fourth year means $41,757 less in tuition, which will reduce the average student’s debt at graduation to $150,575, according to school officials.

Mary Keith, one of two students who began the Mercer program last year, just completed the track’s summer course. Being on a different track from other students “felt a little weird at first,” she said, but when she reunited with classmates for the second year, they were impressed that she already was involved in clinical studies and would graduate a year before them.

“Students in this track feel special,” said Robert Pallay, M.D., chair of family medicine at Mercer’s Savannah campus. Working in the residency program, “they get a lot of attention because everyone there thinks, ‘Here is someone I might be working with for several years.’”

According to Pallay, students on the three-year track are not missing anything. Medical students often use fourthyear elective clerkships to get a sampling of the different specialties and “audition” with perspective residency programs, he said, but the three-year students already have selected family medicine. Furthermore, once they enter a family medicine residency—not necessarily at Mercer—they will rotate through many of the specialties they missed in the fourth year.

With summer course work and shorter breaks during the school year, the total length of study is 131 weeks, 14 weeks shorter than Mercer’s four-year curriculum, but just above the 130-week minimum mandated by the Liaison Committee on Medical Education (LCME). Students in the three-year track take the clinical skills portion of the United States Medical Licensing Examination Step 2, but do not receive the results before graduation.

Does the tighter schedule lead to burnout? Buchanan recalled some stressful moments during his second year at Texas Tech, but said he could still spend evenings with his family. Officials at both Texas Tech and Mercer report that demands in the initial summer course and the second year are kept in check. “The point is to keep them tied in, not to overwhelm them,” Pallay said.

Pallay and Berk said that getting LCME approval for their programs was relatively easy because the LCME has approved three-year programs at two Canadian schools for several years. Bruce Wright, M.D., associate dean for undergraduate medical education at the University of Calgary Faculty of Medicine, one of the Canadian schools, said his school keeps an eye on potential stress. While a few students drop out every year, it is not because of the tighter curriculum.

“We think the students handle the load we give them amazingly well,” Wright said, “and so does the LCME.”

While all students at the two Canadian schools are on three-year tracks, there are no such plans for the U.S. schools.

“The separate track helps us make family medicine very attractive,” Berk said. “If we became a three-year school, we would defeat the purpose.” Berk added that the three-year track at Texas Tech will not extend to other primary care specialties because most students who choose internal medicine and pediatrics go into the subspecialties.

Both U.S. tracks carefully select candidates. Pallay and Berk noted that many students need the fourth year to mature, and there always will be applicants more interested in cutting a year of school than in dedicating themselves to family medicine.

The two U.S. schools and Calgary report their three-year students have average or above-average grades compared with their four-year peers. Still, at Calgary, Wright wondered whether opening the three-year route just to family physicians, even with their good grades, would leave “an asterisk beside their name, sort of ‘medical school lite.’”

Pallay dismissed such concerns. “There is no reason to have an inferiority complex. We are producing physicians skilled in all aspects of medicine,” he said.

October 2012 Home

pediatrician with child and mother

“Students from small towns and other health care professions will flourish in the new track.”

Steven Berk, M.D., dean of Texas Tech School of Medicine