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Monday Jun 15, 2015

How Long Should It Take to Train a Family Physician?

I began medical school in the summer of 2005 during a trend among schools to get first- and second-year students more patient exposure. Many medical schools were dabbling with increased patient contact (including my school, the Medical College of Wisconsin), while others made wholesale changes to their curriculum to evenly blend the needed activities of four-year training.

As medical education continues to evolve, questions persist regarding the appropriate length and format of medical training.

Many of my colleagues and I look back fondly on our fourth year of medical school. It’s not that it was such a great training experience -- quite the opposite: It provided us a reprieve before residency. We spent a lot of time interviewing for residency, taking vacations and signing up for “cushy” rotations. Although some things were worthwhile, such as subinternships -- which function more as an audition for a specific program than for any significant educational purpose -- they were more the exception than the rule.

But although that fourth year did not add much to my education, it did add more than $50,000 to my student debt. For this very reason, a common discussion about medical education focuses on the possibility of eliminating the fourth year of medical school(www.washingtonpost.com).

Specifically, a few schools are offering accelerated, three-year programs for students interested in primary care. Students who enter these programs have to agree to choose primary care training right from the start, but in doing so, they significantly lessen their debt burden. That's important because student debt is a common reason(www.graham-center.org) why medical students initially interested in primary care often end up choosing subspecialty careers instead.

Opponents of this idea point out how much there is to learn in medicine. The discussion then moves on to whether family medicine residencies should last four years rather than three, and a national pilot program is evaluating that concept. Eliminating the fourth year of medical school and lengthening the time spent in residency could make more efficient use of education time by adding more specialty-specific training that would expand our scope.

But the underlying question is: How much medical training is needed for physicians? Including undergraduate education, it now takes 11 years to become a family physician, but, as mentioned, some schools are eliminating the last year of medical school. So are three years of medical school and three years of residency enough to train a quality family physician? And are we training people the right way to meet future health care needs?

My opinion is that six years is plenty(jama.jamanetwork.com) of time to adequately train a family physician without compromising the quality of care that family physician provides. However, we likely need to change how we train future physicians.

Medical training that lasts six years, seven years or even 20 years is not enough to fully understand all of the available medical knowledge, especially given its current rate of growth. I believe training should focus more on how to obtain reliable information quickly and efficiently to help patients at the point of care. Thus, training should incorporate tools that can be embedded into electronic health records, such as Watson from IBM(www.ibm.com) or the Isabel diagnostic tool(www.isabelhealthcare.com). Use of such tools does not lessen our experience as physicians; it adds to it.

The other ingredients essential to a training program are learning how to manage practice transformation and cultivating the ability to cope with change in our medical environment. Any physician who has practiced for more than 10 years has seen multiple changes in practice models, reimbursement trends, regulation and, consequently, the physician-patient relationship. Most of these changes can cause frustration, although many end up benefiting both the physician and the patient(content.healthaffairs.org). Greater understanding and training on how to not only navigate these changes, but to lead them, is crucial to the success of our health care system.

Much change abides in our health care system and medical education, so that many schools today look nothing like the experience I had when I started 10 years ago. No doubt, this trend will continue to evolve. The main lesson for all of us is to ensure that we prepare our future physicians in the most efficient and effective ways possible to fortify our future system needs.

Kyle Jones, M.D., is a faculty member at the University of Utah Family Medicine Residency Program in Salt Lake City. He is the director of primary care at the Neurobehavior HOME Program, a patient-centered medical home for those with developmental disabilities. You can follow him on Twitter @kbjones11.

Posted at 02:15PM Jun 15, 2015 by Kyle Jones, M.D.

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