[Note: Blue Marble University Medical School offers an “Executive” style M.D. degree which can be obtained online in three years. This non-traditional MD degree puts our graduates on the same footing as other graduates of medical school who chose not to pursue licensing exams and instead have entered careers in peripheral medical fields including the pharmaceutical industry, basic and clinical medical research, clinic and hospital management, health insurance, corporate insurance departments, state and federal insurance licensing agencies, management of self-directed medical facilities and testing labs. For those others only interested in being a practicing physician, Laurence V. Hicks, Sr., D.O. summarizes some of the ways to get to the end faster and cheaper. Dr. Hicks is a graduate of the University of Western States, the Canadian College of Naturopathic Medicine and the University of New England College of Osteopathic Medicine. He is a board-certified family physician and diplomate clinical nutritionist, and has a private practice in Twin Falls, Idaho. What follows is his report of his investigation concluded October 30, 2019 and graciously shared with us for publication. Cite as: Hicks, L.V. Sr., “How to Become a Practicing Physician Faster”, published online by Blue Marble University Medical School, November 4, 2019, https://bluemarbleuniversitymedicalschool.com/2019/11/03/how-to-become-a-practicing-physician-faster/ ]
By the time they have entered high school, many young folks have already determined that they intend to become a doctor. Many others would also have thought about a medical career, but the plain fact is it takes too long to get a medical degree and so these potential physicians choose another career path.
In the United States (US), medical education has generally required a minimum of eight years of higher education to acquire either a D.O. or an M.D. degree.
There are four primary strategies that, when carried out, will have the effect of shortening the duration of time required to obtain a medical credential.
(1) Complete College Credit While Still in High School. The first tactic allowing a student to get a quicker start is to complete college credit while still in high school. Existing programs are in place that permit students to acquire college level course credit before completing high school. The programs I am referring to include Advance Placement (AP), College Level Exam Program (CLEP), American Council on Education (ACE) credit recommendations and Duel Credit courses. Alternatively, a high school junior might just sign up for classes at the community college and complete those in lieu of his/her 3rd and 4th year classes.
(2) Complete All Pre-medical Requirements During the First Two Years of College, or sooner. Thereafter, starting them into the basic medical science courses characteristic of the first two years of medical school, as is currently offered in the accelerated undergraduate combined M.D. 6-year programs. Ideally, students would take two years to complete undergraduate pre-medical requires and then begin the basic medical courses characteristic of the first two years of medical school. Thereafter, they would transfer their biomedical course credits back to their undergraduate college or university and obtain a baccalaureate halfway through their medical training.
(3) Go Overseas for 6-year Programs That Start After High School. A third consideration would be for students to advantage of any of several international undergraduate medical degree programs, which are designed to be completed in 6 years, or less.
(4) Choose Medical Schools With Accelerated Programs. A fourth design recognizes that a few medical schools operate a curriculum over a shortened training time, allowing students to complete medical school in 3 years, instead of four, by taking classes without traditional breaks for summer. This is not a new or novel idea, and, in fact, three-year medical curricula were common during World War II. A few three-year programs exist at present and represent a viable option for students to reduce the time to a medical degree.
(1) Complete College Credit While Still in High School
High Schoolers can Convert Test Scores into College Credit
A number of programs offer students the opportunity to take courses or tests for college credit. With an adequate exam score, college credit is readily available. The programs include Advanced Placement (AP), the College Level Exam Program (CLEP) and American Council on Education (ACE) credit recommendations.
Advanced Placement
The preparation for medical school initially begins in high school with an emphasis on math and science. [1] “Peterson’s College Bound” recommends that high school students who are interested in pursuing a career in medicine should take AP courses in math and science-related subjects. [2] There are 38 AP exams in total, including such subjects as biology, calculus, chemistry, physics and psychology—the very courses pre-medical students need!
The usual required courses for acceptance into medical school are:
1 year of General Chemistry with associated lab
1 year of Organic Chemistry with associated lab
1 year of Biology with associated lab
1 year of Physics with associated lab
1 year of English
1 term of Calculus or other advanced Math, including Statistics.
Some colleges use AP test scores to exempt students from introductory coursework, others use them to place students in higher designated courses, and some do both. Each college’s policy is different, but most require students to obtain minimum cut-off scores to receive college credit. [3]
AP offers college-level curricula and examinations to high school students.
American colleges and universities may permit placement and course credit to students who obtain sufficiently high scores on AP examinations. Even though AP credits from high school do not themselves satisfy premedical requirements, the advanced college and university courses, for which students are made eligible for with AP credits, may then be substituted instead of introductory-level courses in each of the needed pre-medical subjects.
College Level Exam program
Anyone can earn credit for a fraction of the cost of a college course, using the College Level Exam Program (CLEP). CLEP is a group of standardized tests created and administered by the College Board. [4] Courses available for premedical requirements include, but are not limited to, Biology, Chemistry, College Algebra, Calculus and Introductory Psychology; however, CLEP tests assess college-level knowledge in thirty-six subject areas and provide a means to earn college credits without needing to take college courses. [5]
Each college or University awards credit to students who meet the institution’s minimum qualifying score for that exam. The passing score may vary by site and exam. These tests are especially useful for individuals who have obtained knowledge outside the classroom. Many students take CLEP exams because of their convenience and the reduced cost when compared to tuition for a semester of comparable coursework credit.
A maximum of 27 credit hours may be accepted towards as bachelor’s degree in the area of “General Examinations” or a maximum of 30 credit hours will be accepted from “Subject Examinations” towards a bachelor’s degree. A combined 57 credit hours will be accepted towards a bachelor’s degree from the “General and Subject Examinations,” but 30 credit hours is the maximum accepted towards an associate degree from the “General and Subject exams” combined
American Council on Education Plus Straighter Line
The American Council on Education (ACE) is a nonprofit U.S. higher education association established in 1918. Members of ACE are the leaders of approximately 1,700 accredited, degree-granting colleges and universities and higher education-related associations, organizations and corporations. An ACE credit recommendation is a formal recommendation to colleges and universities, requesting that they award college credit for certain courses, examinations and certifications acquired outside the classroom. Although it doesn’t guarantee credit, it can heartily influence college registrars to grant transfer credit. [6]
“Straighter Line” is a program offering the option to test for course credits. Tests are offered in many different content areas, including the pre-medical sciences. Tests successfully passed, through programs, such as “Straighter Line,” can then be submitted to ACE which provides guidance to colleges, allowing credit to be granted. Credit for military service training may also be endorsed through ACA, but high school students would not have entered military service. [7]
High Schoolers can Also Complete College Courses While in High School
Additionally, students can sign up for “dual credit” courses or officially sign up for and take college classes full-time at the beginning of their junior year, in lieu of sticking with mundane high school classes. Anyone or a combination of all the various above discussed approaches can propel one more quickly toward a medical career.
Duel Credit
Dual credit, sometimes called “concurrent enrollment,” is credit obtained from a course in which a high school student is enrolled in and is simultaneously counted as college credit and as a secondary course for high school graduation purposes.
Dual Credit course offerings will differ from one high school to the next, depending on the availability of on-site instructors and academic calendars. In general, however, arrangements for Dual Credit opportunities are available in many subjects, including but not limited to the following:
Chemistry and Physics
English
Biological Science
College Algebra
English: Writing and Rhetoric I and II
Biology I
Medical Terminology
Introduction to Psychology
Fundamentals of nutrition and
Calculus
Following a carefully planned agenda, with duel credit, it may be possible for a student to simultaneously complete a high school diploma and an associate degree. [8]
Take Full-time College Courses While Still in High School
It may well be possible to sign up for and take college classes full-time from the 3rd year of high school onward. However, this particular strategy may need to be modified in one or more ways, depending upon rules that may vary from one school jurisdiction to the next; therefore, it would be prudent to consult with appropriate school officials in the student’s locale.
In planning biology requirements, this author, based on personal experience in both education and clinical practice, believes students should complete Anatomy and Physiology I and II, which are more useful for medical students. Vertebrate and Invertebrate Zoology courses are most suited for biological science majors. If basic biology courses are required, perhaps they can be satisfied by AP, CLEP, etc.
These core prerequisites, total 36 credits and can be completed in the freshman and sophomore undergraduate college years. In a 64 credit A.A. or A.S. degree program 28 credits would be available to bolster the academic resume with the below considerations:
Medical Ethics: 3 credits
Medical Terminology: 2 credits
General Psychology: General 3 credits
Abnormal Psychology 3 credits
Pathophysiology: 3 credits
Physiological Psychology: 3 credits
College Algebra: 3 credits
Essentials of Nutrition: 2 credits
General Microbiology: 4 credits
Statistics: 3.0 credits
Introductory Pharmacology: 2 credits
Embryology: 3 credits
Calculus: 4 credits
Genetics: 4 credits
A student, who starts pre-medical courses early in high school would be able to develop a more robust college transcript earlier, with credits far in excess of those needed for an associate degree and would ideally make early arrangements for medical school admissions. [9]
(2) Complete All Pre-medical Requirements During the First Two Years of College
Combined Accelerated B.S./M.D. programs
An estimated 25% of US medical schools make provisions for a combined B.A./M.D. program directed toward high school students. Successfully admitted, high school students leave high school, entering medical school directly, without having to complete typical application requirements for medical school at all. Medical schools will affiliate with one or more undergraduate institutions located in the same geographic region to make this possible. Commonly, the undergraduate college and the medical school are part of the same university system, but they may be independent institutions as well. If admitted, students will spend two to four years at the undergraduate college completing their B.S. or B.A. degrees along with premedical requirements, and/or the first two years of medical school. Then, they will proceed on through the medical school affiliated with the undergraduate institution to acquire the M.D. While a portion of these programs are accelerated, meaning that students would get their B.S. or B.A. and M.D. in six or seven years instead of the traditional eight. Nevertheless, most of the programs are eight years long. [10]
Although AP classes are not required for the B.S./M.D. programs, most students will have taken many AP classes and exams. The average student will take six or seven AP classes by the time they graduate.
The interest in combined B.A./M.D. programs is obvious. Students who are admitted to these programs eliminate the stress of medical school applications, competition and are essentially guaranteed a spot in medical school, while traditional pre-meds are stressing about getting an A in almost every class and getting at least a 513 on their MCAT. Instead of competing against tens of thousands of other applicants with less than a 50% chance of acceptance, students accepted in combined M.D. and Bachelors programs only need to maintain their GPA and score a minimum on the Medical College Admissions Test. [11] However, in order for the six-year accelerated program to work out; potential students are required satisfy all pre-medical course requirements.
A prudently planned curriculum will certainly position undergraduate students to take advantage of a 6-year accelerated B.S./M.D. opportunity.
There are currently several six-year accelerated B.S./M.D. programs, already up and running. They include:
The UMKC School of Medicine B.A./M.D. Program which coordinates undergraduate course work at the University of Missouri-Kansas City with the University of Missouri—Kansas City School of Medicine, completing B.A. and M.D. degrees in six years.
The Medical Scholars Program, with undergraduate schooling at Saint Louis University
coupled with medical school at Saint Louis University School of Medicine. While completion takes six years, here the medical school admission is not guaranteed.
The NEOMED B.S./M.D. Program includes undergraduate studies at Kent State joined with medical school training at Northeast Ohio Medical University. Time to completion is variable at seven or, possibly six years. [12]
California North state University (CNU) offers the only Bachelor of Science to Doctor of Medicine (BS-MD) Combined Programs in the state of California. They indicate that highly motivated and goal-oriented students are given the opportunity to complete undergraduate and medical education in six or seven years, as well as the traditional eight years. [13]
Howard University’s B.S./M.D. Program allows students to complete the requirements for both the B.S. and M.D. degree in six years instead of the customary eight years. A limited number of students enrolled in the College of Arts and Sciences will be admitted each year to the Howard University College of Medicine as part of the entering class of traditionally selected students. [14]
Texas Joint Admissions Medical Program (JAMP) offers a six-year B.S./M.D. [15]
Additionally, multiple seven year accelerated programs are also in operation. The mere existence of these various programs provides the greatest evidence that it is possible to accelerate medical so that training time is reduced from eight to as low as six years.
(3) Go Overseas for 6-year Programs That Start After High School
International Six-year Medical degrees Offer a Reasonable Alternative Pathway
In lieu of attending medical school in the US, a student could study abroad and return for residency training by demonstrating medical proficiency through passing the United States medical Licensure Examination (USMLE) examinations. The advantages of this strategy might be to cut tuition fees and living expense costs while gaining experience in another part of the world. We have already shown that medical schools in the UK, Australia, India and Thailand, etc. offer their medical degrees in six years.
In the British Commonwealth system of education an equivalent medical degree, i.e., M.B., M.B.B.S. and M.B., Ch.B. (B.Ch.) can be earned in six years from beginning college through completion of the first professional medical degree. These credentials are referred to as undergraduate medical degrees. [16]
Most undergraduate medicine degrees are five- or six-years duration in Australia, but due to the intensive tri-semester system Bond University allows a student to complete an undergraduate medical degree in four years and eight months. [17]
Pakistan has one of the shortest medical education, allowing students can go directly to medical school after completing their A levels and join a program of four years, sometimes five. Afterwards, they can take and pass an exam which allows them to practice medicine abroad, including the States. So, they can become a working doctor in four or five years after high school. [18]
Hope Medical Institute offers a six-year program to high school graduates. [19] Two excellent Poland medical school offers a six-year program right out of high school [20]
Similarly, medical degrees can be obtained in six years in Thailand, in English. [21] Two German medical schools offer six-year programs. [22] US training hospitals accept international graduates for US residency training, when they score passing grades on USMLE exams, which are the required standard for all US and international medical students.
This practice suggests their system is turning out a standard medical product like our M.D. degree programs, and generally, they are doing it in less time. It seems logical that we should be able to provide a quicker approach to completing a medical degree in America, reducing education costs and hastening qualified doctors into residencies sooner, thereby reducing the pending burdens of a doctor shortage looming on the horizon associated with retiring and burned out physicians and providing a pathway to a more plentiful supply of primary care physicians.
(4) Choose Medical Schools With Accelerated Programs
The Three-Year Medical School Curriculum: A Great Way to Shorten Training Time
Art Kauffman, D.O., PA-C, director of Lake Erie’s Accelerated Physician Program, believes that it may be possible to change pre-medical school curricula, allowing students to take many of the core sciences before they start medical school. He states, “in my opinion the way to accelerate medical school to 3 years is to go back to pre-med. We don’t use physics and organic chemistry in clinical practice…We need to learn human anatomy, physiology and ethics (before we start medical school.”
This author is not advocating that we throw out undergraduate physical sciences, but rather, we start preparing earlier and enrich pre-medical course in ways described above.
Ronald Weinstein, M.D., professor of pathology at the University of Arizona School of Medicine, and a staunch supporter of 3-year medical programs, supports Kauffman, thinking much of the core science teaching could should be done in the undergraduate years.
A few US medical schools have already shortened training duration by allowing students to complete medical school in 3 years, instead of four, by taking classes without traditional breaks for summers. Cutting medical school training time to three years is not a new idea. Fitzhugh Mullan, M.D., Murdock Head Professor of Medicine and Health Policy at George Washington University has “no doubt that we can train excellent physicians in three years.” We have done it previously, during WW II, in an effort to provide more physicians necessary to support the war effort. It was a solid idea then, as well as now, and it worked well! [23]
The effort produce three-year medical programs is one element in the plan to modernize medical education, as an exception to the century old pattern of four-year schools. Tailoring the time required in medical to the needs, ability and clinical backgrounds of students is one theme promoted by the AMA “Accelerating Change in Medical Education Consortium,” which began in 2013 to address a general consensus that medical education has needed to change so as to address significant gaps in physician development and to prepare doctors to practice effectively in 21st century health plans.
The nexus of a looming physician shortage and the six-figure physician education debt has prompted evidence-based rethinking of the best length for medical school education. Some accelerated programs that focus on primary care may also serve a social function by increasing doctor access in rural and underserved populations. By accelerating medical training, it may be possible to reduce student debt from an anticipated $200,000 to $150,000 and ease the anticipated physician shortage expected to burgeon to 120,000 by 2030. [24]
The University of California, Davis School of Medicine offers an accelerated, competency-based primary care, partnered with Kaiser Permanente Northern California. The program features a six-year pathway to practice, consisting of three years each of medical school and residency. Here, the students learn history taking and physical exam skills in the first few weeks of medical school.
In traditional four-year medical programs, the last year is filled with electives and the process of securing a residence position. The actual value of the fourth year is under some debate. Ezekial and Fuchs, in a JAMA article, affirmed that years of schooling have been added without evidence of enhanced clinical skills or quality of care. This has added wasteful financial burdens to young physicians, raised healthcare costs and it appears that training time could be reduced approximately 30% without affecting physician competence or quality of patient care.
New York University offers a three-year M.D. program and it offers opportunities broader than primary care and family medicine. They start the three-year pathway six-weeks prior to the four-year program and students work in summer fellowships between the first and 2nd year in order to accomplish their training on time.
Texas Tech University Health Sciences Center offers an accelerated Family Medicine Track, culminating in the M.D. degree which is followed by a three-year family medicine residency in either Lubbock, Amarillo or the Permian Basin.
Mercer University champions an Accelerated Track in Family Medicine for students with a strong desire to stay in Georgia. The curriculum, while similar to their four-year plan, is compressed into 131 weeks of instructional time. Dan Hunt, M.D., M.B.A. co-secretary and senior director of accreditation services at LCME affirms that medical schools have significant leeway in designing curriculum: “There is only one standard that has a specific number in it: it’s the number of weeks you have to have of instruction, 130 weeks (same is true for D.O. programs.”
Columbia University’s College of Physicians and Surgeons has an accelerated program, open only to students with an earned Ph.D. in biological sciences designed to permit biomedical research opportunities as a physician-scientist.
Lake Erie College of Osteopathic Medicine (LECOM) puts forward the Primary Care Scholars Pathway to students committed to complete residency training in family medicine or general internal medicine and then practice primary care for a minimum of 5 years after completion of the residency. Here the basic medical sciences are completed in 18 months followed by, with summers involved, then clinical rotations, including a sub-internship in the hospital where they will complete residency training after graduation.
LECOM, Mercer and the Texas Tech programs condensed the curriculum in similar fashion. The first three years were untouched, except for eliminating the summer recess between the first and second year and most of the 4th year rotations were cut, in order to assure success on the USMLE. [25]
While the three-year medical school is gaining traction, some are concerned. J. William Eley, M.D., M.P.H. says there are counter arguments to consider over shortening medical school, time to residency and lessening student debt. He contends that medicine is now more complicated, doctors require increased knowledge and experience to manage the current patient populations and disease interventions are more sophisticated than that which was considered in the past. [23]
Duke University School of Medicine allocates only one year to the basic sciences. In contrast to Eley’s assertion, Edward Buckley, M.D. vice dean of education, contends “the modern medical school needs to teach some basic skills—understanding medical vocabulary, understand context of human anatomy, understand disease processes and know how to find medical and research information (you need).” [23]
Additionally, St. James School of Medicine, a premier, accredited Caribbean program, advertises a three-year course covering the basic medical and clinical sciences. [26] Their 10-semester program guides the student through Step 1 and Step 2 of USMLE, and clinical rotations at hospitals and clinical facilities in the US, culminates in graduation with a M.D. degree.
Accredited by both of the principal accrediting bodies that operate in the Caribbean, they also are the first Caribbean Medical School to provide a USMLE Step 1 Pass Guarantee, and at the same time, they offer the lowest tuition amongst all accredited medical schools, at approximately $6,350 per semester.
Concluding Remarks
In summary, we have learned that there are many methods, pathways and strategies making it possible for students to shorten the duration of medical training. These acceleration pathways are viable in reducing training time without adversely affecting the student’s educational and clinical opportunities.
If we ask ourselves how old is the average medical school graduate? We understand that in the US, it is typically at least 26. High school graduation occurs at age 18. After four years of college, followed by four years of medical school means doctors are at minimum 26. A student who completes pre-medical college courses while in high school would ready themselves for medical school in a quick start with a three-year curriculum, obtaining their medical degree at 21-23 years of age. A student spending two years in college and using the six-year B.S./M.D. route would be 24 years old at medical graduation. Entering medical school after two intensive undergraduate years in either a three-year medical school curriculum or in a six-year accelerated B.S./M.D. program would permit the student to complete their medical credentials in 5 or 6 years, the same as they could in a British Commonwealth or other international medical schools.
References
[1] https://work.chron.com/long-become-doctor-us-7921.html
[2] https://work.chron.com/classes-need-become-doctor-8227.html
[3] Understanding AP Exams Archived September 8, 2008, at the Wayback Machine from PathAspire.com
[4] https://bigfuture.collegeboard.org › testing › learn-about-the-clep-program
[5] https://study.com › academy › popular › clep-exam-list-credits-offered
[6] https://www.acenet.edu › news-room › Pages › How-To-Get-ACE-Credit-Re…
[7] https://www.straighterline.com/
[8] https://blog.collegevine.com › dual-enrollment-what-you-need-to-knowdual-…
[9] https://www.thecrimson.com/article/2013/9/26/the-real-premed-requirements/
[10] Johnson, Todd A. and Johnson, Kelly Anne • BS/MD Programs-The Complete Guide: Getting into … – Amazon • https://www.amazon.com › BS-MD-Programs-Complete-Guide
[11] https://www.prospectivedoctor.com/high-school-to-medical-school/
[12] https://blog.collegevine.com/admissions-heros-top-25-combined-bsmd-programs/
[13] BS-MD Combined Program California North state University • healthsciences.cnsu.edu/ programs-offered/bs-md-combined…
[14] Dual Degree Programs • Howard University College of Medicine • medicine.howard.edu/ education/dual-degree-programs
[15] https://www.directbsmd.com/6-year-bsmd-programs.html
[16] https://infogalactic.com/info/Bachelor_of_Medicine,_Bachelor_of_Surgery
[17] https://bond.edu.au/intl/program/medical-program
[18] https://www.quora.com › Which-country-has-the-shortest-medical-education
[19] https://www.hopemedicalinstitute.org/academics/programs/6-year-md/
[20] http://pums.ump.edu.pl/programs/6-year-m-d-program/admission-to-the-6-year-m-d-program-in-english/
[21] https://wenr.wes.org › Asia Pacific
[22] https://www.studying-in-germany.org › study-medicine-in-germany
[23] Hartman, Ben • The 3 Year Medical School: Is Shorter Good Enough? • Medpage Today • 9/16/2013
[24] Why Medical Schools are Building 3-year Programs • American Medical Association • 8/20/2018 • https://www.ama-assn.org › accelerating-change-medical-education › why-…
[25] The Three-Year MD Program • Collegiate Gateway • 2/24/2016
[26] www.sjsm.org/
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Editor Note: It is a tough trail to becoming a practicing physician in America. A quick online M.D. degree that teaches you the language of medicine and how it works with immediate entry into a variety of non-clinical careers that can pay just as well may be the correct path for many students.
Blue Marble University Medical School 