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Part of the problem is the unnecessarily long path to becoming a doctor in the US. It takes 4 years longer in the US, compared to UK, to become a doctor. In th

Part of the problem is the unnecessarily long path to becoming a doctor in the US. It takes 4 years longer in the US, compared to UK, to become a doctor. In the US medical school is a graduate program, which means students must obtain a bachelor’s degree before going on to medical school. The subjects US students study vary: earning a “pre-med” degree is not necessarily required to qualify for medical school. In fact, medical students can and do major in everything from mathematics to physics, even music! Becoming a doctor in the US takes a minimum of 11 years: 4 years to obtain an undergraduate degree, followed by 4 years to complete medical school then 3 years of residency. Compare that to UK: There the study of medicine starts at the undergraduate level. After spending between 5 years in medical school, students earn their bachelor’s degree and enter the workforce as junior doctors. They then spend 2 years in the “foundation programme,” which is intended to reinforce what they have learned at the university in a professional environment. That's a total of 7 years to become a doctor in the UK. The difference is the 4 years US students spend obtaining an undergraduate degree before starting medical school. This seems wasteful. Eliminating this requirement will reduce the amount of debt medical students accumulate, and encourage more people to become doctors.

koheripbal 6y ago
> 4 years US students spend obtaining an undergraduate degree before starting medical school. This seems wasteful. While it's not required, the majority of students DO follow a pre-med program that allows them to take Biology, Organic chem, Chemistry, Physics, Psychology, etc... These aren't wasted years, for the majority of medical students. I think the solution is more about having more medical schools and reinforcing STEM for younger students so that the supply can keep up with demand. One of the reasons so many foreign students go into medicine is because they come from countries with very strong culture of STEM education at a young age - something that's not done in the majority of US school districts.
- arcticbull 6y ago
  > These aren't wasted years, for the majority of medical students. They aren't wasted but they're not necessary either, and I think that was the point. Let's say I wanted to become a general contractor, but for some reason that's a graduate program. I spend 4 years taking civil engineering. Did I waste my time learning about concrete... no, probably not, but it is necessary to do my job? Also no. It's also hard to equate your "stronger early focus on STEM" with a pre-med program. If all it takes is teaching biology and math a little earlier, is that 4 years really the best use of time?
  - senortumnus 6y ago
    I place enormous value on my undergrad training in chemistry before going on to med school. Impossible to prove but I do think the deeper your foundation in life sciences the better your ability to adapt to new medicines, procedures, & other advances in medicine. Speaking as a urologist. Edit: the pre med prereqs are a good start. But I value the skills & concepts from the senior level bio/chem classes that I wouldn’t have gotten with a 6 yr track. Something also to be said for the emotional maturity that comes with 4 yrs prior to med school.
    - TheTruestKyle 6y ago
      But not the real world.
    - asapatient 6y ago
      "Impossible to prove..." sure, but that's tautology outside some very constrained problem domains like mathematics. The salient question is cost/benefit. What is the cost in terms of lives and resources of those extra years? Do sufficient benefits obtain? The US is globally known as a great place to get treated for cancers, especially. 5 year survival rates are relatively high - but of course only a fraction of Americans actually have access to the kind of diagnostics and treatments that deliver these outcomes, and only a smaller fraction of those with said access actually pass on significant assets to their heirs. For most, the medical- and death-industrial complex fulfills its primary extractive purpose. I find it deeply ironic that your literally academic perspective ("Something also to be said for the emotional maturity that comes with 4 yrs prior to med school") is so utterly subjective - i.e. about your feelings, NOT data around outcomes. In the OECD, people live longer, on average, in places where less time and money is spent educating physicians. Yes, there are confounding factors - but this is true even controlling for the big ones like obesity
    - renewiltord 6y ago
      Presumably, at a whole society level that would then mean the UK adapts poorer to new procedures than the US. Have you observed things that make you believe that is the case? Not looking for proof of what you say (you say “impossible to prove” after all, and that’s fair) but surely something makes you believe this.
- soluproj 6y ago
  All accredited US allopathic schools do require the same set of prerequisite classes to be taken by applicants (the ones you mentioned). The required courses typically take 1-2 years to complete depending on an individual’s course load and pain tolerance.
  - titanomachy 6y ago
    Does anyone use the term "allopathic" besides naturopaths or osteopaths? If you just say "medical school" people will assume MD program.
    - deleted 6y ago
      [deleted]
    - glioma 6y ago
      In the US if someone says medical student or medical school they either mean a DO or MD. If someone says allopathic, the mean the MD school subsection of medical students. As of last year, MD and DO students go on to the same residencies, the difference lies only in name and the addition of osteopathy (a combination of valid physical therapy and some voodoo techniques) which the majority of DO students don't believe in, and the few that do keep perpetuating the BS forward unfortunately
      - titanomachy 6y ago
        Thanks for the perspective, my country (Canada) doesn't have DO so it's not something I understand too well. Here, "allopath" seems mostly used as a derogatory term by naturopaths, homeopaths, etc.
- loraa 6y ago
  Also remember that many third world type countries see these types of careers as a way to leave their country to go to the western world. People in the western world figure out they can make more than doctors by being jackasses on YouTube.
- burfog 6y ago
  It's wasted, mostly. Add it up: These are good students, so they enter college with AP Chemistry and AP Biology credit. Start off college with Organic Chemistry 1, then Organic Chemistry 2, then Biochemistry. That's just 1 year to take the classes actually needed to enter medical school in the USA. Some students might even take those classes via dual enrollment (a.k.a. dual credit, early college, etc.) while still in high school. That is 0 to 1 years needed after high school. The medical schools demand a 3-year degree (actual time) at minimum, which in the USA means a 4-year degree. Subtract as you please, and you'll get an unjustified excess of 2 to 4 years.
  - deleted 6y ago
    [deleted]
  - oasisbob 6y ago
    Do AP classes require a strong lab component? My honors chem class was in 10th grade. It barely touched on electronegativity, nor acid/base chemistry in a through way. To expect a student to pull that experience forward two years later and integrate it with calculus to pull off organic chemistry seems non-ideal for many students. And you really need the through physics/calculus component unless you want to wave biochem students past thermodynamics, which seems crazy to this former biochem student. Cut the one quarter quantum mechanics class, perhaps.
    - burfog 6y ago
      AP science classes do require a strong lab component. This is required for use of the "AP" trademark on a transcript. There is a competing college credit test system, International Baccalaureate, that actually includes lab work as part of the test. Physics and calculus are available too. The right ones would be AP Calculus BC, AP Physics C Mechanics, and AP Physics C E+M.
nashashmi 6y ago
Theoretically medical schools only require two years of undergraduate before entry. But the high competition for a medical school seat means complete graduates are highly preferred to "prove" they can handle medical school.
- angel_j 6y ago
  this is the problem, academic gate-keeping, denying an education to those who seek it and giving it to select foreigners, in the name of competition.
  - aesclepius 6y ago
    While there is gate-keeping in medicine (MCAT scoring preferring English-native applicants, limited residency spots, financial costs of medical school) I would argue the residency system as it is prefers American-educated applicants versus foreign-born grads. You can see this when looking at prestigious residency programs where the rosters are primarily filled with AMGs. In fact, highly sought after specialties such as dermatology, orthopaedics or neurosurgery tend to accept only AMGs because the number of qualified applicants usually outstrips the available residency spots. Though International Medical Graduates (IMGs) are usually academically outstanding (in my experience as an MD working alongside them) they are more likely to fill residency spots (rural, less prestigious) that AMGs don't want. Not to say that there are not IMGs in highly-sought after residency programs, it's just that their qualifications usually outstrip comparable AMG or they have other connections.
    - ghufran_syed 6y ago
      I assume you meant “prefers American-educated vs foreign-educated”? If so, I think that’s true, but having trained in the UK and the US, I thing the US system is much fairer (= less unfair) than the UK. At least once you match to a residency program, it’s almost inevitable that you will complete residency and be able to get licensed and board-certified. In the UK, it was pretty easy for foreign grads to get stuck in some dead-end medical job with no way to advance - though my experience is at least 10 years out of date, so things may have changed since then. From my colleagues who have spent time working in France, France is apparently even worse than England in this regard. The question is why are local grads preferred? I suspect because even with good USMLE scores, US program directors have no good way to judge the quality of applicants, compared to US-educated grads who have formal standardized letters of recommendation from other program directors where the applicant spent time during medical school (med students often do ‘sub-internships’ at outside medical schools during their studies in order to introduce themselves to those programs and improve their chances of matching there). I suspect that if a foreign-educated medical student arranged subinternships in the US in their chose specialty while in medical school, their success rate would be much higher, because it reduces the risk for the program. Unfortunately, most foreign grads (including myself) have already finished medical school by the time they think about coming to the US, and while I believe it’s relatively easy for foreign medical students to get sub-internships, it’s almost impossible for foreign doctors to do the same.
bananaquant 6y ago
Yes. And it makes it very appealing for hospitals to just import practicing doctors from abroad on H1-B visas. It also makes those doctors very dependent on their employers due to their visa restrictions, which allows to suppress their wages and makes them even more appealing.
- curiousgal 6y ago
  Can they? I was under the impression that the U.S. doesn't recognize medical degrees from other countries.
  - arcticbull 6y ago
    In Canada at least, foreign-trained doctors need to complete a medical degree equivalency exam and to re-do their residency. Due to the complete lack of residency spots available to them a low number of foreign trained doctors ever end up practicing medicine again after moving to Canada. It's pretty nutty. Curious how it works in the US but I suspect it's not wildly different.
  - flowerlad 6y ago
    If you have a medical degree from a foreign country you take the USMLE test followed by 3 years of residency in order to get a license to practice in the US. See https://www.usmle-courses.eu/united-states-medical-licensure-requirements/ https://www.usmle-courses.eu/united-states-medical-licensure...
dmurray 6y ago
This comparison isn't right. Most UK doctors will be doing further training after the foundation programme, pretty similarly to the US residency scheme. For example, it takes 3 more years training in the GP scheme to become a GP (family doctor) [0]. Other specialities can take longer. The British doctors will have spent a year longer hanging around hospitals by the time they are qualified to hang up their own shingle, but the overall timeline is pretty close. Edit: also, you get paid, both as a trainee doctor in the UK and as a resident in the US. [0] https://www.ucas.com/ucas/after-gcses/find-career-ideas/explore-jobs/job-profile/general-practitioner https://www.ucas.com/ucas/after-gcses/find-career-ideas/expl...
- alistairSH 6y ago
  But for those 3 years, the UK doctor (in training) is seeing patients and being paid (stipend or smaller wages)? From the MD’s perspective, the timeline may be similar, but for society, those doctors in training are available to supplant fully qualified MDs (vs the US, where they’re sitting in a classroom).
  - mech422 6y ago
    I'm sorry...but "doctors in training" who "supplant _fully qualified_ MD" sounds like a step down to me?' Hell, I generally prefer an MD to a PA...
    - pmiller2 6y ago
      I think “supplant” was an autocorrect typo for “supplement.”
      - mech422 6y ago
        ahh... that could be
        alistairSH 6y ago
        lol. Yup. Autocorrect - either my brain or my Mac, not sure which. Supplement, not supplant. Like PAs, but on the path to being fully qualified MDs.
sunflowerfly 6y ago
To add on, they also limit the number of seats in med school. Doctors are only scarce, and thus well paid, because of the extra 4 years and the artificial seat limit.
kkylin 6y ago
This is in part cultural. In UK, much of Asia, and continental Europe, students specialize earlier. On average, most degree programs (and especially professional degrees like MD) take longer in the US system. Not saying this is necessarily how it should be, but it is how things are. There are a few combined UG-med programs in the US, but not as many as one might think. So perhaps there just isn't demand for them. Or they're too selective.
ghufran_syed 6y ago
There are combined BS/MD programs in the US, which I think take around 6 years to complete: https://blog.prepscholar.com/ba-md-bs-md-programs-list https://blog.prepscholar.com/ba-md-bs-md-programs-list So that’s only one year longer than the UK system, and if you wanted to get a BSc and and MD (MBBS) degree in England, it would take you 6 years there too.
taurath 6y ago
And think about the cost difference on any given year, despite the length increase. Doctors tend to graduate with 170k in debt. On average, they're paid $60-70k per year for 3 years of residency in which they're the most productive they will probably ever be in their lives. As usual in the US, the middlemen (hospitals in this situation) have figured out how to perfectly extract all the monetary gains.

koheripbal 6y ago

> 4 years US students spend obtaining an undergraduate degree before starting medical school. This seems wasteful. While it's not required, the majority of students DO follow a pre-med program that allows them to take Biology, Organic chem, Chemistry, Physics, Psychology, etc... These aren't wasted years, for the majority of medical students. I think the solution is more about having more medical schools and reinforcing STEM for younger students so that the supply can keep up with demand. One of the reasons so many foreign students go into medicine is because they come from countries with very strong culture of STEM education at a young age - something that's not done in the majority of US school districts.

arcticbull 6y ago
> These aren't wasted years, for the majority of medical students. They aren't wasted but they're not necessary either, and I think that was the point. Let's say I wanted to become a general contractor, but for some reason that's a graduate program. I spend 4 years taking civil engineering. Did I waste my time learning about concrete... no, probably not, but it is necessary to do my job? Also no. It's also hard to equate your "stronger early focus on STEM" with a pre-med program. If all it takes is teaching biology and math a little earlier, is that 4 years really the best use of time?
- senortumnus 6y ago
  I place enormous value on my undergrad training in chemistry before going on to med school. Impossible to prove but I do think the deeper your foundation in life sciences the better your ability to adapt to new medicines, procedures, & other advances in medicine. Speaking as a urologist. Edit: the pre med prereqs are a good start. But I value the skills & concepts from the senior level bio/chem classes that I wouldn’t have gotten with a 6 yr track. Something also to be said for the emotional maturity that comes with 4 yrs prior to med school.
  - TheTruestKyle 6y ago
    But not the real world.
  - asapatient 6y ago
    "Impossible to prove..." sure, but that's tautology outside some very constrained problem domains like mathematics. The salient question is cost/benefit. What is the cost in terms of lives and resources of those extra years? Do sufficient benefits obtain? The US is globally known as a great place to get treated for cancers, especially. 5 year survival rates are relatively high - but of course only a fraction of Americans actually have access to the kind of diagnostics and treatments that deliver these outcomes, and only a smaller fraction of those with said access actually pass on significant assets to their heirs. For most, the medical- and death-industrial complex fulfills its primary extractive purpose. I find it deeply ironic that your literally academic perspective ("Something also to be said for the emotional maturity that comes with 4 yrs prior to med school") is so utterly subjective - i.e. about your feelings, NOT data around outcomes. In the OECD, people live longer, on average, in places where less time and money is spent educating physicians. Yes, there are confounding factors - but this is true even controlling for the big ones like obesity
  - renewiltord 6y ago
    Presumably, at a whole society level that would then mean the UK adapts poorer to new procedures than the US. Have you observed things that make you believe that is the case? Not looking for proof of what you say (you say “impossible to prove” after all, and that’s fair) but surely something makes you believe this.
soluproj 6y ago
All accredited US allopathic schools do require the same set of prerequisite classes to be taken by applicants (the ones you mentioned). The required courses typically take 1-2 years to complete depending on an individual’s course load and pain tolerance.
- titanomachy 6y ago
  Does anyone use the term "allopathic" besides naturopaths or osteopaths? If you just say "medical school" people will assume MD program.
  - deleted 6y ago
    [deleted]
  - glioma 6y ago
    In the US if someone says medical student or medical school they either mean a DO or MD. If someone says allopathic, the mean the MD school subsection of medical students. As of last year, MD and DO students go on to the same residencies, the difference lies only in name and the addition of osteopathy (a combination of valid physical therapy and some voodoo techniques) which the majority of DO students don't believe in, and the few that do keep perpetuating the BS forward unfortunately
    - titanomachy 6y ago
      Thanks for the perspective, my country (Canada) doesn't have DO so it's not something I understand too well. Here, "allopath" seems mostly used as a derogatory term by naturopaths, homeopaths, etc.
loraa 6y ago
Also remember that many third world type countries see these types of careers as a way to leave their country to go to the western world. People in the western world figure out they can make more than doctors by being jackasses on YouTube.
burfog 6y ago
It's wasted, mostly. Add it up: These are good students, so they enter college with AP Chemistry and AP Biology credit. Start off college with Organic Chemistry 1, then Organic Chemistry 2, then Biochemistry. That's just 1 year to take the classes actually needed to enter medical school in the USA. Some students might even take those classes via dual enrollment (a.k.a. dual credit, early college, etc.) while still in high school. That is 0 to 1 years needed after high school. The medical schools demand a 3-year degree (actual time) at minimum, which in the USA means a 4-year degree. Subtract as you please, and you'll get an unjustified excess of 2 to 4 years.
- deleted 6y ago
  [deleted]
- oasisbob 6y ago
  Do AP classes require a strong lab component? My honors chem class was in 10th grade. It barely touched on electronegativity, nor acid/base chemistry in a through way. To expect a student to pull that experience forward two years later and integrate it with calculus to pull off organic chemistry seems non-ideal for many students. And you really need the through physics/calculus component unless you want to wave biochem students past thermodynamics, which seems crazy to this former biochem student. Cut the one quarter quantum mechanics class, perhaps.
  - burfog 6y ago
    AP science classes do require a strong lab component. This is required for use of the "AP" trademark on a transcript. There is a competing college credit test system, International Baccalaureate, that actually includes lab work as part of the test. Physics and calculus are available too. The right ones would be AP Calculus BC, AP Physics C Mechanics, and AP Physics C E+M.

nashashmi 6y ago

Theoretically medical schools only require two years of undergraduate before entry. But the high competition for a medical school seat means complete graduates are highly preferred to "prove" they can handle medical school.

angel_j 6y ago
this is the problem, academic gate-keeping, denying an education to those who seek it and giving it to select foreigners, in the name of competition.
- aesclepius 6y ago
  While there is gate-keeping in medicine (MCAT scoring preferring English-native applicants, limited residency spots, financial costs of medical school) I would argue the residency system as it is prefers American-educated applicants versus foreign-born grads. You can see this when looking at prestigious residency programs where the rosters are primarily filled with AMGs. In fact, highly sought after specialties such as dermatology, orthopaedics or neurosurgery tend to accept only AMGs because the number of qualified applicants usually outstrips the available residency spots. Though International Medical Graduates (IMGs) are usually academically outstanding (in my experience as an MD working alongside them) they are more likely to fill residency spots (rural, less prestigious) that AMGs don't want. Not to say that there are not IMGs in highly-sought after residency programs, it's just that their qualifications usually outstrip comparable AMG or they have other connections.
  - ghufran_syed 6y ago
    I assume you meant “prefers American-educated vs foreign-educated”? If so, I think that’s true, but having trained in the UK and the US, I thing the US system is much fairer (= less unfair) than the UK. At least once you match to a residency program, it’s almost inevitable that you will complete residency and be able to get licensed and board-certified. In the UK, it was pretty easy for foreign grads to get stuck in some dead-end medical job with no way to advance - though my experience is at least 10 years out of date, so things may have changed since then. From my colleagues who have spent time working in France, France is apparently even worse than England in this regard. The question is why are local grads preferred? I suspect because even with good USMLE scores, US program directors have no good way to judge the quality of applicants, compared to US-educated grads who have formal standardized letters of recommendation from other program directors where the applicant spent time during medical school (med students often do ‘sub-internships’ at outside medical schools during their studies in order to introduce themselves to those programs and improve their chances of matching there). I suspect that if a foreign-educated medical student arranged subinternships in the US in their chose specialty while in medical school, their success rate would be much higher, because it reduces the risk for the program. Unfortunately, most foreign grads (including myself) have already finished medical school by the time they think about coming to the US, and while I believe it’s relatively easy for foreign medical students to get sub-internships, it’s almost impossible for foreign doctors to do the same.

bananaquant 6y ago

Yes. And it makes it very appealing for hospitals to just import practicing doctors from abroad on H1-B visas. It also makes those doctors very dependent on their employers due to their visa restrictions, which allows to suppress their wages and makes them even more appealing.

curiousgal 6y ago
Can they? I was under the impression that the U.S. doesn't recognize medical degrees from other countries.
- arcticbull 6y ago
  In Canada at least, foreign-trained doctors need to complete a medical degree equivalency exam and to re-do their residency. Due to the complete lack of residency spots available to them a low number of foreign trained doctors ever end up practicing medicine again after moving to Canada. It's pretty nutty. Curious how it works in the US but I suspect it's not wildly different.
- flowerlad 6y ago
  If you have a medical degree from a foreign country you take the USMLE test followed by 3 years of residency in order to get a license to practice in the US. See https://www.usmle-courses.eu/united-states-medical-licensure-requirements/ https://www.usmle-courses.eu/united-states-medical-licensure...

dmurray 6y ago

This comparison isn't right. Most UK doctors will be doing further training after the foundation programme, pretty similarly to the US residency scheme. For example, it takes 3 more years training in the GP scheme to become a GP (family doctor) [0]. Other specialities can take longer. The British doctors will have spent a year longer hanging around hospitals by the time they are qualified to hang up their own shingle, but the overall timeline is pretty close. Edit: also, you get paid, both as a trainee doctor in the UK and as a resident in the US. [0] https://www.ucas.com/ucas/after-gcses/find-career-ideas/explore-jobs/job-profile/general-practitioner https://www.ucas.com/ucas/after-gcses/find-career-ideas/expl...

alistairSH 6y ago
But for those 3 years, the UK doctor (in training) is seeing patients and being paid (stipend or smaller wages)? From the MD’s perspective, the timeline may be similar, but for society, those doctors in training are available to supplant fully qualified MDs (vs the US, where they’re sitting in a classroom).
- mech422 6y ago
  I'm sorry...but "doctors in training" who "supplant _fully qualified_ MD" sounds like a step down to me?' Hell, I generally prefer an MD to a PA...
  - pmiller2 6y ago
    I think “supplant” was an autocorrect typo for “supplement.”
    - mech422 6y ago
      ahh... that could be
      - alistairSH 6y ago
        lol. Yup. Autocorrect - either my brain or my Mac, not sure which. Supplement, not supplant. Like PAs, but on the path to being fully qualified MDs.

sunflowerfly 6y ago

To add on, they also limit the number of seats in med school. Doctors are only scarce, and thus well paid, because of the extra 4 years and the artificial seat limit.

kkylin 6y ago

This is in part cultural. In UK, much of Asia, and continental Europe, students specialize earlier. On average, most degree programs (and especially professional degrees like MD) take longer in the US system. Not saying this is necessarily how it should be, but it is how things are. There are a few combined UG-med programs in the US, but not as many as one might think. So perhaps there just isn't demand for them. Or they're too selective.

ghufran_syed 6y ago

There are combined BS/MD programs in the US, which I think take around 6 years to complete: https://blog.prepscholar.com/ba-md-bs-md-programs-list https://blog.prepscholar.com/ba-md-bs-md-programs-list So that’s only one year longer than the UK system, and if you wanted to get a BSc and and MD (MBBS) degree in England, it would take you 6 years there too.

taurath 6y ago

And think about the cost difference on any given year, despite the length increase. Doctors tend to graduate with 170k in debt. On average, they're paid $60-70k per year for 3 years of residency in which they're the most productive they will probably ever be in their lives. As usual in the US, the middlemen (hospitals in this situation) have figured out how to perfectly extract all the monetary gains.