Shortened training would offer advantages

January 15, 2007

The president of my university, William Brody, MD, PhD, says we take too long to train the current generation of physicians and biomedical scientists. I agree.

"They say that we are better educated than our parents' generation. What they mean is that we go to school longer. They are not the same thing."-Douglas Yates

The president of my university, William Brody, MD, PhD, says we take too long to train the current generation of physicians and biomedical scientists. I agree.

Some will perceive this view as anti-intellectual, but I think we spend years of student-physicians' lives teaching them things they don't need to know and making them do things that will not be germane to their future careers.

No evidence exists that this additional requirement elevated the quality of ophthalmologists practicing in the United States compared with those who came before us. Rather, we learned to use drugs with names primarily of historic interest today to treat diseases we no longer managed once our internships were completed.

Trust me when I tell you that most of what I was taught and required to memorize in medical school has been long forgotten and never used in the practice of my profession.

Are these youthful trainees up to American standards? My observation is that many countries outside the United States are producing outstanding clinicians and superb surgeons. My residents, many of whom travel to other countries for elective courses, commonly tell me how impressed they are with the skills of these ophthalmologists.

People involved in designing medical school curricula tell me that they are not trying to teach medical students to know everything, especially because biomedical science totally changes every few years. Rather, they say, they seek to teach medical students "how to think." But why does it take 4 years to teach a medical student to think? Can't someone who was tops in his or her class in high school and college be taught to think in 3 years?

In many specialties, trainees are finishing their residencies and fellowships in their mid-to-late 30s, especially if they took time to get a PhD along the way. They graduate with an average of $250,000 in student loans, may be married and have a child or two, and suddenly are worried about paying off their debt, buying a first home, and otherwise providing for their families.

When some of these brilliant young people decide not to pursue academic careers, many academics shake their heads sadly and wonder why.

My view is that we who are doing the training may be sowing the seeds of our own extinction by virtually bankrupting the next generation, making it increasingly not economically viable for most of our graduates to accept the lower incomes of academicians.

Pedagogical scientists may prove that I am wrong and that our current lengthy training programs are appropriate and are producing better physicians than in the past.

But if I were king, we'd shave a few years off the time required for training ophthalmologists in the United States, dramatically cut the debt burden on our trainees, and get them out in the world to start their careers when they are younger and brimming with great ideas.

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