USMLE directly?

[agrimond]

Hello,

I'm a foreign student, and have just gotten a BS at a major US university.

I wonder if it's possible to study directly for and take the USMLE stages without the intervening medical school years.

After all, this makes sense for me. I have two and a half years of work authorisation ahead of me, thanks to OPT regulations. Most medical schools won't admit me or require 4 years of tuition in advance in escrow. I'd rather not be indebted for the ridiculous sums of tuition needed. Foreign candidates can study for and take the USMLE directly. And I derive little benefit from either the formal structure or community nature of university education.

I'm not really interested in replies discouraging me merely because this is difficult. I know it is. I just want to know if there's anything I should take into account in my calculation. Can I apply to residency programmes directly with the USMLE? Is there any real reason for going to medical school? Have people done this sort of thing before? Is there anything in the totality of the medical school experience that I cannot reproduce on my own? (The practical bits don't worry me; I can make up for them either by shadowing or by going back to Wales for access to things like anatomy or pathology labs.)

Thanks,
Adrian Grimond

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[sindadel]

I have wondered the same thing myself. I poked around a bit and it seems like the short answer is that you are not eligible to register for the USMLE Step 1 exam unless you meet certain criteria according to the ECFMG (http://www.ecfmg.org/) which determines whether foreign medical school graduates and students are eligible to take the USMLE.

2. Why would I want to be certified by the ACGME?

If you are an international medical graduate and wish to enter an ACGME-accredited residency or fellowship program in the United States, you must be certified by ECFMG before you can enter the program. You must be certified by ECFMG if you wish to take Step 3 of the three-step United States Medical Licensing Examination (USMLE). ECFMG Certification is also one of the requirements to obtain an unrestricted license to practice medicine in the United States. See ECFMG Certification.

To be eligible for Step 1, Step 2 CK, and Step 2 CS, you must be officially enrolled in a medical school located outside the United States and Canada that is listed in IMED, available on the ECFMG website, both at the time that you apply and at the time you take the exam. In addition, the “Graduation Years” in IMED for your medical school must be listed as “Current” at the time you apply and at the time you take the exam. Your Medical School Dean, Vice Dean, or Registrar must certify your current enrollment status; instructions will be provided at the time of application. As soon as you graduate and receive your medical diploma, you must send two photocopies of your medical diploma and one full-face, passport-sized, color photograph to ECFMG (see Provision of Credentials and Translations). The photograph that you send must be current; it must have been taken within six months of the date that you send it. A photocopy of a photograph is not acceptable.
In addition to being currently enrolled as described above, to be eligible for Step 1, Step 2 CK, and Step 2 CS, you must have completed at least two years of medical school. This eligibility requirement means that you must have completed the basic medical science component of the medical school curriculum by the beginning of your eligibility period.
Although you may apply for and take the examinations after completing the basic medical science component of your medical school curriculum, it is recommended that you complete your core clinical clerkships, including actual patient contact, before taking Step 2 CK and Step 2 CS.

 

[agrimond]

Thanks for the info. It looks like I won't be saving money on this. Perhaps I can cram everything into 2 or 3 years, though.

 

[student1799]

Thanks for the info. It looks like I won't be saving money on this. Perhaps I can cram everything into 2 or 3 years, though.

I seriously doubt this, because I've never heard of a US medical student graduating in less than 4 years. (Some actually take more, because they spend an extra year doing research.)

 

[DrMidlife]

LECOM has a family practice track that's 3 years.

 

[bioteach]

Thanks for the info. It looks like I won't be saving money on this. Perhaps I can cram everything into 2 or 3 years, though.

Medical school doesn't work that way, sorry.

 

[Non-TradTulsa]

Hello,

I'm a foreign student, and have just gotten a BS at a major US university.

I wonder if it's possible to study directly for and take the USMLE stages without the intervening medical school years.

Nope, you have to go to medical school to take the USMLE - LCME, AOA, or ECFMG.

After all, this makes sense for me. I have two and a half years of work authorisation ahead of me, thanks to OPT regulations. Most medical schools won't admit me or require 4 years of tuition in advance in escrow. I'd rather not be indebted for the ridiculous sums of tuition needed. Foreign candidates can study for and take the USMLE directly. And I derive little benefit from either the formal structure or community nature of university education.

Um, you don't learn how to practice medicine from reading books.

I'm not really interested in replies discouraging me merely because this is difficult. I know it is. I just want to know if there's anything I should take into account in my calculation. Can I apply to residency programmes directly with the USMLE? Is there any real reason for going to medical school? Have people done this sort of thing before? Is there anything in the totality of the medical school experience that I cannot reproduce on my own? (The practical bits don't worry me; I can make up for them either by shadowing or by going back to Wales for access to things like anatomy or pathology labs.)

Either you're a troll, or you're very scary. Honestly, how would you expect those of us who have jumped God-only-knows how many hurdles to be admitted to medical school, then sacrificed years of our lives and hundreds of thousands of dollars to react to an asinine question like this? "Oh, okay, you're above all that." Please. I've seen arrogance in medical school in my day, but not wanting to be bothered with little things like 4 years of med school is pretty amazing. The idea that you could be competent enough to survive an internship with no formal training at all is insulting.

To answer your question - no, you are not eligible for the USMLE under any circumstances - heck, even if you were, you wouldn't meet licensure requirements in any jurisdiction in the world.

 

[unsung]

Nope, you have to go to medical school to take the USMLE - LCME, AOA, or ECFMG.

Um, you don't learn how to practice medicine from reading books.

Either you're a troll, or you're very scary. Honestly, how would you expect those of us who have jumped God-only-knows how many hurdles to be admitted to medical school, then sacrificed years of our lives and hundreds of thousands of dollars to react to an asinine question like this? "Oh, okay, you're above all that." Please. I've seen arrogance in medical school in my day, but not wanting to be bothered with little things like 4 years of med school is pretty amazing. The idea that you could be competent enough to survive an internship with no formal training at all is insulting.

To answer your question - no, you are not eligible for the USMLE under any circumstances - heck, even if you were, you wouldn't meet licensure requirements in any jurisdiction in the world.

This is overly harsh. While the OP's idea is unworkable, I don't think it's so *insulting* to even ponder, per say. The first two basic science years, in particular, seem doable for the motivated individual.

After all, don't a significant portion of real medical students basically end up skipping all their classes (pre-clinical) and studying the material by themselves? Not saying the majority do this by any means... but it's been widely confirmed that a large number of students do skip class to go to the library and learn it all themselves (excepting labs & tests, of course.).

That said, I think few people would actually be motivated enough to do this every single day for two years, unless they were already enrolled in the program and forced to take regular tests. It's simply a large mass of information to master.

 

[Law2Doc]

This is overly harsh. While the OP's idea is unworkable, I don't think it's so *insulting* to even ponder, per say. The first two basic science years, in particular, seem doable for the motivated individual.

After all, don't a significant portion of real medical students basically end up skipping all their classes (pre-clinical) and studying the material by themselves? Not saying the majority do this by any means... but it's been widely confirmed that a large number of students do skip class to go to the library and learn it all themselves (excepting labs & tests, of course.).

That said, I think few people would actually be motivated enough to do this every single day for two years, unless they were already enrolled in the program and forced to take regular tests. It's simply a large mass of information to master.

The basic science years are the least important part of med school. They are merely background/foundation. They may seem important at the time, but they are not, and as a result, residencies barely even look at your grades from those years. The real guts of med school is the clinical years. Without that (or some reasonably comparable experience), you are not ready for residency, and no real point in sitting for licensing exams. Not to mention that you probably would have trouble with some of the later steps without having done clerkships anyhow. I have to agree with the prior poster that you do not learn how to practice medicine from books. You learn by experience. We have what is basically an apprenticeship system in place, and you really can't or shouldn't try to bypass this or try to learn it yourself. To do so misses the whole point of US medical training. So no, I'm not so sure the prior poster was unduly harsh. You cannot bypass the medical training required in this country and still become a doctor. And for really good reason. We have accrediting bodies (eg LCME) precisely to ensure that folks are adequately trained before they get licensed. We have licensing exams with rigid hoops for eligibility before you can demonstrate your minimum competence to be licensed. It's all about quality control. Because US society demands it. And so no, you cannot bypass this, and it should be obvious why.

 

[Non-TradTulsa]

This is overly harsh. While the OP's idea is unworkable, I don't think it's so *insulting* to even ponder, per say. The first two basic science years, in particular, seem doable for the motivated individual.

Yes, it was harsh. Note that the poster was not talking about only 2 years - he was talking about applying to residency programs with self-taught USMLE scores. I find the idea that anyone could have the arrogance to even consider that one might be competent to touch a patient with no clinical training at all appalling - he didn't want to do rotations either, you know, or bother with that little sheepskin that confers the title "M.D." or "D.O."

I don't regret how harsh I was, I regret posting in such an absurd thread. But, Law2Doc posted, and I always respect was he has to say, so I'm not in bad company.

 

[njbmd]

Hello,

I'm a foreign student, and have just gotten a BS at a major US university.

I wonder if it's possible to study directly for and take the USMLE stages without the intervening medical school years.

In a word, "No".

 

[futureboy]

I wonder if it's possible to study directly for and take the USMLE stages without the intervening medical school years.

Might as well take the bar exam and CPA exam while you're at it. Law and accounting degrees are overrated anyway...

 

[Law2Doc]

Might as well take the bar exam and CPA exam while you're at it. Law and accounting degrees are overrated anyway...

Actually in one or two states you may take the bar exam without going to law school. You have to apprentice with a lawyer first, and the passing rates are pretty negligible, and you'll never get a law firm job with that credential, but it is possible.

 

[nontrdgsbuiucmd]

CPA rules do require roughly 27 hours of accounting courses unfortunately. Best I can tell, these can be taken online rather than in a classroom (no exclusion per my read of the state licensing rules). And those online additional accounting hours should satisfy the 150 hour rule (total semester hours required to sit for the CPA). One would need a separate grad degree to avoid working under a licensed CPA for a year, though -- working with a CPA being too similar to clinical work --

 

[futureboy]

Actually in one or two states you may take the bar exam without going to law school. You have to apprentice with a lawyer first, and the passing rates are pretty negligible, and you'll never get a law firm job with that credential, but it is possible.

Yeah, I heard of that when I was in law school, but didn't think it was still around. Turns out that 7 states and D.C. still allow admission to law practice with either "law office study, "correspondence study," or both. (see, Comprehensive Guide to Bar Admission Requirements (2007), by the National Conference of Bar Examiners and the ABA Section of Legal Education and admission to the Bar, p. 10-13). http://www.ncbex.org/fileadmin/mediafiles/downloads/Comp_Guide/2007CompGuide.pdf

Interestingly, one of these states is California. Yes, the same California that will not license medical school grads from decent Carib schools like St. Matthews. An aspiring lawyer in California can take the bar exam after 4 years of study at an unaccredited law school, a correspondence school registered in California, or a law office. (Id., p. 12)

 

[Law2Doc]

Interestingly, one of these states is California. Yes, the same California that will not license medical school grads from decent Carib schools like St. Matthews. An aspiring lawyer in California can take the bar exam after 4 years of study at an unaccredited law school, a correspondence school registered in California, or a law office. (Id., p. 12)

The big difference though is that almost everyone in medicine will eventually pass the boards, and so unless you set up such rules as CA has done, everyone will get licensed eventually, but the same is not true for bar exams. There are some state bars where the passing percentage is like 65%, and I suspect a whole lot lower for those folks who didn't attend law school. Not to mention that if you pass the bar but never went to law school you are never going to get a job working for anyone other than yourself. So most people would never consider this a viable route anyhow. So it's a pretty low yield path and not even worth the ink involved to get it off the books. More like an interesting idiosyncrasy than a real career option.

 

[dragonfly99]

There are some important differences between the practice of law and the practice of medicine also. The practice of medicine involves doing procedures and administering medications that can harm or kill a patient if things aren't done correctly. And don't tell me that everything important is learned in residency, because that isn't true. The idea of someone not "needing" to attend medical school to become a physician is ludicrous.

 

[futureboy]

More like an interesting idiosyncrasy than a real career option.

Seems like it would almost be easier to just go to law school.

 

[Law2Doc]

Seems like it would almost be easier to just go to law school.

Which is why pretty much everybody does.

 

[futureboy]

Still, it's ironic that California has probably the strictest licensing requirements for foreign medical graduates, yet it allows attorneys to be licensed without even going to law school. Yes, I agree that medicine has the most severe consequences for incompetent practice, but an argument could be made that law has the second most severe consequences for incompetence...

 

[student1799]

Still, it's ironic that California has probably the strictest licensing requirements for foreign medical graduates, yet it allows attorneys to be licensed without even going to law school. Yes, I agree that medicine has the most severe consequences for incompetent practice, but an argument could be made that law has the second most severe consequences for incompetence...

It's probably a situation that seldom arises these days, so they don't feel compelled to go out and change the law. It's like those ancient laws in many towns against swearing, women wearing pants, etc.: historical curiosities that are seldom enforced.

Besides, I gather that CA's bar exam is incredibly tough, which would suggest that if someone can pass it (law school or no), they must have a pretty good handle on things. There's a guy named Maxie Filer--who DID go to law school, BTW--who holds the world's record for taking it the most times: he passed it on his 45th try.

 

[Law2Doc]

Still, it's ironic that California has probably the strictest licensing requirements for foreign medical graduates, yet it allows attorneys to be licensed without even going to law school. Yes, I agree that medicine has the most severe consequences for incompetent practice, but an argument could be made that law has the second most severe consequences for incompetence...

I would actually make the argument that law has the more severe consequences for incompetent practice. Most people get far more upset when you lose them $1,000,000 on a business deal than when you accidently bump off their uncle Morty. Sad, but true -- they get over the loss of a loved one much quicker than financial ruin.

And lawyers also get sued pretty significantly for malpractice, have high premium rates, and actually are subject to far more significant disciplinary action. Far more lawyers lose their licenses, get suspended, and fined each year than doctors. Doctors end up paying more settlements, but rarely does it impact their license.

But I'm not sure this is really a contest. The goal shouldn't be to be incompetent in either field. It's pretty moot that a few states still have old laws on the books allowing alternative paths to licensing. It's meaningless if almost nobody does it, and they don't. There are a lot of obscure silly laws still on the books. Simply not worth the trouble to overturn, because they have no impact.

 

[atomi]

Yes, it was harsh. Note that the poster was not talking about only 2 years - he was talking about applying to residency programs with self-taught USMLE scores. I find the idea that anyone could have the arrogance to even consider that one might be competent to touch a patient with no clinical training at all appalling - he didn't want to do rotations either, you know, or bother with that little sheepskin that confers the title "M.D." or "D.O."

I don't regret how harsh I was, I regret posting in such an absurd thread. But, Law2Doc posted, and I always respect was he has to say, so I'm not in bad company.

Aren't you all high and mighty? This is why a lot of the population hates doctors. The way they have set up the system to keep people out and maximize earnings for those who get in is many ways one big scam. If you can pass the USMLE step 1 by studying on your own (which is definitely possible), then you should be allowed to go directly to clinical training. IMO the entire system needs to be re-vamped in order to get rid of the elitism, 'rights of passage', and wasteful studies. There is no reason it should take someone 7-8 years of postgraduate training to obtain a medical license. The system keeps perpetuating itself because young people put up with all the b.s. and finally finish and don't want to see changes because they had to go through all of it. Nevermind that it doesn't make sense or that change could benefit everyone. They've obtained the doctor status quo and will do anything to protect it. Entitlement is a dangerous sentiment.

The system doesn't make sense. Period. It's an archaic dinosaur left over from a time when higher level academic degrees were only available to elite classes. The training structure is of little relevance in today's world, and very few doctors even remember more than just a little bit of what they learned in their first 2 years of medical school. Medical school should be three years, and there should be the option to start with clinical training given the necessary prerequisite USMLE Step 1 scores from either a prior related course of study or from self study.

 

[bradt9881]

Aren't If you can pass the USMLE step 1 by studying on your own (which is definitely possible), then you should be allowed to go directly to clinical training.

Next he will be advocating that you can get your medical degree on line through the University of Phoenix.........

 

[jcampbell]

...very few doctors even remember more than just a little bit of what they learned in their first 2 years of medical school.

Where is this information coming from? Are you speaking to the fact that a larger amount of knowledge comes from the clerkships of years 3/4 and residency training than from the didactic portion?

 

[Dirt]

Actually in one or two states you may take the bar exam without going to law school. You have to apprentice with a lawyer first, and the passing rates are pretty negligible, and you'll never get a law firm job with that credential, but it is possible.

Correct me if I am wrong but this is not the case with medicine. You need a M.D. D.O. or a comparable foreign degree. I don't care if you score 260 on step 1, you can't be a doctor with a B.S. degree.

 

[atomi]

Next he will be advocating that you can get your medical degree on line through the University of Phoenix.........

You could definitely do the first 2 years (i.e., prepare for Step 1) online. In fact, many students do this already. They don't attend lectures and study entirely by themselves using their books and the professor's online lectures. Looking down on online classes or self-study towards a board exam is just another form of academic elitism because such studies would allow anybody the chance and bypass the admissions process of keeping certain individuals out.

 

[njbmd]

Aren't you all high and mighty? This is why a lot of the population hates doctors. The way they have set up the system to keep people out and maximize earnings for those who get in is many ways one big scam. If you can pass the USMLE step 1 by studying on your own (which is definitely possible), then you should be allowed to go directly to clinical training. IMO the entire system needs to be re-vamped in order to get rid of the elitism, 'rights of passage', and wasteful studies. There is no reason it should take someone 7-8 years of postgraduate training to obtain a medical license. The system keeps perpetuating itself because young people put up with all the b.s. and finally finish and don't want to see changes because they had to go through all of it. Nevermind that it doesn't make sense or that change could benefit everyone. They've obtained the doctor status quo and will do anything to protect it. Entitlement is a dangerous sentiment.

The system doesn't make sense. Period. It's an archaic dinosaur left over from a time when higher level academic degrees were only available to elite classes. The training structure is of little relevance in today's world, and very few doctors even remember more than just a little bit of what they learned in their first 2 years of medical school. Medical school should be three years, and there should be the option to start with clinical training given the necessary prerequisite USMLE Step 1 scores from either a prior related course of study or from self study.

Nothing "high and mighty" here. One is simply not eligible to take USMLE (Comlex) Step I (or 2 or 2CS or 3) without attending medical school. One may not even register for the exam without attending medical school.

There is a pretty good reason that we don't just open the practice of medicine to any yahoo who believes that they can come in, sit down with a few books and pass an exam. It's because in the practice of medicine, one makes hundreds of decisions that affect the lives of patients. Medicine is simply not about taking four standardized exams and then experimenting with living humans on your own.

My assertion, having been through a Ph.D, an MD, seven years of residency and two years of fellowship that the poster above isn't qualified to have any idea of what is "archaic" in the medical profession because they are standing outside and attempting to look in and most likely, by undergraduate performance, unable to get into medical school.

Everyone has a right to an opinion but in the case of the above poster, ignorance is bliss and buzzwords do not make for a convincing argument especially when you have no idea (by your post) of what's involved in what you are advocating. In this case, the internet has failed you. Now, I am being "high and mighty" and "elitist too".

 

[atomi]

that the poster above isn't qualified to have any idea of what is "archaic" in the medical profession because they are standing outside and attempting to look in and most likely, by undergraduate performance, unable to get into medical school.

Everyone has a right to an opinion but in the case of the above poster, ignorance is bliss and buzzwords do not make for a convincing argument especially when you have no idea (by your post) of what's involved in what you are advocating. In this case, the internet has failed you. Now, I am being "high and mighty" and "elitist too".

Your suppositions about me are false. I was never advocating the direct full licensing of doctors without clinical training. I support to some extent the option of bypassing the first two years with step 1 scores and continuing directly into clinical training. I highly question the traditional first 2 years curriculum (as do many schools who are implementing alternative teaching strategies) and its necessity. I never advocated full licensure by passing all step exams without going through a residency. Your argument kind of undermines the necessity of the USMLE exams though - as in what's their point if they don't really judge a person's ability to treat patients.

The attitude in question is that of "I went to school for a long time so therefore nobody else can know or say anything about the work I do unless they went to school for equally as long." The doctor scheme (for lack of a better word) in America is a very interesting subject to study. Things need to change, but the way the system is set up, those with the power to effect change no longer have the desire to do it once they have gone through the system. The major things I see:

1. The cost and length of medical education need to be reduced (the cost needs to be significantly reduced).
2. Medical school needs to be made more accessible and the insane admissions process needs to be reformed. The traditional curriculum needs to be reformed and brought into the 21st century.
3. Physician compensation needs to become reasonable and in-line with other professional lines of work while at the same time reducing the cost of care. Along with this should come insurance and possibly tort reform to reduce physician overhead.
4. The number of medicines available without prescription should be made more reasonable.
5. The number of residency slots need to be increased and re-balanced to eliminate "competitive" specialties and fix specialist shortages. It's ridiculous to have to wait 3 months to see a dermatologist only to have to pay $500 to get a mole examined and removed in 5 minutes.

Obviously, this is just touching the education side of much more involved national health care reform. These changes can't come about alone.

In my opinion, this will bring more respect back to the profession in the eyes of the public, lead to better doctors, and result in more accessible and more affordable care.

In short, the whole system seems over-regulated and appears controlled to guarantee an excellent job for anyone lucky enough to get in and suffer through the training. The result is a lot of smart people trying to transition into medicine in order to guarantee a high paying job (just look at all the lawyers trying to get in after they've learned they aren't going to make the big bucks in law) with little regard to patient care (whether or not they admit it). You've got people going into medicine because they are book-smart and want to make money and achieve status, not because they possess any attributes of a good physician. I have had enough bad doctors in my life to know this is very true. I'm not saying it's always the case, but I'm saying that there are a lot of people like this who get in the system. Unfortunately, the system as it is seems to reward those bad docs with exorbitant payouts from private insurance, pharmaceutical companies, and unnecessary procedures while punishing those who actually want to care for patients, regardless of their ability to pay. This type of job 'fixing' just seems un-American to me and breeds elitism. This is why a lot of the public, particularly the public educated in other fields, is bitter towards the MD and AMA.

All I got to say about that.

 

[futureboy]

(just look at all the lawyers trying to get in after they've learned they aren't going to make the big bucks in law) with little regard to patient care (whether or not they admit it). You've got people going into medicine because they are book-smart and want to make money and achieve status, not because they possess any attributes of a good physician.

I strongly disagree on this point. When you factor in the opportunity cost (cost of education and substantial loss of income), most successful professionals, including most attorneys, would be better off financially if they stayed in their current career. In my situation, it would be about a break even situation unless I practice in a very lucrative specialty (at this point I'm not particularly interested in surgery, derm, etc, but I'm keeping an open mind). The idea that we want to switch to medicine for the money is simply absurd.

 

[QofQuimica]

Your suppositions about me are false. I was never advocating the direct full licensing of doctors without clinical training.

*You* may not be advocating this, but the OP is. Re-read his or her post; this person wants to know if it's possible to apply *directly to residency* after taking the USMLE Steps 1 and 2. You're setting up a straw man here by arguing about merely skipping the preclinical years.

I support to some extent the option of bypassing the first two years with step 1 scores and continuing directly into clinical training. I highly question the traditional first 2 years curriculum (as do many schools who are implementing alternative teaching strategies) and its necessity.

I doubt anyone within the system would argue with the need for changing certain things, and medical schools are certainly moving away from the old traditional curriculums. Some examples include incorporating clinical training into the first two years and requiring scholarly projects. There are also some schools that are moving away from charging tuition or substantially reducing it. More specific to this thread, a few schools do offer a track of independent study for the first two years of medical school. Even the USMLE is going to be substantially changed for the entering medical school classes of 2011. Thus, many of these things you're calling for are already happening.

FWIW, it is probably true that a highly motivated person could pass Step 1 without attending medical school. However, you really aren't in a position to know what aspects of a medical curriculum could or could not be done away with at this point. As an engineer, you would undoubtedly appreciate the importance of thoroughly understanding a system first before deciding to whole-sale revamp it. My substantial experience with having used electrical appliances throughout my lifetime (some of which did not function properly or were not particularly user-friendly) doesn't exactly qualify me to tell your university how they could better educate electrical engineers like you, does it?

 

[atomi]

As an engineer, you would undoubtedly appreciate the importance of thoroughly understanding a system first before deciding to whole-sale revamp it. My substantial experience with having used electrical appliances throughout my lifetime (some of which did not function properly or were not particularly user-friendly) doesn't exactly qualify me to tell your university how they could better educate electrical engineers like you, does it?

Yes, but I don't actually need to be in medical school to have a valid opinion about it. A lot of admissions directors never went to medical school and THEY are the ones who have a strong say in who gets in! With enough research into the electrical engineering curriculum, you could surely gain enough insight to formulate a reasonable opinion about curriculum problems. In my case, I've spent 5 years studying the medical school curriculum and admissions process including building credentials strong enough to gain admission. I feel very comfortable in saying that I know far more about medical school curriculum than the average applicant. I have met plenty of applicants on interviews who didn't even know what they step exams were and had no idea what goes on in medical school until that was explained to them in the information session. An ad hominem defense against what I'm saying isn't really fair and was part of my original point. Do I need to go through medical school for my opinions to be valid? Because if I do, they won't change. I may end up bitter, but I'll never sell myself out the way the current system encourages students to. The MD job-fixing scheme in America needs to end. Certainly the doctors don't want to see it end. And I'm willing to bet a vast majority of those trying to go through medical school now don't want to see it end. They want their cake and to eat it too.

And to the poster who said some baloney about opportunity cost and how going into medicine is a dumb financial move, get over it. That's the way it is and it's part of the scheme. Doctors may way, way more money than any other profession. Even primary care doctors. Deal with it. The scheme provides you a recession-proof job that will pay exorbitantly well. Nothing irritates me more than those who pretend not to acknowledge what it is. Opportunity cost? Give me a break.

 

[atomi]

including most attorneys, would be better off financially if they stayed in their current career.

By the way, most attorneys are barely getting by. Which was my point. You have all these people who went to law school back in the 80s and 90s that did it because they had good grades and wanted to make a lot of money. But they couldn't land a firm job, piddled along in a middle class existence, and are looking for some other way to achieve that status. Doctor is the next logical step. Law doesn't have the job fixing scheme that medicine has (anymore). Whether they admit it or not, this is what's happening. The number one reason people go to law school is because they want to increase their earning potential (this is a researched fact). It would make sense the reason people leave law is that they still want to increase their earning potential. If I were on an admissions committee, a lawyer applying to medical school would throw a huge, HUGE red flag.

 

[dragonfly99]

atomi,
having been through med school, residency and now currently doing a fellowship, I disagree that we should do away with any of the years of med school. You can disagree - in fact many people have proposed getting rid of 4th year of med school, which I actually thought was the MOST educational one, so people have various opinions.

There are various ways to do medical education. The Europeans do it differently than we do.

I don't think we should do away with the admissions process. It is frustrating if you don't get in - I had to try twice. There are always more qualified folks each year than the number of spots available, but usually with persistence one can get a spot if one is qualified. If not, options include going to UK or Caribbean to get a degree, then coming back. Not an easy road but not impossible either. As far as your comment about the admissions folks not being physicians, almost everybody I was interviewed by was an MD (few PhD's in there @research oriented schools) so not sure what you are talking about there.

I disagree strongly that the 1st two years of med school are unnecessary, or that people forget "everything" they learn. Sometimes we SAY that, but basically you need a certain level of knowledge in basic sciences (and also in clinical skills/examining patients and taking histories) to success in 3rd and 4th year and as a resident. I agree that the curriculums have been, and still are, imperfect and that we need more innovation in medical education.

In terms of 1st and 2nd year of school being unnecessary - no, they are not. My med school, and in fact most schools, now have significant patient contact in the 1st and 2nd years, and teach physical exam skills, medical ethics, etc. I don't think you can replace all that with an online curriculum. Also, as you point out, not everyone is cut out to do medicine, ethically or personality-wise, and we need some sort of admissions process to decide who gets in. Yes, unfair decisions are made, but the world is imperfect and filled with imperfect people and situations. I was very disappointed when I didn't get in to med school on my first try, since on paper I was definitely qualified, and I consider myself a nice person and was going in to medicine I thought for good reasons (i.e. to help people and because I had an interest in science, progress of medical care, etc.). I just tried again and then I got in....one could argue for an open admissions process, or a semi-open one as in some other countries., but then you would have to weed out people during the schooling, and have people who had borrowed 1-2 years tuition and then flunked out or been kicked out, so that would create its own problems.

 

[atomi]

In terms of 1st and 2nd year of school being unnecessary - no, they are not. My med school, and in fact most schools, now have significant patient contact in the 1st and 2nd years, and teach physical exam skills, medical ethics, etc. I don't think you can replace all that with an online curriculum. Also, as you point out, not everyone is cut out to do medicine, ethically or personality-wise, and we need some sort of admissions process to decide who gets in. Yes, unfair decisions are made, but the world is imperfect and filled with imperfect people and situations. I was very disappointed when I didn't get in to med school on my first try, since on paper I was definitely qualified, and I consider myself a nice person and was going in to medicine I thought for good reasons (i.e. to help people and because I had an interest in science, progress of medical care, etc.). I just tried again and then I got in....one could argue for an open admissions process, or a semi-open one as in some other countries., but then you would have to weed out people during the schooling, and have people who had borrowed 1-2 years tuition and then flunked out or been kicked out, so that would create its own problems.

All very good points. However, I don't think the first two years MUST be a requirement. The material learned in these years can be taught to oneself or in an undergraduate curriculum (how about a REAL pre-med track that actually teaches the first two years of the current med school in the last two years of undergrad?). At many schools now, students choose never to attend lecture and teach themselves the material. Certainly some of the other 'first half' courses that teach practical skills like patient interviewing and medical ethics are also important. That's why I think a 3 year curriculum makes a lot more sense. In regards to the admissions process, it's just ridiculous. I agree there need to be standards. But so much filth gets through. The delusions of grandeur among pre-meds and medical students are absurd. People laugh at you for saying you want to be a doctor to benefit society. From everything I've witnessed (as an outsider looking in sure, but I've spent plenty of time in med school classrooms and with the student body), it's about status, elitism, and surefire prosperity. The elitism is what really gets to me. This whole process has so embittered me that I am sitting here wondering whether I can actually be a part of this world (I say world because MDs pretty much are in their own world) and go through this no matter what my intentions. How will I be received as someone who wants significant reform resulting in lower pay for doctors? I feel as if I will either be called a phony or spit on. Either way it seems like a miserable existence for someone not trying to conform to the MD mold. You sound like you've got it together, and as it's looking like I'm not going to make it through this, please try be one of the good guys and bring about positive change. This field needs so much of it.

 

[QofQuimica]

Yes, but I don't actually need to be in medical school to have a valid opinion about it.

I would argue that anyone's opinion can be "valid" in the sense that they have the right to their beliefs, but that doesn't make every opinion equally informed. Medicine is a field of *doing*, not of studying or reading (although of course studying and reading are necessary in order to better know what to do and avoid re-inventing the wheel). If you haven't ever been in the field, so to speak, your knowledge of that field is inherently limited.

A lot of admissions directors never went to medical school and THEY are the ones who have a strong say in who gets in!

This is a perfect example of what I'm talking about concerning how a lack of experience prevents an outsider from being able to see the entire picture. Unless you've been on an adcom, you have almost certainly made incorrect assumptions about how they function. Admissions directors are involved with running the admissions office, and they may attend admissions meetings. But the admissions director is often not an adcom, and in that case, they certainly don't vote on student apps!

With enough research into the electrical engineering curriculum, you could surely gain enough insight to formulate a reasonable opinion about curriculum problems.

This is the crux of my disagreement with you. I would argue that I could study engineering curriculums for the rest of my life and still not be as informed about them as a person like you who went through such a curriculum and worked as an engineer. Considering how crazy the education PhDs at my school (who have no training as either scientists *or* physicians) make the students, I would argue that in fact, people who design med school curriculums *should* have to go through them first themselves. The most universely reviled, annoying, and (seemingly) useless parts of our curriculum were put in place by people who have never set foot in a hospital or lab unless they got lost somehow on the way to their offices in the education building.

In my case, I've spent 5 years studying the medical school curriculum and admissions process including building credentials strong enough to gain admission. I feel very comfortable in saying that I know far more about medical school curriculum than the average applicant. I have met plenty of applicants on interviews who didn't even know what they step exams were and had no idea what goes on in medical school until that was explained to them in the information session.

I didn't know that much about the USMLE Steps when I was an applicant either. And even if I *had* read extensively about them, what good would it have done me as a premed? The USMLE is a hoop to make sure that everyone who graduates from medical school has a certain basic level of knowledge. When the time comes, you study for it, and then you jump through (hopefully on the first try). Tests are tests. But taking the USMLE has nothing to do with educating you to be a physician, except that if you don't pass it, you (probably) can't graduate from med school or become licensed. This is an important point that doesn't seem to be coming across very clearly: you don't go to medical school to learn how to take the USMLE. You go to medical school to learn how to be a physician. Those are two *very* different things.

An ad hominem defense against what I'm saying isn't really fair and was part of my original point. Do I need to go through medical school for my opinions to be valid? Because if I do, they won't change. I may end up bitter, but I'll never sell myself out the way the current system encourages students to.

See my above points. I haven't made any criticism about your lack of informed opinion that I haven't made about my own concerning fields I have never trained in. And I would argue that if you do go to medical school, your opinions *will* change. For good or ill, you don't go through this kind of training and not have it leave a lasting imprint on you. Medical school is nothing like what you expect as a premed. No amount of shadowing, no amount of reading, no amount of anything you do can prepare you for the reality of what you find when you're up to your neck in this s***. That's been my experience, anyway; others are free to disagree if they choose.

The MD job-fixing scheme in America needs to end. Certainly the doctors don't want to see it end. And I'm willing to bet a vast majority of those trying to go through medical school now don't want to see it end. They want their cake and to eat it too.

I don't even really understand what you mean by this. All jobs work by basic supply and demand. The difference between medicine versus many other professions is that medicine cuts people off at the beginning of the pipeline instead of the end. I think that's actually kinder instead of letting them get through the whole training process only to leave them swinging in the wind. We had 50% attrition in my grad school program, and that's not counting the people who came in as PhD students and left with terminal MS degrees. It's also not counting the ones who have spent 5+ years as post docs because they can't find permanent positions as PhD-level chemists. They'd have been better off leaving with MSes; one of my friends who did that has never had trouble getting a job--after every time he gets laid off due to downsizing, that is.

 

[futureboy]

And to the poster who said some baloney about opportunity cost and how going into medicine is a dumb financial move, get over it. That's the way it is and it's part of the scheme. Doctors may way, way more money than any other profession. Even primary care doctors. Deal with it. The scheme provides you a recession-proof job that will pay exorbitantly well. Nothing irritates me more than those who pretend not to acknowledge what it is. Opportunity cost? Give me a break.

I never said that it's a dumb financial move to go to medical school. The vast majority of medical students will make enough as physicians to pay back their medical and undergraduate school loans, and have plenty left over to have a nice (though not necessarily opulent) lifestyle. I was specifically referring to non-traditional students already in financially successful careers making the switch to medicine (this is a non-traditional student forum, after all). If you factor in (1) the cost of medical school and any undergraduate prerequsites (plus interest accruing on loans), (2) the income you don't make while in school and in residency, plus (3) the fact that you will have fewer years in practice than traditional students, I would submit that many students would not necessarily come out ahead financially by switching to medicine. There is no agenda here; it's just math. Hence, it is absurd to say that lawyers and similarly situated non-trads are going into medicine solely for the money.

 

[futureboy]

By the way, most attorneys are barely getting by. Which was my point. You have all these people who went to law school back in the 80s and 90s that did it because they had good grades and wanted to make a lot of money. But they couldn't land a firm job, piddled along in a middle class existence, and are looking for some other way to achieve that status. Doctor is the next logical step. Law doesn't have the job fixing scheme that medicine has (anymore). Whether they admit it or not, this is what's happening. The number one reason people go to law school is because they want to increase their earning potential (this is a researched fact). It would make sense the reason people leave law is that they still want to increase their earning potential. If I were on an admissions committee, a lawyer applying to medical school would throw a huge, HUGE red flag.

I can't imagine that lawyers are applying to medical school in droves. I would think that the numbers are pretty small based on the relatively low science aptitude in the profession (based on my experience) and the opportunity costs involve (see above posts).

Sorry you're so bitter about the legal profession, too.

 

[MeowMix]

I am one of the former professionals now in medicine. I think it's cost me about $800,000 so far to have made this switch. As a resident, I'll make about $10/hour for the next 3 years.

I like my work. I never imagined it would be a good financial decision. When you factor in the immense responsibility and the intense emotional demands, I don't think I will be overpaid at all even when I make closer to $40/hour as a family doc. And let's be clear, there are plenty of professionals in the U.S. who make more than that with a whole lot less responsibility and training. I wish my "physician compensation" would actually be more in line with what other professionals make.

3-year med school sounds fine. There are already Canadian schools doing just that; slim down the bloated preclinical years and do the important stuff.

 

[atomi]

And let's be clear, there are plenty of professionals in the U.S. who make more than that with a whole lot less responsibility and training. I wish my "physician compensation" would actually be more in line with what other professionals make.

No there aren't. Physicians as a group make far more than any other professional. Sure there are some lawyers, accountants, bankers, Realtors, actors, and athletes that earn more than physicians, but they represent the top of the top in their field. Even the lowliest physician can earn 6 figures without breaking a sweat. This is my point. The system is fixed to guarantee an extremely high level of compensation if you get through it. If you don't think $175k/year before taxes is enough money, then you will receive very little sympathy from the general public. A few people, like yourself, go into medicine and take a paycut. The vast majority do not.

 

[atomi]

to have a nice (though not necessarily opulent) lifestyle. I was specifically referring to non-traditional students already in financially successful careers making the switch to medicine (this is a non-traditional student forum, after all). If you factor in (1) the cost of medical school and any undergraduate prerequsites (plus interest accruing on loans), (2) the income you don't make while in school and in residency, plus (3) the fact that you will have fewer years in practice than traditional students, I would submit that many students would not necessarily come out ahead financially by switching to medicine. There is no agenda here; it's just math. Hence, it is absurd to say that lawyers and similarly situated non-trads are going into medicine solely for the money.

Then tell me, what exactly is the percentage of non-trads going into medicine to take a paycut? If it's anything more than 5% I'll shut up. I don't buy this at all. You missed my point about lawyers entirely; go back and re-read what I wrote.

I can post the math if you like, but your argument just doesn't fly. If you earn 70k/year, then you haven't had an opportunity *loss* of $560k over 8 years. Nobody saves 100% of their salary before taxes, and certainly not at that level. The lifestyle and savings that a $200k salary affords versus a $70k salary is tremendous. I've seen it posted here all the time and it irritates me to no end. In my opinion, the system should be broken up, which would lead to doctors making less money, which is the way it should be. In no other field do you have some governing body limiting the number of practicing professionals. It's just not right.

 

[atomi]

I don't even really understand what you mean by this. All jobs work by basic supply and demand. The difference between medicine versus many other professions is that medicine cuts people off at the beginning of the pipeline instead of the end. I think that's actually kinder instead of letting them get through the whole training process only to leave them swinging in the wind. We had 50% attrition in my grad school program, and that's not counting the people who came in as PhD students and left with terminal MS degrees. It's also not counting the ones who have spent 5+ years as post docs because they can't find permanent positions as PhD-level chemists. They'd have been better off leaving with MSes; one of my friends who did that has never had trouble getting a job--after every time he gets laid off due to downsizing, that is.

That is my point. Medicine does not work by supply and demand. The supply is artificially controlled. This leads to salary inflation of those in practice. It's a racket.

It's kinder to cut people off at the beginning? How in the heck does an MCAT score and an undergrad GPA indicate true desire to do medicine. Why not let the school weed out those who shouldn't be there? Why is medicine so special from everything else? It's a racket. And it's no wonder why so many people want to get in on it.