There have been a spate of articles about the value of a college education. Most conclude that its value resides solely in a piece of paper that gets its owner a higher paying job. They go on to declare that most jobs really gain nothing from a college education. All of them allow that a select few professions require a bachelor’s degree. Medicine is always prime among these.
What’s the evidence that success in medical school and thereafter benefits from a college education? There is none. For more than a century every medical student has first gone to college so there are no medical students without college to compare with their baccalaureate colleagues. Thus, only an opinion can be offered.
I have been observing medical students for well more than half a century and can think of virtually none who have learned anything remotely useful for a career in medicine during their college days. The profession tacitly, and perhaps unknowingly agrees, calling medical students undergraduates despite their possession of a college degree. Furthermore, the medical faculty assumes they know nothing about medical science as the first two years of medical school are devoted, mainly, to the basic sciences which teach the sciences which underpin medical knowledge. And these courses start from square one. Medical students are taught as if they had no exposure to science before entering medical school. The premed science requirements seem to have no more than a decorative value.
When the student graduates and enters a specialty that requires special knowledge of a science – anatomy for a surgeon, physiology and/or immunology for a nephrologist, etc – the assumption again is that the student knows nothing about that science and it’s taught again. This time it sticks. Thus, not only does college seem unnecessary for a medical career, medical school seems to have limited value.
While educators fret about compacting medical school to three years as is now done a some schools, I think that both college and medical school could easily be compressed to a two year curriculum whereupon the student could enter the discipline of choice and start to learn the material that’s really required for the practice of that medical specialty. Eight years of college and medical school seems to benefit only those who administer the schools and those that teach the courses that will later be ignored.
What would be studied during these two years. Even disregarding the useless fluff that makes up a major component of today’s university’s curriculum, there are subjects that are useful to those who wish the learn them. These include the humanities and the arts. Not only do entering medical students know little about science, they know even less about the arts and humanities. The ignorance of these fields does not prevent them from becoming excellent doctors. These are subjects that one can easily learn by yourself; all you need is inclination and books or recordings. Many physicians pick up a good knowledge of history, music, philosophy, etc as their lives mature. So, I wouldn’t include them in the two year curriculum that would substitute for college and medical school.
Mathematics, on the other hand, is much harder to master on your own. I would include a heavy dose of the subject in the two years preceding immersion in a medical specialty. Medicine has a jargon or lingo that a prospective doctor must acquire. This can be learned as part of a simple introduction to medical nomenclature and culture. Professional medical educators have proliferated in inverse proportion to the size of a teaching physician’s office. They try to inculcate sensitivity, good judgement, and ethics as if these qualities could be taught and learned as easily as trigonometry. If not resisted with vigor they proliferate like kudzu in Mississippi.
Bureaucracy is irresistable; so I’m sure that even a brief combination of college and medical school will be taken over by bureaucrats. But it will only be for two years. Will something like I just outlined ever happen? It would allow fully trained doctors to emerge into practice between the ages of 23 to 27. Inertia, however, is irresistible. Divisions, no armies, of administrators and superfluous faculty will fight to the death to maintain courses of instruction that both guarantee their livelihood and the massive student debt of those they teach. If college and medical school were compressed to two years the amount of student debt that might prevent a medical graduate from pursuing a career in primary care would be sharply reduced. The leaders of our profession both declaim the need for more primary care physicians while making the process of becoming one prohibitively expensive.
Finally, most of the service provided by a primary care doctor can just as effectively be rendered by a nurse practitioner or physician’s assistant. Increasing their number would both decrease the number of doctors needed and also shorten the duration of training. Will anything related to medicine be fixed. Remember the last lines of The Sun Also Rises:
“Oh, Jake,” Brett said, “we could have had such a damned good time together.”
Ahead was a mounted policeman in khaki directing traffic. He raised his baton. The car slowed suddenly pressing Brett against me.
“Yes,” I said. “Isn’t it pretty to think so?”