By John J. Seidenfeld, MD

Six-Year Combined Baccalaureate and MD Programs

By John J. Seidenfeld, MD

The cost of a medical education continues to spiral out of reach for many, particularly underrepresented minority students. For those who matriculate, the debt load is a cause of great anxiety. Fourth-year students in the UIW (University of the Incarnate Word) SOM (School of Osteopathic Medicine) Business of Medicine course often choose to research debt and student loan repayment as their sole topic of study. The concern has worsened as tuition continues to rise over $70,000/year at many schools. Even if debt cancellation programs are eventually enacted, they usually only pay a minor fraction of medical debt. Since the 2010 Patient Protection and Affordable Care Act, consternation over individual and societal costs of medical education has increased for all learners and their parents. To pay back debt, many learners seek graduate medical education (GME) programs (medical and surgical specialties) that will lead to higher paying jobs and accelerated debt repayment.1 At the same time, we see data which show an educational system that produces poorer quality medical outcomes than most other industrialized countries.2 In addition, we produce significantly fewer doctors per 100,000 people than in many countries. We need more doctors, more training slots after graduation (GME) and more primary care doctors. This discussion will focus on studies which have looked at shortening the duration of training.1

A review in 2012 by Eaglen et al. found that of learners in combined baccalaureate and MD programs (BA-MD), 20% pursue a truncated course taking less than the usual eight years to complete both degrees.3 Concerns are raised about the quality and maturity of graduates. According to Carrothers, “An essential way for medical schools to help restore public trust is to select and nurture professionals who see medicine in a broad social context, who have learned to listen to feedback, who are capable of responding and communicating clearly and honestly in those areas and about those issues where they are uniquely qualified to contribute.” This group developed an emotional maturity questionnaire for applicants to help in acceptance decisions that is applicable for traditional and accelerated programs.4

Most European countries such as France, Germany, the Netherlands, Italy, Sweden, UK, Denmark, Austria and Finland have shortened programs after learners demonstrate competence through testing. Learners receive only a medical degree, have a six-year training period, and proceed to clinical rotations and specialization. Combined degree paths are the exception. All these programs require learners to demonstrate dedication, hard work, proficiency in complex subjects and mission orientation to care for patients.1

A US (United States) literature review reveals no difference between traditional and abbreviated programs in attrition, withdrawal, performance on licensing examinations, matching to residency programs and performance in medical school examinations. In studies where the two groups were compared by entry SAT scores, the abbreviated program participants did as well as matched controls but better than the rest of their classmates on most performance measures.5

In 2021, Gonnella reviewed data from a review of 723 men and 411 women who attended the combined Penn State and Jefferson Medical College shortened program. The six-year program was compared to class year matched controls of those learners in the regular program with acceptance after a four-year baccalaureate degree and a four-year medical degree. Study participants were matched by year of entrance to school, gender and scores on the Medical College Admission Test (MCAT). The authors conclude after assessing decades’ worth of educational and professional outcomes of an accelerated combined BS–MD program that began more than 50 years ago that it is feasible to reduce the cost and time required to obtain an MD degree without

compromising educational outcomes and professional competence. Additional benefits include avoiding redundancies in the baccalaureate and medical school curricula and graduating younger physicians with longer career spans to serve the public greater good.5 Greene et al. reported similar findings after examining outcomes for abbreviated versus eight-year programs at Northwestern University.6

It is time to consider abbreviated programs for medical graduates in the United States. We need more doctors, more primary care doctors, more doctors from underserved minorities, lower education debt, more GME training slots, and less pressure on medical graduates to seek high pay specialties and urban practices to repay loans. The two medical schools in San Antonio would be ideal testing sites for such programs. Texas and the federal government would benefit from a greater supply of physicians, and lower training costs. Governmental groups have authority over public university systems and should exercise it for the health of the states and country at large.1

References 1. The case for shortening medical education. Robert Orr and

Anuska Jain, Anuskahttps://www.niskanencenter.org/the-casefor-shortening-medical-education/ 2.https://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror-wall-2014-update-how-ushealth-care-system 3. Acad. Med. 2012:87:1600-1608.The scope and variety of combined baccalaureate-MD programs in the US (United States).

RH Eaglen, L Arnold, JA Girotti, et al. 4. Acad. Med. 2000; 75:456–463. Measuring Emotional Intelligence of Medical School Applicants. Robert M. Carrothers,

MA, Stanford W. Gregory, Jr., PhD, and Timothy J. Gallagher,

PhD 5. Acad. Med. 2021; 96:101–107. Preparing for the MD: How

Long, at What Cost, and With What Outcomes? Joseph S.

Gonnella, MD, Clara A. Callahan, MD, James B. Erdmann,

PhD 6. Acad. Med. 2016;91:256–261 Academic Performance of Students in an Accelerated Baccalaureate/MD Program: Implications for

Alternative Physician Education Pathways. Marianne M. Green,

MD, Leah Welty, PhD, John X. Thomas Jr, PhD, and Raymond

H. Curry, MD

John J. Seidenfeld, MD is the Chair of the BCMS Publications Committee.