The difficulty with shortening medical education is not only deciding how much information can be compressed. Information is the easiest part to imagine compressing.
What is much harder to compress is the slow formation of clinical judgment: learning what uncertainty feels like before it has a name, how to notice when a case is becoming unstable, when not to close too early, and how to carry responsibility before confidence has fully arrived.
We can count curriculum hours, test scores, debt, and workforce needs. It is much harder to measure the time it takes for a person to become safe inside uncertainty.
Well, this is slightly off topic, so I hesitate - but maybe a post of its own is in the future.
I have a small Assisted Living home in South FL, and as such, we encounter emergency situations more frequently than most. Our staff are trained in CPR and many of our residents have DNROs.
This comment is about another type of emergency. Your resident is in the ER or maybe has been admitted for example, this one was a seizure triggered by a side effect: SIADH.
I've been skeptical of AI, everywhere from the ordering screens replacing people at restaurants to "Alexa", ChatGPT for students failing to learn and EllieQ gave me the heebeejeebies.
For a problem much more common than I realized, that I've informally polled with 75% of ALF Admins even know about, it's been a lifesaver. Drug interactions/side effects.
As antipsychotics and other mental health meds became more common over my 16-year career as owner/operator of a small one, I worried that these residents will 'become their diagnosis', and it's happened. The focus with MH residents becomes controlling behavior. This can be a problem.
The large corporate ones have security cameras, and charting is where they use AI, but just to record data, not to actively help avoid deadly drug interactions.
To be clear, we are Assisted Living. Some larger corporate ALFs have nurses, but just for minor first aid, mostly. Everyone's myriad insurance rip-off HMOs and Medicare mean their own doctors, almost endless referrals, pre-approvals, but that's another subject.
Nobody in our world acts as a SNF nor do we have doctors or ARNPs to review meds at large.
I happen to be a real estate appraiser of 42 years, and my Life in that profession is RESEARCH.
I see a pattern, run the search on a different map, figure out the reason for the variation in (marketing time, other factors and eventually, comparative values)
On Monday, Memorial Day, our Minerva needed to pee, so she said. I'd noticed a pattern and stayed over for weeks to verify it, day and night. She felt the urge, and most often got up to go, but on arrival, sat and said, "Oh, I guess not, nothing's happening." So after a week or two, my "Duh" reflex kicked in. I'd noticed and occasionally started to use the AI mode in my Google search.
Nobody trains Anybody in Assisted Living on drug interactions and side effects. It's a BIG subject and if we made it a requirement, all ALFs would close due to the liability in over-regulation.
Minerva had also had a seizure or two, a couple of years ago. Meanwhile her son and I have whittled and changed medications for her, adding phosphatidylserine, alphabet vitamins, dried beef liver caps (don't get me started on the inappropriately Low threshold and ferritin issues - they indirectly cause falls, the single biggest mortality factor in my world)
So AI had been handy for that.
It seemed she was also inordinately thirsty. I had thought it's part of her MH issues to gulp water, so despite her complaints, I began to insist they do Not put ice cubes in her tea & coffee, but that she learn (and she did on days when I was present at breakfast) patience by giving her tea with a splash of milk, but No ice. She'd touch the cup, complain it's hot, and we now say, "Sure, but everyone else has theirs much hotter. It will cool, just sip carefully." Getting her to slow down also included smaller spoons, so she had time to chat and normalize. I thought it was behavioral and partly it was.
I didn't realize the Thirst driven by one medication and the SIADH locked in place by two others.
She wanted to dump the water, but seldom peed successfully before noon.
My research revealed the medication issue.
Her "psych provider" is a face on a screen - these people make only Outgoing calls. You Cannot Call them; her son arrives every 6 weeks or so cellphone in hand, missing work and whatever mood she's in and in the afternoon, everyone says "She's fine", when in the morning she may have slapped me or other staff members because she couldn't do what Everyone does, pee the first thing, before getting dressed and going to breakfast.
The fluid was retained by the drugs' actions and sodium was diluted. Fussiness was also BP from a full bladder, warring factions of her body's operation under medication. It Depended not on only Today's fluid intake/output, but the past Three days or so, and overall level of electrolytes.
We also tend to divorce brain from body and "other" mental health patients/residents.
This AI helped a LOT, but we didn't have Time to go through fixing it, as it turned out.
One seizure happened before 3 am on 4/4, and she was taken to the ER for an unobserved fall. This was a Saturday morning and my phone was not on my nightstand. I'd just asked her son to give me access to labs via MyChart, so when I saw the ER I called them first, before my staff. She walks without devices - I was sure it was someone else, but still, I logged in to see if it was Minerva, while dialing at 6:30.
Lo & behold, there are new labs to see.
The ER nurse answered, and I identified myself. "Wait, what's your name?" Doreen Campbell, I own an ALF... "Oh, yes, I see she has a mental health diagnosis so I think it's that."
That rang a bell. I asked if I was Not the owner of the house, her Son is and I let staff abuse her.
"Yes, that's what she said!" came the stunned answer. "OK, look at the sodium level, I think she's had a seizure from hyponatremia." She read the notes and we agreed it's possible. I mentioned SIADH and she said she was new to the ER. She understood once I explained but was skeptical simple sodium could cause that and why didn't we just give her more salt on her food...
OK, I said to watch the sodium level (was 118 at 3 am admission, edging up b/c the First thing they do is a saline drip) However, it also Adds Water...
Discharge would be later, and I said I'd call about 9:15 or sooner if I saw significant improvement. We would then see who I was when she asked Minerva.
At 915 as I reached for the phone and it rang. "Hello, this is Flo the ER nurse and you're a genius!" It seems she'd seen significant improvement in sodium, as I did, and mentioned me to a Different woman who said, "Oh, Doreen?! She's wonderful, and takes Great care of me and my friends. Can she come and take me home? She is the owner of the house."
Well, well, well, if it ain't the invisible drug interactions again...
So she was released, but I feared a repeat given the obstacles to responsive drug changes. Luckily she had a psych "visit", to use the term loosely, and mirtazipine was cut in half to 7.5 with the plan to end it June 1. That left risperidone and venlafaxine, actually bigger culprits per AI.
Algo es algo (Minerva's Gringa Latina like me)
Then Monday, an Observed seizure while on the toilet trying to pee. Medics came she went to ER. I joined her an hour later, and she'd not peed much, if at all. I explained to ER nurse SIADH and she said, "I know the term, but it must be rare." Nope, it's RARELY Considered b/c the rush is to Stable Vital signs and a discharge when the problem isn't Right in our faces.
So now they admitted her and we were both relieved when she peed big in the ER, and became Responsive. But there was word salad... In Spanish, and attempts to get out of bed to go pee. Previously she had been fine with the purewick and her output could be handily measured. This 2nd time, whether because of a weekday or the individual doctor, the drip was Not in place, precisely to Avoid dilution of sodium, this time I might get the Root Cause addressed.
Nope, two days later, they're telling me: "Look at her, she's happy, she loves you, she's Fine. It's Not a psych issue, we've given the same meds she came in on. Follow up with psych later. We're just going to give her Sodium pills and maybe a diuretic.
You Cannot Make this stuff Up!
Her kidney function panel was off and by Wednesday the nephrologist tells me, "It's the bad diet syndrome, we see it. Not enough protein." (meanwhile feeding her a Standard Tray) That day I said well I'm staying til Lunch. This woman gets protein (we're I think the first bio-hacking alf) and if not for that, she would not be here. The evening labs showed marked improvement in albumin and anion gap, but they Still wanted us to deal with psych Later...
Yeah, AI was Very helpful to me and Minerva. It remains to see if they'll Switch her to Abilify from risperidone and OH, she tested initially Monday, toxically high for keppra, a drug she hasn't taken in over a year. So again AI to the rescue, but it's Getting them to Listen that's a challenge. The drug is a chemical cousin to Briviact, her current anticonvulsant.
I asked for the test to be done properly so they can Adjust the Dose properly and Briviact now has a generic so part D is done with the brand name and locally we only find 50 mg, not 75. So now I have to Insist they give us enough at discharge to last several days, to be sure that is sorted out.
I'd say, now that she is speaking both languages again fluently, that she was near death on Monday, slurring word salad in Spanish. Likely saved her life and totally certain her quality of life with AI.
I did college and med school in 6 years. Absolutely worth it especially now with outrageous cost of education. However we went ALL YEAR ….Inteflex at University of Michigan- we only had 50 students in our classes for the first 2 years of med school. It was great. They ended it because we did not become family docs -17/50 were Valedictorians - I was accepted into med school from high school. No MCATS - the results -very impressive group of docs (Sanjay Gupta is one) -saved students money and we graduated early-practiced longer. I skipped 8th grade as well. Worked out because an auto accident ended my career but I worked 3 more years than I otherwise would have done the usual way.
If you want to shorten anything, do it with pre-med in college. Most of my learning about serious subjects other than bio-medical came after med school when I had a little life experience and started self-motivated reading.
That being said, a potential doctor needs some time to grow up psychologically and socially. I guess that's what college is for, but I think a lot of it is wasted time that would be much better spent in doing and learning something productive.
That may sound heretical but I think these days for much of our population our tendency is to extend childhood way too long.
Medical training when I started med school in 1961 was a lot shorter. For the large majority - 4 years of med school, 1 year of internship and then practice.
I don't know the full process to become a doctor but I know it's long and expensive. Could they not shorten the premed or pre degree that they need just to get accepted? Possibly draw from nursing schools for potential doctors so that either way you have a health care professional?
The one in my province that needs fixing is the education of grade or high school teachers. Mostly they need people skills and they need to be a little smarter than the kids they teach. This requires them to get a four year degree and then attend two years of "teacher's college" if they are accepted. The process seems to be to create a shortage of them thus driving up their wages and making it prohibitively expensive to have enough of them.
Dr. Cifu- I agree although I'm not quite sure it's just the education curriculum alone that will do the job. I've been an RN in NYC and remember in the not so distant past, doctors were either mandated or strongly encouraged (depending on the the hospital in which they were either employed or doing clinical rotations and residency programs) to take "sensitivity training." In my opinion this basically meant; listening to their patients and not from up on a pedestal". I'm the perfect example that quite a lot needs to be evaluated and changed. This is gonna be a bit of a short story so I apologize. Call me patient X. 64 year old male, who was still working and very active. History of a fall in 2020 dx with hamstring "strain or partial tear". (Despite severe swelling and black and blue from butt to toes of right leg). Urgent care , sports Medicine doctor and home PT. Within 10-12 weeks was back to work with no noticeable residual that I could tell and was commuting and doing 12 hr night shits on an acute inpatient 35 bed adult psychiatric unit-during the early days of COVID. (3 RNs:35 very sick patients).
Fast forward to your point and my extremely frustrating ongoing experience. My PCP is amazing, he listens, he shares his knowledge and thoughts and the plan of care is made by us both.
Mid 2025 I noticed posterior thigh soft tissue mass. Had periodic severe cramping of right leg always in bed during sleep hours. Then worsened increase cramps with certain movements, then a noticeable decrease in strength when walking even short distances or inclined, then numbness and tingling of foot, then hip and back pain and then left leg to a much lesser extent. As a nurse i was thinking some of it is compensatory ( and admittedly getting up there age wise). I read and as I investigated I said to myself , I think this is an Avulsion". (Didn't even know the term prior that night). My state insurance was horrible but fortunately I turned 65 in October 2025 and my primary and myself started trying to figure out what's actually going on. 1) firstI saw a physiatrist who after seeing back x-rays done the year before concluded it's my back. I said what about the referral which is to evaluate my right leg. His response "oh let me get you a pair of shorts" I dropped my drawers and he said - wow- I'm gonna Rx an MRI of your leg.
Sure enough complete separation with a differentiated 13 cm retraction. (No one knows how I'm still running al over town. Go back to see him. Follow-up and he admittedly had no clue or advice. I already set up 2 other visits. A sports medicine surgeon who use to do exercise videos and would include modifications for older patients. Submit tons of info and images and at the appt say what is the actual problem. The sane justice info I submitted for the appt and that the PA had been taking; I start reiterating. He stops me and says "I'm not the doctor for you" and "don't charge this guy" and that was that. I was in such disbelief I had to laugh with a nurse who happened to be standing there and nice enough to ask if I needed anything else.
Takes 45 days but I make an appointment with a spine and sciatic nerve doctor who required 3 more imaging studies in addition to everything I submitted and everyone I've seen and that I can't get answers for the most basic questions- do I do PT, do I exercise and if so what to avoid, do I work long hours. Forget about surgical options, recovery periods, is it a multi-team surgical procedure.
At the very least I asked he refer me to a surgeon who specializes in Avulsion repair. The response "I'm a spine doctor and I'll write a Rx for PT for your back and epidurals. The first thing I think k is Will I be doing further damage to my leg!!
So I ask for the orthopedic sports medicine surgeon referral and the indication reads "hamstring pain." I left furious, angry, upset, puzzled and thinking -Getting ALL the proper information to make a decision is gonna be up to me!
I'm not saying these doctors are necessarily bad. They're all respected in their practice but my body is the sum of all its parts. To your point on education: doctors can't specialize and know everything, but I do think if you choose to be in any healthcare profession and you can't listen, use common sense, offer advice and provide support even if you can't answer every medical question then quite possibly the individual or the academic systems requirements to practice are falling short...Very short.
I am an osteopathic school graduate. I highly recommend an osteopathic curriculum to produce high quality generalists which is what your article focuses on. There are a lot of osteopathic schools opening in the US and the more established ones are really providing primary care physicians for the states that they are in. There are still problems with osteopathic curricula, but they still outshine allopathic curricula at producing high quality generalists.
I'm going to go against the grain. I think that medical training should be longer.
Osteopathic grad here too. I graduated from a 4 year Medical School program followed by a 1 year "rotating internship". The Internship consisted of 1 month of OB-gyne, 1 month of Pediatrics, 1 month of Radiology, 1 month of EC, 3 months of General Surgery, 3 months of General Medicine, 2 weeks of "House Nights", 2 weeks of "House days", and 4 weeks of electives. Basically a well rounded "5th" year of Medical school in which you were paid and had much more responsibility.
Following this many graduates became "General Practitioners" mostly in underserved areas. Others went into specialty training. The year of the "rotating internship" was invaluable - it molded you into a well rounded Physician. Times were different then - an Internist with 3 years of Internal Medicine training was considered a specialist. They managed a wide variety of illnesses that nowadays are turfed to sub-specialists. Internists managed patients with most infectious diseases, most endocrine problems, most pulmonary problems, and many cardiac diseases. Referral to sub-specialists for diabetic management, pneumonia/COPD, or atrial fibrillation was rare.
Yes, it took me one year longer to finish training, but I believe that it served me well in the 40 years of caring for patients.
Years of practicde in general internal medicine and specialty GI have shown me the value of knowing statistics and being able to evaluate evidence the way exemplified by Vinay Prasad, John Mandrola, Timothee Olivier, and John Ioannides. And yet, we also need to learn from a grerat clinician, as I did, how to focus on the patient in front of you. (How do you know a great clinician? In some ways its is like Justice Potter's quote about Knowing pornography, but there's also evidence, such as other doctors choosing that doctor for themselves). A focus on early exposure to clinical medicine -- at McGill, we did in early second year -- anchors the learning from sciences, pathology, etc. As Osler said, "“He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.” And practice and questioning shows you how uncharted that sea really is.
We have a medical school here in lowly Saginaw Michigan that sends third year students into clinical experiences in the surrounding community, including the remote Upper Peninsula of Michigan. Central Michigan University Medical School punches above its weight in cranking out generalists and generalist-competent physicians
With respect to the continuing growth of specialty care in medicine, “we know more and more, about less and less. Soon we will know everything about nothing.” Dr. William MacMillan Rodney.
Many facets to this issue and the points you raise. Most everyone involved (government at every level, payers, employers, med schools, physicians and patients) see the reality: too much being spent on healthcare, very difficult to see a primary care doc and all manner of medical tasks being offloaded to lesser trained professionals. So what's not to like about making med school quicker, and therefore cheaper, and increasing throughput.
The issue is that the health care system writ large that created these problems needs to be changed on a fundamental level, or the outcome - the types of physicians produced, in the specialties they choose, their priorities in to their lives - won't meaningfully change.
Are the payers too big to fail?
(Disclaimer: I retired from 35 years in primary care last year.)
Egads, no... We're already talking about replacing doctors with AI and now we want doctors Less qualified? Plus, we already have remote everything, likely a chunk of the present education length, and now we want Less education? Nope not me.
Beautifully stated. I was trained classically with the only wasted time "scut work," that actually wasn't that bad because it helped me find veins and it helped me quickly tell what was good for the patient. And I suppose it gave a little foretaste of our now much worse medical system.
Aside from the balderdash of woke and DEI requirements the worst criticism of contemporary medical education is that for the past ~30 years everything has been "teach to the test." I can count on 2 hands the number of students and trainees who could think. And this is not the fault of the students but of our leaders in education. Yes, our colleagues at ACGME, the deans, etc. They have harmed American healthcare, American patients, and American physicians. Too bad we can't vote them out.
I especially agree that doctors need to be pushed into critical / analytical thinking, especially regarding the analysis of clinical trials results. Too many simply focus on reading brief summaries that are highly biased and generally published by Big Pharma.
There is no way to fight AI in medicine, so training should include how to effectively and appropriately use AI in their medical practices, and how to double check the accuracy and reliability of their AI tools.
As long as you have doctors practicing medicine according to payment schedules, you will have mediocre care-at best.
The idea of going into medicine to make money was poisoning the pool long before modern medicine took over. That has to be dealt with. Because the predominant desire to get rich cannot coexist with ethical principles.
If you cannot instill ethics in premed, no amount of medical training will be enough
The difficulty with shortening medical education is not only deciding how much information can be compressed. Information is the easiest part to imagine compressing.
What is much harder to compress is the slow formation of clinical judgment: learning what uncertainty feels like before it has a name, how to notice when a case is becoming unstable, when not to close too early, and how to carry responsibility before confidence has fully arrived.
We can count curriculum hours, test scores, debt, and workforce needs. It is much harder to measure the time it takes for a person to become safe inside uncertainty.
Oh My, About AI:
Well, this is slightly off topic, so I hesitate - but maybe a post of its own is in the future.
I have a small Assisted Living home in South FL, and as such, we encounter emergency situations more frequently than most. Our staff are trained in CPR and many of our residents have DNROs.
This comment is about another type of emergency. Your resident is in the ER or maybe has been admitted for example, this one was a seizure triggered by a side effect: SIADH.
I've been skeptical of AI, everywhere from the ordering screens replacing people at restaurants to "Alexa", ChatGPT for students failing to learn and EllieQ gave me the heebeejeebies.
For a problem much more common than I realized, that I've informally polled with 75% of ALF Admins even know about, it's been a lifesaver. Drug interactions/side effects.
As antipsychotics and other mental health meds became more common over my 16-year career as owner/operator of a small one, I worried that these residents will 'become their diagnosis', and it's happened. The focus with MH residents becomes controlling behavior. This can be a problem.
The large corporate ones have security cameras, and charting is where they use AI, but just to record data, not to actively help avoid deadly drug interactions.
To be clear, we are Assisted Living. Some larger corporate ALFs have nurses, but just for minor first aid, mostly. Everyone's myriad insurance rip-off HMOs and Medicare mean their own doctors, almost endless referrals, pre-approvals, but that's another subject.
Nobody in our world acts as a SNF nor do we have doctors or ARNPs to review meds at large.
I happen to be a real estate appraiser of 42 years, and my Life in that profession is RESEARCH.
I see a pattern, run the search on a different map, figure out the reason for the variation in (marketing time, other factors and eventually, comparative values)
On Monday, Memorial Day, our Minerva needed to pee, so she said. I'd noticed a pattern and stayed over for weeks to verify it, day and night. She felt the urge, and most often got up to go, but on arrival, sat and said, "Oh, I guess not, nothing's happening." So after a week or two, my "Duh" reflex kicked in. I'd noticed and occasionally started to use the AI mode in my Google search.
Nobody trains Anybody in Assisted Living on drug interactions and side effects. It's a BIG subject and if we made it a requirement, all ALFs would close due to the liability in over-regulation.
Minerva had also had a seizure or two, a couple of years ago. Meanwhile her son and I have whittled and changed medications for her, adding phosphatidylserine, alphabet vitamins, dried beef liver caps (don't get me started on the inappropriately Low threshold and ferritin issues - they indirectly cause falls, the single biggest mortality factor in my world)
So AI had been handy for that.
It seemed she was also inordinately thirsty. I had thought it's part of her MH issues to gulp water, so despite her complaints, I began to insist they do Not put ice cubes in her tea & coffee, but that she learn (and she did on days when I was present at breakfast) patience by giving her tea with a splash of milk, but No ice. She'd touch the cup, complain it's hot, and we now say, "Sure, but everyone else has theirs much hotter. It will cool, just sip carefully." Getting her to slow down also included smaller spoons, so she had time to chat and normalize. I thought it was behavioral and partly it was.
I didn't realize the Thirst driven by one medication and the SIADH locked in place by two others.
She wanted to dump the water, but seldom peed successfully before noon.
My research revealed the medication issue.
Her "psych provider" is a face on a screen - these people make only Outgoing calls. You Cannot Call them; her son arrives every 6 weeks or so cellphone in hand, missing work and whatever mood she's in and in the afternoon, everyone says "She's fine", when in the morning she may have slapped me or other staff members because she couldn't do what Everyone does, pee the first thing, before getting dressed and going to breakfast.
The fluid was retained by the drugs' actions and sodium was diluted. Fussiness was also BP from a full bladder, warring factions of her body's operation under medication. It Depended not on only Today's fluid intake/output, but the past Three days or so, and overall level of electrolytes.
We also tend to divorce brain from body and "other" mental health patients/residents.
This AI helped a LOT, but we didn't have Time to go through fixing it, as it turned out.
One seizure happened before 3 am on 4/4, and she was taken to the ER for an unobserved fall. This was a Saturday morning and my phone was not on my nightstand. I'd just asked her son to give me access to labs via MyChart, so when I saw the ER I called them first, before my staff. She walks without devices - I was sure it was someone else, but still, I logged in to see if it was Minerva, while dialing at 6:30.
Lo & behold, there are new labs to see.
The ER nurse answered, and I identified myself. "Wait, what's your name?" Doreen Campbell, I own an ALF... "Oh, yes, I see she has a mental health diagnosis so I think it's that."
That rang a bell. I asked if I was Not the owner of the house, her Son is and I let staff abuse her.
"Yes, that's what she said!" came the stunned answer. "OK, look at the sodium level, I think she's had a seizure from hyponatremia." She read the notes and we agreed it's possible. I mentioned SIADH and she said she was new to the ER. She understood once I explained but was skeptical simple sodium could cause that and why didn't we just give her more salt on her food...
OK, I said to watch the sodium level (was 118 at 3 am admission, edging up b/c the First thing they do is a saline drip) However, it also Adds Water...
Discharge would be later, and I said I'd call about 9:15 or sooner if I saw significant improvement. We would then see who I was when she asked Minerva.
At 915 as I reached for the phone and it rang. "Hello, this is Flo the ER nurse and you're a genius!" It seems she'd seen significant improvement in sodium, as I did, and mentioned me to a Different woman who said, "Oh, Doreen?! She's wonderful, and takes Great care of me and my friends. Can she come and take me home? She is the owner of the house."
Well, well, well, if it ain't the invisible drug interactions again...
So she was released, but I feared a repeat given the obstacles to responsive drug changes. Luckily she had a psych "visit", to use the term loosely, and mirtazipine was cut in half to 7.5 with the plan to end it June 1. That left risperidone and venlafaxine, actually bigger culprits per AI.
Algo es algo (Minerva's Gringa Latina like me)
Then Monday, an Observed seizure while on the toilet trying to pee. Medics came she went to ER. I joined her an hour later, and she'd not peed much, if at all. I explained to ER nurse SIADH and she said, "I know the term, but it must be rare." Nope, it's RARELY Considered b/c the rush is to Stable Vital signs and a discharge when the problem isn't Right in our faces.
So now they admitted her and we were both relieved when she peed big in the ER, and became Responsive. But there was word salad... In Spanish, and attempts to get out of bed to go pee. Previously she had been fine with the purewick and her output could be handily measured. This 2nd time, whether because of a weekday or the individual doctor, the drip was Not in place, precisely to Avoid dilution of sodium, this time I might get the Root Cause addressed.
Nope, two days later, they're telling me: "Look at her, she's happy, she loves you, she's Fine. It's Not a psych issue, we've given the same meds she came in on. Follow up with psych later. We're just going to give her Sodium pills and maybe a diuretic.
You Cannot Make this stuff Up!
Her kidney function panel was off and by Wednesday the nephrologist tells me, "It's the bad diet syndrome, we see it. Not enough protein." (meanwhile feeding her a Standard Tray) That day I said well I'm staying til Lunch. This woman gets protein (we're I think the first bio-hacking alf) and if not for that, she would not be here. The evening labs showed marked improvement in albumin and anion gap, but they Still wanted us to deal with psych Later...
Yeah, AI was Very helpful to me and Minerva. It remains to see if they'll Switch her to Abilify from risperidone and OH, she tested initially Monday, toxically high for keppra, a drug she hasn't taken in over a year. So again AI to the rescue, but it's Getting them to Listen that's a challenge. The drug is a chemical cousin to Briviact, her current anticonvulsant.
I asked for the test to be done properly so they can Adjust the Dose properly and Briviact now has a generic so part D is done with the brand name and locally we only find 50 mg, not 75. So now I have to Insist they give us enough at discharge to last several days, to be sure that is sorted out.
I'd say, now that she is speaking both languages again fluently, that she was near death on Monday, slurring word salad in Spanish. Likely saved her life and totally certain her quality of life with AI.
I did college and med school in 6 years. Absolutely worth it especially now with outrageous cost of education. However we went ALL YEAR ….Inteflex at University of Michigan- we only had 50 students in our classes for the first 2 years of med school. It was great. They ended it because we did not become family docs -17/50 were Valedictorians - I was accepted into med school from high school. No MCATS - the results -very impressive group of docs (Sanjay Gupta is one) -saved students money and we graduated early-practiced longer. I skipped 8th grade as well. Worked out because an auto accident ended my career but I worked 3 more years than I otherwise would have done the usual way.
What about the apprenticeship model to teaching vs giant groups of students at a time?
If you want to shorten anything, do it with pre-med in college. Most of my learning about serious subjects other than bio-medical came after med school when I had a little life experience and started self-motivated reading.
That being said, a potential doctor needs some time to grow up psychologically and socially. I guess that's what college is for, but I think a lot of it is wasted time that would be much better spent in doing and learning something productive.
That may sound heretical but I think these days for much of our population our tendency is to extend childhood way too long.
Medical training when I started med school in 1961 was a lot shorter. For the large majority - 4 years of med school, 1 year of internship and then practice.
I don't know the full process to become a doctor but I know it's long and expensive. Could they not shorten the premed or pre degree that they need just to get accepted? Possibly draw from nursing schools for potential doctors so that either way you have a health care professional?
The one in my province that needs fixing is the education of grade or high school teachers. Mostly they need people skills and they need to be a little smarter than the kids they teach. This requires them to get a four year degree and then attend two years of "teacher's college" if they are accepted. The process seems to be to create a shortage of them thus driving up their wages and making it prohibitively expensive to have enough of them.
Dr. Cifu- I agree although I'm not quite sure it's just the education curriculum alone that will do the job. I've been an RN in NYC and remember in the not so distant past, doctors were either mandated or strongly encouraged (depending on the the hospital in which they were either employed or doing clinical rotations and residency programs) to take "sensitivity training." In my opinion this basically meant; listening to their patients and not from up on a pedestal". I'm the perfect example that quite a lot needs to be evaluated and changed. This is gonna be a bit of a short story so I apologize. Call me patient X. 64 year old male, who was still working and very active. History of a fall in 2020 dx with hamstring "strain or partial tear". (Despite severe swelling and black and blue from butt to toes of right leg). Urgent care , sports Medicine doctor and home PT. Within 10-12 weeks was back to work with no noticeable residual that I could tell and was commuting and doing 12 hr night shits on an acute inpatient 35 bed adult psychiatric unit-during the early days of COVID. (3 RNs:35 very sick patients).
Fast forward to your point and my extremely frustrating ongoing experience. My PCP is amazing, he listens, he shares his knowledge and thoughts and the plan of care is made by us both.
Mid 2025 I noticed posterior thigh soft tissue mass. Had periodic severe cramping of right leg always in bed during sleep hours. Then worsened increase cramps with certain movements, then a noticeable decrease in strength when walking even short distances or inclined, then numbness and tingling of foot, then hip and back pain and then left leg to a much lesser extent. As a nurse i was thinking some of it is compensatory ( and admittedly getting up there age wise). I read and as I investigated I said to myself , I think this is an Avulsion". (Didn't even know the term prior that night). My state insurance was horrible but fortunately I turned 65 in October 2025 and my primary and myself started trying to figure out what's actually going on. 1) firstI saw a physiatrist who after seeing back x-rays done the year before concluded it's my back. I said what about the referral which is to evaluate my right leg. His response "oh let me get you a pair of shorts" I dropped my drawers and he said - wow- I'm gonna Rx an MRI of your leg.
Sure enough complete separation with a differentiated 13 cm retraction. (No one knows how I'm still running al over town. Go back to see him. Follow-up and he admittedly had no clue or advice. I already set up 2 other visits. A sports medicine surgeon who use to do exercise videos and would include modifications for older patients. Submit tons of info and images and at the appt say what is the actual problem. The sane justice info I submitted for the appt and that the PA had been taking; I start reiterating. He stops me and says "I'm not the doctor for you" and "don't charge this guy" and that was that. I was in such disbelief I had to laugh with a nurse who happened to be standing there and nice enough to ask if I needed anything else.
Takes 45 days but I make an appointment with a spine and sciatic nerve doctor who required 3 more imaging studies in addition to everything I submitted and everyone I've seen and that I can't get answers for the most basic questions- do I do PT, do I exercise and if so what to avoid, do I work long hours. Forget about surgical options, recovery periods, is it a multi-team surgical procedure.
At the very least I asked he refer me to a surgeon who specializes in Avulsion repair. The response "I'm a spine doctor and I'll write a Rx for PT for your back and epidurals. The first thing I think k is Will I be doing further damage to my leg!!
So I ask for the orthopedic sports medicine surgeon referral and the indication reads "hamstring pain." I left furious, angry, upset, puzzled and thinking -Getting ALL the proper information to make a decision is gonna be up to me!
I'm not saying these doctors are necessarily bad. They're all respected in their practice but my body is the sum of all its parts. To your point on education: doctors can't specialize and know everything, but I do think if you choose to be in any healthcare profession and you can't listen, use common sense, offer advice and provide support even if you can't answer every medical question then quite possibly the individual or the academic systems requirements to practice are falling short...Very short.
I am an osteopathic school graduate. I highly recommend an osteopathic curriculum to produce high quality generalists which is what your article focuses on. There are a lot of osteopathic schools opening in the US and the more established ones are really providing primary care physicians for the states that they are in. There are still problems with osteopathic curricula, but they still outshine allopathic curricula at producing high quality generalists.
I'm going to go against the grain. I think that medical training should be longer.
Osteopathic grad here too. I graduated from a 4 year Medical School program followed by a 1 year "rotating internship". The Internship consisted of 1 month of OB-gyne, 1 month of Pediatrics, 1 month of Radiology, 1 month of EC, 3 months of General Surgery, 3 months of General Medicine, 2 weeks of "House Nights", 2 weeks of "House days", and 4 weeks of electives. Basically a well rounded "5th" year of Medical school in which you were paid and had much more responsibility.
Following this many graduates became "General Practitioners" mostly in underserved areas. Others went into specialty training. The year of the "rotating internship" was invaluable - it molded you into a well rounded Physician. Times were different then - an Internist with 3 years of Internal Medicine training was considered a specialist. They managed a wide variety of illnesses that nowadays are turfed to sub-specialists. Internists managed patients with most infectious diseases, most endocrine problems, most pulmonary problems, and many cardiac diseases. Referral to sub-specialists for diabetic management, pneumonia/COPD, or atrial fibrillation was rare.
Yes, it took me one year longer to finish training, but I believe that it served me well in the 40 years of caring for patients.
Years of practicde in general internal medicine and specialty GI have shown me the value of knowing statistics and being able to evaluate evidence the way exemplified by Vinay Prasad, John Mandrola, Timothee Olivier, and John Ioannides. And yet, we also need to learn from a grerat clinician, as I did, how to focus on the patient in front of you. (How do you know a great clinician? In some ways its is like Justice Potter's quote about Knowing pornography, but there's also evidence, such as other doctors choosing that doctor for themselves). A focus on early exposure to clinical medicine -- at McGill, we did in early second year -- anchors the learning from sciences, pathology, etc. As Osler said, "“He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.” And practice and questioning shows you how uncharted that sea really is.
We have a medical school here in lowly Saginaw Michigan that sends third year students into clinical experiences in the surrounding community, including the remote Upper Peninsula of Michigan. Central Michigan University Medical School punches above its weight in cranking out generalists and generalist-competent physicians
With respect to the continuing growth of specialty care in medicine, “we know more and more, about less and less. Soon we will know everything about nothing.” Dr. William MacMillan Rodney.
Many facets to this issue and the points you raise. Most everyone involved (government at every level, payers, employers, med schools, physicians and patients) see the reality: too much being spent on healthcare, very difficult to see a primary care doc and all manner of medical tasks being offloaded to lesser trained professionals. So what's not to like about making med school quicker, and therefore cheaper, and increasing throughput.
The issue is that the health care system writ large that created these problems needs to be changed on a fundamental level, or the outcome - the types of physicians produced, in the specialties they choose, their priorities in to their lives - won't meaningfully change.
Are the payers too big to fail?
(Disclaimer: I retired from 35 years in primary care last year.)
Egads, no... We're already talking about replacing doctors with AI and now we want doctors Less qualified? Plus, we already have remote everything, likely a chunk of the present education length, and now we want Less education? Nope not me.
Beautifully stated. I was trained classically with the only wasted time "scut work," that actually wasn't that bad because it helped me find veins and it helped me quickly tell what was good for the patient. And I suppose it gave a little foretaste of our now much worse medical system.
Aside from the balderdash of woke and DEI requirements the worst criticism of contemporary medical education is that for the past ~30 years everything has been "teach to the test." I can count on 2 hands the number of students and trainees who could think. And this is not the fault of the students but of our leaders in education. Yes, our colleagues at ACGME, the deans, etc. They have harmed American healthcare, American patients, and American physicians. Too bad we can't vote them out.
I especially agree that doctors need to be pushed into critical / analytical thinking, especially regarding the analysis of clinical trials results. Too many simply focus on reading brief summaries that are highly biased and generally published by Big Pharma.
There is no way to fight AI in medicine, so training should include how to effectively and appropriately use AI in their medical practices, and how to double check the accuracy and reliability of their AI tools.
As long as you have doctors practicing medicine according to payment schedules, you will have mediocre care-at best.
The idea of going into medicine to make money was poisoning the pool long before modern medicine took over. That has to be dealt with. Because the predominant desire to get rich cannot coexist with ethical principles.
If you cannot instill ethics in premed, no amount of medical training will be enough