A. For Travis Hill, it was an offer too good to refuse. Last year when the 30-year-oldneuroscientist was admitted to a new program at NYU School of Medicine that wouldallow him to complete medical school in only three years and guarantee him a spot inits neurosurgery residency, he seized it. Not only would Hill save about $70,000--thecost of tuition and living expenses for the fourth year of medical school--he wouldalso shave a year offthe training that will consume the next decade of his life.
B. The chance to finish medical school early is attracting increased attention fromstudents burdened with six-figure education loans: The median debt for medicalschool graduates in 2013 was $175,000, according to the Association of AmericanMedical Colleges. This year, the combined cost of tuition and fees for a first-yearmedical student range from just over $12,000 to more than $82,000.
C.Some medical school administrators and policymakers see three-year programs asa way to produce physicians, particularly primary-care doctors, faster as the newhealth-care law allows millions of previously uninsured patients into the medical system.Enormous student loans are cited as one reason some newly minted doctors chooseprofitable specialties such as radiology (放射学) or dermatology ( 皮肤病学 ) ,which pay twice as much as pediatrics ( 小儿科 ) or family medicine.
D.But debt and the shortage of primary-care doctors are not the only factors fuelinginterest in accelerated programs. Some influential experts are raising questions aboutthe length of medical school in part because much of the fourth year is devoted toelectives and applying for a residency, a process that typically takes months. (Similarquestions are being raised about the third year of law school.)
E.In a paper published in a journal of the American Medical Association in 2012,University of Pennsylvania Vice Provost Ezekiel Emanuel and Stanford economistVictor Fuchs proposed that a year of medical school could be eliminated "withoutadversely affecting academic performance". The overall time it takes to trainphysicians, they wrote, is an example of waste in medical education and could beshortened without affecting patient care or eroding clinical skills; students could beassessed on "core competencies rather than on time served."
F.So far, fewer than a dozen of the nation's 124 medical schools are offering oractively considering three-year programs, which typically involve the elimination ofelectives, attendance at summer classes and the temporary guarantee of a residencyoffered because three-year graduates might be at a disadvantage compared with otherapplicants.
G.NYU launched its program in September with Hill and 15 other students chosen froma pool of 50 applicants--nearly a third of the medical school's 160-member class.
Texas Tech University Health Sciences Center in Lubbock graduated its first three-year class in 2013; its nine students are training in family medicine. Fifteen morestudents started this fall. In September, Columbia University's College of Physiciansand Surgeons launched a "fast track MD" for candidates who already hold doctoratesin biology; there were 40 applicants for four quotas.
H.Despite the growing popularity of such programs, critics question the wisdom ofjettisoning (抛弃，投掷 ) the fourth year of medical school, which they say playsa crucial role in preparing doctors for residency and subsequent practice. Some notethat the three-year track was offered by a few dozen medical schools in the late 1970sbut subsequently abandoned, largely because of student burnout from trying to jamtoo much into three years.
I.Supporters of the three-year option say that contemporary medical school programsare different from 1970s curricula, which relied more heavily on rote memorization,and that the new programs have been designed to minimize burnout.
J."This has been tried before, and it was a miserable failure," said Stanley Goldfarb,associate dean for curriculum at the University of Pennsylvania's Perelman School ofMedicine, who co-authored an essay opposing three-year programs in a recent NewEngland Journal of Medicine. "Since the 1970s things have gotten so much morecomplex in medicine," he said. The more relaxed fourth year, he said, gives studentsthe chance to pick the field that best suits them and to carefully evaluate residencies.
More than three-fourths of students, he said, enter medical school uncertain abouttheir eventual specialty. Goldfarb said he favors enhancing the fourth year, noteliminating it.
K. Medical students have mixed feelings about three-year programs, said Nida Degesys,president of the Reston-based American Medical Student Association. While manyare eager to reduce their debt, they are also concerned about missing opportunities;fourth-year electives can include ophthalmology (眼科学) , critical care andemergency medicine.
L."There have always been some individuals who wondered about the length of medicalschool," said John Prescott, former dean of the medical school at West VirginiaUniversity and chief academic officer at the Association of American MedicalColleges. Prescott calls the current three-year programs "well-designed experiments"that may provide models about how to prepare students "in the most cost-effectiveway." But he doubts they will substitute the conventional four-year track for moststudents.
M. Steven B. Abramson, vice dean of NYU's medical school, agrees, but he said heexpects three-year programs to multiply over the next five years. NYU's acceleratedprogram, he said, is best suited for highly qualified students who are typically older,more mature and certain of their choice of specialty. Because three-year students takethe same core courses as their classmates, they will be equally well prepared, he said.And Abramson noted the spread of dual-degree programs: students who earn an MDalong with a graduate degree in science, business administration or public health.
N. While students at NYU can designate a variety of specialties, the three-year FamilyMedicine Accelerated Track at Texas Tech is limited to those who intend to pursuethat specialty. "There weren't enough primary-care doctors before the AffordableCare Act," said Texas Tech medical school dean Steven Berk, who trained as a familyphysician. "There are lots of towns in Texas with 25,000 people and no doctor. Andit's the primary-care physicians who find the small breast mass ( 乳腺肿块 ) orcontrol patients' blood pressure. They are essential to the functioning of the health-care system."
O. Texas Tech students are awarded a $15,000 full tuition scholarship to cover thefirst year. When they graduate, their average debt for tuition and living expensestotals about $60,000, Berk said. Like the NYU program, students have the option ofswitching to the four-year track--none has so far--and are granted a residency spotwhen they enter med school. Fears that they will not perform as well as their four-year counterparts have not been confirmed, Berk said. Scores on licensing exams areequivalent, and burnout has not been a problem. Charles Willnauer,30, a graduate ofTexas Tech's first three-year class, said the accelerated program worked well for him.The promise of a residency in family medicine, a specialty that "fits with my valuesand goals," was tempting, as was the lower price tag. "A lot of people have to applyto 30 or more residency programs," said Willnauer, now a first-year resident. "That'sa very large cost and a lot of time."