High school to MD in five years

California Lt. Gov. John Garamendi wants to combine college with medical school, enabling a high school graduate to earn an MD in five years.

University of California at Merced, a new campus that’s still under-enrolled, would house the program.  Merced is in the rural Central Valley, which is short on doctors.

Garamendi hopes to put a medical degree within reach of young people who may be discouraged by the prospect of eight years of college — and a  load of debt — to get to a poorly paid residency. The program should work for all those kids taking AP classes in high school: They don’t need four years to prepare for medical classes.

Currently, the University of Missouri-Kansas City School of Medicine offers a six-year program.

In Britain, many students start a five-year medical course at 18, after leaving high school with  high science scores. Others complete a three-year undergraduate degree and do four years of medical school.

About Joanne


  1. Garamendi has come up with some asinine ideas in the past, but this one takes the cake! Would you like your son or daughter being treated by a real-life Doogie Howser? It sounds to me like this is a proposal to create a two-tiered standard of care. Let the poor Latinos in the central valley get “MDs lite,” and everyone else get fully trained physicians. UCLA has a program that admits a very few extremely talented, intelligent, and mature undergraduates as freshmen while also giving them conditional admission to the UCLA Med School after three years of college. They complete all of their pre-med classes in three years and then the four-year med school curriculum. This makes sense; Garamendi’s plan is nuts.

  2. I am not advocating this program, but I think that many people are unaware that many of the doctors who have come here from overseas (think J1 visas; to serve initially in underserved areas) have come from programs of similar length. In some parts of the word, medical school is not necessarily proceeded by college, but the physicians must meet residency/board certification standards in order to practice here.

  3. Is there any evidence for eight years being better than five? On the one hand, more years implies a higher standard. On the other hand, I don’t know any MDs, but I’ve seen students use their undergraduate years inefficiently. So the idea of cutting out “wasted” years appeals to me as an outsider. However, the aforementioned students were not on a medical track. Maybe undergraduates aiming for medical school take a solid four years of relevant coursework.

    RMR/Dad fears a two-tier system. Does such a hierarchy exist in Britain with its three ways to become a doctor (according to the Yahoo! page Joanne linked to), or are all three ways considered to be equally valid there?

  4. equally valid there

    I meant “of equal quality.”

  5. Momof4 is right.

    I have no direct knowledge of medical school but…

    In Europe they go directly from a college prep high school to med school, but they have a higher attrition rate in these med schools. These high schools traditionally cover the first two years of a US college science curriculum. Traditionally only the upper 5% get into the college prep high schools.

    Most US premeds major in Chemistry, Biology, Microbiology or Biochemistry, but the required courses could be completed while majoring in the fine arts. I knew a guy who went into medical school with a Chemical Engineering major.

    My recollection is:

    Calculus, 2 semesters
    Biology, 2 semesters
    Psychology, 1 semester?
    General Chemistry, 2 semesters
    Organic Chemistry, 2 semesters
    Physics, 2 semesters

    It seems to me a good bit of this can be done in high school advanced placement.

    I think the reason they major in science is it will give them a better score on the medical school admission test.

    Cutting out 2,3 or 4 years of college would save a lot of money for the students, their families and society.

    How important is liberal arts education for a physician? Does a liberal arts education exist anymore?

  6. that’s great. just what we need, for doctors to know even less about the world they live in. no knowledge of history, literature, political science, or philosophy. no sense of who we are and what the relevant truths are for humanity, no ability to communicate in words, either written or spoken-, no knowledge of what’s fixable and what isn’t. Even their science courses are limited, because they wouldn’t want to take anything they wouldn’t ace, so no advanced physics or math, no high end biology or engineering, no learning how to think.

    so professional degrees should just become another round of vocational ed, it seems?

    Perhaps it’s just another example that doctors were only learned and respected when medicine and law were the only natural endpoints for bright college educated folk. Now that there are a zillion other endpoints, doctors aren’t any brighter than any other profession.

  7. MD lite is already the status quo in Britain. It exists in the form of “nurse practitioners” for every specialty, not just internal medicine, but everything else, including surgery, anesthesia, oncology, emergency med, etc. And it is coming here. it is a disaster there. we have been warned.

  8. And to the point of “let’s make it less expensive”: there are a zillion ways to make state undergraduate education less expensive, but the expense of medical school is not from UNDERGRAD education ANYWAY. It’s from paying for medical school.

    Why doesn’t the UC just make another med school, hm? Funny that they don’t just do that in Merced.

    But Merced was always an asinine idea. Too far from current private sector high tech locales, and too far from an international airport to ever become a desirable location for research faculty, and hence unable to ever create the feedback of university-spin off private sector growth which would expand Merced to where faculty would want to live there. that’s why the way they staff Merced is with adjunct faculty who took their coursework lock, stock and barrel from other universities, rather than wait for tenured faculty to create their own.

    The goal is to keep the bright Central Valley students in Merced so as to attract FACULTY there. Ha! The bright students all leave to UC Berkeley or UCSD, and Merced continues to be the undesirable UC for faculty.

    The notion that Merced is short on doctors is odd, though. If you paid them, they would go. But surely the ex CA insurance commissioner understands why docs in CA aren’t paid more, doesn’t he?

  9. Allison: It won’t surprise you that I’m in agreement 100%, esp as it relates to UC Merced. UC never wanted a Merced campus; the central valley legislators and politicos just kept pushing until they got what they wanted. Merced couldn’t be justified based on systemwide lack of capacity; UC had plenty of excess physical capacity.Using its campuses year-round and providing incentives for students & professors to be there in the summer would generate a lot more capacity than UC Merced, at a heckuva lot less than it’s costing to build out, equip, and staff a new campus. Now Merced is the dumping ground for those in the bottom of the UC-eligible applicant pool. It would be interesting to see the distribution of students who went there because they (1) couldn’t get in to any other UC campus, (2) wanted to attend Merced because it’s close to home, (3) both 1 & 2, or (4) other.

  10. “In Britain, many students start a five-year medical course at 18, after leaving high school with high science scores.”

    Uh, yes, and Britain has nationalized health care. Nationalized health care means governemnt run. By definition, government run means poor quality. By definition, poor quality means that the doctors in the program don’t have to be very good or the service doesn’t have to provide doctors at all (see post above about nurse practitioners). From someone who knows, the quality of doctors in the US is declining. Now, let’s do something more to lower the quality of our physicians?

  11. As someone who advises pre-meds, the requirements are:
    2 semesters of English composition
    2 semesters of General Chemistry
    2 semesters of Organic Chemistry
    2 semesters of General Biology
    2 semesters of Physics
    Some med schools require one or two semesters of calculus, and others will let statistics substitute for one semester of calculus. Psychology is required for dentistry but not for med school.

    However, there’s a subtlety. Med schools won’t take AP credit, and require that students take the course over. They simply don’t trust that the quality is high enough or consistent enough. They also aren’t keen on Community College coursework — the usual advice is that if you take a premed class there, you need to get an A, while for med school in general you only need a 3.5 or better.

    AP credit also typically only gets you out of one semester of these courses, not both, so AP credit for Chemistry would let you enter the second semester of General Chemistry. The only major exception is the BC calculus exam (but the AB exam is only the first semester of college calculus). A student with AP credit in English, Chemistry, Biology, Physics, and Calculus (BC) (and very few students have all of these!) would still have 6 courses to complete, which would require three semesters (since they need to complete General Chemistry before organic) even if med schools would take it.

    As for how long it takes to complete the coursework, there are several postbaccalaureate pre-med programs around the country that allow students who have completed a degree to do just the premed work, and these typically take two years, since the required coursework is typically the first two years of a science major.

    For this program, I wonder what they would squeeze out, though. Some students who take Biochemistry in college can skip that course in med school, but it still takes three years to get to that point (since you need to complete Gen Chem and organic first). I’d worry the curriculum would look like a nursing curriculum –lots of specific, low-theory classes that aren’t very generalizable (or useful if students transfer out of the program!)

  12. RMR/Dad, what’s the point of obliging medical students to do an undergraduate degree in the first place? I’ve been treated by NZ doctors and by American doctors, I’ve never seen any difference in their ability.

    Allison: no knowledge of history, literature, political science, or philosophy. no sense of who we are and what the relevant truths are for humanity, no ability to communicate in words, either written or spoken-, no knowledge of what’s fixable and what isn’t

    What do American schools teach at high school if students only learn this stuff at college?

    I grew up in NZ and managed to get direct entry from high school into engineering school (if not I would have had to have done an intermediate year at university). But I can communicate in words, written and spoken, I picked up the spoken thing before I even got to school (I needed some speech therapy, but that was unusual) and was taught how to write and type at primary school. Literature and history – I took English and history at high school, and of course we studied literature informally before then. History involves itself in political science, literature with philosophy. I do think that studying history weakened my sense of who I am, as it made my understanding more sophisticated and made me realise how much NZers share with other cultures. What the relevant truths are for humanity – well I have some ideas but I still change my mind about that regularly, based on new information. What do you think the relevant truths are for humanity? I don’t know what you mean about “no knowledge of what’s fixable and what isn’t”, presumably medical students are taught things like you can treat a bacterial infection with antibiotics, but not a viral infection.

    Do American high schools just have their students sit and look at blank walls for four years? If students are leaving high school with so little knowledge, what are taxpayers paying for?

  13. “that’s great. just what we need, for doctors to know even less about the world they live in. no knowledge of history, literature, political science, or philosophy. no sense of who we are and what the relevant truths are for humanity, no ability to communicate in words, either written or spoken-, no knowledge of what’s fixable and what isn’t. Even their science courses are limited, because they wouldn’t want to take anything they wouldn’t ace, so no advanced physics or math, no high end biology or engineering, no learning how to think.”

    From what I have read this is already the case for many of our college graduates.

  14. Margo/Mom says:

    Wow–there’s a lot to respond to here. In reading the article, I see at least a well-reasoned plan for a program designed to meet a critical need in a different way. Certainly there are many ways to combat the inequitable distribution of doctors between urban and rural areas. In Cuba they do it by requiring some years of service as a family doctor in a rural area before admission to a specialty (except for surgery). I suspect that we would have difficulties with that here. We make some attempts in this country through J1 visa plans and through various funding schemes that offer loan repayment for years spent in medically underserved areas (MUAs). I worked for several years in such a health center–ironically within spitting distance of a large state university with a medical center. It takes more than just the physical presence of doctors within a geographical area to ensure that some folks (ie: those on Medicaid and those with no health coverage) have access to a doc.

    I am pretty big on liberal arts as a rule, and I wouldn’t wipe them out. But I also would not discount the value of local learning. When a med school has adopted a mission of turning folks with local knowledge into docs to serve the local area, I tend to listen. This is another endorsement, to my mind, of the value of liberal arts. I recall the sense of disconnect when my kids’ pediatrician carefully covered the value of wearing a bicycle helmet–but gave no thought to some of the more pressing dangers of living in an urban neighborhood, such as what to do when shots are fired, or when you find a syringe discarded in an alley.

    Just a special shout out to anon, who said: “Britain has nationalized health care. Nationalized health care means governemnt run. By definition, government run means poor quality.” That’s a nice little piece of propaganda–however by any quality standards used in health care (percentage of low birth weight babies, infant mortality, children vaccinated on time, longevity, etc), the US, as the only industrialized nation without something that would be termed “government run” health care, lags behind the world. We are very good at research and provision of care for those with considerable resources. We fail miserably at distribution of quality health care throughout the population.

  15. Charles R. Williams says:

    “just what we need, for doctors to know even less about the world they live in. no knowledge of history, literature, political science, or philosophy. no sense of who we are and what the relevant truths are for humanity, no ability to communicate in words, either written or spoken-, no knowledge of what’s fixable and what isn’t.”

    General education should be done in high school and it is in countries with strong educational systems. I doubt that many of US college graduates meet this standard.

    In Northeast Ohio we have NEOUCOM which offers a six year MD degree to students who come directly from high school. Five years seems to be pushing it considering the poor educational background even our best students have.

    It is not uncommon outside the US for people to enter the professions without a BA.

    Part of the answer is to begin tracking students who aspire to the professions in the 6th grade and to make a world-class education available to every student who will do the work. This is not a question of cost. It is a matter of accepting the fact that most students are not capable of this level of achievement or are unwilling to do the work. It also requires us to accept that the ethnic mix in these programs will not, for many decades, mirror that of the general population.

  16. So these kids become the equivalent of barefoot Drs? I know health care is sliding down the status scale, but isn’t this a bit much?

  17. Thanks for all of your thoughts — some in favor and some opposed to my position. At the least, I stimulated some intelligent debate, which is important in a free society.

    The one thing that would cause me to moderate my position is momof4’s point about the requirement to pass board exams and residency programs. On the one hand, I know someone who didn’t get into a US med school and so studied at a Mexican med school, took his boards, and is now doing just fine as a practicing physician. On the other, I’m a bit wary of trying to measure one’s mastery of the entire medical school curriculum through exams.

    Not having experienced med school myself, I can’t speak to the content of the programs. What I do know, however, is that it’s extremely difficult to get in to a US medical school and, once in, the students are subjected to an intense curriculum that leaves little time for anything else. Part of the rite of passage in becoming a doctor, for example, is that interns work several 24-hr shifts in a week.

    Just a few other points/replies: Amritas, I can’t imagine any US medical school even considering the application of a student who had “wasted” part of his/her undergrad years.

    I think gbl3rd’s information on medical schools in the UK reinforces my position. There are few, if any, high schools in the US that cover the first two years of a college curriculum — much less do so rigorously. We’re engaged in a battle just to get all students to take algebra in 8th grade. Gbl3rd further notes that only about 5% of those who succeed in the curriculum are admitted to med school and, or those, a good percentage drop out. (Also, students need to pass exams to be admitted to private — or as the Brits call them, “public — high schools.) It sounds like, on the admissions end, getting in to a UK med school is at least as difficult as getting in to a US one (although gbl3rd doesn’t mention how many years the UK med school curriculum is).

    Also, despite what the College Board would have you believe, AP courses are generally less rigorous than the college courses that they purport to replace. My son (a freshman at UC Berkeley) had a choice between taking AP math at Davis HS or taking the “same” curriculum at UC Davis. He opted for the latter, because it covered more material, in greater depth.

    I truly don’t know if most med school applicants major in the hard sciences. I do know that med schools don’t discriminate against applicants who have majored in other subjects. For example, I have friends who majored in music and economics who are now doctors. Of course, they had to complete all the required pre-med courses, too.

    Tracy W — you would be appalled by how little most California high schools offer and even more appalled by most students’ unwillingness or inability to learn what is taught. This is a whole subject in and unto itself that is too complex to discuss here.

    I am a believer in the power of incentives (monetary and otherwise) to produce a desired outcome most cost-effectively. For example, I have no problem with providing subsidized student loans in exchange for practicing in underserved areas or, even more directly, providing a direct subsidy to those doctors who serve such populations. I think the “command and control” approach of requiring students to spend a certain number of years as “barefoot doctors” (as they did in China)would be a disaster.

  18. Devilbunny says:

    As a doctor myself, let me start by explaining a little more about how medical education actually works (since almost nobody outside the field understands it).

    High school

    College – 4 years, although almost all requirements can easily be done in 2.

    Med school – 4 years. 2 classroom, 2 clinical.

    Internship – 1 year

    Residency – additional 2-6 years

    In some fields, the internship and residency train for the same thing (e.g. internal medicine, pediatrics, surgery), while in others they are not necessarily related (radiology, anesthesiology, dermatology).

    As a result of all this, med school attendees are seven to ten years behind their peers in getting started in life. Forty years ago, when GPs started practice immediately after internship, and even most surgeons did only three years after med school, this was bad but often tolerable. Today, with considerably lower pay when out in practice and longer residencies (with bad pay) to boot, it’s become more of a problem. I spent my twenties watching friends take around-the-world trips, live in great places to be young, and kick around for a few years before knuckling into their career and family, while I… studied and worked at a hospital. I like what I do, and it was worth it, but if I could have graduated at 23, and finished residency by 27, I could have had my cake and eaten it, too.

    I enjoyed a lot of things I learned in undergrad that I wouldn’t be able to study under this kind of curriculum, but most of them only made me better at Trivial Pursuit. It’s not as though I’ve stopped reading and learning on my own since I graduated from college. (Had I been paying for school, rather than on a full ride, I very well might have angled to get out in three years anyway.)

  19. Devilbunny: As I read your post, it would still take six years to complete undergrad + med school (unless you propose cutting med school curriculum from four years to three). Am I missing something? BTW, much as I hate to admit it, I agree with your Trivial Pursuit observation. It reminds me of the old Saturday Night Live sketch where Father Guido Sarducci proposed a greatly abbreviated undergrad curriculum based on what you remember ten years after graduation. (“Economics–supply and demand.”)

  20. Margo/Mom said, “We are very good at research and provision of care for those with considerable resources. We fail miserably at distribution of quality health care throughout the population.”

    I detect a non sequitur here. What was said has nothing to do with the point that I made about government health care and the quality of physicians. The quality of physicians in a country has nothing to do with the distribution of health care in a country.

  21. Donalbain from the UK says:

    By definition, government run means poor quality.

    So, the US military is “poor quality”?

  22. Donalbain from the UK

    The US Military has its own special legal code and court system to enforce compliance, can draft resources, and is not run by civil service or business rules. Would a government health care system run the same way?

  23. Elizabeth says:

    Considering the joke that Liberal Arts have become in most university settings – is it really that important for your doctor to have taken courses such as “Feminist Media Perspectives” or “History of Grunge Rock”?

  24. Soapbox Diva says:

    Ah, this takes me back to my days when I worked in a lab at Indiana University Medical School. My boss’s husband was a product of Britain’s accelerated doctorate degree program, although he earned a PhD in biology instead of MD. He counted it as a six year program, but I believe it was five years of classes and a year’s credit of an internship working in a research lab. I think that it took an additional six months to get his thesis approved. He was already working toward his first post-doctorate internship by the time his thesis was approved and he could then officially count himself as a doctor.

    He was an unusual case in that he also graduated from high school at age 16 and was just barely 23 when his doctorate thesis was approved. I think roughly that he skipped 8th grade, finished high school in three years, did five years of college and graduate classes combined, did a year internship and thesis project, and then he was done being a student. He always said that he would have never been able to stand the traditional program of the United States and he always argued that United States should be more willing to reduce the amount of classroom time. He complained of bookish types that did well in the prolonged American style school system while sitting in a classroom, but then later chocked on the actual job. I remember that he felt that it was much tougher to get into graduate or medical school in Britain compared to the U.S. Straining my memory here, but I believe that he said it was tougher to get into the accelerated program in the first place, then a lot of people were weeded out that could not handle the accelerated pace, and that one had constantly earn their way through the entire program, that there was no automatic graduations just because one was admitted to the accelerated program.

    He is “good enough” to teach for Indiana University Medical School in addition to his full time plus research and I remember that he wanted to kick out some bookish types as he called them out of medical school that even though they could somehow memorize their way through class to make the grades, but he truly believed that they would make terrible doctors in reality. Time has usually proved his case for him. He felt that medical students needed to be accessed more on how they would actually in reality versus the classroom.

    I was supposed to go the full PhD route in biology and I because nearly every other biology major at the small college that I went to was pre-med, I took the exact same course load as the pre-med students, even though I was pre-grad. (Actually I was originally a double major of science education and pre-grad biology to complicate matters.) Biology is the degree that most naturally fits with the required courses to enter medical school, but one really can be any major. It is true that there are certain additional science courses that are supposed help students earn higher scores on the MCAT, so students usually take these extra courses too. By the time one takes the required courses and the extra courses that are supposed to help the MCAT score, one is usually approaching a biology major, or at least a science major.

    This reminds me of how much I miss being scientist, but I have to argue against the earlier comment that “by definition, government run means poor quality”. I think there is confusion between government interference causing things to go amok or for government to break something that did not need fixing, but government honestly covers the whole gamut of poorly run to exceptional (except everyone is too cynical to believe it.) Now if the argument was that “government run” is usually not the best example of how to run something, then that is a valid argument. I have worked in several different types of government and have now spent years researching the three sectors of government, non-profit, and the private sector, and government often gets an unfair rap. I used to firmly believe that private sector was the best simply because it was the private sector, but years of experience, research, and the abject failure of some privatization projects (that turned former government to private), have begrudgingly led me to a more moderate conclusion. I am now more of fan of the three sectors working together model (and face it, eventually there is a point where the three sectors have to meet and get along with each other anyway). I think charters and vouchers fit nicely within the three sector model approach.

    So where does this leave the accelerated medical school idea. There is a portion of the population that really needs it and would benefit from the accelerated option. I say take the same approach that I have for charters, and let it have a chance to as an alternative. I really believe that performance, standards, and the end results are what should be ultimately measured.

  25. Devilbunny says:

    RMR/Dad: It would not be hard to push it into 5 years if you got rid of summers off. After all, if you’re going into medicine, you’re not going to be interning at a job the way business majors might.

  26. Devilbunny says:

    Oh, and one more thing – we could treat it the way the British do, and grant the initial degree as a bachelor’s in medicine, with the actual MD earned (if at all) by projects during residency training.