Doctor Training

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Only a handful of decades ago, we knew so little about the human body and its possible ailments that when someone said "doctor," she implied a person who treated all problems, from pregnancy and childbirth to cancer and tuberculosis.

That was then, this is now.

Today, we know so much about the human body and its conditions that many physicians have specialized—specifically focused on infectious disease, or pregnancy and childbirth, or cancer—and some have subspecialized—concentrating particularly on one type of cancer or infection. Some physicians even have subspecialized further: I know of radiologists who focus specifically on soft tissue in the hands, for example.

We know so much about each possible medical area, physicians today can focus extremely narrowly. And they do.

So I'm not sure I understand the logic behind today's medical training.

As of right now, after undergraduate school, future physicians attend medical school, where they spend four years learning a little about every specialty. They do a rotation in proctology, for example, which they follow with a rotation in orthopedics, after which they do pathology, and so on. After these four years, they focus on a specialty, which then serves as their focus for four years in residency. Often, after residency, physicians undertake a fellowship, where they gain even more practice and education in their specialty.

After all that—a solid ten years of education after four years of undergraduate school—physicians practice medicine.

Given that physicians cannot possibly gain a deep knowledge in every specialty in medical school—as they only spend a brief period in each one before they move on—wouldn't it make more sense and produce better physicians if students pick a specialty after undergraduate school and spend medical school focused on acquiring deep experience in their chosen specialties and learning only what they need to know about related and affiliated specialties?

A brief search turned up a few clinical professionals advocating medical education reform, so I'm not alone in this thinking—and that's validating (and a relief). Their editorials point to studies that found no evidence that physicians in shortened medical training programs performed worse on exams, in residency placement, in practice, or in "other significant metrics of competence."

After all, physicians don't need a particularly deep knowledge in other specialties to do their jobs well. Other than knowing that certain medical conditions can cause or complicate certain mental disorders, why does a psychiatrist need training in proctology? If he believes a psychological issue is related to some other cause, he will refer that patient to another doctor—not personally treat the patient.

Reforming medical education in this fashion would vastly shorten the time it takes to produce a practicing physician, reduce the cost of educating physicians, and likely produce better doctors, who have had more focused training on their particular areas of interest and future practice.

And given that there are concerns about a coming shortage in doctors, couldn't this reform help?

Thoughts? Am I missing something? Is the current system to train physicians ideal? Does my suggestion make sense? Why or why not?