PERSPECTIVE 3-YEAR M D.-- ACCELERATING CAREERS, DIMINISHING DEBT "age creep. "Although shortening UME training alone will not in crease the number of graduating physicians, it will allow graduates to enter practice sooner and there- 5 by increase the physician-years in practice on the national level, The 3-year pathway to the MD ill als so ena between UME and GME. cur- rently, U.S. medical schools with 1990 2011 3-year M.D. programs place grad- uates in residency programs at Percentage of Physicians in the United States Who Are Younger Than 35 Years of Age, their own institutions, engaging 1975-2011 students with mentors in the pro- gram during their first year of Canadian medical schools(Mc- the LCME's minimum require- medical school. Such connectivity Master University s Michael G. ment of 130 weeks of instruc- creates an opportunity to develop De Groote School of Medicine and tion. Unlike the Texas Tech and longitudinal competency-based the University of Calgary s Fac- Mercer programs, NYUSOM's assessment models that span the ulty of Medicine) award an M.D. model is not limited to the train- UME-GME continuum, tracking degree to all their students in ing of primary care physicians. learning and its effect on clinical 3 years. Several allopathic medi- Students in the accelerated pro- outcomes. As an increasing num- cal schools in the United States, gram have been offered condi- ber of medical schools adopt a including Texas Tech University tional acceptance, at the time of 3-year pathway, residency pro Health Sciences Center School of admission to medical school, into grams will probably begin ac- Medicine, Mercer University School a residency program at NYU Lan- cepting fast-tracked students from of Medicine, and most recently gone Medical Center. Interest in other programs, perhaps through NYUSOM, have introduced dedi- this new pathway was high: 50 of a consortium, extending the pos- cated pathways that offer select- the approximately 280 students sibility of tracking learner data ed students the option of obtain- who were initially offered admis- along the UME-GME continuum ing a medical degree in 3 years. sion to the medical school in across institutions In addition, a consortium of six 2013 submitted the required sup- Another benefit of a 3-year medical schools, comprising Texas plemental application for this pathway is its effect on reducing Tech, Mercer, Louisiana State Uni- pathway, indicating interest in 16 the student debt burden. The eco versity, Indiana University School different fields, including both nomic advantage to the student of Medicine, East Tennessee State medical and surgical specialties. is not only a 25% reduction in University, and the University of The NYU program also offers an debt, but also an additional year Kentucky, are in discussions to "opt-in"pathway, whereby stu- of earnings from entering the develop a 3-year M D. model. dents can defer the decision about workforce earlier. According The first cohort of 16 highly fast tracking and specialty choice the Association of American Med- competitive students was admit- until the beginning of year 3, ical Colleges(AAMC), in 2011, ted into the 3-year pathway at when they can make applications the mean medical school debt for NYUSOM this summer. These stu- to one of our(or in the future indebted graduates was $147, 188, dents had a mean grade-point other) graduate medical education with 64% of medical students average of 3.84 and a mean score (GME) programs carrying a debt of s of 36.5 on the Medical College One benefit of shortened train- more. 5 On the 2012 AAMC Medi- Admission Test(MCAT). Four had ing, whether at the premed, un- cal School Graduation Question already earned advanced degrees: dergraduate medical education naire, 50% of graduating medi 2 Ph. Ds and 2 master's degrees. (UME), or GME stage, is to help cal students reported that their Participating students will meet reverse the trend of physician level of educational debt influ N ENGL J MED 369: 12 NEJM.ORG SEPTEMBER 19, 2013PERSPECTIVE 1086 n engl j med 369;12 nejm.org september 19, 2013 Canadian medical schools (Mc￾Master University’s Michael G. DeGroote School of Medicine and the University of Calgary’s Fac￾ulty of Medicine) award an M.D. degree to all their students in 3 years. Several allopathic medi￾cal schools in the United States, including Texas Tech University Health Sciences Center School of Medicine, Mercer University School of Medicine, and most recently NYUSOM, have introduced dedi￾cated pathways that offer select￾ed students the option of obtain￾ing a medical degree in 3 years. In addition, a consortium of six medical schools, comprising Texas Tech, Mercer, Louisiana State Uni￾versity, Indiana University School of Medicine, East Tennessee State University, and the University of Kentucky, are in discussions to develop a 3-year M.D. model.4 The first cohort of 16 highly competitive students was admit￾ted into the 3-year pathway at NYUSOM this summer. These stu￾dents had a mean grade-point average of 3.84 and a mean score of 36.5 on the Medical College Admission Test (MCAT). Four had already earned advanced degrees: 2 Ph.D.s and 2 master’s degrees. Participating students will meet the LCME’s minimum require￾ment of 130 weeks of instruc￾tion. Unlike the Texas Tech and Mercer programs, NYUSOM’s model is not limited to the train￾ing of primary care physicians. Students in the accelerated pro￾gram have been offered condi￾tional acceptance, at the time of admission to medical school, into a residency program at NYU Lan￾gone Medical Center. Interest in this new pathway was high: 50 of the approximately 280 students who were initially offered admis￾sion to the medical school in 2013 submitted the required sup￾plemental application for this pathway, indicating interest in 16 different fields, including both medical and surgical specialties. The NYU program also offers an “opt-in” pathway, whereby stu￾dents can defer the decision about fast tracking and specialty choice until the beginning of year 3, when they can make applications to one of our (or in the future other) graduate medical education (GME) programs. One benefit of shortened train￾ing, whether at the premed, un￾dergraduate medical education (UME), or GME stage, is to help reverse the trend of physician “age creep.” Although shortening UME training alone will not in￾crease the number of graduating physicians, it will allow graduates to enter practice sooner and there￾by increase the physician-years in practice on the national level, helping to address the shortage. The 3-year pathway to the M.D. degree will also enable linkage between UME and GME. Cur￾rently, U.S. medical schools with 3-year M.D. programs place grad￾uates in residency programs at their own institutions, engaging students with mentors in the pro￾gram during their first year of medical school. Such connectivity creates an opportunity to develop longitudinal competency-based assessment models that span the UME–GME continuum, tracking learning and its effect on clinical outcomes. As an increasing num￾ber of medical schools adopt a 3-year pathway, residency pro￾grams will probably begin ac￾cepting fast-tracked students from other programs, perhaps through a consortium, extending the pos￾sibility of tracking learner data along the UME–GME continuum across institutions. Another benefit of a 3-year pathway is its effect on reducing the student debt burden. The eco￾nomic advantage to the student is not only a 25% reduction in debt, but also an additional year of earnings from entering the workforce earlier. According to the Association of American Med￾ical Colleges (AAMC), in 2011, the mean medical school debt for indebted graduates was $147,188, with 64% of medical students carrying a debt of $100,000 or more.5 On the 2012 AAMC Medi￾cal School Graduation Question￾naire, 50% of graduating medi￾cal students reported that their level of educational debt influ￾A 3-Year M.D. — Accelerating Careers, Diminishing Debt Percentage of Physicians in the U.S. <35 Yr of Age 30 5 10 0 15 20 25 1975 1980 1990 2000 2011 Percentage of Physicians in the United States Who Are Younger Than 35 Years of Age, 1975–2011