For most medical school students, summer means fun in the sun and a much-needed break from studies. But Aljanee Whitaker was hard at work in mid-June, having just started a year-round UC Davis program that fast-tracks primary care doctors to graduate in three years instead of four.
About a dozen medical schools in the nation now offer a three-year medical degree program. Many focus on primary care, an area where low-income patients say it’s almost impossible to find a doctor. The U.S. is expected to face a shortage of 45,000 primary care physicians in the next eight to 10 years. The problem may be worse in California, where 5 million new patients are enrolled in coverage through the Affordable Care Act and in need of general physicians.
Health care reform happened as many primary care physicians were retiring, and few young doctors were coming in to take their place, said Dr. Calvin Wheeler, institutional director for undergraduate and graduate medical education at Kaiser Permanente Northern California. During the last four years, the American Medical Association has given out millions of dollars in grants to fund “competency-based” programs, which push students through the pipeline based on skill level rather than time spent in school.
Cutting down on school time and payments is a key way to draw students into primary care, which tends to be less lucrative than specialty practice. Medical school at UC Davis costs about $40,000 annually for California residents and $52,000 for other students.
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“Over the last 15 years, physicians looking at the increasing cost of medical school, and the increasing debt to pay it back, began to look at specialties where the salaries were higher,” Wheeler said. “There’s been a shift toward dermatology, radiology.”
Whitaker, 27, is one of six students in the new cohort of the Accelerated Competency-based Education in Primary Care program offered through UC Davis and Kaiser Permanente. Launched in 2014, the program just graduated its first group of doctors, who are now in medical residencies throughout the region. Another 19 are working toward degrees. Students skip summer break, instead splitting their time between classes and clinical observation.
“What really drew me to the three-year program is it allows me to do what I want to do, faster,” Whitaker said. “Financially, it’s easier. For me, knowing I don’t have to pay for another year of medical school makes it much more attractive. Later on when I start my practice, I won’t have to worry about debt – I can focus on serving patients.”
Unlike traditional medical school students, Whitaker and her classmates won’t spend time during their senior year interviewing at residency programs all over the nation. Instead, UC Davis and Kaiser Permanente work together to place primary care students in residencies at the UC Davis Medical Center, Kaiser Permanente Napa-Solano, Kaiser Permanente Santa Clara and other regional hospitals, said Dr. Tonya Fancher, associate dean of workforce innovation and community engagement at UC Davis.
During their three years, students learn how to interact with patients in a clinical setting, and how to treat common primary care conditions such as diabetes, obesity and high blood pressure. The program gets several hundred applicants per year, Fancher sid.
“We think of the clinical exposure as the framework to learn all the other stuff in medical school, which flips the way medical school usually is,” Fancher said. “You can learn anatomy and biochemistry and then see patients after two years. But you can see patients and experience the joy of taking care of them, and then you learn the anatomy and say, ‘That’s what’s going on.’ ”
Some leaders in education have questioned whether students can thoroughly learn the skills needed to be a primary care physician in just three years. Dr. Fredric B. Meyer, dean of the Mayo Clinic School of Medicine, said it’s doable, but difficult.
“It’s going to be a little more intense, and it’s going to require students to really commit to that effort, and it’s going to require more work,” he said. “It’s going to be a little harder to preserve a ‘wellness’ approach in a three-year medical school, because inherently things are crammed closer together.”
Whitaker said she’s used to giving up summers to study or gain practical experience. Currently she and her classmates take courses three days a week and shadow a doctor in clinic two days a week. On top of that, Whitaker spends about four hours each day reading case studies and preparing for class.
“(Working in the clinic) really gives purpose to your book work,” she said. “Thursday we were learning about chest pains, and on Friday at clinic I knew why the doctor was asking certain questions. It really clicked and helped solidify the information in my head.”