1-2-3 … Go!

The fast track: Pros & cons of finishing medical school in 3 years

LECOM currently offers the only three-year primary care program at an osteopathic medical school.

In 2007, David S. Keith, DO, MSPH, found himself weighing the benefits of pursuing a career in medicine against the significant financial and time commitments it would require.

The father of two young children at the time, Dr. Keith was especially concerned about the impact giving up his full-time job at United Healthcare would have on his ability to support his family.

An interview at the Lake Erie College of Osteopathic Medicine (LECOM) in Erie, Pennsylvania, drew Dr. Keith across the country from his Salt Lake City home—and would ultimately change the course of his career.

While visiting the osteopathic medical school, he learned of LECOM’s plan to establish a three-year accelerated primary care program, which would allow him to avoid a full year’s worth of tuition and start practicing medicine 12 months earlier than students in traditional programs.

Dr. Keith graduated in 2010 as part of LECOM’s inaugural Primary Care Scholars Pathway class. The program continues today with about 12 students participating every year; it is currently the only three-year primary care program at an osteopathic medical school. LECOM also offers a three-year DO degree program for applicants who are certified physician assistants.

Interested in finishing medical school in three years instead of four? Here are the pros and cons of doing so.

Pro: LECOM’s curriculum is nearly identical to a four-year program’s coursework.

LECOM’s accelerated program aligns with all the existing standards prescribed by the Commission on Osteopathic College Accreditation (COCA)—even the one that stipulates colleges provide four years of instruction, which COCA defines as roughly 130 weeks. The program achieves this by having students attend classes and clinical rotations during summer breaks and take certain courses as independent directed studies.

“When we initially presented our curriculum to COCA, they accepted it with our first presentation because we proved to them that those three years of education were equivalent to the four years that were traditional,” says Richard A. Ortoski, DO, the clinical director of LECOM’s three-year primary care program.

Pro: Receive a 25% discount on your medical education.

Dr. Keith, who graduated with $220,000 in medical education debt, estimates he saved roughly $75,000 by participating in LECOM’s three-year program.

“My wife’s biggest concern about medical school was the amount of debt I would accrue,” he says. “It was nice to have an option where my debt wouldn’t be so insurmountable.”

Pro: Start practicing a year earlier.

Not only did Dr. Keith graduate with less debt, he was able to start practicing a full year early. This head start was crucial for his family because the day after he finished residency, his wife had the couple’s fifth child. To support a wife and five children on a resident’s salary would have been challenging, Dr. Keith notes.

Con: Compressed program means less time off for vacation and test prep.

Students in LECOM’s accelerated program attend classes during the first summer and clinical rotations during the second. Without breaks, the training can be intense and leave little time to prepare for board exams.

Having obtained his MSPH while working full time, Dr. Keith says he was used to constant studying. Still, he says the inaugural class struggled with their second board exam because their schedules were so tight—but that leadership provided more study time for the second class.

Con: Committing to one specialty at the outset.

Students in LECOM’s three-year program sign a contract pledging to pursue a family medicine or general internal medicine residency and to practice primary care for at least five years after finishing residency. If you’re on the fence about your specialty, this program isn’t for you.

Con: Perception by some that three years isn’t enough.

Naysayers argue that as the pace of medical advances increases, medical students need, at the very least, four years to learn everything they need to know to begin residency.

Dr. Ortoski counters this argument with the point that his three-year students have obtained equivalent scores on COMLEX exams to four-year students—and that’s with less time to study.

8 comments

  1. My comments come from a fellow DO who attended DMU/COMS in the 70’s when a pilot three year program was in effect. I do believe we were able to get all the necessary didactic work when compared to my four year counterparts. However, when I began my anesthesia residency at the University of Iowa it became very apparent that my clinical exposure was much more limited than those residents who had attended a four year medical school. My personal opinion is a four year educational process with added clinical exposure is a plus if one contemplates entering a field that requires critical thinking and working with patients with multiple organ system diseases in an intensive care setting. Perhaps the three year program is enough for those interested in primary care.

    1. “critical thinking” , “multiple organ systems” , “intensive care settings” …
      wow sounds like primary care to me
      MSU 83 three year grad

  2. I am also a successful product of the DMU/COMS three year program of the 70’s. Beyond the year around program, we were only required to fulfill a one year, general rotating internship prior to entering general practice. A formal two year residency in family medicine was optional after the internship. Board certification became an option after so many years in practice and most of us who took this career path sat for and passed the certification exams.

    My experience validated I was at least as well equipped if not better equipped to deal with the multitude of challenging healthcare cases I faced as an intern, and I equate much of this to the awareness and exposure my osteopathic training provided. Upon opening my practice following the internship, admittedly I was a bit green around the ears. In retrospect, much of this was about confidence which only came with experience. With the support of the small community I chose to work in and the support of fellow medical providers, I found my way and realized I could compete with the residency trained FPs in most areas, especially in the clinical setting, and for reasons obvious to us, our osteopathic hands-on practical experience gave me a leg up on my colleagues when it came to working with real life issues.

    Congratulations to all involved in successfully creating this three year osteopathic school pathway. The decision to save time and money, while allowing for more osteopathic physicians to be trained, is fantastic. While it may not be right for all students, it clearly has been shown to be another creative way to move the profession forward in these expensive and fast-paced times.

  3. I would like to give further information regarding the Primary Care Scholars Pathway at LECOM. The clinical exposure in the curriculum for the students in PCSP is not simply a reduction in rotations from 24 to 13 as what might have occurred in the past. The curriculum does enhance clinical experiences due to the decrease in rotation time.
    1. Rotations designed as audition rotations for those students not sure of their medical career paths are decreased while others are specified to meet the requirements of a primary care physician.
    2. The students start seeing Primary Care Mentors the first semester and continue throughout the 3 years, even while on rotations.
    3. A second year Enrichment Module exposes the students to different clinical aspects of medicine concentrating on the humanistic aspects.
    4. The students have specific Osteopathic Principles and Practices training throughout their 3 years with monthly capstone experiences on each rotation and a specific OPP rotation.

    In regards to critical thinking:
    Critical thinking as defined by the National Council for Excellence in Critical Thinking –
    “Critical thinking is the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action.”

    I believe all physicians in any specialty have a requirement to use critical thinking in their responsibilities in patient care. Primary care physicians are using critical thinking and are treating patients with multiple organ system diseases such as diabetes, hypertension, cardiac disease, hyperlipidemia, to mention only a few. Many are working in critical care settings.
    There is no justifiable reason to minimize primary care physician training, careers, or practices when they must be knowledgeable regarding all specialties to serve their patients and yet refer when necessary.

    1. I agree! Its even harder, our scope is huge!!

      As per his # points:
      #2 was amazing and helped me work closely with a Family doctor who became a great mentor (as well as Dr. Ortoski) during medical school.
      #3 The modules placed me in experiences in hospice, an STD clinic, and other experiences side by side with staff in very crucial situations that helped me become more understanding of the complexity of what I chose to pursue.
      #4 I felt my OMT skills were greater than my counterparts, even now, one of my LECOM classmates who started with me, but did 4 years, doesn’t do as much OMT as I, and many of those I know don’t either, I had extra training in it and was encouraged in residency to continue to use it. I use it nearly daily in clinic and hospital. We had time every rotation to reflect and focus on what we were doing in preparation for Primary care all alone in capstones discussions.

  4. Dr. Ortoski did a great job using the clinical enrichments to catapult those of us in the pathway to greater preparation for clinical rotations. By the time my entering classmates in the regular pathways came into the same clinics, I was already up to speed and running!

    For me it truly was a blessing and I think it has a place for the right student. The first class did have several people who did not finish, it wasn’t right for them and that was good to find out.

    For me, I feel that residency was no more difficult than my peers, and did well on in-training exams. I passed BOTH boards when I was done without difficulty.

    I do full scope FP with OB + C/Sections, ER medicine monthly, inpatient and hospice medicine. Many choices and work due to my initial exposures to the PCSP enrichments which prepared me well.

    I think its a great choice for any student as passionate about primary care as me, and not because it lacks critical thinking, but because it requires a LOT of critical thinking. Organ systems and personality conflict/cooperation, and coordination of care.

    Thank you LECOM, and Dr. Ortoski!

    David

  5. Three year programs started during WWII to keep doctor supply adequate. It produced a lot of mediocre doctors in primary care but did not affect specialty care which narrows the volume of medicine a doctor must master and practice. That may have been a force that created a massive trend away from primary care in the first place-lack of depth in clinical experience and training-so narrow to a specialty.

    Time and money are important but with medicine becoming more complex by the day we cannot shortchange doctors by compressing our 4 year curriculum into three. I think it might be longer to be even more effective.

    As a parallel, lawyers have three years and have to find their specialty niche after graduation and get mentored and maybe certified when an added year would help them a lot for some type of special interest pursuit.

    I say keep the four years and make a better doctor.

Leave a comment Please see our comment policy