Around 75 percent of U.S. physicians are U.S. MD/DOs who have completed pre-medical training, while the remaining 25 percent are international medical graduates (IMGs) who may not have completed pre-medical training but are still able to take the United States Medical Licensure Examination (USMLE) and become licensed to practice medicine in the U.S.
From the patient’s perspective, pre-medical training may not be necessary unless pre-medical training-deficient IMGs are not evenly distributed among active U.S. physicians across the country. There may be a disparity in the recruitment of active U.S. physicians, with health care resources naturally directing pre-medical training-deficient IMGs to serve underserved populations.
Assuming four years of college for pre-medical training, four to five years of medical school in a U.S. MD/DO program, and three to four years of graduate medical education (GME) residency program, a U.S.-educated person can become an independent physician at around 30 years of age. In comparison, a person who completes a six-year medical college program in an international MBBS program followed by three to four years of GME residency training can start practicing medicine independently in the U.S. earlier, unless their preparation for the USMLE delays their entry into GME programs. Nonetheless, U.S. physicians are likely to begin practicing independently around the age of 30, regardless of whether they have completed pre-medical training or not.
Is the four-year pre-medical training preventing U.S. citizens from choosing to attend medical school before the age of 22, and is this inadvertently creating a disparity in the physician workforce? Are international medical graduates prematurely choosing to attend medical school at age 18, and is this impacting the quality of health care both in and outside the U.S.? If not, what is the purpose of the four-year pre-medical training?
Puberty typically occurs around the age of 11-12, and adolescents have the opportunity to mature under supervision before being emancipated at age 18. However, if maturity to become a U.S. physician is not achieved until age 22, how can individuals enlist in the U.S. military at age 17, despite needing to complete a four-year college program before becoming an officer?
In modern times, is the period of neoteny (extended adolescence) being prolonged compared to ancient times when our adolescent ancestors were exposed to more opportunities and experiences earlier? Why are there different age requirements for adulthood, emancipation, driving, drinking, and voting? Is there no single age that works for everyone, as individuals genetically and environmentally mature at different rates, and there is no clear diagnostic method to assess maturity levels in terms of effectively managing one’s emotions?
If neither chronological nor mental age is the issue, could it be assumed that U.S. high school environments are not adequately preparing adolescents to make informed decisions about their futures, leading them to wait until they are in college before considering a career as a U.S. MD/DO? Alternatively, is it purely an economic decision, with mandated college education generating revenue for society after compulsory public schooling has depleted societal resources?
In essence, mandating pre-medical training may be exacerbating disparities in the physician workforce by only allowing privileged U.S. individuals who can afford to take on four years of college debt to pursue medical education, while marginalized individuals may drop out of college due to the burden of debt or never consider becoming U.S. physicians in the first place by not enrolling in college.
Deepak Gupta is an anesthesiologist. Sarwan Kumar is an internal medicine physician.
