A doctor by age 24?

It may be possible at Queen’s in 2013

Photo by Andrew Tolson

Queen’s University may soon allow gifted high school graduates to enroll in a six-year program that would offer them a Doctor of Medicine (MD) degree by the time they turn 24-years old.

The Accelerated Pathway to Medical School program received faculty approval on May 4 and will be considered at Queen’s Senate in the fall.

The length of medical school has long been debated. In English Canada, students must complete three or four years of undergraduate education before applying to four-year medical programs.

Fierce competition means that most students who get into MD programs already have four-year degrees. Indeed, many have master’s degrees, which take one or two years more to complete.

That means most doctors aren’t practicing until eight, nine or 10 years after high school. For someone eager to work in family medicine in a region with a doctor shortage, it’s simply too long.

Some people will question whether six years of school is enough. But as Queen’s Dean of Medicine Richard Reznick points out in the Queen’s Journal, shorter programs work fine in Europe and Asia.

While the program is exciting news for future doctors, young brainiacs shouldn’t get too excited. Admission would require a high school average of at least 90 per cent, a nomination from a high school and the completion of an interview. Only ten students per year would be taken.

The University of Texas is also piloting several programs that aim to reduce the length of medical school. One program, called SHAPE, will offer 60 freshmen students a guaranteed spot in a four-year medical school program if they do well in the first three years of school, starting in 2013.

To see a list of admission requirements for Canadian medical schools, click here.

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A doctor by age 24?

  1. I don’t how this is much different from what is done in Quebec already where students graduate high school after completing Grade 11 (at 17 years old), do two years CEGEP (bringing them to 19 years old) and can subsequently enter medical school as a pre-med for one year. They then complete their three year MD. Any student who does this (and I have friends who have) would have their MD at the age of 23.

  2. I graduated as an MD from University of Ottawa at 22 years of age in 1977. At that 25% of students to med school were accepted after two years of undergraduate education.

  3. High time. The North American model makes little sense – the value of the pre-requisite undegrad 3-4 year period is debatable, and simply adds time and cost. Current realities and future projections dictate that we can ill afford the wasted time and cost. In South Africa, I completed Grade 12 at the age of 17. Med School was 6 years : I was a qualified MD at age 23, and after a year’s internship was up and practicing independently as a GP at the age of 24. Compare this to the North American model of entering practice in their late twenties or early thirties at best. And I challenge anyone to produce hard evidence that the North American model produces a superior MD to the model followed in South Africa, the UK, Ireland, Australia and New Zealand.

  4. The length of time it takes to become an MD in Canada is a great deterrent to not only the underprivileged for fear of the mountain of debt you have to incur, but also to women who want to have a stable career before starting a family. Being in your mid-late thirties by then doesn’t give you much time to do so. This is a step in the right direction.

    • Both your points are untrue.

      First, let me suggest that anyone who is deterred from medicine because it will take “too much time in school,” or incur a “mountain of debt,” is not properly motivated to become a doctor. NO underprivileged person would ever be unable to attend medical school because of cost – if you think this, you simply aren’t properly informed. I did not receive a dime of “family money” to attend med school (at age 30), nor did I have savings; the day you’re accepted, you’re extended an extremely generous line-of-credit regardless of collateral – your future career IS your collateral. My (highly-motivated) best friend finished residency (where you “start off” earning about $48K) and paid off $165K of student loans in less than a year. It took me considerably longer, but be serious – medicine is a well-paying job regardless of what specialty your choose, and you don’t hear doctors complaining about being broke.

      As for having a family, MANY of my classmates already had children when they started! We had several married moms, several single moms – even a single dad; one woman had a baby while IN medical school, and MOST WOMEN who want babies have them during residency because it is their last chance to take advantage of paid maternity leave – something OHIP doesn’t provide.

  5. I think our current system in Canda takes too long for students to complete their medical training. It is also extremely costly for students to complete their 3 or 4 years prerequisite training, particularly since many are then not accepted into a medical program and are left with a degree they may not be able to find work with. A direct entry program into medical school would be a much better approach, more time efficient and less expensive for the student. Other professional programs such as engineering and nursing accept students directly from highschool, why not medicine?

    • You make a fair point about students graduating with science degrees and being unable to get into med school. Still, “more time-efficient and less expensive” doesn’t mean better – the system you propose would require serious, virtually lifelong commitments from what are basically teenagers – young people who, simply by virtue of their age, are still emotionally immature and have little life experience to draw on. Simply put, 17 is too young to be deciding what to do for the rest of your life.

      A little-known fact: each year, on average, one medical student or resident in Canada commits suicide. I don’t think this is because of the stress of medical training, but instead, because they realize this is not the job for them. But what are you going to do? Walk away from $165K in student debt? Disappoint your family – in many cases, a family from a culture such as China, where the whole family is counting on you to support them? Yes, engineering and nursing accept students directly from high school – but that doesn’t make those systems are right, either, just because they exist. Thanks for considering these points.

  6. I can see the need for shortening the time for becoming an MD but the idea of direct-entry into an MD degree program after high school would worry me. High-school achievements are suspect nowadays. As a professor I have seen students with high-school averages in the 90′s perform poorly at university, as well as students who were undistinguished in high school do extremely well at university. I’d still prefer prospective med students to have a year or two of arts and science, so that they can to some extent show their true colors. Their performance in those courses could then be used to determine eligibility to sit for an entrance exam for med school.

    • Well-reasoned. A valuable opinion from someone on the “inside.”

  7. I couldn’t disagree with this more. I am a physician myself, working at a university student health clinic where I have seen thousands of young people struggling to figure out what they want to do with their lives. This is exactly what they *should* be doing at this age! There is simply no way that someone at 17 years old (when someone would apply into this program) can *know* that medicine is for them. To hear a teenager say, “I’ve always known I wanted to be a doctor” makes me laugh, because here’s what it really means – “I think being a doctor sounds cool, I love the show ‘House,’ and my parents brag to all their friends that I’m going to be a doctor.”

    Despite the prestige for which medicine is known, being a doctor is a service-oriented job. And it requires far more than being book-smart. I’ll give you an insider tip – med school isn’t actually that hard – but it does require a high degree of maturity and good clinical judgement, and someone simply can’t have this without the benefit of age. Medicine isn’t just about diagnosing a serious illness – nearly anyone can be trained to follow algorithms to do that – it’s about knowing how to tell someone the bad news, how to comfort them, and sit with them while they go through the process. Few people would find comfort in the words of an uneasy 21 year-old-in-training.

    This article is deceptive – it says “For someone eager to work in family medicine in a region with a doctor shortage, [the length of training at present is] simply too long.” Guess what? Most doctors don’t go into family medicine – even if they say they’re going to at their med school interview. There’s lot of reasons why this is the case, but it’s an undisputed fact. What’s more – most who DO go into family medicine, don’t head for rural areas, and this is despite financial incentives. Every year, family medicine residency spots go unfilled, and letting kids into med school isn’t likely to change that.

    This is not an answer to the doctor shortage – I believe it’s an attempt by Queen’s to set themselves apart from other med schools in some ways, because their reputation has been suffering in recent years. The government could solve the doctor shortage very simply by licensing extremely competent foreign doctors with an agreement that they work in under-serviced communities, rather than having them drive taxi’s. But the government doesn’t want more doctors, because every time you go to the doctor, it costs money. The new solution is to create a population of “nurse practitioners” – to give nurses a little more prestige and a little more money, and save on the cost of doctors.

    My opinion, for what it’s worth. Thanks for considering.

    • I used to think similarly until I went to med school in Ireland and saw first hand 17-18 year olds succeeding and thriving in their medical studies. Sure some of them could have been viewed as being immature, however for the most part they seemed fairly mature and acted appropriately in sensitive clinical settings. In fact, I initially thought many of my classmates were 21-22 years old when we started until someone informed me that in fact they were admitted into med school right out of high school. I’ve been around both mature 20 year olds and immature 30 year olds. It is not fair to judge one’s level of maturity simply on their age. Additionally, with regards to a young adult not being able to truly decide on a career choice, why then do I hear of 30 year olds who after a few years of med school or residency later deciding that medicine is not for them and then dropping out of the field entirely?… Perhaps Canadian medical schools should start recruiting from old age retirement homes. Then we can all be sure that they are mature and ready.

  8. Jeremy : if your assertions are correct, why does the model followed in the countries I mentioned work so well ? Care to provide evidence to back up your statement that a 21 year old is incapable of sufficient maturity / judgement to make it through med school ? The very existence of those programs producing MDs on par with their North American equivalents illustrates the contradicion. With respect, your assertions are based on assumptions based on your experience of “the way it’s always been done here”. Imho it also smacks of medical elitism – your rationale of “immaturity” would need to apply to an airline pilot / structural engineer / nurse etc in training. There is no evidence that the requisite undergrad is required to “mature” someone sufficiently, nor should it be the intent or purpose. It’s an inherent quality : you either have it, or
    you don’t by the end of your Grade 12 career – and no, I don’t believe the Canadian school system is flawed in comparison to the countries I mentioned. I don’t tout this as a solution to the doctor shortage, but on the basis of it being non-evidence based and an irrational financial barrier to those who have decided (despite your assumptions as to their motivation) to pursue a career in medicine. Just my two cents.

    • The assertion that the model followed in other countries “works so well” is based on what? You ask me if I care to produce evidence that the North American model works better – yet where is your evidence that it doesn’t? You need to apply your own requirement for “evidence-based” arguments to your own. Ironically, we don’t automatically accept foreign-trained graduates as being “on-par” with those trained here in Canada (I don’t agree with this, and I think there’s other reasons for blocking foreign-trained MDs from practicing in Canada, nonetheless, it’s the party-line).

      People may jump all over this, but I’ll say it nonetheless – I believe (and yes, based on my own anecdotal experience, just like yours), that young people of different cultures may, by virtue of that culture, mature at different rates. I have been struck – literally, by the high degree of maturity seen in young doctors who have grown up and trained in the Middle East; I don’t pretend to know why this is, it’s just something I personally observed.

      Some 30 years ago now, McMaster University became world-renowned for it’s ground-breaking program of “small-group problem-based learning,” which is the model now followed by all “modern” medical schools (ironically, I heard that Queen’s medical school was recently criticized for not modernizing in this way). McMaster also became renowned for valuing the life experience of the older applicant – traditionally (and probably even now in most places), it would be more likely for a prospective med student to face age discrimination on the basis of being older – not younger.

      Contrary to what you say, I don’t assert that an undergrad degree is required to “mature” someone – I do assert that a period of time is required to do this. Might the benefit of a few years make someone a better pilot, a better nurse, or a more competent engineer? Actually, I have no idea – but neither do you. I doubt there have been studies done to look at this (and of course, we would need to qualify what we mean by “better”). My perspective doesn’t come from “medical elitism” – indeed, I am probably the least-elitist physician you would ever care to meet, and I am a staunch believer in change (for eg. changing the ridiculously outdated practice of 36-hour call, propogated by physicians because “it’s the way we did it”), however, I believe in change-for-the-better – not change-for-the-sake-of-change, or change to adhere to another country’s model, without clear evidence that that country is doing something better.

      I respect your perspective as a younger student – and person – however, I would ask that you respect a different perspective as well. From my experience, it is more common for a younger person to later change their mind (because a young person’s mind, literally, is “changing”) – though yes, of course it *could* happen to anyone, at any age.

      As an aside, I well recall watching the appalling behaviours of some of my younger classmates amd thinking – boy, if these kids had worked even one year in the real world (an actual job) where they weren’t automatically extended reverance for being “Dr Anyone”, they’d get their asses fired in short order, and learn respect for ALL members of a medical team, including those they see as “lower” in rank.

      Elitism can be observed at any age, but it has to start sometime, and I hazard to guess that for many, it starts early; to my mind, every medical student should have documented experience of working in service industries, to suggest that they’ve done more than “think” about whether working with – and in the service – of others is truly for them. I’d trust this more than a high mark in physics – again, why some schools, again following McMaster’s lead, are ditching the outdated science requirements in favour of candidates with superior communication (rather than superior science) skills. As you’re probably seeing, the learning of medicine isn’t actually that hard – but the practice of medicine is indeed “an art.” Thanks for considering this long-winded reply!

      • Jeremy, just to back you up based on my anecdotal evidence, I offer the following story. Right after my husband’s second year in medical school, he did a rotation at a major hospital in Dublin, Ireland. This was only about 5 years ago, so these events are not ‘outdated’. My husband at the time had only completed 6 months of ‘in hospital’, clinical training. That being said, the residents at the hospital, who were left alone with patients to make life and death decisions, had less clinical training than my husband. In fact, they do not receive clinical training as part of their medical degree. Their medical degree is purely theoretical and they are expected to ‘learn as they go’. Yes, medical students here are also left alone with patients and may make mistakes, but as they are students, the degree of supervision of their actions was higher in Canada (from what I know from my husband) than in Ireland.

        Obviously, the above is only a statement about medical training in Ireland. Also, likely, with a few years of residency under their belts, Irish doctors probably ‘catch up’. That being said, from what I have seen, even developed Western countries may not have medical training anywhere on par with Canadian medical training … perhaps if Ireland’s medical training was longer they would have had the time to train their doctors in a medical setting.

  9. In response to “Me” – that is certainly interesting, and actually quite relevant, as I know of many Canadians who receive their medical training in Ireland. The “hands-on” clinical training starts early in Canada by means of a practical “clerkship,” although at McMaster (at least), the hands-on aspect of learning begins on Day One.

    A little-known fact that may surprise some – medical school at McMaster is short – primarily because there are no “summers off” – and so the entire length of medical training prior to residency is not 4 years, as it is at Queen’s and most (perhaps all?) other Canadian med schools, and not even 3 years, as is commonly believed for McMaster, but in fact, even shorter – just 2 years and 8 months! Not drawing any conclusions based on this – I’m just saying it’s interesting.

    As you say, your point – and also my points, and the points of the other posters here – are largely anecdotal, and of course, that makes it hard for us to say anything with certainty. There simply are no studies, to my knowledge, to compare different medical training models in a way that would determine which makes a “better” doctor (if we could even define what that it).

    There’s no doubt about it – each person is unique, and certainly there must be highly mature 18 year olds (though I hazard to guess my own father was not one of them when he began medical school in Glasgow at the precocious age of 16 – at the time, the youngest student ever admitted to Glasgow Medical School). My father will tell you today that 16 was far too young to embark on medical trining; not to say it would be for all younger people, just that it was for him – despite how well he had (clearly) distinguished himself academically.

    Perhaps there are those who would be mature enough to drive before 16, and drink before 19. But how do we know who these young folks are? What test would give us confidence in waiving these age-minimums – and really, what harm is done anyone is waiting – for driving, for drinking, OR for attending medical school? In all these instances, I’d prefer to err on the side of caution, not just for society at large, but for the young person themselves. Anecdotally, I was witness to a grave error in judgement, which I believe may have been made because of the student’s very young age. No way to know, of course, but I was left wondering.

    Finally, consider this – those arguing in favour of deciding on medicine at age 17 and starting at 18, are *themselves* young people! They will no doubt argue the following enthusiastically, but consider this – their arguments are limited for exactly the reason in question – because they are the perspectives of a young person! Like your husband, I have been a young person AND an older person, and I’d be curious to hear these youngsters points-of-view as they themselves age and mature. It may well be that, with the benefit of time and experience, they might appreciate the point I’m making. Of course, they may not – but only time will tell.

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