Letters to the Editor
Dr. Walsh is advocating for gathering evidence about all the possible ways the medical education system can transition to one that improves the quality of the educational experience being provided while at the same time decreasing its cost. This is, of course, a laudable goal. But the immediate challenge now facing the U.S. graduate medical education system is to increase the number of entry-level and subsequent-year training positions in the system’s core specialties, thereby increasing physician supply, without increasing the aggregate cost to the country. I maintain that the only way to increase the number of training positions in core specialties in a budget-neutral fashion is to decrease the length of the training required in those specialties by shortening or eliminating certain training experiences that are currently required for accreditation purposes.
The fact is that the nature of practice in the U.S. health care system has changed dramatically in recent years, resulting in a narrowing of most physicians’ scope of practice. As a result, there are examples of training requirements in every core specialty that could be eliminated without adversely affecting a resident’s preparation for modern-day practice. That being the case, there is no legitimate reason why residents should be required to spend time on those rotations, and they should be eliminated. It is essential that the specialty boards and the Accreditation Council for Graduate Medical Education’s Residency Review Committees revise current training requirements in ways that will allow residents to experience only the education and training experiences they truly need to prepare for practice. This is the only way that the length of training can be shortened to allow a budget-neutral increase in the number of training positions needed to increase physician supply.
Michael E. Whitcomb, MD
Medical education consultant, Phoenix, Arizona; firstname.lastname@example.org.