A practicing physician can look back to answer the question: what time was wasted during training? In other words, what was not applicable and forgotten. The answer is about 50% of college, 40% of medical school, 20% of residency and 20% of specialty training. Altogether the inefficiency of training (wasted years) adds to about 3 years for primary care and 4 years for a specialist. Wasting years of time is bad for students and bad for the US health care system.
Freedom to choose a type of practice seems to be the basis for US training. Consequently, the training is designed for maximum student choice. Required courses cover all the basics until far into training when finally a choice dawns.
The illusion of choice is the student never knows what practice is like, does not know what care givers are actually needed and assumes they can practice anywhere. Sometimes they choose just based on potential income — since they do have to pay off student loans.
Some would say: the student paid for training so they are entitled to choose. The fact is they pay a very tiny fraction of training cost, which society reimburses them many times over. Reimburses with a salary after medical school, reimburses by taxes going into Medicare and Medicaid, reimburses from insurance premiums paid by individuals and business. Society is paying for health care providers in aggregate. Health care has become a utility.
Given the utility nature of healthcare providers, why should health-care students have full choice of specialty, location or fees? A proper utility should provide uniform service and access where needed.
The problem: a disconnect between the demand for manpower and the product of training.
A solution: The pay-forward system. Openings for health care training should be presented before college. The student makes a decision very early. Education can be focused and much shorter. The options might be: nursing, primary care, laboratory medicine, surgical specialties, anesthesiology,dermatology, radiology, hospital care, or medical specialties (with a similar manpower guided choice a few years later). In exchange for participating in the new system, education is free to the student — paid for by reducing the salary over the career of the provider. But, there is an obligation to practice what and where manpower demands indicate.
The advantage of focused training is the ability to go into productive work in less time:
Dermatology: 6 years (vs. 12 years)
Primary care: 7 years (vs. 11 years)
Cardiologist: 8 years. (vs. 14 years)
Neurosurgery: 12 years (vs. 18 years)
Those students who perceive the need for a more broad education could spend several years in college pursuing whatever they want before committing to the health care track. One would expect some students would not make the grade needed in the health care track — they may want to fall back on another career possibility.
The University is helped by moving health care training away from other majors. The new track would allows majors in chemistry and biology to concentrate without the competition of pre-med students who do not intend to work in those fields.
The best part is the results of training program yield the providers needed. And, the providers practice where there they are needed — without crushing debt.