I graduated from the Penn State University/Thomas Jefferson University premedical-medical program (i.e., their accelerated BS-MD program) in 2004, as a 6-year programmer (colloquially known as a Prog). I matched at Jefferson for my emergency medicine residency, serving as chief resident in my senior year. July 2020 will mark the start of my fourteenth year as a Jefferson attending physician.
I read the recent Academic Medicine article by Gonnella and colleagues with great interest. Since 2004, I have often thought of my time as a Prog. One of the most meaningful experiences of my life, the program substantially impacted my formative years. I have found that the reduction of school debt is absolutely true (and much appreciated). Additionally, for me, the program’s attractive conditional acceptance to medical school ultimately superseded an option to study engineering at a respected university elsewhere.
That said, the path was not easy. I faced great criticism before I was even accepted to the program. “I don’t believe you really want to be a doctor. You’re doing this because your parents want you to.” My interviewer’s words of doubt about my motivation remain seared in my memory.
The program is not right for everyone. The Gonnella and colleagues article identifies a Prog’s decreased global satisfaction with medical school (particularly, the second year). My second year was the emotional nadir of my professional life. I was 21 years old, strained by the pressures of competing against colleagues with abilities I believed dwarfed my own. I saw former high school friends receive job offers, graduate from college, and productively join society. Meanwhile, my school workload was ramping up with board exams imminent. (This tension may ease in the future, although I doubt it, as more schools and the boards themselves are transitioning to pass/fail grading.) Medicine is a path of delayed gratification. All medical students feel this, though traditional medical students might feel this slightly less, depending on their previous academic path. By year two of medical school, a Prog has experienced no graduation since high school (a rare few even forego that), an accomplishment and rite of passage that has an impact, seen or not.
Therefore, motivation, as my interviewer clearly understood, is of utmost import. I would not have survived even the first year of medical school, far less the years that followed, had my primary impetus for medicine been anything but genuine. I did not choose this program because my Asian parents wanted me to become a respected physician. I wanted to be a physician because my grandmother passed away from complications from a car accident when I was an impressionable 13 years old. Her doctors did not take time to care for us, her family, in our time of need. Given the chance, I vowed never to let a family suffer the same way.
A capable person truly wishing to become a physician has every advantage to gain by choosing a premedical-medical program such as the Penn/Jefferson program. Gonnella and colleagues demonstrate no differences in various outcomes between program students and traditional medical students over 47 years. The program does what it intends—it produces competent physicians at a speedier pace than the normal process. That timeline is not suitable for everyone. Many Progs face valid criticism for being emotionally immature compared to traditional medical students who generally have more life experience. If a Prog lacks sincere internal motivation, the problems compound, and the already arduous journey is even more formidable.
Of note, the program was partly created to address the need for primary care physicians in rural and underserved communities. Gonnella and colleagues demonstrate the specialty choice of program students mirror that of nonprogram students. Thus, the program does not predispose its students to choose a certain specialty. Without added covenants, the program cannot serve as a vehicle to meet our country’s (increasing) need for primary care physicians.
Fears of whether the accelerated pace of such programs may compromise educational or professional outcomes could be dispersed, in my opinion—so long as both the motivation for the program’s existence and those of its enrollees remains a true-hearted desire to contribute to the betterment of humanity.
By: Wayne Bond Lau, MD
W.B. Lau is professor of emergency medicine at Sidney Kimmel Medical College/Thomas Jefferson University Hospital in Philadelphia, Pennsylvania. He is a clinician, researcher, and teacher. He tweets daily at the handle @WBLMD.
- Gonnella JS, Callahan CA, Erdmann JB, et al. Preparing for the MD: How long, at what cost, and with what outcomes? [published online ahead of print March 10, 2020] Acad Med. doi: 10.1097/ACM.0000000000003298