For-profit undergraduate medical education: back to the future?

One hundred years ago, Abraham Flexner wrote a report that profoundly influenced U.S. medical education. His conclusion-that medical degree (MD)-granting education programs should occur in not-for-profit universities and include hands-on laboratory and patient care experiences in teaching hospitals and clinics-led to the creation of the current model of U.S. MD education. Although this model has served the United States well, it is lengthy and costly. As the United States struggles to deal with a growing shortage of physicians, other models of medical education, including osteopathic medicine and offshore, MD-granting schools, have increased production of graduates. New private colleges of osteopathic medicine, including one accredited proprietary school, are nimble, cost-effective competitors for MD-granting schools. Do these schools portend the establishment of a U.S. for-profit medical education sector in the same way that proprietary universities have become well established in higher education? How should MD medicine respond? Can and should MD educators shorten the time needed to produce a fully trained MD-holding physician? How can MD educators make the training process shorter and less expensive to respond to the nation's physician shortage while maintaining the appeal of MD careers and without compromising educational quality? Models of shorter, less expensive pathways to earning an MD exist and have proven effective. Now is the time for MD educators to debate whether they should apply these pathways more widely. Six recommendations could help realize the goals of shortening and making less costly the training of MD physicians in the United States.