USMLE hurdles an unneeded turn-off to those considering a medical career

Regarding "Physician shortage? Push is on for more medical students" (Article, March 14): Your article is well-taken, but there was a major issue that was not considered in it. A point has to be made about the influence of the National Board of Medical Examiners on medical school application numbers.

In addition to the expense of attending a U.S. medical school, a fairly well-informed college student will be aware of the proliferation of examinations required for U.S. medical school graduates to earn the privilege to practice medicine in the state or states of their choice.

It was bad enough when students had to take only the U.S. Medical Licensing Examination step 1, USMLE step 2 (clinical knowledge only), and the USMLE step 3 examinations. With the addition of yet another even more expensive test to an area that is already heavily burdened with very expensive and potentially devastating tests, it is no wonder that large numbers of college students who are interested in medical careers are opting for physician assistant programs, nursing programs, optometry programs, and PharmD programs.

Logically, if a U.S. citizen or permanent resident alien has been deemed acceptable for matriculation at an accredited U.S. medical school, based on college performance and MCAT scores, that student should be required to take only the USMLE step 3 examination in order to obtain a medical license. Otherwise, what does medical school accreditation mean?

The USMLE step 3 is really the only National Board of Medical Examiners test that is relevant to the safe practice of medicine for graduates of accredited U.S. medical schools. Requiring U.S. medical students to take all the USMLE steps suggest that U.S. medical school accreditation means absolutely nothing.

This further suggests that U.S. medical schools have no confidence in their educational efforts and have failed their mission to produce competent physicians. The residency programs then receive these students and somehow manage to transform them into competent physicians. Consequently, the National Board of Medical Examiners' series of tests have become Band-Aids applied to the gaping wound of U.S. medical schools' educational failure during the first four years of medical training.

Combined with the expense of obtaining a U.S. medical degree, the proliferation of USMLE step examinations will continue to induce excellent potential physicians to turn away in disgust. Meanwhile, the U.S. medical schools will, no doubt, continue to pass their medical educational responsibilities to the residency programs and USMLE-driven prep courses, while increasingly focusing on basic science research and the lucrative funding that is obtained through their PhD faculty.

Dennis C. Wooten, MD, PhD, Dallas

Note: This item originally appeared at http://www.ama-assn.org/amednews/2005/07/11/edlt0711.htm.