For more than 75 years, the Liaison Committee on Medical Education (LCME), a joint venture of the American Medical Association (AMA) and the Association of American Medical Colleges (AAMC), has been tasked with maintaining excellence in American medical education by accrediting all medical schools in the U.S. and Canada. At first glance, LCME seems like a necessary and useful organization. But is it?
Its effect on the training of U.S. doctors is counterproductive. The cost in time and money of becoming a doctor in America is now so prohibitive that it’s constraining the supply—the U.S. is facing a projected shortfall of between 42,600 and 121,300 physicians by 2030. My colleague Chris Pope and I have suggested that this problem could be solved if American students could begin studying medicine immediately after high school and complete their studies in six or seven years, not eight, which is the U.S. norm. Countries where medical students can follow this path wind up with more physicians per capita, lower rates of physician pay, and comparable medical quality with that in the U.S.
But LCME requirements currently make it nearly impossible to streamline medical education in this fashion. To get accredited, a medical school must encourage “potential applicants to the medical education program to acquire a broad undergraduate education.” LCME technically allows schools to integrate undergraduate and medical education but provides no standards for schools that wish to do so, requiring them to design their own programs and hope that they will pass muster. Facing such uncertainty, it’s no wonder that only a handful of schools have tried.
Health outcomes are adversely affected by the shortage. In lower-income areas, which are feeling the impact of too-few physicians already, patients are increasingly being treated by practitioners who attended for-profit medical schools in the Caribbean. These schools, known for their lower standards, are the kinds of institutions that LCME was founded in 1942 to police and prevent. Patients of such doctors tend to have higher mortality rates than those of physicians who attended medical school in the United States. Without the constraints imposed by LCME, more qualified doctors would be available. Medical schools would be free to experiment with ways to increase the supply of well-educated physicians through programs that integrate undergraduate education with medical education or that help accomplished nurses retrain as physicians.
LCME’s accrediting may not even be needed any more. The landscape of medical education in the U.S. has changed dramatically since 1942. Accreditation was necessary to reform substandard medical colleges in an era when such institutions could operate in isolation; that’s not possible today. Internet sites like Yelp, ZocDoc, and HealthGrades have made physician credentials and reputations easier to access and share than ever before. Under such constant scrutiny, it’s hard to imagine how medical schools could drastically lower their standards without anyone knowing.
And why would they want to? LCME acts as though it is the only thing preventing American medical schools from downgrading standards, but these institutions are jealously protective of their reputations. They want to be able to say that they have the highest standards—higher than their competitors. In other words, competition does more than aging accreditation standards to get medical institutions to excel.