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Three Year vs Four Year Medical School Programs

A friend recently asked me for some input regarding 3 year vs 4 year medical school programs. She was fortunate enough to have received several medical school acceptances and wanted to know the differences between the lengths of schooling. Currently in Canada, most medical schools are four year programs. Only McMaster University and the University of Calgary run a three year curriculum.

I went to a four year medical program, so I am biased towards four year programs but intrinsically there is nothing wrong with three year programs. I think shorter programs appeal to certain people and can work well for them.

How Do Three Year Programs Work?

How is it possible to compress four years of medical school education into three years? The answer is that you don’t take breaks. At McMaster and Calgary, students don’t have summer vacations during their first and second year. Instead, they receive a short break, typically two weeks, before their next school year begins.

At the end of the day, these three year schools receive roughly the same total amount of pre-clinical and clinical training.

Advantages of a 3-year program

One Year Less of School – For people who have finished an undergrad degree, perhaps did an advanced degree, maybe even a PhD, a year less of school can mean a lot. Older applicants or people from non-traditional backgrounds might want to be done school sooner, so they can move forward with their lives.

Finances – The money you save in a three year program can be quite substantial. One less year of tuition can save you $15-20k. The year you save is also a year less of being in the red. Instead you get a year of income albeit a resident salary. The financial difference might come out to be $50,000. In the long run it might not be life-changing but with graduate debt so high, every bit counts.

Continuous Learning – Not having large gaps of time in your learning can help with retaining knowledge. Three year programs are more intense. Being completely immersed in an environment is one of the quickest ways to grow. It forces you to be efficient with your time and make the most of opportunities given to you

Advantages of a 4-year program

More Time to Decide – I believe the best thing about four year programs is that it gives you time to decide on what you want to do. Selecting a specialty is one of the most important decisions you will make. Most students don’t know what kind of a doctor they want to be when they first start medical school. It’s hard to come to a conclusion during pre-clinical years. You won’t really know what each specialty is like until you rotate through them during your clinical years.

One thing I appreciated about my school was that we did all our core rotations during our third year. We were also given elective time to explore different specialties. Rotating through all the disciplines early on helped guide my specialty decision. I felt like I got a good exposure and made an informed choice to do internal medicine.

I also liked having my electives after my mandatory core rotations. Most of my fourth year was spent doing electives. All my electives were pre-CaRMS, so I was able to get reference letters from preceptors easily and visit various schools I was intersted in.

Better Scheduling – Talking to a friend who was in a three-year program, I felt like I was more at peace with my specialty choice. Just when they were starting their clerkship in February, I had already done eight months of rotations and a few electives. By the time they were doing their core rotations, I was  doing electives at various schools, networking and preparing for CaRMS.

Three year schools can often feel rushed. Everything is on a tighter deadline. With a four year program, you have better spaced time to arrange electives and complete your CaRMS applications. For example, I didn’t take much call in my fourth year and used that extra time for applications. During the interview tour, I met some applicants from 3-year programs who had to take Obsgyn call DURING their interview period and some who had several core rotations left to complete. I on the other hand had already wrapped up my all my clinical duties, including subspecialties.

Summers Off – There’s a lot to be said about the benefits of having a chunk of time off from school. I truly appreciate the months I had off during first and second year. I got to travel quite a bit and had some unique learning opportunities overseas. I finally realized that bench research wasn’t for me. I took a summer to train and achieve one of my life-long goals of completing a marathon.

I am a much happier and enriched person because of those summers. Medical training is long, why rush into a grueling residency so soon?

Are there Advantages and Disadvantages for CaRMS?

I think one of the most misleading rumors I have heard is that 3-year program students are “disadvantaged” when it comes to CaRMS. The argument goes that because there are no summers, there is no time to do research or network with the right people. These students have a harder time arranging electives with their tight schedules. Because they haven’t completed their core rotations, when these students go for their audition electives, they don’t perform as well as other school’s medical students.

Looking at the 2012 Match Statistics, it may appear that McMaster had 18 unmatched students, more than average (PDF 41), which reflects poorly on their match results (PDF 10). But if you dig deeper, you can see that this year’s poor result was probably because they had more applicants applying for competitive specialties without backing up. Looking at (PDF 25), you can see that McMaster had 7 people gunning for ophthalmology and 6 for plastic surgery. Even if these people had attended a 4-year school, they wouldn’t have all matched based on the laws of supply and demand. Furthermore in PDF 26, when your school’s percentage of students who ranked family medicine as their 1st choice is the lowest in Canada – McMaster (28.6%), Calgary (27.8%), Queen’s (27.9%) – your school match rate will be guaranteed to be lower too.

While there may be anecdotal evidence for these claims that 3-year programs are disadvantaged, there are just as many counter examples of great applicants that refute them.

When it comes to CaRMS, the school you go to matters less than you think. The strength of your CaRMS application is more dependent on the strength of the applicant and their qualifications. There will always be hidden gems and rotten apples at every school.

The Bottom Line

Whether you go to a 3-year or a 4-year medical school, you will be properly trained to be a doctor. According to research comparing the lengths of medical school there is no significant differences worth noting. All Canadian medical schools are in good academic standing.

I previously wrote that when choosing a medical school, location is probably still the most important factor.

You won’t be disadvantaged in the CaRMS match if you go to a 3-year school. You will be disadvantaged if you choose a competitive specialty, even if you go to a 4-year program.

My advice is that if you are a younger and still undecided about your career, go to a 4-year medical school. You will have a bit more time to decide on what you want to do. If you are a bit older or you know exactly what you want to get out of medical school, a 3-year program might just be for you.

To read more, check out this NEJM perspective on three year medical schools. 

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  1. Ryan Burkholder
    Ryan Burkholder May 21, 2012

    This is exactly what I am looking for…. As a dual citizen, I am trying to decide if I am going to go to a 3 yr osteopathic medical school (Lecom) or if I am going to go to a regular 4 yr MD program. Either way, I am going to be family doctor or Internal medicine, since I am going back to a very rural area in Canada. This is pretty carved in stone. I’ve had many years to ponder this.
    I would save on tuition, but might have to do a 3 yr family medicine residency in the US before returning to Canada because the D.O. degree is harder to match into Carms (family medicine)

    I will not be a surgeon or such… I have watched it all. Surgery and other specialties are cool, but not for me, I know that I want a FM lifestyle in a rural underserved area.
    The DO degree is just not like an MD, although I have the same rights when practicing, and the students might be less smart (lower mcat/gpa) but honestly, will this matter even 15 yrs from now working in a small town where people trust me?

    Let me know your thoughts.

    • medaholic
      medaholic May 21, 2012

      Hi Ryan,
      It sounds like a 3 year school might be right for you. Since you’re pretty set on what and where you want to practice, a quicker go through medical school and earlier entry into the workforce might be right for you. I’m not sure about the differences between D.O and MD programs in the states, but my suggestion is to figure out where it’s easiest to get your training done. Perhaps finish in the states before returning to Canada. Awesome that you’re planning to work in rural Canada, we need more people like you! -m

  2. Gary
    Gary June 10, 2012

    Very insightful article!

    I had the option between a 4 year and 3 year MD program this year (I was very fortunate!). Although I had just come out of undergrad and I was under no rush, I chose the 3 year program. For me, it came to location, curriculum, and the campus culture.

    I don’t know much about Calgary’s curriculum, but I know that Mac designed their curriculum to compensate for the fact that there is less time pre-Carms. The weekly schedule has far less class time than a traditional curriculum, so one has more time to schedule electives (and earlier!) and do other things that other med students would do in the summer. Further, Mac has a lot of elective time and you do most of the core rotations before CARMS. So it is very possible to as prepared for CARMS as one from a 4 year program.

    For people like me, being able to do class, electives, etc. simultaneously and continuously is more appealing than the “block” nature of a 4 year program. But I am biased 😉 I feel that as long as approach med school with an open mind, study hard, take advantage of all the opportunities before you, and do what you love, you will be fine.

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