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Committing to being a doctor at age 20-28 is very different than age 16. At the latter people are mostly forced in by their parents, haven't explored their interests and haven't exhibited durable commitment. With how bad residency is, that's important.
Why would someone need to commit to being a doctor at the age of 16 instead of at the end of / after high school?
In most countries with this model everyone takes one giant exam that determines what you are allowed to do based off of scores. That's pretty self-explanatory and enables placement very proximal to graduation.
In the U.S. everyone (even for regular undergrad) does this whole thing with letters, and exams, and grades, and extracurriculars and a whole bunch of shit. This takes time. For Medical School as is - you have a full application year, given that this other stuff would not go away (for all kinds of reasons - including wokeness, racism, and more).
So you need to apply in the 15-17 range and have interest before that (assuming graduation age is 17-19).
The U.S. doesn't really have a culture of time off between high school and college (which to my understanding much of Europe does).
Over here the entry to study medicine is based on the nation wide matriculation exam and an entrance exam. The only time off is a couple of months in the spring of last year of high school to study for those exams (where the matriculation study is more or less considered part of the high school itself). In the good old days (ie. until around a decade ago), this would apply to most university level subjects. The only time "off" for studying for the entrance exams is around a month and half, certainly not an entire year (unless you are a middling student with delusions of higher performance or just too lazy to study that year in which case you probably won't get in after a gap year either).
Up until the winter of final year the only preparation you have to ensure is to take enough math courses (because math applies for anything remotely STEM-like) and whatever other subjects that give points for entrance (or are relevant in the exam). Thus the only extras you'd need to go from "pure engineering route" (ie. max math, physics & chemistry) to medicine would be a handful of extra biology courses, a fairly trivial undertaking for anyone actually capable of thriving in med school and something you'd probably do out of interest anyway if you were such person.
I don't see any reason why med school in the US couldn't use a similar combination of SAT scores and a dedicated entrance exam if they wanted to. Move the exam date slightly later, have the high school graduation in May and there's really nothing that would prevent a similar entrance exam based system.
I mean other than that's not how we do it here?
The woke have just run through a multi decade mostly successful plan to get rid of the ACT/SAT for general undergrad admissions and it's only now starting to cool off. They even managed to kill one of the physician licensing exams (making Step 1 pass/fail - was the main way to discriminate amongst candidates prior, and now the situation is awful).
Even beyond that extracurriculars have been a core part of admissions of all kinds in the U.S. for over a hundred years. It started as a way to discriminate against Jews and is now a way to discriminate against Asians and for other minorities but it's part of the environment and making it go away is a total non-starter.
You won't be able to change it just for medical education.
If your answer is "because the schools outright don't want to", then you should go and actually say it. Otherwise you're just stuck in a "We have to do it like this because this is how we do it"-loop that leads to absolutely nowhere.
I still don't see any reason that would prevent those med schools from just doing it if they wanted to. Which student is going to say "No, I'll just go and do a pointless and expensive intermediate degree instead and only then apply to what I actually want to study." Having entrance exams certainly doesn't seem to be any problem for various art schools that award university degrees, so there doesn't appear to be any fundamental limit to that.
If the answer is that we have to make massive changes to the entire structure of higher education in the US (and secondary education, too, since most high schools graduate in June), then that isn't really an answer. Not having to pay tuition will also encourage more people to go to medical school, as is the case where you are. I agree with you generally, but I don't think that it's feasible to suggest we overhaul our entire educational system.
But you don't! Don't touch high schools. Don't touch colleges.
Only change med school to admit based on entrance exam that tests qualifications for studying medicine (ie. a bunch of medicine textbooks) and having graduated high school. Nothing more. Afterall, med school admission is already an entirely separate track (due to requiring a college degree or significant studies).
What you're suggesting gives kids coming out of high school two options:
Go to a normal college. If you don't know what you want to major in you can just take core classes the first couple years, since that's mostly what you'll be taking anyway. If you decide on a program that's too difficult or that you don't like, you can change your major at little to no additional cost, depending on when you do it and what your credit situation looks like.
Go to medical school where you'll immediately lock yourself into a career path. It will be more difficult and more expensive than going to a regular college, and if you can't cut it or decide you don't like it, you'll have to drop out and effectively start your education over having wasted a lot of time and money. There may also be even more of a time delay because medical schools operate on an entirely different academic calendar than the rest of the college. We also have to have duplicative faculty here, since US medical schools don't currently teach core courses.
I'm not saying that literally nobody will select option 2. What I'm saying is that it's not particularly attractive to a graduating senior, at least not enough that I think it would significantly increase the number of people going to med school. Deciding to take the plunge at age 22, after you already have a college degree and have experience with taking college-level courses is a lot different than getting thrown into the fire when you don't know what to expect.
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