Dr. Levinson's oration speaks about two of the problems in current residency programs: "curriculum reform and trainee indebtedness." The two are interlinked. Medical students incur debt from their student loans. They are more likely to choose a high-paying specialty because it allows them to pay off their huge debts more quickly than if they were in general practice. The proposed lengthening of the medical school curriculum would mean more debts for graduates to pay off, resulting in more physicians going into specialties. Consequently, a given community will be flooded with specialists and have a shortage of general practitioners.
A lengthened medical school curriculum would include training in medical ethics and informatics among other traditionally non-medical fields. These subjects are not currently offered because medical schools must make room for rapidly expanding medical discoveries. Levinson says that medical schools have modified their curricula differently; some emphasizing physical examination skills and bedside manner while others focus on pathophysiology and pharmacology. As a result, residency programs must bring the recent graduates up to speed in both areas, and it has been proposed that they too should be lengthened. Instead of changing the residency length, post-residency fellowships, have been created to provide even more medical knowledge to residency graduates. Dr. Levinson identifies the root of the problem as being in students' premedical training. He says college graduates enter medical school without adequate skills in areas like the history of science, statistics, critical reading, and library use. Although he believes "a single oversight entity" to "review, evaluate, and make recommendations" would help solve the problems of the "content of premedical schools, medical schools, residencies, subspecialty fellowships, and advanced fellowships," Levinson says that first the problem must be recognized by these institutions.
Since a crucial component of the problem of medical education is the debt owed by medical students, Dr. Levinson suggests ways to lessen this burden on students and diminish its effect on the education and curricula themselves. He believes that, "the current healthcare system is so badly broken that it cannot be fixed and we must begin to construct a new one" and "if we are going to have to build a new healthcare system, primary attention should be given to how we train physicians and how we pay for that training."