Why Medical Education Must Change — and What That Means for Our Community
There is a particular cruelty to what happens to idealistic young people who enter medical school. They arrive — curious, empathetic, often idealistic, drawn by a genuine desire to help other human beings. What follows is four years of relentless memorization, obedience to hierarchy, and the systematic suppression of independent thought. They emerge, eight years later, shaped into something that can pass licensing exams and survive hospital rounds, but may have lost the very qualities that made them want to become doctors in the first place.
This is not an abstraction. It has consequences for every patient in Southern Oregon.
The Big Idea: We Are Training Doctors for a System That No Longer Serves Patients
Dr. Makary does not mince words about medical education. “When we go through medical school, you’re just memorizing and regurgitating and it’s this terrible robotic dogmatic training.” He is not alone in this view. The dean of the medical school at the University of the Incarnate Word told Makary: “I would love to teach self-awareness, uncertainty, applied statistics, and the critical appraisal of research. But I can’t. Because the AAMC dictates what we teach and we have to teach to a test.”
The AAMC — the Association of American Medical Colleges — is a private organization that effectively controls the curriculum and licensing pathway for every medical school in the United States. It sets the content for the USMLE licensing exam, which in turn dictates what medical schools prioritize. The AAMC is connected to the American Board of Medical Specialties, which issues board certifications and now requires physicians to pay fees every two years to maintain those certifications — a model that has been compared to a university calling alumni and telling them their degrees expire unless they keep paying.
The result is a system optimized for compliance rather than curiosity, for recall rather than reasoning, and for the defense of established practice rather than the pursuit of better evidence.
What Gets Taught — and What Doesn’t
Medical students spend enormous time memorizing the enzymatic steps of metabolic pathways, the Latin names of nerves, and the chain properties of bacteria — information that can be looked up on a smartphone in seconds and is largely irrelevant to clinical decision-making. Meanwhile, according to Makary, a recent medical school graduate from Oklahoma told him that approximately 50% of his curriculum was devoted to this kind of rote memorization. He received eight hours of training on transgender sensitivity and two hours on nutrition — and those two hours on nutrition, he said, were so poor they may have been worse than no instruction at all.
Compare this to what a primary care physician actually needs to practice well. They need to understand how to appraise a research study — to ask: is this a randomized controlled trial or an observational study? What is the effect size? What confounders might explain the finding? What is the quality of the journal? They need to know how to think about uncertainty and probability — to say to a patient, honestly, “Here is what we know with high confidence, here is what is less certain, and here is how we’ll watch and update.” They need to understand the gut microbiome, sleep physiology, the evidence on nutrition, and the downstream effects of the prescriptions they write every day.
None of this is reliably taught. Peter Attia notes that he was fortunate to have been a math major before medical school — trained in probability theory and statistics — because that background gave him a natural framework for thinking about uncertainty that most physicians never develop. That framework should not be a matter of luck. It should be required curriculum.
“One of the most important qualities of a physician is humility — knowing your limits and having the self-awareness that you could be wrong.”
— Dr. Marty Makary
The Culture of Obedience
The curriculum problem is compounded by a cultural problem. Medical training — from medical school through residency — is built on a hierarchy of authority that has more in common with military service than with scientific inquiry. You do what you are told. You do not question the attending physician. You do not suggest that the protocol might be outdated. You survive by compliance.
This culture, Makary argues, is not merely uncomfortable. It is dangerous. It is the same culture that allowed the peanut allergy recommendation to persist for seventeen years without challenge, that kept unnecessary pre-operative antibiotics as universal protocol long after the evidence for many procedures had evaporated, that made it possible for one small group of researchers to push a flawed study about hormone replacement therapy into clinical practice and watch a generation of women be deprived of treatment they needed.
The culture of obedience does not stay in the hospital. It follows physicians into community practice, into the examining room, into the conversations they have with patients. A doctor who has been trained to not question the guideline does not suddenly become a questioning, independent thinker once they graduate. The reflex persists. .
Makary describes filling out a continuing medical education form before giving a lecture and finding a clause requiring him to certify that everything he would say “complies with generally accepted norms and standards recognized by consensus within the medical profession.” He refused to sign it. His view is that if medicine had always required consensus before speaking, it never would have discovered that antibiotics can treat appendicitis, that H. pylori causes ulcers, or that the ovarian cancer we’ve been treating for decades may actually begin in the fallopian tube.
A Generation Ready for Something Different
The most hopeful part of this conversation is that a new generation of physicians knows something is wrong — and many of them are pushing back.
Makary notes that fifty percent of medical students at Johns Hopkins are now pursuing a second degree alongside their MD, suggesting they want tools and frameworks beyond the standard curriculum. Many are drawn to public health, biostatistics, and health policy — fields that require exactly the kind of systems-level, probabilistic thinking that clinical training tends to suppress.
A growing community of physicians — including Makary himself, along with Vinay Prasad, John Mandrola, and others — has begun publishing outside of traditional peer-reviewed journals, in platforms like Sensible Medicine, where they analyze research in real time, call out flawed studies, and model the kind of honest, humble scientific discourse that the major journals have too often abandoned. Their readership has grown to over 100,000 subscribers.
The questions this new generation of doctors is asking — and that some practicing physicians are already acting on — are the ones patients in Southern Oregon deserve answers to: Should we be treating type 2 diabetes with cooking classes before insulin? Should sleep medicine be first-line treatment for hypertension rather than third? Should we talk about school lunch programs before Ozempic? Should physical therapy and chiropractic be the default for pain rather than surgery and opioids?
The Southern Oregon Picture: Strengths and Structural Gaps
Southern Oregon’s healthcare landscape reflects, in microcosm, both the best and worst of what Makary is describing. Asante Health System — which serves over 600,000 people across nine counties from its base in Medford — operates Rogue Regional Medical Center, a nationally recognized Level II trauma center that has recently earned a five-star rating and a spot on Forbes’ Top Hospitals list. It does acute care exceptionally well. The system is investing in cardiology, gastroenterology, and cancer services. These are real achievements.
But the structural gaps are significant. Jackson County is federally designated as a Health Professional Shortage Area for primary care, dental care, and mental health care. A 2024 Oregon workforce report found that rural and remote areas of the state have approximately 40% fewer primary care providers than the population needs — and the situation will worsen without significant intervention, as more physicians retire than are entering practice in these areas. Wait times for new patients at primary care practices can stretch to months. When people cannot get appointments, they delay care, use emergency departments for routine needs, or go without.
This shortage has a direct connection to the educational problem. Oregon has historically been a net importer of physicians — it trains far fewer medical residents relative to its population than it needs. A 2024 report from the Oregon Academy of Family Physicians noted that while Oregon has increased its family medicine residency slots from 128 to 191 since 2020, the state still needs roughly a 40% increase in primary care practitioners to meet projected demand over the next decade. And the physicians who are trained are leaving — burned out by administrative burdens, EHR documentation requirements, and the relentless pressure of seeing more patients in less time.
What gets lost in that environment? Everything Makary is calling for. The curious conversation. The shared decision-making. The honest acknowledgment of uncertainty. The time to ask: is there a better way?
What’s Missing Structurally: Southern Oregon currently lacks: (1) a medical residency program, meaning the region cannot grow its own physician base; (2) adequate funding for integrative and preventive care approaches that fall outside standard insurance reimbursement; (3) antibiotic stewardship programs embedded in primary care practices; and (4) community-level health education that teaches patients how to appraise medical evidence and ask better questions. Reimagine Healthcare’s work directly addresses the fourth gap — and advocates for the first three.
The Integrative Medicine Community as a Model
One of Southern Oregon’s genuine strengths is its integrative medicine community. Practices including Siskiyou Vital Medicine, Valley Integrative Health, Bear Creek Naturopathic, Monarque Health & Wellness, Mederi Center in Ashland, and Resolute Integrative Health are already doing what Makary advocates: spending time with the whole person, asking about root causes, discussing the evidence for and against multiple approaches, and treating patients as partners in their own care rather than passive recipients of protocol.
These practices operate largely outside insurance reimbursement, which is both their freedom and their limitation. The freedom means they can spend an hour with a patient, ask unconventional questions, and recommend approaches that a fifteen-minute appointment cannot accommodate. The limitation means their care is less accessible to lower-income patients — exactly the people the Southern Oregon health system most needs to reach.
The integration that Southern Oregon needs is not a merger of conventional and alternative medicine. It is a culture of medicine that incorporates the best of both — rigorous science, honest uncertainty, and time to actually practice both. That is what Reimagine Healthcare advocates for, and that is what the next generation of physicians, trained differently, might someday be able to deliver.
What Good Medicine Looks Like
It is important to end with what Makary, Attia, and others are clear about: medicine has done extraordinary things, and the people in it are almost uniformly motivated by genuine care for other human beings. Acute care in the United States, when you need it, is among the best in the world. Cardiac surgery, trauma care, neonatal intensive care — these disciplines have saved countless lives that prior generations could not have saved.
The goal of calling out blind spots is not to tear down medicine. It is to make it better — to create space for the honest acknowledgment that certainty in science is always provisional, that new evidence should always update practice, and that the humility to say “I might be wrong” is not a weakness. It is the foundation of trustworthy medicine.
The doctor who says “according to the task force, you should do this” is reciting a catechism. The doctor who says “here is what the evidence suggests, here is how confident I am, and here is what I don’t know” is practicing medicine. Southern Oregon needs more of the latter — and the education system, the insurance reimbursement structure, and the cultural norms around physician authority all need to change to make that possible.
Call to Action
For patients and community members:
- Look for primary care providers — whether conventional, naturopathic, or integrative — who demonstrate humility, who welcome your questions, and who speak in terms of probability rather than absolute certainty. These qualities are as important as any credential.
- Support efforts to expand medical residency training in Southern Oregon. A region that trains its own doctors is more likely to retain them. Contact your state legislators about funding for residency programs at regional hospitals.
- Advocate for insurance coverage of integrative and preventive care approaches. The current system pays for procedures and medications but not for the time-intensive, relationship-centered care that produces better long-term outcomes.
- Engage with Reimagine Healthcare’s education programming. The most powerful thing a patient can do is become an informed partner in their own care — one who can read a headline critically, ask the right question in a fifteen-minute appointment, and know when to push for a second opinion.
- Share this series with your doctor. The physicians in our community are, in the vast majority of cases, working hard in a broken system. The conversation Makary and Attia are having is one that practicing physicians need to hear — and many are hungry for it.
The medicine of the future, Reimagine Healthcare believes, will be less about certainty and more about wisdom. Less about following the protocol and more about following the evidence. Less about what we’ve always done and more about what the best available science actually supports.
That future starts with the conversation we’re having right now, here in Southern Oregon, with the community of patients and providers who know that something has to change.