Dr Lindeque is from the Department of Orthopedics, University of Colorado-Denver, Aurora, Colorado. Dr Lindeque has no relevant fi nancial relationships to disclose. Correspondence should be addressed to: Bennie G.P. Lindeque, MD, Department of Orthopedics, Mail Stop F722, University of Colorado-Denver, 1635 N Aurora Ct, Aurora, CO 80045 (bennie.lindeque@ucdenver.edu). doi: 10.3928/01477447-20100924-01 I have had the opportunity to train medical students, fellows, residents, and attending physicians for 25 years. I have been exposed to and have worked with these groups on more than one continent, experiencing fi rsthand the good, the bad, and the ugly regarding medical student education. In the United States, we believe it is better to have medical students obtain a college degree fi rst so they mature and grow up in an academic world, gaining cognitive, academic, and emotional skills. We believe it will provide those who plan to attend medical school with the necessary skills to become a wellrounded physician. Let us look at the fi nancial cost of such a venture. Whether a student is privileged to receive bursaries or scholarships or whether their parents or some fi nancial institution pays for it, it does not really matter: the cost to society remains the same. What are the costs? In interviews with numerous medical students and residents over a long period, medical school costs are approximately $35,000 per year for a college degree, and by the end of medical school they are $250,000. No one, during residency, is able to signifi cantly reduce the capital debt that normally allows for living expenses. This signifi cant amount only accrues terrifying amounts of interest with big loans and the hefty task of paying back their loans at age 30 years or older (remember a fellowship also needs to be completed). Let us look at the merit of this unbelievably expensive education. Is there unequivocal proof that a medical student is too immature to start medical school directly after graduation from high school? The answer is no. Many European countries start medical students directly after high school. Most students complete a 5to 6-year medical school education and then enter a residency program. Asking medical students and residents their opinion, I have yet to meet one who thinks a 4-year college degree is essential. When asked about 4 years in medical school, they all agree that they waste time on a curriculum