KANSAS CITY, Mo.

When Tiffany Williams graduated from high school in 1999 she wrestled with a choice: take off across the country to prestigious Duke University or head downtown to University of Missouri-Kansas City.

Williams chose UMKC, and not because it was close to home. She chose it because at 18 and right out of high school Williams was accepted into its six-year medical program.

Now at an age when other medical students are just getting the hang of anatomy class, Williams is applying for residencies in physical medicine and rehabilitation. She graduates in May with her M.D. and a bachelor's in liberal arts.

"I have a friend who's 28, and he's doing the same thing I'm doing now," said Williams, who has sent out about a dozen applications to residency programs across the country. "He won't graduate until he's 30, and I'm graduating at 24."

She said it was difficult to turn down Duke.

"It's the whole name thing. It was hard for me to get past that and realize that this is not about the name, and that it's about what I want to do with the rest of my life."

The University of Missouri-Kansas City Medical School is one of about 30 medical schools in the country that takes students directly out of high school. About seven of those schools offer six-year combined degree programs. The others are seven- or eight-year programs.

The UMKC program, which was developed in 1971, gets about 600 applications for its 100 openings each year. Students from Missouri must have at least 26 on their ACT or a 1,200 SAT score, said Basma Jaffri, administrative assistant to the council on selection for the UMKC Medical School. The medical school admission test, or MCAT, isn't required.

About 60 percent of the students are female, and 19 percent of the students drop out, she said.

Programs cut costs

UMKC is one of the only medical schools to offer a six-year combined medical degree program as its main option, said M. Brownell Anderson of the Association of American Medical Colleges. She said the six-year programs have been successful and are a good way for students to cut costs.

"In some ways [six-year programs are] going to be more important as the costs for medical school continue to increase, and medical schools are going to have to find ways to produce physicians cost effectively.

"That's one issue, certainly, fewer years in school," Anderson said.

But Joan Jacobson, advanced education counselor at Shawnee Mission South High School in suburban Kansas City, said it's the rare student who fits into six-year medical school.

"It takes a certain kind of very intense, focused student because what they're literally doing is putting eight years of med school into six," Jacobson said. "When they ask me what I think, I say first of all, 'What's your hurry?'

"I have had students do the six-year program and be very successful," Jacobson said. "But I hesitate to recommend it unless students come to me to say 'This is my goal.'"

Henry Lin, 22, from Fort Wayne, Ind., is in his fifth year in the UMKC Medical School. His choices for college were studying communications at University of Indiana or University of Chicago or UMKC.

"I thought I'd try UMKC for a year and see how it was," he said. "I loved it."

Lin has spent some of his time at UMKC developing a public health program for elementary schools and hopes to pursue a combination of pediatrics and public health.

"The one bad rep we have here is that we're not as strong in the medical science classes," Lin said. "But we're strong in the clinical exposure. We have been in clinics, seeing our own patients since the third year, so we get four years of clinical exposure. That's about twice as much as other medical schools, and it's a huge difference."

But he said UMKC Medical School is one of the more expensive public medical schools in the country. In-state tuition is about $25,000 a year, and out-of-state is about $50,000.

In 2002, the average tuition and fees at public and private U.S. medical schools were $14,577 and $30,960, according to the American Medical Student Association.

Dr. Brenda Rogers, 40, completed the UMKC program in 1990 and now teachers internal medicine and pediatrics in the six-year program.

"One of the most rewarding things for me is that I see them as third-year students, and when they come in they're talking about who they're dating on Friday night and who has a really ugly dress on.

"Then the next year there's less of that and more talk about their clinics," she said. "As they continue through it I get to see the shift in priorities, which is so rewarding."