Several months ago, a philanthropist donated a billion dollars to the Albert Einstein School of Medicine in New York City for the purpose of providing free tuition for all medical students at that institution.  Tuition is $60,000 per year.

Benefits

The average indebtedness for medical school graduates in the United States (including undergraduate and graduate studies) is $250,000.*  

Theoretically, this benefit could provide an incentive for students to go into much needed, and relatively underpaid, primary care specialties such as Pediatrics, general Internal Medicine, and Family Medicine.  Healthcare policy makers hope that removing the burden of debt will steer graduates to these less remunerative specialties.

The impact on minority enrollment is thought to be a positive also.  In the face of extraordinary debt upon graduation, talented minority students are tending to eschew medical careers in favor of law and business, particularly investment banking.  The idea is that tuition forgiveness will result in a much needed increase in our minority physician workforce.

It is also hoped that relatively debt free students will practice in underserved rural areas, which historically are less lucrative for doctors across the board.

Finally, in the face of free tuition, more applications to medical schools are anticipated. 

Reality

New York University has pursued the free tuition policy for some years, so some preliminary data on the above assumptions are available.  

While applications to NYU by African Americans have doubled, the amount of black graduates from medical school remained the same.  This highlights the difficulty of finding qualified minority candidates for medical school and shows recruitment of minorities is far more complex than monetary concerns.  

Even with the free tuition benefit at NYU, students flocked to the highest paid specialties (ones with highly reimbursed procedures like surgery, gastroenterology, cardiology, and the like).

And there is no need to attract more applicants to medical school.  In 2022, the most recent year for which data are available, applications to medical school were at an all time high.

Finally, in order to appreciate the great opportunity that a medical career affords, maybe some “skin in the game” in the form of some amount of indebtedness is desirable.  And doctors are better positioned to retire debt than other professionals.

The Hopkins Program

Of course many students need grants to attend medical school and avoid ruinous indebtedness.  But a more nuanced policy, rather than blanket tuition forgiveness, is possible.  The Johns Hopkins School of Medicine is instituting a tuition subsidy program that is tied to income.  Families of medical students with incomes of more that $300,00 per year have to pay the whole freight.  And families with incomes of less than $175,000 per year also qualify for living expenses.

Commentary

Studies show that the percentage of medical school matriculants coming from families with yearly incomes of greater than $200,000 is increasing (currently about 75%), while students whose families’ yearly incomes are less than $75,000 is decreasing at the same rate.

So the goals for the free tuition policy are commendable.  But the idea is too new to tell whether, for instance, students who escape staggering indebtedness will go into less lucrative specialties and more needed general practice.  Studies are ongoing, but preliminary data indicate no change in students’ predilection for going into areas with the highest incomes.

As for attracting more minorities into healthcareI, this is a challenge that is far more complex than mere monetary considerations.

Though well intentioned, the Einstein intervention is flawed.  There are many medical students whose families easily have the means to pay for the expense of medical education.  In a study published in 2017, 48% of medical students’ families enjoyed incomes in the top fifth quintile.  So it seems to me that subsidizing the scions of multi-millionaires is bad policy, and that the Hopkins approach provides funds for students in actual need, without providing largesse for the rich.  

There are many areas in healthcare that could provide greater value to society than free tuition for all medical students.  To name but a few: free clinics for indigent people, debt forgiveness for patients who are faced with bankruptcy, comprehensive mental health services that are affordable and available, subsidies for staggeringly expensive drugs, and many more.

*In Canada’s heavily government subsidized education system, this figure is $19,250.