Free Medical School, 6/30/19
The health care crisis continues unabated. There are many causes to the continuously expanding cost: new technologies, new medications, the legal systems’ impact on malpractice costs and doctors caught between serving patients and running themselves as a business.
Some doctors want to be rich, certainly. But many would be happy making a comfortable living, but are thrust into a business role primarily by their massive school debt, which averaged $192,000 per student in 2016, according to CreditDonkey.com.
In August 2018, New York University Medical School announced it would pay the full tuition costs of medical students regardless of need. What would be the advantages of extending this program nationally? What would it cost?
As for costs, there are about 20,000 medical students in the U.S. at any one time, so multiplied by the $192,000, the total cost for free medical school would be about $4 billion.
This seems like a lot of money until contrasted with the size of the health care market nationally. In 2016, total health care expenditures were $3.3 trillion — 18%of the GDP. That $4 billion med school tuition cost represents 1.25% of the total health care spend.
Those students taking advantage of the free tuition would (in my scenario) work for two years post-residency in rural or inner-city areas. Call it “Doctors Across America.”
Any doctor who wishes to take advantage retroactively and participate in Doctors Across America could do so, and have their remaining debt cancelled. The advantages are powerful:
1. Health care is stuck uncomfortably between being the largest business sector in the country and being a government-subsidized right. Regardless of what health care should look like structurally, starting the highest profile players in the health care system with a $200,000 debt burden can only distort the system.
2. Most doctors would be satisfied making couple of hundred thousand dollars in annual salary if they had little or no education debt.
3. Most docs would not feel driven to pursue business ventures (imaging clinics, etc.) if they didn’t have school debt.
4. It would remove the stressors from doctors at a time of great change and would reduce the dropout rate of doctors.
5. By removing the debt incentives for doctors to enter higher-paying specialties, it would resolve the current shortage of general practitioners and geriatrics specialists nationally.
The notion of applying this to all student debt would certainly be proposed by some, but the argument that doctors are unique is powerful. Only doctors have the ability to personally impact the business environment of their ecosystem so powerfully. Nurses don’t; hospital administrators don’t.
The program could be implemented at the federal level or on a school-by-school basis, particularly by schools with large endowments that do not depend on tuition for their survival, or state schools whose legislators could fund the program and solve their rural general practitioner problems.
The more schools implement the program, the more market pressure there would be for others to do so, as students would gravitate towards tuition free programs.