Ever since The New York University School of Medicine announced that it would waive the tuition of all its students, regardless of merit or need, citing concerns about the “overwhelming financial debt” facing graduates, opinions have been across the board about the wisdom of the decision.
One side applauded the move as a way to reduce (not eliminate) the crushing student debt of medical students, now about $200, 000 on average. The other side questions the wisdom of giving those who can pay a free pass.
Will tuition free medical school make a difference in producing more doctors, produce a more diverse talent pipeline, and, eventually, do a better job of reducing the quality, cost, access, experience and equity gaps that plague the system? I'm skeptical for the following reasons:
- The demand for medical education, based on recent applications, does not seem to be price elastic.
- The graduate medical education (residency) still represents a significant bottle neck and the mechanisms to fund it is likely to remain stuck in the maw of partisan politics in Washington.
- Making a dysfunctional and out of date educational system tuition free will only encourage more people to be dysfunctional and out of date graduates.
- The evidence that levels of medical student debt drives specialty choice is inconclusive and reducing the debt burden is unlikely to alter not just general-specialty choice, but the existing geographic maldistribution as well.
- The clinical half life of newly minted doctors might shrink given generational attitudes about work-life balance and the increasing attractiveness of alternative non-clinical career paths, such as side gigs, and entrepreneurship. Some, those on FIRE, will just wait until they can pay off their loans and rewire to do something else.
- More women in medicine, based on patterns of productivity, family care demands and the white ceiling, will not significantly satisfy the demand for services.
- The fundamental restructuring of the economy and the future of sick care work demands that we stop fighting the last war to meet the almost infinite global demand for sick care services, regardless of how much less it costs.
- The medical school business model is unsustainable and giving money to subsidize it has a limited life span. Pretty soon you run out of other people's money.
- Premeds have little or no understanding of what a sick care job means. Putting more doctors on the grill to get burned out won't help.
- We might be looking at a medical school bubble.
- As long as the US higher educational system stays rigged in favor of the lucky haves who won the ovary lottery, the have-nots, like low income first generation students, will struggle.
- The medical manpower supply chain is extremely long and is regulated and impacted by multiple entities from high school to graduate medical education and state boards of medical examiners.
The sick US medical education system has a long problem list. Treating it with just another pill is unlikely to make a significant difference in reducing long term morbidity or mortality.
Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs.
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