Why Medical School Should be Free

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Why Medical School Should be Free

Too bad it will never happen due to lobbying by loan sharks and specialists. CDOs of med student loans are always rated at AAA😀

 

[Narmerguy]

Already posted
http://forums.studentdoctor.net/showthread.php?t=825495

 

[LizzyM]

Read it carefully. Those wishing specialty training would, no doubt, borrow living expenses for the years of fellowship training that would not pay a stipend under this plan. So there would still be loans, perhaps higher than would have been borrowed for medical school, as the cost of living rises each year and the costs associated with being a grown-up (home, family, automobile) are greater than the lifestyle of most students who economize with roommates and ramen. Also, even if medical school is free, one will still need to cover living expenses which may require loans.

 

[AmicaVera]

I hate to say this, but I think that the prohibitive cost of medical school is a good thing. It's another barrier to overcome, and while it might not weed out all of the people who shouldn't be in medicine, it does ensure that not everyone will want to take on that risk.

Would I like to not take out six figures worth of loans? Sure. But if I look at it objectively, I think the high cost is a decent investment.

 

[NickNaylor]

I hate to say this, but I think that the prohibitive cost of medical school is a good thing. It's another barrier to overcome, and while it might not weed out all of the people who shouldn't be in medicine, it does ensure that not everyone will want to take on that risk.

Would I like to not take out six figures worth of loans? Sure. But if I look at it objectively, I think the high cost is a decent investment.

What? The only barrier the high cost impacts is poor people. Academic standards already ensure that qualified people enter medical school and ultimately become physicians. Who else do you want to exclude? There's also already a substantial investment in attaining those academic requirements, so there is, as you put it, a "risk" of sorts.

I suppose the high cost pigeon-holes medical students and prevents them from leaving the field for a very long time.

 

[dd128]

I hate to say this, but I think that the prohibitive cost of medical school is a good thing. It's another barrier to overcome, and while it might not weed out all of the people who shouldn't be in medicine, it does ensure that not everyone will want to take on that risk.

Would I like to not take out six figures worth of loans? Sure. But if I look at it objectively, I think the high cost is a decent investment.

lol, why on earth should the cost of medical school be a "barrier" to over come to become a physician? If you aren't rich enough to afford medical school you shouldn't be there? 🙄

 

[Law2Doc]

...
I suppose the high cost pigeon-holes medical students and prevents them from leaving the field for a very long time.

I think this is probably the bigger value. You are going to be much better thought out before you undertake a path that is hard to bail on. If it were free, you'd see the first year class full of dabblers, folks who are just going to give it a try for a year or two to see if they like it, and then bail. Folks will go to med school simply because they "ran out" of college. Essentially what you see going on in the lower tier law schools. Classes will be full of folks who really don't want to be there, and who will quit at the first sign of adversity. Not the folks you want in med school. These are the folks you screen out when you create a barrier to quitting.

The article is based on the assumption that there are lots of people who don't go into primary care because the income isn't high enough to service the debt. I think that to take that stance, you had better be sure that folks aren't shunning the primary care fields for totally different reasons than money. Honestly, with the average pediatrician earning about $140k which is enough to service a fair amount of tuition debt, and with primary residencies shorter than most of the specialties, I don't really think it's all about the money. I mean according to a recent survey, orthopedics is on the other extreme from peds, with the highest average salary, of about $350k, but yet I know of no orthopedists who ever said, "you know, if it weren't for the money, I would have done peds". Money is but one of many factors folks use in choosing careers, and outside of pre-allo it usually isn't the most important factor.

 

[shaggy alfresco]

I like that plan to be honest.

 

[FIREitUP]

I think this is probably the bigger value. You are going to be much better thought out before you undertake a path that is hard to bail on. If it were free, you'd see the first year class full of dabblers, folks who are just going to give it a try for a year or two to see if they like it, and then bail. Folks will go to med school simply because they "ran out" of college. Essentially what you see going on in the lower tier law schools. Classes will be full of folks who really don't want to be there, and who will quit at the first sign of adversity. Not the folks you want in med school. These are the folks you screen out when you create a barrier to quitting.

The article is based on the assumption that there are lots of people who don't go into primary care because the income isn't high enough to service the debt. I think that to take that stance, you had better be sure that folks aren't shunning the primary care fields for totally different reasons than money. Honestly, with the average pediatrician earning about $140k which is enough to service a fair amount of tuition debt, and with primary residencies shorter than most of the specialties, I don't really think it's all about the money. I mean according to a recent survey, orthopedics is on the other extreme from peds, with the highest average salary, of about $350k, but yet I know of no orthopedists who ever said, "you know, if it weren't for the money, I would have done peds". Money is but one of many factors folks use in choosing careers, and outside of pre-allo it usually isn't the most important factor.

Did I just read this as a justification for people avoiding primary care fields because they don't like it as opposed to the low salary?

 

[Dbate]

"Read it carefully. Those wishing specialty training would, no doubt, borrow living expenses for the years of fellowship training that would not pay a stipend under this plan. So there would still be loans, perhaps higher than would have been borrowed for medical school, as the cost of living rises each year and the costs associated with being a grown-up (home, family, automobile) are greater than the lifestyle of most students who economize with roommates and ramen. Also, even if medical school is free, one will still need to cover living expenses which may require loans.

Despite these problems, such a plan would have a built in incentive for people to pursue primary care, which is currently a huge policy goal. Thus the plan, although it is unfortunate for specialties, would be good for the nation as a whole. Also, this plan would save money for specialists because they would be able to immediately start paying back their loans after they complete their fellowship, rather than waiting 5+ years after med school, during which time interest will have accrued.

 

[Law2Doc]

Did I just read this as a justification for people avoiding primary care fields because they don't like it as opposed to the low salary?

That's my point. Folks pick what they enjoy, subject to what they are competitive for. Claiming money is why everyone isn't becoming a family practitioner or pediatrician is naive, and yet it is the crux of that article. There are many folks out there who cannot imagine being any kind of doctor other than a FP or pediatrician, and they are doing so notwithstanding the tighter income. Then there are other folks who are choosing to take longer routes into specialties, and they too are usually not driven by the paycheck as much as the fact that they actually enjoy those specialties more. You don't become an orthopedist, etc just because, on average, after 3 additional years of training, it pays twice what you get in family medicine or peds. You do it because you enjoy and find it more interesting. So yeah, I'm saying the premise is all wrong. If you want more people to go into primary care, all you have to do is increase med school seats, put more admissions emphasis on folks who purport to want to work in primary care underserved areas, and fund more primary care residency slots (at a slower rate than you are increasing med school seats). Making school cheaper/free or making those fields more lucrative has less impact because folks are making decisions for primarily nonmonetary reasons. that's my two cents. Sorry for the soap box.

 

[Socrates25]

Under this plan, the first thing that happens is that med schools nationwide expand their classes by 5000% and jack up their tuitions 10 fold.

Whats not to like? Free money from the federal govt? No possibility of student loan default? Cash up front?

My god if this plan ever came to fruition you'd see places like Rocky Mountain Vista start charging 200k per year.

 

[Dbate]

I think this is probably the bigger value. You are going to be much better thought out before you undertake a path that is hard to bail on. If it were free, you'd see the first year class full of dabblers, folks who are just going to give it a try for a year or two to see if they like it, and then bail. Folks will go to med school simply because they "ran out" of college. Essentially what you see going on in the lower tier law schools. Classes will be full of folks who really don't want to be there, and who will quit at the first sign of adversity. Not the folks you want in med school. These are the folks you screen out when you create a barrier to quitting.

I feel as if the clinical exposure component and other requisite aspects for admission would screen out people who don't want to be doctors. At the end of the day, the high cost of medical school only prevents poor and middle income people from attending medical school.

The article is based on the assumption that there are lots of people who don't go into primary care because the income isn't high enough to service the debt. I think that to take that stance, you had better be sure that folks aren't shunning the primary care fields for totally different reasons than money. Honestly, with the average pediatrician earning about $140k which is enough to service a fair amount of tuition debt, and with primary residencies shorter than most of the specialties, I don't really think it's all about the money. I mean according to a recent survey, orthopedics is on the other extreme from peds, with the highest average salary, of about $350k, but yet I know of no orthopedists who ever said, "you know, if it weren't for the money, I would have done peds". Money is but one of many factors folks use in choosing careers, and outside of pre-allo it usually isn't the most important factor.

I think that money is a primary driver of people when they are staring at 200K worth of debt. I will concede that other considerations come into, though. For example for me time is much more important than money, so I want to do a short residency and get it out.

 

[Dbate]

I like that plan to be honest.

Me too. Alot.

 

[FIREitUP]

That's my point. Folks pick what they enjoy, subject to what they are competitive for. Claiming money is why everyone isn't becoming a family practitioner or pediatrician is naive, and yet it is the crux of that article. There are many folks out there who cannot imagine being any kind of doctor other than a FP or pediatrician, and they are doing so notwithstanding the tighter income. Then there are other folks who are choosing to take longer routes into specialties, and they too are usually not driven by the paycheck as much as the fact that they actually enjoy those specialties more. You don't become an orthopedist, etc just because, on average, after 3 additional years of training, it pays twice what you get in family medicine or peds. You do it because you enjoy and find it more interesting. So yeah, I'm saying the premise is all wrong. If you want more people to go into primary care, all you have to do is increase med school seats, put more admissions emphasis on folks who purport to want to work in primary care underserved areas, and fund more primary care residency slots (at a slower rate than you are increasing med school seats). Making school cheaper/free or making those fields more lucrative has less impact because folks are making decisions for primarily nonmonetary reasons. that's my two cents. Sorry for the soap box.

I'm inclined to agree with you, to an extent (i.e., people do what they enjoy), however, I wouldn't expect someone who is drawn towards peds to be drawn towards a surgery field. Furthermore, we have to take into account lifestyle considerations and hours worked per week in order to be entirely fair. In the end, though, when you're 300k in the hole, money does play a huge factor. I'm not saying someone who hates ortho will go into it, but I am saying, someone who perhaps has proclivities towards surgery and enjoys general surgery moreso than ortho, will still choose ortho for the money. I don't think it's as cut and dry as we'd like to make it (i.e., people do what they enjoy or people flock towards the money). I also have to raise the question: why over the years has there been a drastic increase in specialization and lack of primary care physicians?

 

[MCAT guy]

What about people who just borrowed 300k? Are they screwed? Whether or not this would work would rely on how the transition was designed.

I think L2D made a good point that costs make people think more about taking the plunge. I think there should be a cost. At the same time, cutting the cost in half would be better.

 

[Law2Doc]

I'm inclined to agree with you, to an extent (i.e., people do what they enjoy), however, I wouldn't expect someone who is drawn towards peds to be drawn towards a surgery field. ...

I used peds and ortho as examples because a publication's recent national salary survey listed peds as the lowest and ortho as the highest average salary, respectively. I agree that the surgery versus nonsurgery decision might drive this train, but consider that yet another example of non-monetary criteria in choosing a specialty.

As to why there has been an increase in specialization and a falling off of primary care, there are multiple answers:

(1) As the amount of medical knowledge increases, there are benefits to carving out a smaller field in which you can "know everything". The dude in derm may be able to keep up with reading all the major journals and keep abreast of the major changes within the field. A broader specialty like a family medicine GP is at a huge disadvantage, and will have trouble keeping up. Which has liability risk, among other things.

(2) Non-physician competition -- someone who specializes isn't going to be fighting for business with the DNP at the CVS minute clinic like the family medicine guy might.

(3) An undermining of the doctor patient relationship thanks to insurance companies. At one time being a family doctor was more fun, because you could get to know your patients. Now, thanks to the way reimbursements work, you need to average less than 20 minutes a patient to maintain a decent standard of living. So a lot of the enjoyment of family practice that used to attract folks to the field is gone.

There are lots of others, and again, these are primarily non-monetary reasons. I do note that primary care was much more popular in this past match than in years past though, so perhaps we are seeing a resurgence.

 

[Avoidthetiger]

I don't like this plan.

1. Because I already have loans from undergrad. I will still have to take out living expensive loans in medical school. AND then on top of that I would have to pay loans for my specialty. What about my current opportunity to get a scholarship for medical school - gone. Will they give me a scholarship for residency...who knows.. maybe.

Regardless this is ALOT of Loans (especially with the interest rate nowadays). 4 years undergrad, 4 years during medical school (living expenses) and now 3-10 years during residency/fellowship... rather than just starting to pay back my med school loans immediately after medical school. It sounds like I will never ever get to have a family, own a car/home, or ever be able to save for retire if med school was paid for by paying for residency instead.

2. I don't think everyone is choosing specialties because they "pay more". Many have better life styles, might be more interesting, and yes, might be more stable of an income (which does factor into your choice). Honestly though, if I wanted to go into primary care, I would have gone into nursing and then become an DNP. It takes less time and dedication than getting medical school does, and with the same outcome. I honestly think that in the future, people that go into medical school will be the ones highly specialized in a field. Why spend all the time in school (participating in research, being a leader, volunteering, ect) and not shoot to be the best in whatever interests you - rather than a PCP that just refers the patient with a bad illness to a specialist... as they then immediately see another patient.

[edit. I still might go into primary care - pretty undecided. I love surgery but I love people too. Regardless, I imagine many people would actually go into primary care then because they would need the stipend to support themselves, their family, and pay their old loans. We would probably then have a shortage of specialists. haha]

 

[deleted307836]

Law2Doc brings up an excellent point in this debate. Everyone talks about how the salary is the main deterrent for medical students, but there are many more factors which in my opinion play an even bigger role. Personally, I'd rather be a specialist for primary care money than a PCP for specialist money just because I know the practice realities of primary care would make me very unhappy.

 

[circulus vitios]

I hate to say this, but I think that the prohibitive cost of medical school is a good thing. It's another barrier to overcome, and while it might not weed out all of the people who shouldn't be in medicine, it does ensure that not everyone will want to take on that risk.

Would I like to not take out six figures worth of loans? Sure. But if I look at it objectively, I think the high cost is a decent investment.

You're right. Weeding out people who aren't 100% committed completely justifies a quarter million dollar cost of attendance.

 

[AntiHouseMD]

Right now, I'm debating between emergency doctor and pediatrician. The variety and thrill of the emergency room appeals to me, although working with children and directing their health care is also interesting to me. Guess it's something I'll have to decide later. Honestly, barring any unforeseen drastic changes, money isn't what'll make my decision. My personal goals (possible marriage, lifestyle, etc.) and interests will have a much larger influence on my choice.

 

[MCAT guy]

 

[circulus vitios]

Right now, I'm debating between emergency doctor and pediatrician. The variety and thrill of the emergency room appeals to me, although working with children and directing their health care is also interesting to me. Guess it's something I'll have to decide later. Honestly, barring any unforeseen drastic changes, money isn't what'll make my decision. My personal goals (possible marriage, lifestyle, etc.) and interests will have a much larger influence on my choice.

You'll think different when it's time for you to apply for residencies and you want to have a kid and buy a house.

 

[gettheleadout]

I feel as if the clinical exposure component and other requisite aspects for admission would screen out people who don't want to be doctors. At the end of the day, the high cost of medical school only prevents poor and middle income people from attending medical school.

Except people still drop out of medical school during every single year, even MS4's quit.

You'll think different when it's time for you to apply for residencies and you want to have a kid and buy a house.

Maybe, maybe not. Not everyone has extravagant med school debt and not everyone cares how much money they make once they're above a certain amount, and most doctors make at least $150k/year.

 

[AntiHouseMD]

Maybe, maybe not. Not everyone has extravagant med school debt and not everyone cares how much money they make once they're above a certain amount, and most doctors make at least $150k/year.

That's pretty much where I am. As long as I have enough money to raise my family and live a modest life, I'm fine. Fortunately, my state's med tuition is usually 40-50 thousand each year (different amounts each year, usually below 45,000) and has a great program. So, I'm looking okay right now (let's hope it stays that way).

 

[yamaraja808]

I think this article is too humbling. Lets say people do choose specialties over primary care because it pays more. If those people choose those specialities because they were drawn to the money...well then its because they were drawn to the money - not the 'pay off my loans faster'. If thats their motivation to go into that field, then why would they settle for less?

It is because they know physicians in general make more than most professions. There are a few who have been in the working world and they find that their degree in engineering or business is not yielding what they were hoping for (not everyone becomes a CEO and makes a 6 to 7 digit income). They go into the field of medicine thinking the payoff is better. For some people, it actually is and for others not so much.

 

[Slack3r]

That's my point. Folks pick what they enjoy, subject to what they are competitive for. Claiming money is why everyone isn't becoming a family practitioner or pediatrician is naive, and yet it is the crux of that article.

Law2Doc brings up an excellent point in this debate. Everyone talks about how the salary is the main deterrent for medical students, but there are many more factors which in my opinion play an even bigger role.

While not the only determinants, I'd say money and lifestyle (and these are interconnected) are among the primary determinants. Do you honestly think derm is as competitive as it is because that many people LOOOVE dermatology? Bull****.

It's no huge secret why primary care specialties are the least competitive. Similarly, it's no secret why fields that have some combination of low hours and high pay are as competitive as they are. Do you honestly think if FM paid as much as ortho and ortho paid as much as peds we'd be having this discussion? Of course not. We'd have the same situation we have now (only reversed), where there are plenty of orthopods who enjoy the work regardless of salary and plenty of family docs who were swayed by the $$$.

 

[FIREitUP]

I used peds and ortho as examples because a publication's recent national salary survey listed peds as the lowest and ortho as the highest average salary, respectively. I agree that the surgery versus nonsurgery decision might drive this train, but consider that yet another example of non-monetary criteria in choosing a specialty.

As to why there has been an increase in specialization and a falling off of primary care, there are multiple answers:

(1) As the amount of medical knowledge increases, there are benefits to carving out a smaller field in which you can "know everything". The dude in derm may be able to keep up with reading all the major journals and keep abreast of the major changes within the field. A broader specialty like a family medicine GP is at a huge disadvantage, and will have trouble keeping up. Which has liability risk, among other things.

(2) Non-physician competition -- someone who specializes isn't going to be fighting for business with the DNP at the CVS minute clinic like the family medicine guy might.

(3) An undermining of the doctor patient relationship thanks to insurance companies. At one time being a family doctor was more fun, because you could get to know your patients. Now, thanks to the way reimbursements work, you need to average less than 20 minutes a patient to maintain a decent standard of living. So a lot of the enjoyment of family practice that used to attract folks to the field is gone.

There are lots of others, and again, these are primarily non-monetary reasons. I do note that primary care was much more popular in this past match than in years past though, so perhaps we are seeing a resurgence.

You make good points, but number two basically contradicts your argument; i.e., not having to compete for patients is a monetary reason, and so is having to increase patient volume to make up for diminished profit margins (it not only makes PC less enjoyable, but it makes it less sustainable). There is no doubt that money and lifestyle are amongst the biggest reasons for specialty choice, besides personal affinity to certain specialties.

 

[45408]

This plan will just make the increasing shortage of general surgeons even worse. Overall, I think it's a terrible idea.

 

[45408]

You'll think different when it's time for you to apply for residencies and you want to have a kid and buy a house.

Smooth. Cast aspersions on his motivating factors.


I know people who picked non-competitive, low-paying specialties despite the fact that their academic achievements would have allowed them quite a few lucrative specialties. You know, there are people who aren't primarily driven by money.

 

[Narmerguy]

I know people who picked non-competitive, low-paying specialties despite the fact that their academic achievements would have allowed them quite a few lucrative specialties. You know, there are people who aren't primarily driven by money.

Can't say that on SDN.

 

[MeowMeowCAT]

I thought the reason for the already high tuition was the same as why most of the top undergraduate universities have high tuition. To artificially ensure "perfect students". When you are facing $40k+ tuition not everyone is willing to bite the bullet, regardless of their academic stats.

Exclusivity. Make it inaccessible to most, but still available to those who are willing to put in the effort. As a result, only people that really want it get through the doors, graduate, and keep the school's stats high.

Good statistics leads to better and more funding for the school. That's why you hear the top 10 undergraduate schools often in the news, because they can afford the funding for research and related.

And I am pretty sure running a medical school is not cheap either. So they rather keep the tuition high, and have students that will not be a waste of space and resources.

 

[Long Way to Go]

I thought the reason for the already high tuition was the same as why most of the top undergraduate universities have high tuition. To artificially ensure "perfect students". When you are facing $40k+ tuition not everyone is willing to bite the bullet, regardless of their academic stats.

Franklin W. Olin College of Engineering has done well for itself, despite only being founded a decade or so ago. It's attracting students who would have otherwise gone to MIT or CalTech--and many of them had to make that choice. It does this by offering at least half-tuition scholarships to everyone, and it offered full tuition scholarships until the year before last. Of course, being fantastically wealthy per student capita (about $1.1 million in endowment per student enrolled with a total of 300 undergrads) doesn't hurt, but that's about the same ratio as some medical schools.

 

[circulus vitios]

Franklin W. Olin College of Engineering has done well for itself, despite only being founded a decade or so ago. It's attracting students who would have otherwise gone to MIT or CalTech--and many of them had to make that choice. It does this by offering at least half-tuition scholarships to everyone, and it offered full tuition scholarships until the year before last. Of course, being fantastically wealthy per student capita (about $1.1 million in endowment per student enrolled with a total of 300 undergrads) doesn't hurt, but that's about the same ratio as some medical schools.

Cooper Union has given full scholarships to every admitted student for the past 150 years.

 

[mauberley]

Cooper Union has given full scholarships to every admitted student for the past 150 years.

👍

But I think what you'll hear next is how small schools like Cooper and Olin don't fall under the argument about "top undergraduate universities."

 

[SBR249]

Olin and Cooper Union are undoubtedly among the top universities in the country and especially in their fields. They and their cohorts in other fields (Curtis for music, for instance) are just as prestigious and well received by people in the know (the only people that really matters anyway) as Harvard, MIT, Stanford, etc.

However, the one thing to consider with these full-ride schools is size. They are small. Cooper Union has less than 1000 students total. Olin has a little more than 300 total. When compared to even small LACs, these schools are tiny. Hell, they are dwarved by many high schools in this country. That is how they support all those scholarships. The closest medical school equivalent is Cleveland Clinic which started providing full scholarships to all students 3 years ago. Cleveland Clinic has 160 students in total and it's a 5 year program which translates to ~30 students per class. That's just a hair bigger than the largest MSTPs in the country (~25/class) and those programs are usually known for their small sizes.

My point is that this model of small, free/cheap schools is unsustainable if we are going to be pumping out the tens of thousands of doctors that we need in the future and at best can only be applied to niche programs.

 

[SBR249]

Something interesting to consider: under a subsidized tuition model medical school's would like have to report where the money they were allocating was going. I have a feeling that many are not interested in sharing this information, lest it become clear that significant parts of the tuition were funding non-student oriented activities (e.g. things unrelated to actually training the students). Though it's hard to predict since no one besides the financial officers of a school really knows how tuition is allocated.

Out of curiosity, does this apply to public undergraduate colleges? State schools derive a significant portion of their funding from their respective state governments (though it's usually not allocated as "tuition subsidy" per se). The common argument against educational funding cuts is that it would force tuition increases so this funding can be said to be a tuition subsidy in that sense, yet not much has been said about how colleges allocate their resources.

 

[FIREitUP]

I wanted to chime back in to say what a terrible idea this plan is (although I'll stand by my assertions that crappy primary care reimbursements are driving to specialization). Penalizing people because they don't want to do primary care (i.e., making them pay 50k/year for medical school while their counterparts do not have to) is the dumbest thing I ever heard. What if you have no desire to do primary care? Obviously it's not for everyone. $325k seems like a very high median salary for specialists, as well. How about we do something much simpler: PAY PRIMARY CARE PHYSICIANS MORE MONEY? Medicare dictates what primary care physicians make per visit, the easiest thing we could do is increase the reimbursements. Why even bother with this convoluted plan if we can resort to something much simpler and more practical?