The New York University School of Medicine just eliminated tuition for all current and future students.
Administrators believe the reform will help solve the nation’s doctor shortage. Dean Robert Grossman suggests that “without the prospect of overwhelming financial debt,” more people will pursue medical careers. And they’ll be more willing to become primary care providers in underprivileged areas, rather than highly paid specialists in affluent communities.
Unfortunately, that’s wishful thinking. There are many reasons for America’s worsening doctor shortage. Student debt is barely one of them.
To be sure, America needs more doctors. We’ll be short as many as 120,000 by 2030, according to the latest estimates from the Association of American Medical Colleges. That’s an increase of about 14 percent over last year’s projections.
Rural areas are disproportionately affected. Such communities have just 13 doctors for every 10,000 people, compared to 31 doctors per 10,000 in urban areas. Nearly 60 percent of regions with primary care shortages today are rural.
Making medical school tuition-free is unlikely to change that. Most medical students return to communities that match their backgrounds, or where they’ll have access to the most cutting-edge treatments and medical technology.
Today, the vast majority of med students come from wealthier, urban communities. Only one in 20 comes from the bottom economic quintile; more than half come from the top quintile. Few come from rural areas.
True, high-achieving students from lower-income backgrounds may find medical school more accessible if they don’t have to pay for it. But the correlation between income and academic achievement has only tightened in the last half-century.
Wealthier students aren’t going into medicine at higher rates just because they can afford to. They’re also better prepared, at least right now, for the rigors of medical school. Eliminating tuition will not magically equip lower-income students with the skills and knowledge they’d need to qualify for — and succeed in — medical school.
Consequently, free med school will initially benefit many students who least need it — wealthier people likely to return to the urban and suburban areas where they grew up.
If the goal is to make careers in medicine more accessible to disadvantaged students, then philanthropists and public officials will have to intervene in the educational system earlier, with an eye on preparing low-income students for medical school.
And if the goal is to address the doctor shortage, there are far more efficient ways to do so in the short term — for instance, by offering targeted grants to physicians who agree to practice in rural or underserved communities.
Further, there’s little evidence that student debt deters people from becoming doctors. The median med school graduate from the class of 2017 owes $192,000, including undergraduate debt. That’s equivalent to just under $27,000 each year in principal and interest, assuming a typical 10-year loan at a 7 percent interest rate.
That would be a burdensome debt load for the median American household, which earned slightly over $61,000 last year. But the average starting salary for a family practitioner exceeds $160,000. And that’s the lowest-paying specialty. Those who go into general surgery make $280,000 to start. And salaries, particularly for specialists, rise with experience.
Is reducing debt for people who will be making three times the median income when they begin work really the wisest use of resources?
If we want to attract more of our nation’s best and brightest into medicine and narrow the doctor shortage, eliminating tuition will only be marginally helpful. In fact, it could give medical schools and public officials a reason to dictate where doctors must practice after they graduate.
Empowering doctors to practice medicine free of undue government influence, on the other hand, could make the field significantly more appealing — for both current and future doctors.
Federal mandates have increased doctors’ administrative burdens — and are driving many physicians out of the profession. Just look at the Obama administration’s 2014 directive that doctors convert patient files to “electronic health records.”
EHRs were supposed to make patient records easily shareable among physicians. In theory, that would lead to more coordinated care and fewer medical errors.
Instead, the mandate has been a bureaucratic nightmare. Doctors now spend half their time on EHRs and desk work — and barely a quarter of their time with patients. In 2000, doctors spent more than 60 percentof their day providing medical care.
The increasing bureaucratization of health care has left two in three doctors feeling burned out, depressed, or both. A 2016 Advisory Board survey found that 21 percent of physicians planned to scale back their hours within three years. Fourteen percent planned to retire. The same share planned to seek a non-clinical healthcare job.
Those numbers will surely rise if Democrats successfully implement single-payer health care. The Medicare for All bill championed by Sen. Bernie Sanders would set physician payment rates at levels 30-40 percent lower than those currently paid by private insurance.
The road to becoming a doctor has also become much more difficult to traverse. Medical schools are producing more graduates than ever. But the number of residencies hasn’t kept pace. In 2018, more than 37,000medical school graduates competed for about 33,000 residencies.
Rather than making tuition free, America’s philanthropists might consider some combination of expanding the number of medical school slots nationwide, underwriting even more residencies themselves, and encouraging the federal government to lift its two-decade-old cap on funding for residencies.
States can also consider relaxing scope-of-practice restrictions on nurse practitioners and physician assistants, so that doctors can devote their attention and time to the most serious cases. Research shows that these professionals can deliver some types of primary care more effectively and at lower cost than physicians.
Eliminating tuition is a brilliant marketing move for NYU’s med school. The school is already highly ranked and will surely attract even more of the nation’s brightest applicants. But let’s not pretend it will put a dent in the doctor shortage.