By Andrew W. Gurman, MD
ASSH member and former President of the American Medical Association

Disclaimer: The views expressed in this piece are my own, or as referenced, and do not reflect the views of the ASSH or the AMA.

On August 16, 2018, The New York University Langone school of Medicine announced that it would offer free tuition to the incoming class and to all medical students currently enrolled as well as going forward. (1) The announcement stated that it was hoped that medical student debt would not be a factor for NYU graduates in choosing their specialty, thus fostering a move towards primary care. This is not a new argument: Bach & Kocher made the same assertion in an op-ed piece in JAMA in 2011. (2) According to the American Association of Medical Colleges (AAMC), the median debt for graduating medical students is $192,000. (3)  Dr. Robert Grossman, Dean of the NYU Medical School, called this amount of debt: “A moral imperative which must be addressed.” (4) Several authors have questioned the return on investment for medical school tuition, and have argued against the financial wisdom of pursuing a career in medicine. (5) Another factor which free tuition is hoped to address is diversity among the physician workforce, which, according to an op-ed in JAMA, less and less reflects the increasing diversity of the population we serve. (6)

The NYU move was not the first. In December of 2017, Columbia University Medical School announced that it would give free tuition or grants to those students who qualified for financial aid. The Geffen School of Medicine at UCLA gives free tuition to 20% of the class, based solely on merit. There is a smaller free tuition program based on research interest at Case Western/Cleveland Clinic.

According to the AAMC, the amount of debt among residents is similar among residents of both primary care and specialties, and a survey of graduating students revealed that debt is becoming less of a factor in choosing a specialty. (7)

The average yearly cost of medical school is $60,945 for a public institution, and $82,278 for a private school. Although the NYU program covers tuition, it does not cover room and board which is estimated at $27,000 per year. Even that figure may prevent some economically disadvantaged students from considering a career in medicine.

Will free tuition lead to increasing diversity among medical school classes, more graduating students choosing primary care, and an improvement in the health of our nation? Critics have argued that a more effective means would be to address diversity in the admissions process (8) and that the NYU program is simply an unnecessary subsidy to a predominantly non-diverse group that will do well as specialists; and that a better way would be to grant tuition waivers to those who commit to primary care in underserved areas. (9)

All of these programs are new, and there are no outcomes data regarding their efficiency at accomplishing their stated goals of increasing minority representation in medical schools, increasing the number of graduates who choose primary care, and continuing to attract the best and brightest students to careers in medicine.  

Is free medical school tuition a good idea? Only time will tell.     

References

1. Chen, David, New York Times, August 16,2018
2. Bach, Peter, & Kochar, Robert, NY Times Op Ed, May 28, 2011
3. AAMC Information sheet accessed at www.aamc.org
4. USA Today, August 18, 2018
5. Higgins, Stephen L, Forbes, Jan 5, 2017
6. Thomas, Billy, JAMA. 2019;321(2):143-144
7. AAMC Medical school graduation questionnaire 2018
8. Emanuel, EJ, Gudbaranson,E  JAMA 2018: 319(7) 651-652
9. Weissman,J, Slate, Aug 20, 2018