New York University’s free medical school tuition’s impact on career choices

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• New York University said last Thursday that it would
  offer free tuition to its current and future medical
  students. 
• NYU hopes that this move will help with the shortage of
  doctors in the US and encourage more students to go into
  primary care.
• Many physicians voiced their skepticism about this goal
  via Twitter, claiming that free tuition alone won’t alleviate
  the financial barriers of pursuing a career in
  medicine. 

New York University made a bold move on Thursday when
it said it would offer free tuition to current and future medical
students. 

The university hopes this will alleviate the financial
barriers that discourage many promising high school and college
students from considering a career in medicine due to concerns
with high medical school costs. Ideally, without looming medical
student debt, students will choose to go into less high-earning
areas of medicine such as primary care. 

“Saddled with staggering student loans, many medical school
graduates choose higher-paying specialties, drawing talent away
from less lucrative fields like primary care, pediatrics, and
obstetrics and gynecology,” NYU said in a news release. There’s
been a shortage of primary care physicians in the US, in part
because of
how much less they’re paid compared to doctors in more
specialized areas of medicine. 

The funding will draw from the university’s $600 million
endowment, which it built up over the past 11 years for this very
purpose. While the new plan waives tuition which is around
$55,000 per student at NYU, it doesn’t not cover room and board
or fees, which together are an additional $27,000, on
average. 

But many doctors are skeptical that the free ride will lead
to more medical students opting into primary care. On Twitter,
they argued that just covering the tuition alone, won’t be
enough. Many experts believe that without altering the selective
medical school application process or finding a way to
incentivize students to go into lower-paid specialties like
primary care in underserved or poor regions, not much will change
in the field.

Even with the tuition break, students are still more likely
to choose the option to go into more lucrative specialties like
plastic surgery or cardiology. 

“If six-figure debt were enough to motivate, I’d be surprised,”
Mark Friedberg, senior physician policy researcher at the RAND
Corporation told Business Insider.

That’s because of the
pay gap in lifetime earnings between primary care doctors and
doctors that go into specialties. Over a lifetime, primary care
doctors can make as much as $3 million less than their
counterparts in other specialties, Friedberg said. 

Getting a free medical school education

According to a
2018 report by the Association of American Medical Colleges,
there will be a shortage of anywhere from 42,600 to 121,300
doctors by 2030. This is due in some part to the potential for
staggering medical school debt that discourages some students
from pursuing medicine. Several of the nation’s top
medical schools, in response, already offer scholarships that
cover some or all of the costs of attendance based on either need
or merit. 

• UCLA’s David Geffen
  School of Medicine, for example, has a $100
  million fund that pays for the entire cost of medical school
  for all four years, including tuition, fees, books and living
  expenses for its high-merit students, which are approximately
  20% of those enrolled.  
• The Cleveland Clinic’s Lerner College of Medicine in 2008
  announced that it would cover tuition for all students admitted
  to their highly selective five
  year program, with one required research year tacked on at
  the end of the medical education. The class size for this
  program is capped at 32 students. 

Other programs cover tuition — with a catch.

• The National
  Institutes of Health‘s Medical Scientists Training Program
  covers the cost of attendance for 970 students across 49
  schools, but students have to dedicate eight continuous years
  to get a MD and PhD, which means their medical education will
  be extremely research-oriented.
• And students completing the Health Professions
  Scholarship Program (HPSP) or the Uniformed Services University
  of the Health Sciences (USUHS) can have their tuition waived on
  the condition of
  military service. 
• With a focus on motivating doctors to get into primary
  care, the
  National Health Service Corps covers tuition for
  students who agree to work for four to six years in an
  under-served area. These areas — geographic or population-based
  — tend to have shortages
  of primary care doctors. 

Additionally,
in-state tuition for many public medical schools in states
like Texas are becoming affordable, costing around
$15,000-$20,000 a year. 

Other factors at play 

Skeptics of NYU’s free tuition plan say it glosses over
other issues that are creating a physician shortage. 

One is the increasing difficulty of getting into medical
school. From 2006 to 2016, the volume of medical school
applicants has increased by 36%, but
acceptance rates have either steadily decreased or stayed the
same. This means medical programs are becoming increasingly
selective about who they admit. NYU’s average GPA and MCAT scores
for its current first year class are both in the 99th
percentile. 

NYU’s current freshman class is 93 students, a decrease from the
class sizes of previous years, which were in the 120-130
range. 

According to the Association
of American Medical Colleges, in 2017, of the 51,680
applicants who applied to medical schools, only 21,338 students
matriculated. That means from the total populations of students
who wanted to become doctors post-undergraduate, only 41% make it
to medical school. 

And even before pre-med students step into the doors of a medical
school, there are a lot of costs. 

The MCATs, standardized medical school admission tests,
costs $315 dollars to take and is a grueling seven hours long.
The application fee for each medical school is around $100, and
on average, each student applies to about 16 schools each
application cycle. That’s about a $2,000 investment up front. And
not every applicant is successful.  

After medical school, each student is matched to a
residency program, where they’ll spend another four years at, and
more if they choose to specialize. During residency, students
make around $40,000-$60,000 a year, mostly to cover living
expenses. 

It remains to be seen whether current NYU students alter their
career paths and disproportionately get into lower-paying areas
like primary care and pediatrics. And even if they do, Friedberg
said, it might not do much if those doctors decide to practice in
areas of the country that don’t have a shortage.