Medical education cost is a health policy imperative

Whenever I talk about the cost of medical education, I like to bring up this chart. It starkly illustrates just how expensive it is to train a doctor in the United States, compared to Canada and France.

Medical education cost is a health policy imperative

New York Times contributor Pauline Chen wrote a column on the issue recently.  Most doctors graduate with a debt exceeding $150,000, and end up paying for it well into their 40′s and 50′s.  This is giving pause to some who are considering medicine:

Paying so much up front has transformed an education that was once a path to public service into a significant financial investment that needs to yield returns. “Because of all the debt, people stop thinking of medicine as an incredible opportunity to do good,” Dr. Greysen said. For some young people, looming debts mean eschewing a calling to serve a particularly needy, less lucrative patient population or practice, and instead pursuing a well-compensated subspecialty that caters to the comfortably insured.

For others, such large debts mean forgoing a medical career altogether. Cost remains a key deterrent for pre-medical students and is an important reason there aren’t more African-American, Hispanic and Native American doctors.

Policy makers often leave out this fact when talking about physician salaries.  As I wrote before, when discussing the tension between health policy experts and physicians, if policy experts want American doctors to be paid like their colleagues in, say, France, then you have to eliminate the education burden that French physicians never face.

Simply saying that American doctors are overpaid, while excluding the crushing burden of their medical school debt, is an unfair argument and only dissuades more prospective students from becoming physicians.  Any consideration for reducing physician salaries must be accompanied by proportional relief in medical school debt.

As for solutions, a few schools have completely subsidized education.  That’s a step in the right direction, and would allow medical students to choose relatively lower-paying primary care fields without the influence of loan repayment.  But it’s unlikely that many medical schools can simply forgo tuition.

Dr. Chen, in her essay, goes one step further:

We [must] disengage ourselves from the notion that debt is a necessary part of medical education. As long as indebtedness is viewed as a normal part of becoming a doctor, tuition will continue to surge unchecked, and the implications for patients will only multiply. And we will be no closer to an answer for the most important question of all: Just how much should students, and society, pay for the next generation of doctors?

Indeed.

Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitter, and LinkedIn.

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  • http://www.kevinmd.com kevinmd

    The references for the data in the chart can be found here:
    http://cdn1.kevinmd.com/blog/wp-content/uploads/medical-school-cost.jpg?e8bd46

  • Anonymous

    Canada and France have socialist healthcare systems….

    In the US, it’s about making a profit.  Why shouldn’t medical schools charge as much as they can to make a profit.  There certainly isn’t a lack of customers.

    • http://pulse.yahoo.com/_KCL4AO3HM6GTZ2X4RD3BQD5JPI GPZ

      America has Medicaid and Medicare, which are both “socialized” programs and they indirectly dictate prices paid for medical services. 

      Nice try, though. 

      • Anonymous

        The government doesn’t dictate prices for private medical schools.  There are, of course, public medical schools which costs less than private medical schools.  Resident tuition for a public medical school is 60% of the tuition for an out of state medical student.  Four years at a local university is $52,000 in tuition.  Tuition for Harvard is listed as $180,000 for 4 years.

        If we want doctors to accumulate less debt, it seems wise for medical students to attend those socialists public institutions in their home.  Many don’t.   Harvard has no trouble filling those spots with medical students.   Do you want the government to subsidize medical education at a private institution?

        • http://pulse.yahoo.com/_KCL4AO3HM6GTZ2X4RD3BQD5JPI GPZ

          Once again, swing and a miss! 

          By dictating the maximum amount allowed for government loans, the government directly caps the amount schools can charge. Every time the maximum loan amount is increased, tuitions are increased by the schools. Sine the vast majority of students could not afford school without loans, the government directly decides how high tuition can go. 

          Do you ever get tired of being wrong?

          • http://twitter.com/blingeorkl Blingeorkl

            In addition, the government is what sets the outrageous interest rates for med students. Taking out 40k a year, the bulk of that (80%) is unsubsidized with interest rates at a staggering 6.8%. If the initial value of the loans doesn’t flatten you then the compounding interest surely will.

          • Anonymous

            Pell loans were fixed at 7.0% in the 1970s and 1980s, and people paid them off. In that same period, HEAL loans had no fixed rate, rather they floated at 1.5% over 90-day prime, which at one time was 11% or so, yet people still borrowed very heavily at that rate; they had to as those were the only loans available that would cover the tuition rates being charged by medical schools.

            Medical schools have raised tuition as high as they think they can in step with one another and as far as the prevailing loan agencies will permit or guarantee. And the one statistic they never seem to publish is the average indebtedness of their graduates excluding military and public health service scholarship students, whose indebtedness is one of contract service more than money. The last group is included in those averages and always lowers the group average debt figure. You could calculate roughly yourself, but that would take knowing how many recipients of what length scholarships there were, three years, four years and such.

          • Anonymous

            The federal government doesn’t cap private medical school tuition.  Since state medical school tuition rates are far below private medical schools, what does your statement mean?

            So you are saying that potential doctors don’t look at the price of their education, they just borrow as much as the government will allow them and pick the most expensive medical school?

            Once again, you want me to pay for your education with my tax dollars?  Then you want to have a market based system based on supply and demand so you can make a lot of money and I can’t afford healthcare.

            Anyway, you seemed to miss my sarcasm in the first post.

        • Russell Stuart

          I am starting med school at a state school, and my financial
          aid package is ~45K/year. This was a big factor in choosing this school as I
          will only be looking at ~180K of debt after med school. Private would have been
          around 300K for four years, and much of this would have been grad plus loans
          that have a higher interest rate.

          The upfront cost here is a big deal; to me at least.

  • David Chiang

    so i’m a little confused by this debt issue and i’m also extremely naive about living expenses, but…. If a medical student walks out with X-amount of debt, wouldn’t it hold true that lifestyle adjustments could be made to pay off the debt such that the future-MD wouldn’t have to worry about this into their 40s and 50s? that is to say, what is the true reason (taking into account debt, income, taxes, living expenses, etc.) why physicians are paying debt so far into the future?