A moral imperative to address the costs of training our doctors

by Andrew M. Ibrahim and John A. Brockman

Despite the landmark progress of recent healthcare reform, it missed the mark on long term cost control by failing to address medical education.

Radical changes are needed in the way we finance tuition and how we teach our students.

While last month a new graduating class of medical students celebrated their Match into training programs for their specialty, the news wasn’t all good. Following concerning trends of the last few years, US students opted for high-paying specialty careers over primary care. Family medicine, pediatric and internal medicine relied on foreign graduates to fill spots while plastic surgery and dermatology turned down many US applicants.

This pattern is not without reason, and tuition expenses are largely to blame.  This years graduating class was characterized by taking on enormous debt. More than a quarter of graduates have greater than $200,000 in loans. Research continues to show that the level of debt influences students to choose higher paying careers.  More concerning, higher debt has also been associated with poorer quality of life, likelihood of burnout and increased thoughts about suicide.

The negative impact of high tuition on physicians has not influenced medical school administration. In the last decade, the costs of a medical education increased at twice the rate of inflation without justified cause. This leaves graduates anxious to increase their salary and feeling justified to enforce co-pays in their practice, overbill and avoid low-paying insurances, including Medicaid patients. Moreover, they often are paying off this debt well into their 50’s at variable interest rates well above those paid by home owners.

National level intervention is needed to address the unsustainable costs of medical education. At minimum investigation is needed to understand why it has risen at a rate far outpacing similar institutions. While it is unlikely that all of medical education would be subsidized, it could be done for less than 1% of our Medicare budget. Even a partial investment in this direction could represent a common sense strategy to address workforce shortages to care for an aging baby boomer generation.

If we are serious about reducing healthcare costs long term, we have a moral imperative to address the costs of training our doctors. Using capitalist theory to put students in debt and then expect them not to use the same principles for their own interests that drive up utilization costs is unrealistic and unfair.

Andrew M. Ibrahim is the Doris Duke Fellow in Clinical Research in the School of Medicine at Johns Hopkins University in Baltimore, Maryland.  John A. Brockman is national President of the American Medical Student Association in Washington DC.

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