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.

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?


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

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