The unintended consequences of free medical school

I’m probably in the minority on this, but I’m not a fan of the NYU School of Medicine free tuition program. Now I’m all for debt relief for medical students who start their careers with a mortgage. I was one of them. After 13 years, I’m still one of them! I’m also for any initiative that drives more medical students to career paths like primary care, where massive debt makes higher paying subspecialties more desirable. As a practicing primary care internist, and a former academic physician that worked with medical students, this is a cause I’m passionate about. But while NYU continues to be lauded from all directions for this incredible investment and commitment, I suspect the program will not achieve its purported goals.

Let’s start off by respecting the fact that NYU is one of the best medical schools in the country. As a former residency program director at an excellent academic institution, we were always thrilled to recruit students from NYU. NYU med themselves recruit the best and brightest undergraduate students across the country. But the current reality of medical education is this. Whether it’s medical school or in residency, the best students often pursue the highest paying and most competitive fields. There are many reasons for this and education debt is certainly one of them.

With the tuition relief NYU is offering, the medical school will suddenly become even more competitive. I suspect their upcoming classes will be an even less academically diverse sampling of ultra-driven students trying to climb Mount Everest. The assumption that these extremely bright hard-working students will suddenly give up on competitive subspecialty fields (that earn a lot more by the way) is basically the antithesis of their academic and personality traits that probably got them there in the first place. It seems like the school is hoping that being debt free will suddenly cause a rush of altruism that will bring students to fields like medical research, pediatrics, and family medicine. But let’s remember, it is altruism that partly got them into medicine and accepted into medical school in the first place. After talking to students and residents for ten years, I’ve learned that once they are in, many feel that selflessness and commitment to the well-being of others can also be achieved through higher-paying specialty fields like dermatology, emergency medicine, plastic surgery, and cardiology. And I agree with them.

I hope I’m wrong about this. Our broken health care system needs more medical students to choose careers in research and primary care. But a free ride at an elite medical school is not the answer. Like tax cuts to wealthy corporations that often do stock buybacks while augmenting the bottom lines of investors, most of these great students at NYU Med will take the tuition relief and probably just run with it to well-deserved and lucrative career options. And instead of being indebted to banks, perhaps they will feel indebted to their alma mater and become generous donors. That’s a good way to help keep a program going that although looks good on press releases, may not actually make a huge difference.

The author is an anonymous physician.

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