Now is the time to eliminate tuition in the health sciences


My call to medicine came while sleeping on an old couch in a hospital room in Eastern Turkey, while my close friend lay waiting for a diagnosis. We were scared, but one physician put us at ease, giving us a plan, and being there to help whenever he could. It was that service of medicine, that desire to have a career that allowed me to be with a person at some of their most vulnerable points of life that redirected me from future diplomat to future physician. I spent the next two years taking the prerequisite courses I needed and another two years in the Peace Corps to remind myself why I was starting this adventure.

When I started medical school two years ago, the idealism I carried was quickly washed away amidst the sea of bureaucracy and industry. My early visions of being a family physician, alternating between practice in the United States and assignments abroad seemed less attainable while pondering my student debt now totaling into the hundreds of thousands.

Even more alarming was realizing how the high cost of health care was preventing people like myself from accessing the care they needed. When I completed my Peace Corps service in Guatemala, I was required to take three separate stool samples to confirm I was not bringing back any parasitic friends. It turns out I was, though lucky for me, asymptomatically. I took my required medication and arranged a stool sample at my local clinic. The results came back negative, but the bill came back positive at $3,800. After multiple calls with insurance companies, the costs were covered, but I was scarred—mentally, fortunately not with flask-shaped lesions in my colon. It would be another 18 months before I built up the courage to establish primary care, mostly driven by studying for USMLE step 1 and needing verification I was not dying by an array of rare diseases.

Now, what a month ago seemed like an unbreakable cage surrounding health care professionals is losing its grip as U.S. Americans are recognizing that the health care industry is not working for them. Health care worker’s voices are being respected and listened to, and it is time we start talking about improving our system. There are clear first steps, like ensuring adequate protective equipment to keep health care workers safe, but when we come out of this fight on the other side into a broken economy, it is time to redesign our health care system starting with medical education.

To start this transformation, all tuition for medical schools and other health professions should be subsidized and made free. This would enable students to follow their careers in medicine by passion and interest, instead of economic gain. Residents could focus on learning to be the best providers without being distracted by the interest accruing on their pre-existing piles of debt. Young physicians could stand up for their values, without fear of retribution from administrators jeopardizing their ability to care for their families. Older physicians will be able to reflect on careers that left them enriched, both financially and spiritually, where their relationships with patients were considered more valuable than documentation that prioritized billing over patient care.

When students embark on their medical careers, they should be guided towards resources that effectively teach them the content necessary for USMLE Step 1 with small group learning to reinforce the material and draw connections. Multiple online platforms are delivering high-quality material that costs the equivalent of one day of medical school lecture material. Medical schools creating their own inferior content at a huge mark-up is an unnecessary redundancy of the system that needs to be reassessed.

Lastly, we need to recognize that medicine is best learned as a language: through immersion. In exchange for free tuition, students could be recruited to provide in-hospital services and learn early on what it means to be patient-centric in health care. By the time students arrive at their clinical clerkships, they will be better prepared to be of assistance in patient care and equipped with the softer skills needed to go beyond treating a patient’s illness.

We are journeying into unforeseen territory right now, with a map ripped into multiple pieces. It is time for physicians to take action and put those pieces together. It is time for all of us to be leaders in service to our nation and its people. We need a system that works for all Americans, and that starts with making a system that teaches our students what is important: Taking care of their fellow human beings.

Thomas Schroeder is a medical student. 

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