New York University School of Medicine recently announced their tuition-free initiative, meaning four years of medical school will be free to all students, regardless of financial status or ability to pay.
The rationale is vague: “We believe this initiative will lead to better patient care and will benefit society as a whole by turning the best and brightest future physicians into leaders with the potential to transform healthcare.”
Ranked as the no. 3 medical school in the United States for research, NYU is already in the enviable position of having its choice of the best and brightest premedical students.
How many of those students will transform healthcare is based on many other factors including other academic degrees, residency training, fellowship experience, academic appointments, and the desire to “transform healthcare” rather than to simply provide the best care for their patients.
The tuition break is significant — $220,000 for the four-year NYU medical degree. This initiative is still far from a free ride. Other costs, including fees, room and board, books and supplies, and health insurance add another $25,000 per year to the cost. In other words, despite free tuition, it will still cost NYU medical students $100 grand to get their medical degrees.
The rationale for free tuition is the “overwhelming financial debt” facing medical school graduates facing another 3-to-10 years of residency and fellowship training, earning enough to support themselves but hardly enough to pay down their debt.
The “big bucks” come later, once training is completed and physicians begin practice. Big bucks though is a relative term. Practicing in a highly compensated specialty such as plastic or orthopedic surgery means half a million dollars a year. At the other end of the spectrum, in family medicine and pediatrics, average compensation is closer to $200,000 per year.
Nothing to sneeze at but consider having a few hundred thousand dollars in student loans, at 5 percent interest, along with family costs, a mortgage, children’s school tuition, and so on, with any significant earning delayed until doctors reach their early to mid-30s. Suddenly, the numbers aren’t as rosy for future doctors spending 7 to 15 additional years in school after college.
Naturally, many medical students gravitate toward better-compensated specialties that provide a higher return on their education investment, just as many law school students seek jobs in the big law firms, where partnership promises a hefty paycheck, or business school students look to work in corporate finance or consulting for the same reasons.
This is one of the reasons for NYU offering free tuition. As the New York Times explained, “In the field of medicine, schools have become worried that students saddled with steep debt are increasingly pursuing top-paying specialties rather than careers in family medicine, pediatrics and research.”
Despite free tuition, many students will still choose higher-paying specialties. They may have other school debt. Or they may want a lifestyle afforded by a higher income after spending 30-plus years in school. In other words, payback after decades of hard work and delayed gratification.
What might work better than free tuition? Think of the tax code with its breaks and credits. Instead of giving all students free tuition, leaving them with no incentive to pursue lower-paying specialties, why not cut them a break only after they choose such a career path?
Already, the Federal Government provides loan forgiveness programs through various public health programs and military service. But these are after the fact, not before. Offer these types of incentives for students choosing under-supplied specialties or committing to work in underserved geographic locations.
While this is a form of “social engineering,” the tax code has always been used for such purposes, encouraging certain activities, discouraging others, using the carrot and stick of the IRS.
This allows students to weigh their career options as they are going through school, making decisions based on incentives instead of giving all students what is essentially a “get-out-of-jail-free card” before they even begin the game and relying on altruistic motives rather than the much more reliable “follow-the-money” incentive to guide their specialty choices.
While NYU’s free tuition program is well-meaning, it doesn’t create the incentives necessary to alleviate the physician shortage in particular specialties or underserved locations. Loan forgiveness or income tax breaks would work far better than hoping that medical students simply make career choices solely out of appreciation for their free tuition.
Brian C Joondeph, MD, MPS, a Denver based physician and writer. Follow him on Facebook, LinkedIn and Twitter.
The views and opinions expressed in this commentary are those of the author and do not reflect the official position of The Daily Caller.
