Has the free medical school experiment failed?

Among the many problems facing the U.S. medical industry, one of the really big ones is the dearth of doctors. According to a report from the Association of American Medical Colleges, America will be short up to 86,000 physicians by 2036.

A few years ago, philanthropists came up with a potential solution: subsidize medical school tuition in the hope that students would not only choose lower-paying specialties but that the student body would also diversify. However, the tuition-free experiment has not gone as hoped.

“Marketplace” host Kai Ryssdal was joined by Rose Horowitch, an assistant editor at The Atlantic, who recently wrote about what is ailing tuition-free initiatives. The following is an edited transcript of their conversation.

Kai Ryssdal: So talk to me, just as a place to start, about [New York University], which was one of the schools that went completely tuition-free for medical school like six or something years ago. And you say in this piece it has been a failure. Discuss.

Rose Horowitch: So NYU medical school went tuition-free in 2018 and, you know, at the time they set out these metrics and were kind of saying that, you know, it will be a success because more students will go into primary care, we will admit students who otherwise maybe couldn’t have gone to medical school. And so judged against those metrics, they really haven’t succeeded. Their percentage of financially disadvantaged students actually decreased. And the proportion of Black students kind of slightly declined, with Latino students having just a small increase as well.

Ryssdal: OK, why?

Horowitch: That is the million-dollar question. So, making medical school tuition free is based on this great idea that will solve the problems that are in the medical profession. And it’s true that students are graduating with hundreds of thousands of dollars of debt, but if you really think about it, making medical school tuition free doesn’t actually do anything to solve these specific issues. You know, there’s research showing that the income differential between primary care specialties and specialty care is actually much more significant in what people choose to go into than their medical school debt. And then it also just makes getting into that school much more competitive because everybody wants to go to one of the few medical schools that are tuition-free. And we know that medical school application processes really advantage wealthier students, and so it just makes sense that the students who get in would be wealthier.

Ryssdal: So, look, if literally giving away a medical school education won’t get it done, what’s the answer to the undercount of physicians that we have in this country, which is critical, right?

Horowitch: It is a very important issue, and everyone agrees that it’s a really important problem. So some of the solutions that came up in my reporting were more targeted financial aid or subsidies for low-income students or for people that choose to go into primary care. And then also just focusing on how to expand the supply of medical school and residency slots. It’s more of a supply issue than a demand one.

Ryssdal: When you talked to the schools and said, “How’s this going?” What did they say to you?

Horowitch: NYU was really the only school where the change was made long enough ago that we can have results on how it went. And they were sort of saying that it shouldn’t be evaluated solely on the metrics and that this does have real benefits for students, and that is true for the students who do end up going to these schools. It reduces their stress, and on the margins, it might lead a few more of them to go into primary care or to practice in an underserved area, but it’s just not having the changes on the larger scale that we would hope.