Tuition rates have exploded across the United States in recent years and total student loan debt has now surpassed credit card debt as one of the nation’s primary sources of debt. Medical school, with its required access to advanced medical equipment and highly specialized curricula, exacerbates this problem even further. Tuition rates for medical schools continue to climb, and many high-earning physicians struggle to pay off what can often become six-figure debt. This has understandably correlated with a drop in physician empathy, due to the already stressful environment of many medical care centers compounded by crushing long-term debt. How did we come to this, and how do we generate a long-term, sustainable solution that relieves pressure from new physicians while still meeting the tuition costs of their education?
The current (as of 2011) cost of providing medical curricula to the entire U.S. medical student body is estimated at $2.5 billion, approximately one one-hundredth of 1% of the U.S. total healthcare budget. One possible solution would be to forego giving stipends to students who are currently enrolled in specialty training (e.g. cardiovascular surgery). The stipends from these students would compensate for the tuition costs of all medical students in the U.S. In other words, students seeking specialized training (who typically earn significantly more than their primary care counterparts) would most likely require student loans for their specialized education, but general medical school courses would be free to all medical students (including future specialists). Over the long-term this could potentially shift U.S. medical students toward enrolling in more primary care programs as opposed to specializing, but it also shifts the burden of cost to specialists who, once they receive their degrees, are much more capable of paying the student loan debt.
There is enormous incentive for the American public to back such changes in the funding sources for medical education, given its potential effects on baseline prices for healthcare services. Private practices are of course less likely to provide affordable healthcare services if the physicians at the clinic are doing their best to address a six-figure personal debt. They are also understandably less inclined to accept certain kinds of insurance or provide medical consultation to citizens without a well-established rapport with a particular insurance company. Loan repayment and / or forgiveness plans help ease the burden, but only in exchange for a commitment from the new physician to work in a rural location, medically underserved area (MUA), or community health center. Many times this choice is made not out of personal preference, but simply as a source of financial relief, further adding to a new hire’s emotional turmoil. New funding sources, like shifting stipends of specialized students to cover all basic medical school tuition, must continue to emerge in order to keep medical student enrollment high, thus avoiding the creation of more medically underserved areas.