“I knew it’d be high, since I settled on pursuing medical school, although I don’t think it hits you until you’re actually faced with the loans,” says Marie (not her real name), a second-year medical student at Tufts Medical School.
Marie is 23 years old, hilted with over $40,000 dollars in debt after her first year of school. When it’s all over, Marie will owe at least $160,000.
High medical school tuition cost burdens students and compromises healthcare access for everyone. Why? According to Dr. Atul Grover, Association of American Medical Colleges (AAMC) Chief Public Policy Officer, our health system will be short by 90,000 doctors by 2020, a situation driven by an aging population and freezes on Medicare funding. And this is where medical student debt hits the hardest: The largest shortage is in primary care specialties —the most important but lowest paying jobs in medicine. As medical student debt increases, the likelihood of physicians going into primary care plummets — and this gap persists.
Average medical school tuition has increased rapidly over the past twenty years, above and beyond inflation. In real dollars, medical school tuition has increased 50 percent for private medical schools and 133 percent for public school from 1984 to 2003. Today, medical students average around $145,020 in debt when they graduate.
So why is med school so expensive?
Unfortunately, most schools don’t publish their numbers, but studies suggest that most of the costs do, in fact, go toward instruction and education. What that suggests is that these costs are simply increasing — the costs of maintaining a functional hospital, for example, or paying professors. In fact, instructional costs and educational resources costs combined range from 128,000 dollars to 156,000 dollars per student per year, a sum that is often greater than student contributions via tuition over four years of schooling.
To further complicate the matter, the average net income for primary care physicians is decreasing. In 2003, the average net income for primary care docs was 10 percent lower than it was in 1995.
“If you take out the full tuition and living expenses, it will probably take 20 to 30 years to pay back your med school loans,” says Stephanie Wang, a 2nd year medical student at Washington University in St. Louis.
One proposed option to solving the tuition burden is to shorten medical training. In an article in JAMA, Ezekiel Emmanuel, a health ethicist and advisor to President Obama and his coauthor suggest that the system is over-committed. Geared toward creating “triple threat” physicians — clinicians, scientists, and teachers—the education system tries to do too much. Rather, it should focus on training solid clinicians. That said, there are drawbacks. Such a system would imply more training during post-medical school residency programs, increasing teaching burden, and lengthening post-graduate training times.
“In the end, it doesn’t make a difference. I am still going to pursue my dreams, whatever the cost,” says Marie. She hopes to go into cardiothoracic surgery, a specialty that averages more than $400,000 dollars a year after six to nine years of training following medical school.
While it means one less primary care doctor in our medical system, at least Marie shouldn’t have trouble paying off that debt.
Edited by Abdul El-Sayed, Karestan Koenen, and Elaine Meyer.