There is a shortage of physicians and especially a growing shortage of primary care physicians. Many public health advocates believe the high cost of medical school is to blame for the physician shortage. In early 2024 a former professor at Albert Einstein School of Medicine made a historic donation to the university worth $1 billion dollars. The donation will allow the school to no longer require its medical students to pay for tuition. This is huge. It is not uncommon for medical students to graduate with student loans of $200,000 to $300,000. The school reports that tuition and fees formerly cost students $63,000 a year, saving graduates about $250,000. Proponents of free medical school believe that saving up to $250,000 on tuition will allow more lower-income students to attend medical school. The medical school had this to say:
“This donation radically revolutionizes our ability to continue attracting students who are committed to our mission, not just those who can afford it,”
Furthermore, many proponents believe free medical school will encourage more students to pursue lower-paying specialties (e.g. primary care) without the worry of having to repay $200,000 or more in student loans.
The Atlantic reports the reality is not turning out as proponents had hoped:
Six years ago, the New York University Grossman School of Medicine, in Manhattan, announced that it would become tuition-free for all students. The change was made possible in part thanks to a $100 million donation from Kenneth Langone, a Home Depot co-founder, and his wife, Elaine. “It would enable graduates to pick lower-paying fields like primary care and pediatrics, where more good doctors are desperately needed, without overwhelming debt to force them out,” Kenneth said in an interview at the time.
While it may be true that lower-income students would benefit from no-cost medical school, it is unlikely to influence medical students’ decision to pursue primary care.
The school’s shift to a tuition-free model has no doubt been a tremendous boon to those students fortunate enough to gain admission. But judged against the standards set out by the Langones and NYU itself, the initiative has been a failure. The percentage of NYU medical students who went into primary care was about the same in 2017 and 2024… The locations of the hospitals where students do their residencies—often a clue about where they will end up practicing long-term—also remained essentially unchanged. And although applications from underrepresented minority students increased by 102 percent after the school went tuition-free, the proportion of Black students declined slightly over the following years…
Any economist could have predicted this outcome. Economic incentives are partly why many physicians steer away from primary care. The same economic incentives come into play regardless of free tuition. A specialty that pays $500,000 a year is more sought after than one that pays $275,000. The cost of tuition, worth $250,000, barely registers when the debt is one similar to one year’s salary difference.
Further evidence suggests that free tuition not only benefits the wealthiest profession in America (physicians), but it also benefits the wealthiest applicants.
Perhaps most alarming of all, doing away with tuition appears to have made the student body wealthier: The percentage of incoming students categorized as “financially disadvantaged” fell from 12 percent in 2017 to 3 percent in 2019.But health economists are nearly unanimous that such gifts, no matter how generous and well intended, will do little to achieve their broader stated aims—and might even be making health-care inequality worse.
Who really benefits from free medical school tuition? The schools to some degree but mostly the students themselves. Free tuition worth $250,000 makes schools more desirable. Thus, it allows the schools to be more selective, which makes acceptance more competitive. The more competitive a school is, the chances are that the wealthier students will win out. Applicants from wealthier families have the money for private schools, private tutors and MCAT entrance exam preparation classes. They are likely to fare better than economically disadvantaged students whose family lacks those resources.
What could these programs have done differently? Perhaps free medical school for physicians agreeing ahead of time to pursue primary care. Maybe free medical school for economically disadvantaged students agreeing to study primary care. Maybe free three-year primary care programs with a guaranteed primary care residency. Schools could even refund $250,000 to graduating students who choose primary care. In any case, donors should do more to ensure their donations meet their goals, rather than enrich medical schools or their graduates.
The entire article is worth reading: The Perverse Consequences of Tuition-Free Medical School.
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