On Sept. 21 a daylong conference on Capitol Hill discussed the crisis in skyrocketing medical school tuition, high medical student debt and the implications for our nation’s health care.
High tuition costs and high debt are a problem not only for doctors — who, if they choose to enter primary care or to provide care for the uninsured or underinsured may be paying their loans for up to 30 years — but also for the health care system as a whole. High debt levels and expensive monthly repayments are a primary reason why doctors often cannot afford to provide care to patients who cannot pay. This is why there is such a shortage of surgeons and specialists in rural regions of our country. This is the reason there are almost no psychiatrists who can take Medicaid patients. Even primary care doctors, who can usually draw on a much broader patient population, are having trouble providing affordable care.
So what are medical students facing? The median debt for public medical school graduates is $105,000. For graduates of private medicals schools the figure is $140,000. (The real figures are actually higher because 20 percent of medical students do not have debt — they are factored into these numbers). Some medical students graduate with $350,000 in debt.
These sky-high and ever rising tuition costs eliminate diversity in medicine. Sixty percent of medical students come from the wealthiest fifth of the population, while only 3 percent come from the lowest fifth. Of equal concern, while African Americans and Latinos make up 25 percent of the U.S. population, they only make up 12 percent of medical students. A survey by the American Association of Medical Colleges (AAMC) explains that cost of medical education was the primary reason why qualified students of color chose not to apply to medical school.
Existing aid programs include the federal Perkins and Stafford loan programs that provide affordable loans for students to pay rising tuition costs. Aid-for-service programs such as the National Health Service Corps (NHSC) are excellent programs that help students pay debt if they serve as primary care physicians in federally designated underserved areas. However, these programs are not enough. The cap on federal loan programs is significantly below the full cost of tuition and living expenses — this drives students to borrow from predatory banks or take on substantial credit card debt. The NHSC and a similar aid-for-research program from the National Institutes of Health (NIH) are great, but only a fraction of qualified applicants are able to benefit from them due to low funding levels.
In response to this growing crisis in medicine, the American Medical Student Association, the largest independent national organization of medical students and young physicians, led the effort to organize a summit bringing together leaders in organized medicine and stakeholders in the financing of medical education. Experts, congresspeople and staffers, medical school administrators, representatives from loan agencies, representatives from the NHSC and the NIH, and medical students convened to propose a series of consensus solutions. The summit was a victory for those interested in expanding access to medical education and health care.
While the summit was only a first step, much energy has been generated around finding short- and long-term solutions. First, national leaders clearly articulated the link between high medical education costs and the crisis in health care access. Both were recognized as issues that require systemic solutions. Second, leaders from all sides of the issue agreed on the need for increased public support for federal loan and aid-for-service programs. More funding for the NHSC is a priority and similar programs that focus on surgery, mental health and international health are needed to provide essential services for people who cannot access them. Perhaps most importantly, improving access to undergraduate education and fostering diversity in the pipeline to medical school must be considered along with medical school tuition and debt.
The mounting cost of college education and the barriers that keep working-class young people and young people of color from finishing secondary education and entering higher education are part of the problem. Much work remains to expand access to higher education and health care, but medical students have taken an important step forward.
A full web cast of the summit is available online at www.amsa.org/meded/studentdebtsummit.cfm.
Pedro Archanjo is a medical student inspired by health care workers who render aid across borders, the “internationalistas.”
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