Dr. Marc Siegel: Free tuition at medical schools can improve health care
I’ve seen a lot of smiles and innumerable nods of appreciation coming from members of the incoming freshman class at the New York University School of Medicine after they learned they wouldn’t be charged tuition. But the larger question remains – what will going to medical school tuition-free mean to long-term career choices, as well as a new doctor’s passion to practice medicine?
Consider that today’s doctors are weighed down by increasing demands of computer documentation. While electronic health records move us closer to the goal of more efficient and more effective information exchange, they also increase the joyless impersonal time doctors must spend without financial reimbursement.
In fact, a recent study in the Annals of Family Medicine found that primary care doctors must spend more than half their doctoring time (over six hours before and after office hours) interacting with electronic health records.
Doctors now also must learn to jump through more insurance and government approval hoops, so-called “meaningful use” regulations. And in the near future we will be rewarded for the quality of care we provide rather than for the service. This change could prove challenging in complex non-compliant cases.
Will not having to pay tuition be enough to steer budding doctors in the direction of lower-paid specialties, with all the hurdles we still have to climb?
The answer isn’t in yet, but I believe that the incredible generosity on the part of New York University ($450 million raised over 11 years, including a $100 million donation from Chairman of the Board Ken Langone) to eliminate medical school tuition is a big step in the right direction. It is sure to be copied by medical centers throughout the country that want to remain competitive.
I remember choosing the State University of New York at Buffalo as a medical school in part because the tuition was much lower than at private medical schools. Then I chose Bellevue Hospital in New York City for my internal medicine residency, in part because I had taken out a New York state loan that I was able to repay by working at Bellevue.
These steps helped steer me in the direction of primary care medicine. I believe that not having to pay tuition at all will have an even greater impact on the motivation and direction of new doctors.
Implementing a tuition-free policy at the NYU School of Medicine couldn’t be happening at a better time. The Affordable Care Act (ObamaCare) has expanded insurance coverage and federally qualified health centers have created a greater demand for doctors. But nothing has been done to increase the supply of doctors.
In fact a recent report from the Association of American Medical Colleges predicts the U.S. will have 120,000 fewer physicians than we need by 2030, with 15,000 to 50,000 of these being primary care doctors.
Doctors should choose the specialty that suits them best – whether it’s surgery or interventional radiology because they are skilled with their hands, or psychiatry or neurology because they are best at thinking through problems that involve the brain.
Not having to pay medical school tuition increases the likelihood that a doctor will at least consider a lower-paying specialty like family medicine or pediatrics if it suits him or her, whereas a chokehold of loans might have interfered with this choice before.
A family doctor has traditionally been a safety net for an entire family. Patients have enjoyed our commitment without necessarily considering our struggle. This is as it should be. No good doctor wants his or her patient worrying about how to pay our bills for medical care.
At the same time, I’m sure my patients would rather I spend my time worrying about their wellbeing than about how I intend to repay my loans. Getting rid of medical school tuition entirely is a laudable way to get this to happen.