Why Medical School Should Be Free

We estimate that we can make medical school free for roughly $2.5 billion per year — about one-thousandth of what we spend on health care in the United States each year. What’s more, we can offset most if not all of the cost of medical school without the government’s help by charging doctors for specialty training.

Under today’s system, all medical students have to pay for their training, whether they plan to become pediatricians or neurosurgeons. They are then paid salaries during the crucial years of internship and residency that turn them into competent doctors. If they decide to extend their years of training to become specialists, they receive a stipend during those years, too.

But under our plan, medical school tuition, which averages $38,000 per year, would be waived. Doctors choosing training in primary care, whether they plan to go on later to specialize or not, would continue to receive the stipends they receive today. But those who want to get specialty training would have to forgo much or all of their stipends, $50,000 on average. Because there are nearly as many doctors enrolled in specialty training in the United States (about 66,000) as there are students in United States medical schools (about 67,000), the forgone stipends would cover all the tuition costs.

This article is a bit, well, self-serving. Although not really, since it would apply to future graduates and we wouldn’t get a refund. But this addresses something important.

From an international standpoint, doctors in this country are paid a lot. If we brought doctor salaries here in line with other countries, we wouldn’t actually knock all that much off our health care bill. But it touches on something that would. There are a lot of reasons why our health care system is as expensive as it is. In addition to doc salaries, there’s also the tendency of providers to maximize profits. Sometimes they’re what I call “mercenary docs” that go into a retirement home and “evaluate” 25 patients and determine that all 25 need hearing aids. You also have well-intentioned doctors who buy new machines for medicine as well as fun and profit and then end up using the machine more than is necessary because it’s a hammer for which everything is a nail and they get used to the income. And you have doctors, fresh out of residency, looking at a couple hundred thousand dollars in student debt, who sign on to an operation that will pay them $300,000 a year to start instead of $150,000*. An operation that, of course, profit-maximizes.

It’s really quite difficult to describe the amount of pressure a family can feel coming out of the gate. Clancy and I have it good. She had a full-ride scholarship for her undergrad and mine was paid for. But we nonetheless owe more than we have. We’re in our 30’s and can’t really buy a house. We need to get started on a family, but paying for the pregnancy is going to be a struggle. If she’s unhappy with her job, she really can’t afford to quit it. I don’t say all of this so that you will feel sorry for us, but rather because it’s under these financial pressures that I believe doctors respond in ways that set the trajectory for the rest of their career. They take the better-paying job because they have student loans to repay or they want to get started on a family or whatever. But then, once they’re there, they start getting used to the income. People are very loss-averse and it’s hard to take a pay cut voluntarily. In fact, you expect to be making more over time. So you start looking for ways to make more money. You earned it, god-damn-it, going so far in the hole and working for years for $10/hr.

Meanwhile, if doctors weren’t so financially harried when they get started, it’s much more possible that they would take a more measured approach. And with that, they might be less inclined to profiteer. A lot of them wouldn’t, but many of them would. Enough of them would that there would likely be less solidarity in the profession as a whole and it would become easier to take other measures that would result in doctors bringing home less money in the end in exchange for less financial pressure and allowing them to outsource some of their work to mid-level providers and the like. In the status quo, doctors make a lot of money but despite this are miserable. The misery actually provides an opportunity where you can pay them less but allow them a better lifestyle. That’s a hard bargain to make, though, when they’re coming out of the gate so far behind and owing so much.

There are more ways of going about it than just this. Other countries allow would-be doctors to skip undergraduate work and go straight to medical school. Loosening residency so that life doesn’t begin until afterward is another consideration. Basically, you’d want to find a way to restructure things so that all of the sacrifice is not up front for later rewards. It merely makes the demand for the volume of the eventual reward that much higher. A have a lot of ideas for ways that would could bring down medical costs. A lot of them are thwarted when it comes to telling doctors, “I know that you’ve just sacrificed a decade of your life and hundreds of thousands of dollars, but we need you to play along with this lower-pay option even though there are ways that you could extract more money from the system.

* – I kid you not, there was a posting for a job, for which she was qualified, that started at a rate 233% of what she’s presently making. The disparities can be huge.


Category: Hospital, Statehouse

About the Author

Will Truman (trumwill) is a southern transplant in the mountain east with an IT background who bides his time taking care of their daughter while his wife brings home the bacon. You will probably be relieved to know that he does not generally refer to himself in the third-person except when he's writing short bios on his web page.

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