DOCTORS are among the most richly rewarded professionals in the country.
The Bureau of Labor Statistics reports that of the 15 highest-paid professions in the United States, all but two are in medicine or dentistry.
Why, then, are we proposing to make medical school free?
Huge medical school debts — doctors now graduate owing more than $155,000 on average, and 86 percent have some debt — are why so many doctors shun primary care in favor of highly paid specialties, where there are incentives to give expensive treatments and order expensive tests, an important driver of rising health care costs.
Fixing our health care system will be impossible without a larger pool of competent primary care doctors who can make sure specialists work together in the treatment of their patients — not in isolation, as they often do today — and keep track of patients as they move among settings like private residences, hospitals and nursing homes. Moreover, our population is growing and aging; the American Academy of Family Physicians has estimated a shortfall of 40,000 primary care doctors by 2020. Given the years it takes to train a doctor, we need to start now.
Making medical school free would relieve doctors of the burden of student debt and gradually shift the work force away from specialties and toward primary care. It would also attract college graduates who are discouraged from going to medical school by the costly tuition.
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.
While this may seem like a lot to ask of future specialists, these same doctors will have paid nothing for medical school and, through their specialty training, would be virtually assured highly lucrative jobs. Today’s specialists earn a median of $325,000 per year by one estimate, 70 percent more than the $190,000 that a primary care doctor makes. (Although a large shift away from specialty training may weaken the ability of our plan to remain self-financed, the benefits would make any needed tuition subsidies well worth it.)