Before I describe the incredible cost of medical school, I want to mention how I paid for my medical education. I didn’t. You did, and I am very grateful for that. Like about 1800 other American medical students in 1979, I was lucky enough to get a National Health Corps Scholarship, which paid my tuition, gave me money for books, and gave me $550 a month (about $2600 today) to live on. I had to serve one year for every year of support I received, in a place the Public Health Service deemed a health workforce shortage area, which meant I got sent to the mountains of East Tennessee, which wouldn’t have been my first choice. But it was a humbling experience that served me well. Graduating from medical school with no debt meant I could devote my career to primary care and public service, which is exactly what I did – in Pawtucket, Scituate, Central Falls, for Rhode Island and as the volunteer president of a now national organization that aims to provide primary care to all Americans. So I think you and the government got good return on your investment, particularly given that every practicing primary care physician saves somebody about $1 million a year by preventing preventable disease, giving people who are sick an alternative to Emergency Room visits, and helping people with chronic disease stay healthy and out of the hospital, with fewer complications.
In my last column, I described the incredible difficulty of just applying to medical school. This time I want to describe what it costs. Remember, before medical school, you need to complete an undergraduate degree, which cost about $120 000 at in-state public universities and about $252 000 at private universities in 2024 – and about half of US students have to take out student loans to pay for college. Medical school now costs about $286,000, at public medical schools for in-state students, and about $391 000 at private medical schools. So most people who go to medical school will pay about $400,000 to $650,000 for their educations, and they have to study eighty to a hundred hours a week for seven to eleven years.
But it gets worse! If you have to borrow money for medical school, those loans cost 7-9 percent, or $28,000 to $58,000 a year, just for the interest — and probably more, because Congress in its wisdom just put a $200,000 cap on the amount of Federal guaranteed loans a student can borrow for graduate study, which is $86,000 to $191,000 less than it costs to go to medical school. That means medical students whose families can’t afford to pay for medical school from savings have to borrow $86,000 to $191,000 in the private market, where interest rates are higher yet. So many new doctors have loan payments of two to four thousand dollars a month or more — with these loans often taking twenty or more years to pay off.
(Most of this data comes from a recent article in the Journal of the American Medical Association called The Price of Healing [i]. Thanks to Dr. Steve Tarzynsi, ace California pediatrician and leader, for calling it to my attention.)
And this doesn’t include the four to eight years of lost wages, the money you’d make working in tech or on Wall Street or even in Hollywood – places where bright young people often make six figures without going to college or medical school.
If you come from money, perhaps your parents can afford to send you to medical school. But if you are the children of immigrants or of working people, the cost alone is daunting. These costs discourage many of our best students from even thinking about medical school, even those who would think about it despite the hellish application process. All at a time when we desperately need doctors, particularly primary care doctors.
We know that the best health outcomes result from people having doctors who speak their languages and look like them. What do you think are the chances of a Newport kid who speaks Spanish, or a Newport kid from a family of color, or a Newport kid from an immigrant family whose parents work in the tourist industry – what do you think are the chances of any those Newport kids going to medical school? About zero. And yet it is exactly those kids who will help our families and our communities have the best health, if we could only get them to go to medical school – instead of working on Wall Street.
But doctors make lots of money, you might say. That’s true. Doctors make more money than most people. Primary Care doctors make $200-$250,000 a year but cardiologists and orthopedists make $500-600,000 a year or more and neurosurgeons make $750,000 to $1 million a year (but not as much as hospital presidents and CEOs, who usually didn’t go to medical school, just sayin.) Shouldn’t doctors just borrow the money they need for school and pay it back?
We usually do. But the system we have is producing the outcomes it was designed to produce, which means we have doctors who come mostly from families of means, who don’t look like or speak the languages of the people they care for, and aren’t committed to public service – and we end up with poor health outcomes, compared to other advanced nations, and pay twice what people in those other countries pay for health care.
Remember the National Health Service Scholarship I got? There used to be 1800 or so a year. Now there are about 50 a year. About one for every state. But we need one for every community, every year, because we are desperately short of primary care doctors.
Crazy? You betcha. We’re crazy to just let this happen and do nothing about it.
Now is the time for Newport and all our communities to create new scholarship programs, so that all our kids who have the ability and the desire to serve can go to medical school, come home to practice, and take care of people in their own communities, the people who gave birth to and took care of them.
You can find Michael Fine’s commentaries and short stories on
https://michaelfinemd.substack.com/and on http://www.michaelfinemd.com