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A Smoother Path For Future Doctors

detail of a doctor's stethoscope in a grayscale image

It’s really hard to become a doctor in the United States.

You need a decent primary and secondary education– without it, your odds of success are already compromised. Then you need to go to a college that offers an undergraduate degree with the sort of challenging foundational science classes that medical schools demand from their applicants, notoriously including organic chemistry. You also need to master test-taking and test preparation in order to secure a good score on the Medical College Admission Test. A score of 508 or greater out of a possible 528 (the equivalent of 30 out of a possible 45 on the older version of the test) gives you roughly a 70 percent chance of medical school acceptance by some measures, though this varies with your GPA and the programs to which you apply.

Once you make it into medical school, you then face two years of classes, and an additional one or two years of clinical rotations (depending on your program). After you graduate, you will spend an additional three to seven years as an underpaid and overworked resident before you can finally begin to make a decent living in your chosen field.

There is another big obstacle, beyond the raw intelligence, hard work and time the program involves: the cost of all this education. Student surveys conducted by the Association of American Medical Colleges found that 72 percent of 2018 medical school graduates carried debt, and the median loan amount was $195,000. For some students, debt can easily mount much higher, and it can balloon during the necessary years of work as a resident, when doctors earn relatively little income to service that debt. As of 2017, 21 percent of doctors graduating from a private school did so with more than $300,000 of educational debt overall.

But on the point of cost, at least, someone is doing something to try to make the path a little smoother.

The New York University School of Medicine recently announced that it will offer full scholarships to current and future students in its MD degree program, regardless of their financial need. The decision is a major change, and overshadows similar but smaller moves made by schools like Columbia University and University of California, Los Angeles to try to ease their medical students’ financial burden.

At the traditional White Coat Ceremony that marks the beginning of medical school for first-year students, Kenneth Langone, chair of the Board of Trustees of NYU Langone Health, told students and parents that “our hope—and expectation—is that by making medical school accessible to a broader range of applicants, we will be a catalyst for transforming medical education nationwide.” Students partway through NYU’s program will also receive full scholarships, and the school has said it will refund out-of-pocket tuition payments students made for the current year. It will also pay back loans students have taken that they will no longer need.

The initiative will be supported by an endowment funded by more than 2,500 supporters, including trustees and alumni, among others. The Wall Street Journal reported that NYU has secured more than $450 million of the estimated $600 million necessary to fund student tuition indefinitely.

NYU’s move is unique in its scale, if not its concept. The Cleveland Clinic Lerner College of Medicine of Case Western Reserve University has paid full tuition for its students since 2008, but accepts only about 30 students overall. NYU’s scholarships will go to more than 400. Case Western also focuses exclusively on students planning to go into research.

Sometimes people wonder why universities collect huge endowments. This is a great example of how an endowment can do good. Not only does this program lower one of the barriers to entering professional medical practice at all; it also opens an option for more students to pursue important but less richly compensated disciplines, such as primary care and pediatrics, that the country desperately needs. Geriatric care, too, is an area our aging population will require in even greater numbers in coming decades, though current fellowship programs in the discipline sometimes fail to fill. And we need medical researchers, along with practitioners. What we don’t need is for half of our medical students to feel as if they must become neurosurgeons, regardless of their interests, just to pay off their education debt.

Other medical schools are likely to try to follow suit if they can. If nothing else, we can expect the applicant pool at NYU’s already competitive program to get much more competitive in the coming years, and for more admitted students to ultimately attend.

While I think this a great idea applied to medical school, I am not sure how much further it makes sense to take it. Should schools subsidize the creation of more philosophers? Teachers? Lawyers? There are pros and cons to consider, but the reality is that lowering the financial bar to enter a profession relative to other options promotes the creation of more professionals in that discipline. Few people will likely argue we can’t use more healers, especially since we currently face a shortage in both general and specialty care. But other professions could be more controversial.

Some people may argue that all institutions of higher learning should be free. This would avoid the skewing effect of subsidizing some professions and not others. All else being equal, it would also tend to drive students toward fields according to their interests and aptitudes, with less regard for those fields’ economic value to society. Your overall economic philosophy probably governs whether this sounds like a problem to you or not.

Regardless of your reaction, however, the reality is that for now we are a million miles away from free higher education across the board in this country. It seems to me that the doctor’s office is not a bad place to start.

Larry M. Elkin is the founder and president of Palisades Hudson, and is based out of Palisades Hudson’s Fort Lauderdale, Florida headquarters. He wrote several of the chapters in the firm’s recently updated book, Looking Ahead: Life, Family, Wealth and Business After 55. His contributions include Chapter 1, “Looking Ahead When Youth Is Behind Us,” and Chapter 4, “The Family Business.” Larry was also among the authors of the firm’s book The High Achiever’s Guide To Wealth.

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