Letters to the Editor
To the Editor:
The article by Greysen et al1 both sounds and echos warnings about the consequences of the expanding medical student debt. I believe that two other issues should be factored into the discussion.
First, there is major competition among some medical schools for candidates who are extremely well qualified and/or belong to groups designated as underrepresented in medicine or who bring other aspects of diversity to a school. The schools do this to increase their prestige when measured academically or for diversity. This approach can lead to schools' bidding for candidates who are literally exercising their “free agency” option of going to the highest bidder. The consequence of this can be depletion of resources that would otherwise be available to help defray costs for students with more legitimate need.
The related issue is that, from 1987 to 2005, approximately half of all medical students came from families in the top quintile of income.2 I see no evidence that this proportion is lessening. Clearly, the privilege of going to medical school is increasingly for the privileged.
Herbert T. Abelson, MD
Senior associate dean for admissions (retired), The University of Chicago Pritzker School of Medicine, Chicago, Illinois; firstname.lastname@example.org.
1. Greysen SR, Chen C, Mullan F. A history of medical student debt: Observations and implications for the future of medical education. Acad Med. 2011;86:840–845.