To the Editor:
In the run up to the 2020 election, student loan debt has moved to the forefront of the United States’ economic and political consciousness. Presidential candidate Bernie Sanders' plan is to forgive all outstanding student loans—a $1.6 trillion aid package. Although bold, his plan, along with competitor Elizabeth Warren’s plan, fails to address the issue of rising costs of graduate education, and more specifically, medical education. Medical school tuition has grown at nearly twice the rate of inflation over the past 25 years, with the median total cost of attendance for a private medical school now over $300,000.1 By no means are high tuition fees a new problem; in fact, they were captured in Academic Medicine’s “2010 Question of the Year.”2 With resurgent attention, now is the time to rectify this problem with physician-directed programs, eschewing federal policies, to benefit both patients and future physicians.
An effective solution could be recognized by combining and expanding 2 existing programs: 3-year medical school and year-for-year tuition compensation for service in underserved areas. The largest development since Academic Medicine last evaluated this problem is the successful removal of the fourth-year curriculum from medical education that has been undertaken at 16 schools, with over a third of medical schools considering this accelerated pathway.3 The time-served-for-tuition model is currently used for those in uniformed services; however, this is limited in scope, does not aid the underserved, and requires a 7-year commitment.4 This model could be adopted by an expanded National Health Service Corps (NHSC). Presently, the maximum student loan reimbursement for 2 years of service in the NHSC is only $50,000, a small dent in the debt burden of physicians.5 Combining these existing plans allows a novel solution that gives physicians a debt-free start to their careers while encouraging practice in underserved areas.
Student debt will continue to be a major issue in the United States’ political landscape. Until we can address the issue of rising tuition, no iterations of loan forgiveness will solve the “cost” problem. Physicians are uniquely positioned to lead in innovating education and service models to fix this. The exorbitant cost of medical school is going to be addressed one way or another, and it behooves physicians to stay ahead of blunt federal policies that do not specifically consider the nuances of medical education.
Michael G. Jerkins, MD, MEd
Instructor of clinical medicine, Department of Internal Medicine and Pediatrics, University of Cincinnati Medical Center and Cincinnati Children’s Hospital, Cincinnati, Ohio.
Edwin S. Palmer, MD, MPH
Global health fellow, Boston Children’s Hospital, and core ethics faculty, Harvard Medical School, Boston, Massachusetts; firstname.lastname@example.org.
1. Adashi EY, Gruppuso PA. Commentary: The unsustainable cost of undergraduate medical education: An overlooked element of U.S. health care reform. Acad Med. 2010;85:763–765.
2. Kanter SL. 2010 Question of the year. Acad Med. 2010;85:1–2.
3. Cangiarella J, Gillespie C, Shea JA, Morrison G, Abramson SB. Accelerating medical education: A survey of deans and program directors. Med Educ Online. 2016;21:31794.
4. Waechter DM, Gilliland WR, Laughlin LW. The F. Edward Hébert School of Medicine model: Tuition-free medical school in exchange for public service. Acad Med. 2010;85:1683.
5. U.S. Department of Health and Human Services, Health Resources and Services Administration. National Health Service Corps Loan Repayment Program. https://nhsc.hrsa.gov/sites/default/files/NHSC/loan-repayment/nhsc-lrp-fact-sheet.pdf
. Published February 2019. Accessed January 8, 2020.