How much should medical school cost?

It does not seem that many people care very much about the cost of medical education in the US. But we should be concerned. Did you know that the average debt for a medical student on graduation from a state funded medical school is about $150,000. To put that into perspective, the average cost of a four bedroom house in suburban Kansas City, where I live, is $225,517 not much difference.(1)

Many people will see that and say,"who cares, doctors are rich". I can't argue with that fact, doctors are rich. Physician salaries are in the top 5 percent of all jobs in the US. A recent blog from Dr Joshua Freeman described the top 10 paying jobs in America. Physicians held 9 of the spots. There are many ways to fund medical school, including loans, repayment plans, and my personal favorite-having a rich dad. I remember the first day of my medical school experience and one of the women in my class asked a question during the financial aid lecture. "Can you send the bill to my daddy?" Repayment programs can be very effective. Here in Kansas, we have one of the oldest and best. Students that commit to practice in an underserved county (that is most of Kansas), choose a primary care specialty such as family medicine, internal medicine or pediatrics, and maintain their academic standing are given a full tuition scholarship and a monthly stipend. Over its 50 year history the Kansas Medical Student Loan program has placed hundreds of students in communities across Kansas.

So back to why should we care about this? Well, as I discussed in a previous blog, Production of Primary Care Doctors, [ student debt is one of the primary deterrents to students choosing primary care specialties such as family medicine. The equation is fairly straight forward. More student debt leads less students choosing family medicine residency training (and other primary care specialties). Less students in family medicine residencies means less primary care physicians in practice. The data at this point is pretty clear. If there are less family doctors per capita in a county in the US, that county is less healthy. The citizens die more frequently, they are hospitalized more often, and over all they are less healthy.

Wow, all of that because medical school costs a lot? No, not all but enough that a recent Op-Ed in the NYTimes should be given some serious thought. Drs Bach and Kocher proposed that medical school tuition should be free. Then how would we pay for it? Their idea is a good one. Tax the students that want to choose specialty practices. Basically, the idea is that medical school is free if you choose to practice in a primary care field like family medicine or general pediatrics. If you decide that you want to be a dermatologist or a radiologist or another specialty then you have to pay for your training.

That may seem unfair to the students that want to go into dermatology, but remember the state and national government (and we the people) have a huge investment in medical education and the health care field. $1,400 for every car you buy from General Motors is for health costs, medicaid accounts for 1/3 of the budgets in most states, and even private medical school receive millions of dollars from the federal government to support biomedical research. And we don't need more dermatologists. We do need a strong and vibrant primary care infrastructure. The beauty of this idea is that it could be changed as the physician practice population changes. If we need more anesthesiologists then we make the payback less. If we need more general surgeons, then we make the pay back less to do general surgery. If we need less plastic surgeons then we just raise the payback more. How much? How ever much you need. Would a student choose to do orthopedic surgery if medical school was going to cost them a million dollars? How about 2 million? You get the idea?

Will this ever happen? Unlikely, but we can hope...

References
(1) http://money.cnn.com/pf/features/lists/hpci_data/index.html