Health & Wealth Blog
8:23 am
Mon November 21, 2011

Should Medical School Be Free?

Heck yeah!! So should lunch. But two researchers say making medical school free could send more young doctors into primary care and rural practice, thus solving one of the big challenges facing health care today. And they've got a way to pay for it too.

I spoke with Peter Bach, a doctor and researcher at the Memorial Sloan-Kettering Cancer Center in New York about the scheme, and I've posted our conversation, above.

Young doctors leave medical school owing $157,944 on average. Primary care doctor salaries start around $140,000 per year, while many specialists make double that or more, as much as $465,000 starting salary. Do the math ... and primary care doesn't look so enticing.

One way to encourage more doctors to go into primary care is by paying them more, and closing that salary gap.

Another is to forgive loans for doctors who go into primary care. The National Health Service Corps does this.

A third way is somewhat counterintuitive, its proponents admit. But what if med school were free, and doctors going into specialties paid for that extra training in some way? 

Peter Bach and Robert Kocher, a guest scholar at the Brookings Institution, suggest in an op-ed in the New York Times that making med school free would tilt the incentives in favor of primary care, and eventually increase the workforce to the level needed. It would also attract people who are currently turned off by the costs -- particularly those from rural or other underserved communities. Those people would then be more likely to return and practice in those communities.

Under our plan, medical school tuition, which averages $38,000 per year, would be waived. Doctors choosing training in primary care, whether they plan to go on later to specialize or not, would continue to receive the stipends they receive today. But those who want to get specialty training would have to forgo much or all of their stipends, $50,000 on average.  Because there are nearly as many doctors enrolled in specialty training in the United States (about 66,000) as there are students in United States medical schools (about 67,000), the forgone stipends would cover all the tuition costs.

It sounds like a pie-in-the-sky sort of scheme. But Bach and Kocher suggest it might actually be easier to make medical school free than close the wage gap between primary care and specialties. 

Efforts to equalize incomes have been stymied for decades by specialists, who have kept payment rates for procedures higher than those for primary care services. When Medicare has stepped in, most of the increases given to primary care have been diluted by byzantine budgetary rules that cap total spending.

I spoke with Bach for a story I'm working on, on Missouri's rural doctor shortage. Some 80 percent of the state is officially considered a short-staffed in terms of primary care. Check out my recent story on one rural doctor and the story of how he was recruited. And look out for the second part coming soon!

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