Cover tuition only for those doctors who agree to go where they are needed most. The New York University School of Medicine generally won rave reviews last week for announcing that it was eliminating tuition — about $55,000 annually for four years — for all current and future medical students. The stated goal is to eliminate a financial barrier for medical school applicants and to address a crucial imbalance in our country’s physician work force. Research shows that the burden of medical school debt discourages young doctors from going into types of practices that are poorly paid, like primary care, or working in places where many patients are on Medicaid. As a result, there is a shortage of doctors working in these areas. Over all, we have about the same number of doctors for our population as do Canada, Britain and Japan, but American doctors are more likely to be in highly paid subspecialties — orthopedic surgery and the like — rather than on the front lines. N.Y.U.’s plan was a noble attempt to redress this problem. But the medical school got it wrong. And N.Y.U. can look within — to its own law school, in fact — for a far better solution. Many doctors, and certainly most specialists, can pay off those medical school loans quite easily over time. After all, if you’re a doctor, you’re more likely to be a member of the top 1 percent than you would be with any other job. The New York University Medical School in New York City. The doctors who usually have the most trouble paying off their debts are those who work in poor areas. They treat hard-to-manage diseases like addiction. And they focus on primary care for any patient who walks in the door — not just those with good insurance. Instead of making medical school free for everyone, N.Y.U. — and all medical schools — should waive tuition only for those students who commit to work where they are needed most. The N.Y.U. law school is a model. It has long had a program that attracts the best and the brightest to the low-wage corners of the legal profession: Each year, 20 students who commit to a career in public service pay no tuition, while those whose ambition hews toward corporate law are charged full freight. Likewise, let those medical students who want to be private practice ophthalmologists in the suburbs of San Francisco take out loans to pay tuition. But the university could demand no payment from those, for example, who commit to becoming primary care doctors and agree to take Medicare and Medicaid or specialists willing to practice in poor areas with doctor shortages. I know that many young people are not sure of their chosen path when they enter medical school. But there are simple ways to adjust the concept. How about all medical schools commit to forgiving or paying back the loans of young doctors who go into lower-paying fields or set up practice in underserved areas — and keep doing so as long as they stay there? The government could reasonably demand such a system from academic medical centers as a precondition for receiving federal subsidies and payments. After all, many receive billions from the government and pay little if any tax because the I.R.S. allows them nonprofit status, in part because they provide “community benefit.” So if a student chooses to become an ear, nose and throat surgeon in suburban New York or a private cardiologist in Miami, fine. He or she can pay back what has been borrowed. But if that doctor chooses to deliver babies in rural Oklahoma or practice pediatrics on the South Side of Chicago, then he or she should get to keep every penny of salary. The federal government and some states, as well as the military, already subsidize medical school tuition or pay back loans in exchange for limited-time service commitments. But that promotes a tour-of-duty mentality. They are also poorly funded and cover a relatively small number of students. The real goal is not short-term payback but to enable and support young doctors who feel that treating patients is a calling, regardless of the patients’ ability to pay. Still, if we want to train the best, most-caring doctors to take the jobs we most need, we have to come up with a fairer way to finance medical education. The titans of medical education should step up to the plate. N.Y.U. took a shot but missed the mark, despite all the hoopla surrounding its announcement and the framing of its offer as generous philanthropy to the tune of $600 million. Every academic medical center should see training the medical work force America needs not as charity but as an obligation, a “community benefit” of the highest order. Source
