The fall is over, and winter has come, which means I have just wrapped up a busy season of medical school interviews. Most interviews are conducted in a similar fashion with an hour of introduction, speeches by the dean, presentations of facts I already knew from the website, and finally the interviews. Within the first hour, I understand the reason: “We are the best medical school at (fill in the blank).” Though typically nestled between the Dean’s’ speech and interviews is a financial aid officer who briefly lectures on the options available to finance one’s education (as if federal loans differ from one school to the next). This quickly became my favorite part of the interview, and the easiest way to cross an acceptance off of my list. Much like fight club, at every school, the first, second, and third rule of medical school interviews: You don’t talk about cost. You’re here to become a physician; empathy must spill out of your rectum, and you had better be willing to enter into severe debt if you want to walk the noble, and often marble, halls of our medical school institution. You want to help people, how dare you even give thought to the cost of doing so. In the midst of an outstandingly inefficient health care system, where cost-saving primary care medicine is in short supply, bright-eyed prospective medical students exacerbate the problem by fear of a denial. When I buy a car, a home, hell even a laptop, I know the ins and outs of that purchase. I understand how much the processor, sunroof, or extra bedroom cost me. Each cost is plainly laid out for me to see. Yet with medical school, and really all secondary school and above, all the features of an education are rolled into one single cost: tuition. I have no idea how much it cost Ford to make my Fusion or Microsoft to make my laptop. But why does medical school retain the same opaque transparency as private companies? Where does my tuition go? How much does it cost to train me? Are you profiting? Is your property tax high? Are you subsidizing my education, giving me a killer deal? (I doubt it). It could very well be that no artificial driver is hiking tuition costs, thus my cost-benefit analysis now becomes much simpler from school to school. But one thing is sure: unless I do an insane amount of research, I will never know. Why is nobody talking about this? I asked each of the schools I interviewed with why they were more expensive than the first, and cheapest, school I was accepted to. Each of the deans spoke as smooth and as fact-devoid as some politicians. I gave this example (tuition cost only): School A = $40,000 per year and therefore $160,000 at 6% interest. School B = $56,000 per year and therefore $224,000 at 6% interest. Why is school A $40,000 to begin with, and school B $16,000 more a year? Each is pretty comparable in location, board scores, residency placement rates per specialty, and student to faculty ratio. If it is because you need the extra money to function due to fewer public subsidies, I have a right to know. Until students, prospective and current, begin to demand explanation, and quit accepting these costs as status quo, these costs will only rise. Each time I asked this question I was made to feel like the evil, heartless villain who only wants to be a doctor for the money. What a beautiful and cost-effective status quo: Make the students who actually care about cost feel like lepers. Why are doctors broke? It begins with the first step of medical school soil, where acceptance into such a highly competitive field has become priceless. Students place the cost of education as the lowest factor in determining their future, when it should be the first. I asked one of the student tour guides why he chose to attend school B, which will cost him much more than $64,000 over four years of training. He became irritated at the question, telling me he didn’t go into medicine for the money. I don’t blame him for his thinking, but in an age where primary care doctors, the most cost-saving measure of health care, are in huge deficiency because they are broke from medical school debt: Yes, my friend, it is about the money. Source
