When New York University announced last week that it would provide all of its medical students full-tuition scholarships from now on, the school politely challenged its competitors to follow suit. “We hope that many other academic medical centers will soon choose to join us on this path,” Robert Grossman, the school of medicine’s dean and CEO of the NYU Langone Health, said in a statement.
Let’s hope Harvard and Johns Hopkins can resist chasing NYU’s lead. While it’s hard to fault a school for offering its students a free education, this dramatic gesture is, at best, a well-intentioned waste—an expensive, unnecessary subsidy for elite medical grads who already stand to make a killing one day as anesthesiologists and orthopedic surgeons. It would be a pity if other top medical schools decided to imitate it, rather than use their resources in other, more helpful ways that might solve more of the problems NYU claims to be worried about.
NYU says it decided to stop charging tuition at its medical school because the “overwhelming” student debt burdens that today’s young doctors face are “fundamentally reshaping the medical profession in ways that are adversely affecting healthcare.“ This is a pretty common refrain in the medical profession. Three-quarters of medical students graduated with education debt in 2017, leaving school with a whopping median balance of $192,000, according to the Association of American Medical Colleges. This is not necessarily a problem for every graduate, since doctors are generally some of the best paid professionals in the United States, and tend to earn more than enough during the prime of their careers to make up for all that early borrowing. Physicians who go to work at nonprofit or government hospitals can also get their debt wiped after ten years through the federal Public Service Loan Forgiveness program, no matter how much they’ve actually paid. But there is some evidence that high debt loads may discourage young M.D.’s from practicing in needy communities, while pushing them away from important but lower-paying jobs in primary care, and toward much more lucrative fields like dermatology or radiology. That’s an especially urgent problem if predictions that the U.S. will soon face a massive shortage of primary care physicians turn out to be correct.
It’s also possible that the high cost of medical school may be scaring some students away from applying—particularly black and Hispanic students, who tend to come from less wealth. Earlier this year, the New Yorker reported on how some African Americans have started heading to Cuba for medical school, in part because of cost.
According to NYU, nixing tuition will help fix all of these issues—“it addresses both physician shortages and diversity,” as one associate dean for admissions put it. But if those are truly NYU’s goals, then giving every student a free ride, no matter who they are, or what career they pursue, is an incredibly wasteful, haphazard way of tackling them.
Take the school’s apparent desire to produce more primary care doctors. If the administration really wanted more of their graduates to pursue family medicine in places like the south side of Chicago or rural Montana, the most straightforward move would be to waive tuition or offer loan forgiveness for students who actually committed to that sort of a career. The school could take a page from the federal government’s National Health Services Corps., which offers scholarships and pays off debt for M.D.’s who agree to practice primary care in an underserved community for a minimum period of time, and has proven incredibly effective at encouraging participants to pursue long-term careers as general practitioners (unfortunately, the program is badly underfunded). By covering every student’s tuition, without any conditions, NYU’s leaders are essentially crossing their fingers and praying a few more of their grads decide to do something public spirited with their lives. Meanwhile, they’re handing a windfall to every student who plans to make millions as a Manhattan cardiologist.
As for diversity: If NYU wanted more black students, they could—and this might sound crazy, but hear me out—just admit more black students. If those young men and women needed financial help, the school could even offer them a needs-based aid package. I’m sure at least a few of them would accept the deal. That might require NYU to pursue affirmative action a little bit more aggressively, but with its rock bottom admission rate, I’m fairly certain it could find plenty of capable candidates out there. If NYU wants more minorities overall to pursue medicine, it could do more outreach on college campuses or invest in nonprofits that prepare black and Hispanic students to apply to med school, to expand the pipeline (full disclosure: my mother, who works in medical education, helps run one such program). Another ambitious option would be for the country’s top medical schools to pool their resources and create a scholarship fund specifically for talented minority students. That approach, though, would require the schools to be a bit selfless, since none of them would get a recruiting edge out of it.
Anyway, it’s not happening. Instead, NYU is going to offer free tuition to every upper-middle-class Caucasian student destined to make a killing as a urologist in Florida, and hope that a few more exceptional black students show up at its door as part of the bargain.
None of this would be such an affront if it weren’t for the amount of money involved. NYU says it has raised $450 million of the $600 million it needs to fund its scholarship program indefinitely. Those are tax deductible donations from overwhelmingly wealthy men, like billionaire Home Depot founder Ken Langone, whose name adorns NYU’s medical center and who chipped in a cool $100 million to this effort. It’s the kind of money that could actually make a difference on issues like diversity, or the type of practices students pursue, if it were used in a thoughtful way. Instead, it’s a donation from today’s rich to tomorrow’s rich, all at taxpayer’s expense.