The Ongoing Challenge of Financing Medical Education

Eli Y. Adashi, MD, MS, FACOG


April 21, 2009

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The math is simple. The ever-increasing annual cost of attending medical school is now approaching $50,000, thereby giving rise to an educational debt in excess of $150,000. Left unchecked, graduates of the class of 2033 may end up committing up to 30% of their after-tax annual income to service their loan commitments.[1]

Given this state of affairs, are diversity and equity of access still being served? With underrepresented minorities accounting for 15% of the US medical student body[2] -- about half the diversity of the population at large -- and a majority of matriculants hailing from families in the highest income quintiles,[3] substantial work remains to be done. Additionally, does the cost of medical education favor the choice of highly compensated disciplines?[4] That latter possibility, likely further compounded by the growing weight assigned by current graduates to quality of life, is a plain undeniable reality when viewed from the prism of the primary care provider.

Taken together, the growing cost of medical education may very well compromise the principle of egalitarian opportunity, undermine efforts at further diversity, and possibly exacerbate the national shortage of primary care providers.[5] It hardly helps matters when considered in the context of an impending national shortfall in physician supply.[6]

Is it time for the wholesale adoption of need-blind as distinct from need-conscious admission policies? Are there useful lessons to be gleaned from abbreviated 6-year training programs combining medical school and residency? Dare we examine the European 6-year paradigm leading from high school to a medical degree? Whatever we do, we must not lose sight of the imperatives of inclusiveness, multiculturalism, and a primary care-anchored healthcare system.

That's my opinion. I am Eli Adashi, Professor of Medical Science and outgoing Dean of Medicine and Biological Sciences at Brown University.


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