Is Free Medical Tuition Actually Working?

Michele Cohen Marill

Disclosures

September 16, 2019

An Immediate Impact

Fewer students may be feeling left behind, as more medical schools around the country are now offering full tuition support. Perhaps the most notable is New York University's (NYU's) School of Medicine. Its move to free tuition produced an impact from the moment of the announcement in 2018. In the weeks after, applications surged. In all, 8932 applied for the 2019 admission cycle, an increase of about 47%. This year, NYU began accepting new applications on July 1, and within 10 days, 4400 prospective students had already applied.

NYU's entering class is filled with superstars. Rafael Rivera, MD, associate dean for admissions and financial aid at NYU's School of Medicine, says that the incoming median GPA is 3.96 and the median MCAT score is 522, which represents the test's 99th percentile. What's more, applications from underrepresented groups in medicine increased 102%, most notably from black students (up 142%). "I have gotten emails from individuals who said that until this announcement they did not think a medical career was a viable option for them, but now they're applying in the next academic cycle," Rivera says.

The scope of NYU's program was audacious. Even students with high family incomes would receive free tuition, currently valued at $56,272 per year. Students would potentially incur debt only for their living expenses, books, supplies, and fees, estimated to be about $24,000 a year. Current students received free tuition for their remaining years.

If NYU's generosity leads other medical schools to feel pressure to reduce the debt load of students, Rivera says he has no apologies. "I hope, from the bottom of my heart, that more and more schools will do this."

Problems Remain and New Issues Emerge

Billy Thomas, MD, MPH, professor and vice-chancellor for diversity and inclusion at the University of Arkansas System, suggests that free tuition may not be a cure-all. "I think all tuition should be free," he explained. "But that's not the primary problem with workforce issues and overall delivery of care."

Thomas has spent years working on medical school diversity and has seen the number of black applicants and students remain roughly stable when considered nationally. He suggests that full-tuition programs may attract more diversity but that it will probably come at the expense of other schools without the funds to offer significant scholarships.

Beyond free tuition, Thomas advocates for "pipeline" programs. The University of Arkansas brings undergraduates and high school students on campus each summer for research programs and SAT prep. He supports a "holistic" admissions process that looks at life experiences, leadership, and personal qualities in addition to metrics.

"It's really developing an admissions process aligned with the goals and mission of the institution," says Geoffrey Young, PhD, senior director of student affairs and programs for the Association of American Medical Colleges (AAMC), which provides resources supporting holistic admission review. Full-tuition scholarships could be used to reinforce those broader admissions goals, he says, but "I don't think any one method will ultimately solve the problem."

Beyond diversity, when it comes to increasing the number of primary care physicians, free tuition probably won't be a "silver bullet." According to the AAMC, only 1 in 5 medical students cites debt as a strong or moderate factor in their specialty choice. That ranks lower than other factors, such as work-life balance expectations, influence of mentors, and "personal fit."

If debt significantly influenced the selection of medical specialty, primary care residency programs would attract more graduates with lower debt, says Julie Fresne, AAMC senior director of student financial and career advising services. "Our data indicate that debt is pretty consistent across the specialties," she says. In other words, free tuition may not be the gateway to primary care that some believe it to be.

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