Is Free Medical Tuition Actually Working?

Michele Cohen Marill

Disclosures

September 16, 2019

How Will Schools Pay for Free Tuition?

Fixing problems involving debt burden and diversity require a methodical approach. Although NYU's announcement seemed sudden, the medical school had been working toward it for years. "Each year, we would chip away at it, over about a decade," says Rivera. "Our momentum picked up. Our ability to fundraise started to increase over time."

NYU was fortunate to have the support of Ken Langone, a founder of Home Depot, billionaire philanthropist, and chair of the Board of Trustees of NYU Langone Health. He donated $100 million toward the endowment supporting the full-tuition scholarships. However, NYU needs a $675 million endowment to sustain the program and continues to fundraise. At the time of the announcement, the school had raised $450 million.

At Wash U, the new scholarship dollars came from the operating budgets of the medical school and its two affiliated hospitals, part of a $100 million investment in the educational program. In the wake of concerns about fairness in distributing the aid, Wash U deans engaged in conversations with students via a town hall, survey, and one-on-one. Ultimately, the medical school was able to repurpose some existing funds to further support some current students.

At many schools, large donations are the fuel driving the free-tuition engine. Columbia University Vagelos College of Physicians and Surgeons announced a gift in April 2018 that enabled the school to create a $150 million endowment and provide all financial aid as grants rather than loans. About 20% of each class, those with the greatest need, will attend tuition-free.

Elsewhere, thanks to an anonymous $3 million gift, the University of Houston College of Medicine will offer $100,000 to each of the 30 students in its inaugural class, which covers 4 years of full tuition and fees. A separate $3.5 million grant will be used in part to fund scholarships for one third of the second-year students. The medical school is expected to open in 2020.

Long-term Success

While NYU's free-tuition announcement captured headlines, a smaller school preceded them by a decade. In 2008, the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University became one of the first to offer free tuition to all medical students, as a way of encouraging physician-scientists.

Just 32 students per class attend the 5-year MD program, which includes a research gap year. When it went tuition-free 4 years after opening, the Cleveland Clinic Lerner College of Medicine rebated half of the tuition already paid by current students. The overriding goal was to relieve debt as a potential factor in their career path. Although the school set no specific target, graduates have pursued research positions and even outpaced other schools in filling primary care residencies. About 37% of graduates have gone into internal medicine, pediatrics, or family medicine—higher than the 30% of MDs from US medical schools in training for primary care nationally. The medical college has about 2000 applicants each year for its 32 slots.

Free tuition fit with the school's mission to create a collaborative environment, says executive dean J. Harry (Bud) Isaacson, MD. The school uses problem-based learning and has no lectures, no grades, and no class ranking. "It has enhanced the idea that they're part of a family here at Cleveland Clinic," he says.

As far as long-term goals at other institutions, the University of Houston College of Medicine is emphatic in its mission to reshape the physician workforce in Texas. Texas ranks 47th in the country in the number of primary care doctors per 100,000 population, according to the AAMC. The school wants half of its graduates to pursue primary care. It also has an ambitious goal for half the class to be from underrepresented minority groups.

"For some students who come from humble backgrounds, that [free tuition] may actually allow them to go to medical school when they wouldn't have otherwise," says founding dean Stephen Spann, MD, MBA. "We need students who come from underserved communities and modest backgrounds."

It isn't all about the money. Beyond MCAT scores and GPA, the medical college will look for students who seem oriented toward service—for example, through a history of volunteering. The University also plans to focus on "pipeline" programs that encourage children from disadvantaged backgrounds to aspire to become doctors.

"Our state has underserved areas, both urban and rural. We need to get physicians out into those areas," Spann says. "We view our medical school's mission as being accountable to society for improving health and healthcare, in our community, state, and beyond."

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