Thursday, February 14, 2013

Problem with Medical Student Debt

Excerpted from "Tackling the Problem of Medical Student Debt," New York Times, by Pauline Chen, MD. December 13, 2012--The announcement from the University of California, Los Angeles, of a $100 million medical student scholarship fund should inspire all of us to question the fact that medical education in the United States is paid for largely by student debt. The new merit-based scholarships, established by entertainment executive David Geffen, will cover all educational, living and even some travel expenses for a fifth of next year's entering medical school class, some 33 students. Mr. Geffen and school officials hope that eventually the school will be able to pay for all medical students and free them from the obligation to take out student loans. "The cost of a world-class medical education should not deter our future innovators, doctors and scientists from the path they hope to pursue," Mr. Geffen said in a statement. "I hope in doing this that others will be inspired to do the same."

There are several reasons for the runaway costs. One is that the academic medical centers that house medical schools have become increasingly complex and expensive to run, and administrators have relied on tuition hikes to support research and clinical resources that may have only an indirect impact on medical student education. An equally important contributor to the problem has been our society's placid acceptance of educational debt as the norm, a prerequisite to becoming a doctor. Obtaining a medical education is like purchasing a house, a car or any other big-ticket item, the thinking goes; going into debt and then paying over time with interest is just the way the world works. And, say many observers, newly minted doctors will earn big salaries, allowing them easily to reimburse their loans.

While it is true that most doctors can pay off their debt over time, those insouciant observers fail to consider how loan burdens can weigh heavily on a young person's idealism and career decisions. These choices have enormous social repercussions. Despite the well-studied benefits of a diverse physician workforce, more than half of all medical students currently come from families with household incomes in the top quintile of the nation. Even more worrisome, student concerns about debt are exacerbating the nation's physician shortage. By the end of this decade, we will be short nearly 50,000 primary care physicians and an additional 50,000 doctors of any kind. Educators and groups like the Association of American Medical Colleges have been trying to address the problem of medical student debt for more than a decade. Some have suggested simply freezing costs or prorating debt according to the earning potential of a student's chosen area of specialty. But the real importance of Mr. Geffen's donation for the rest of us lies in not its historic largesse, nor its hopeful vision. Rather, it is in the dramatic impact one individual can make when he makes medical education a priority, and the inevitable question such a gesture raises: Why has our society been so slow to do the same? Click here to read full article.

Dr. J. Scott RiesNational Director of Campus & Community Ministries J. Scott Ries, MD: “The philanthropic commitments of people like Mr. Geffen and the Lerner family are certain to be influential on the lives of a number of future doctors. Their generosity not withstanding, the rising costs of medical education are well documented, as are its persuasive effects on specialty choice and practice location. But the question is, even if medical education were “free” for all students, would that be enough? The answer is no.
The primary areas in which Christian doctors struggle consistently fall into four categories:
    1. Overload
    2. Marriage
    3. Parenting
    4. Finances
Yes, finances. But wouldn’t eliminating medical school costs then quell that fourth category of problems? Not likely. Financial struggles faced by our colleagues are often not those related to medical school loans, per se. In fact, they typically present themselves after those loans have been, or are nearly, paid off.

There is a subtle, but strong, undercurrent toward a perspective of entitlement pervasive in medical training, and it doesn’t let go when we graduate. Perpetually elusive, “enough” seems always just around the next corner. And it’s this entitlement mentality that leads to the financial struggles so common among students and doctors alike.

The best antidote to entitlement is found in the occasional email I receive from a medical or dental student relating their desire to give a financial gift to CMDA. It’s not the largesse of the gift or even the fact that God brought CMDA to their mind that makes my day. It’s the outpouring of their entitlement-free heart that brings a sense of grateful joy. “For where your treasure is, there will your heart be also” (Matthew 6:21, NIV 1984).

You may not have the resources to endow the medical education costs of a cadre of future doctors. But you do possess the antidote for entitlement…giving. It’s just what the Good Doctor ordered."

1 comment:

  1. Dr. Ries posits "but the question is, even if medical education were “free” for all students, would that be enough?"

    Why is that the question? Is that the only question? If "the rising costs of medical education are well documented", wouldn't asking "why?" be a reasonable question? Do these astronomical tuition fees truly reflect the cost of providing a medical education, or is tuition just an easy way to subsidize the research, professional advancement, and other activities of medical school faculty and administrators? If so, is it morally proper to impose expenses upon medical students that go far above and beyond the actual cost of providing an education? Wouldn't that be considered "theft" in any other setting? Ought not Christians take a position on that moral issue as well?

    Gee, seems like there could be a lot of questions if one cares to really probe the issue.