A History of Medical Student Debt
A History of Medical Student Debt
There are at least two important conclusions to be drawn from this consideration of medical student debt in historical context. First, by examining the growth of debt in the context of broader changes within American society, the pressure on universities and medical schools to expand can be appreciated. The educational manifestation of this expansion called on medical students to help fund their education in new ways, and this has, unfortunately, led to the rapid growth of educational debt. Similar trends can be observed for college students (Figure 3), further suggesting that medical school debt may simply represent the extreme of a system-wide complication of expansion in American higher education. The second and related conclusion is that unintended consequences have occurred over the last 50 years as a result of this expansion, including increased overall costs of education, lack of transparency and accountability in determining those costs, and disincentives for further workforce diversification with regard to racial/ethnic and socioeconomic backgrounds.
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Figure 3.
Inflation-adjusted tuition averages in undergraduate colleges, medical schools, and Title VII funding, 1965–2005. Sources: National Center for Educational Statistics (http://nces.ed.gov/programs/digest/d07/tables/dt07_320.asp. Accessed March 22, 2011); Association of American Medical Colleges. AAMC Data Book: Statistical Information Related to Medical Schools and Teaching Hospitals (Washington, DC: American Association of Medical Colleges; 2007); Title VII information obtained from personal communication with Patricia Stroup, senior advisor, Health Resources and Services Administration Healthcare Systems Bureau, March 2, 2006.
If the current expansion of U.S. MD-granting schools is to reach its full potential, new and bold approaches to addressing student debt will need to become more important in the planning and execution of this expansion. To reduce the overall costs of education, some recent proposals have suggested reducing the time to complete medical school to three years. Others have proposed increasing the roles of nonacademic ambulatory clinical settings, nonphysician clinical educators, and educational technology to reduce overall costs. These ideas are promising, but much greater urgency is needed in piloting these and other proposals, developing innovative new proposals, and rapidly implementing successful programs that will ultimately "bend the cost curve" of medical education. Although there may not be a single obvious solution to reign in the problem of medical student debt, the current situation is clearly unsustainable. Ultimately, if current costs for medical education are too tightly linked to the research and clinical missions of academic medical centers, they may rise perpetually along with the costs of these two missions. Current expansion of the U.S. physician workforce presents a unique opportunity to interrupt this half-century trend of rising educational costs to students. In light of what we know about the relentless growth of medical student debt over the last 50 years, now is the time to face forward and envision what the financing of medical education can and should look like 50 years from now.
Learning From the Past and Facing Forward
There are at least two important conclusions to be drawn from this consideration of medical student debt in historical context. First, by examining the growth of debt in the context of broader changes within American society, the pressure on universities and medical schools to expand can be appreciated. The educational manifestation of this expansion called on medical students to help fund their education in new ways, and this has, unfortunately, led to the rapid growth of educational debt. Similar trends can be observed for college students (Figure 3), further suggesting that medical school debt may simply represent the extreme of a system-wide complication of expansion in American higher education. The second and related conclusion is that unintended consequences have occurred over the last 50 years as a result of this expansion, including increased overall costs of education, lack of transparency and accountability in determining those costs, and disincentives for further workforce diversification with regard to racial/ethnic and socioeconomic backgrounds.
(Enlarge Image)
Figure 3.
Inflation-adjusted tuition averages in undergraduate colleges, medical schools, and Title VII funding, 1965–2005. Sources: National Center for Educational Statistics (http://nces.ed.gov/programs/digest/d07/tables/dt07_320.asp. Accessed March 22, 2011); Association of American Medical Colleges. AAMC Data Book: Statistical Information Related to Medical Schools and Teaching Hospitals (Washington, DC: American Association of Medical Colleges; 2007); Title VII information obtained from personal communication with Patricia Stroup, senior advisor, Health Resources and Services Administration Healthcare Systems Bureau, March 2, 2006.
If the current expansion of U.S. MD-granting schools is to reach its full potential, new and bold approaches to addressing student debt will need to become more important in the planning and execution of this expansion. To reduce the overall costs of education, some recent proposals have suggested reducing the time to complete medical school to three years. Others have proposed increasing the roles of nonacademic ambulatory clinical settings, nonphysician clinical educators, and educational technology to reduce overall costs. These ideas are promising, but much greater urgency is needed in piloting these and other proposals, developing innovative new proposals, and rapidly implementing successful programs that will ultimately "bend the cost curve" of medical education. Although there may not be a single obvious solution to reign in the problem of medical student debt, the current situation is clearly unsustainable. Ultimately, if current costs for medical education are too tightly linked to the research and clinical missions of academic medical centers, they may rise perpetually along with the costs of these two missions. Current expansion of the U.S. physician workforce presents a unique opportunity to interrupt this half-century trend of rising educational costs to students. In light of what we know about the relentless growth of medical student debt over the last 50 years, now is the time to face forward and envision what the financing of medical education can and should look like 50 years from now.
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