Will free medical school make a difference?

President Biden’s plan to make community colleges free for all students comes at a critical time: The pandemic led to a steep decline in college enrollment, particularly for low-income and minority students. And businesses have struggled to fill vacancies, as the economy adds jobs at a rapid rate. But, what are the results?

According to a 2010 study, roughly 40% of American undergraduate students attend community college but only 5% of students who enrolled in medical school in 2012 had attended community college. Because medical school is so expensive, it is worth it to consider taking premed classes at community college and then transferring to a four-year university to finish out the degree.

Ever since The New York University School of Medicine announced that it would waive the tuition of all its students, regardless of merit or need, citing concerns about the “overwhelming financial debt” facing graduates, opinions have been across the board about the wisdom of the decision.

?A transformative new scholarship program established by Weill Cornell Medicine will eliminate medical education debt for all students who qualify for financial aid.

One side applauded the move as a way to reduce (not eliminate) the crushing student debt of medical students, now about $200, 000 on average. The other side questions the wisdom of giving those who can pay a free pass.

When undergraduate student debt is erased, a huge burden is lifted and people take big steps to improve their lives: They seek higher-paying careers in new states, improve their education, get their other finances in order, and make more substantial contributions to the economy, according to a new research study?Second Chance: Life without Student Debt.

Will tuition free medical school make a difference in producing more doctors, produce a more diverse talent pipeline, and, eventually, do a better job of reducing the quality, cost, access, experience and equity gaps that plague the system? Will it change how graduates choose specialities on factors other than how much income they an expect to make?

I'm skeptical for the following reasons:

1. The demand for medical education, based on recent applications, does not seem to be price elastic.
2. The graduate medical education (residency) still represents a significant bottle neck and the mechanisms to fund it is likely to remain stuck in the maw of partisan politics in Washington
3. Making a dysfunctional and out of date educational system tuition free will only encourage more people to be dysfunctional and out of date graduates.
4. The evidence that levels of medical student debt drives specialty choice is inconclusive and reducing the debt burden is unlikely to alter not just general-specialty choice, but the existing geographic maldistribution as well
5. The clinical half life of newly minted doctors might shrink given generational attitudes about work-life balance and the increasing attractiveness of alternative non-clinical career paths, such as side gigs, and entrepreneurship. Some, those on FIRE, will just wait until they can pay off their loans and rewire to do something else.
6. More women in medicine, based on patterns of productivity, family care demands and the white ceiling, will not significantly satisfy the demand for services.
7. The fundamental restructuring of the economy and the future of sick care work demands that we stop fighting the last war to meet the almost infinite global demand for sick care services, regardless of how much less it costs
8. The medical school business model is unsustainable and giving money to subsidize it has a limited life span. Pretty soon you run out of other people's money
9. Premeds have little or no understanding of what a sick care job means. Putting more doctors on the grill to get burned out won't help
10. We might be looking at a medical school bubble
11. As long as the US higher educational system stays rigged in favor of the lucky haves who won the ovary lottery, the have-nots, like low income first generation students, will struggle.
12. The medical manpower supply chain is extremely long and is regulated and impacted by multiple entities from high school to graduate medical education and state boards of medical examiners.

How it is that inequality has come to define higher education is the subject of Paul Tough’s new book, “The Years That Matter Most.” Tough has spent much of his career as a journalist documenting the injustices of our K-12 system. Here he turns his attention to the years after high school, to our colleges and universities, where we might hope those injustices are addressed. The news is not good. In chapter after chapter, Tough shows how higher education does not ameliorate the inequities of K-12. It magnifies them. Medical schools , selective as they are, perpetuate the cycle.

The sick US medical education system has a long problem list. Treating it with just another pill is unlikely to make a significant difference in reducing long term morbidity or mortality.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Twitter@SOPEOfficial and Co-Editor of Digital Health Entrepreneurship