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The factors at play may be a bit more complicated that some expect.

New York University made waves last week when it announced it will cover all tuition expenses for all its medical students in perpetuity.

While the news left some NYU alumni wishing they had waited just a few years longer to enroll, it also reanimated debate over the problems high educational debt levels can cause for doctors and the healthcare delivery system at large.

In an op-ed for Stat News, fourth-year NYU medical student Eli Cahan noted that researchers have identified debt burden as one of the factors propelling doctors into more lucrative specialty areas, leaving a shortage of primary care physicians.

“Eliminating medical school tuition, and thus medical school debt, could help nudge more students to choose much-needed careers in primary care,” Cahan wrote.

But research suggests the burden of educational debt is one factor among several in a complex relationship affecting the likelihood of new doctors to choose primary care.

A study published in 2014 by the Annals of Family Medicine, for example, concluded that reducing debt for medical students could help to enlarge the primary care physician workforce but that the positive effects of such an initiative would vary depending on which types of students benefited from the debt reduction.

“Students from lower-income families, in general, tend to have more interest in primary care careers, and students from disadvantaged backgrounds tend to have more interest in primary care careers,” lead researcher Julie Phillips, MD, MPH, an associate professor of family medicine at Michigan State University College of Human Medicine, tells HealthLeaders.

“Those same students also tend to have more debt because students from lower-income families don’t have the parents’ resources to help them with medical school costs,” Phillips adds.

The study, which analyzed data from more than 136,000 physicians, found that students from higher-income families were significantly less influenced by educational debt in their specialization decisions. What’s more, although the researchers found that educational debt deterred graduates of public medical schools from choosing primary care, the same could not be said of graduates of private medical schools.

This research suggests that the benefits of tuition-free medical school on primary care could be diminished by the fact that NYU is a private institution. That’s not to say, of course, that the decision to go tuition-free comes without benefits.

“I think it will make a difference. It’s hard to know if it will make a big difference,” Phillips says, calling NYU’s announcement “a great step in the right direction.”

“It would be really wonderful if public schools were able to implement this,” she adds, “but I just think they don’t typically have those resources.”

“The income disparity between primary care doctors and specialists in the United States is concerning, and there’s pretty good evidence that if you change that, the whole game changes,” Phillips says.

“As a culture, we tend to look on people who make money as being more valuable,” she adds, “so the income disparity between primary care doctors and specialists sort of creates a culture or contributes to a culture where primary care is not as well-respected, and that’s a really big problem.”




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