The outrageous cost of working in medicine

June 9

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Over the past two decades, medical school tuition has increased by 312 percent in public institutions and 165 percent in private institutions. This has left students in the health professions with enormous amounts of student debt and, perhaps even worse, has turned many others away from pursuing such fields all together.

This is not consistent with our nation’s goals of increasing student degree attainment and filling much needed roles in the health professions. Projections show that we will need 124,000 more physicians, 157,000 more pharmacists and up to 1 million more nurses in the United States over the next 10 to 20 years, in part due to expanded coverage under the Affordable Care Act.  Yet today, low-income students are discouraged from applying to medical, dental and other health programs because of high tuition and insufficient scholarship funds.

Our elected and appointed policy makers in government, academia and business need to start paying attention. Our nation’s health will increasingly suffer from this growing lack of health providers — and most certainly from a lack of health providers in communities of need.

You shouldn't have to come from a wealthy family (or be willing to tolerate a lifetime burden of debt or the deferral of buying a home and starting a family) to go into health care.

And yet 60 percent of medical students, for example, hail from families with incomes in the top 20 percent of the nation. Meanwhile only 3 percent come from families with incomes in the lowest 20 percent. The prospect of having to borrow and incur debts of $150,000 to $250,000 to enter the profession causes many students to seek careers elsewhere.

Even those students who do successfully navigate the rocky financial terrain of health professions programs graduate with intense financial pressure, which then distorts their professional career choices. It often leads them to choose high-paying, procedurally intense specialties such as anesthesia, dermatology and orthopedic surgery rather than a primary-care field such as family medicine, pediatrics or internal medicine.

The result of this dysfunctional system deprives our country of the health professionals needed, particularly in rural and inner-city areas, and in racial and ethnic minority communities. It also deprives us of diversity within the profession itself. According to an article in the New England Journal of Medicine, the cost of attending medical school is the No. 1 reason why minorities do not apply to medical school.

That comes through in the numbers: Blacks make up less than 6.1 percent of medical students and Latinos make up 8.5 percent.

This unfortunate scenario did not exist before 1975. Up until then, a variety of scholarships and other financial aid mechanisms were available to students, including service-contingent loan programs. Federal Policy makers then made a calculated decision to move away from these scholarship models. They posited that all those with medical degrees would have high earning potential and should therefore be in a position to repay loans without any problem. It hasn’t worked out that way for most young physicians, and now our country is feeling the negative impact of those earlier policy calls.

We could begin to address the problem of high student debt burdens by re-establishing such programs and having them focus on primary care — including pediatrics, family medicine, obstetrics/gynecology and internal medicine — as well as focusing on rural and low-income urban settings.

If we broadly implemented such changes, we would increase opportunities for students from poor and minority families to enter health care, and the development of their talents would strengthen our nation’s ability to meet its rising medical needs. It would also have a great side effect: the democratization of educational opportunity as our society becomes more diverse, racially and ethnically.

Dr. Louis W. Sullivan served as U.S. secretary of health and human services from 1989 to 1993. He is chairman and CEO of the Sullivan Alliance to Transform the Health Professions and is the author of “Breaking Ground: My Life in Medicine” (The University of Georgia Press, 2014). Marybeth Gasman, a professor in the Graduate School of Education at the University of Pennsylvania, contributed to this op-ed.

Read and watch a leadership interview with Dr. Sullivan:

A leader in health care, born out of the segregated South

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