Will Bloomberg’s gift spur others?

Most of Johns Hopkins University medical students will get free tuition starting this fall, thanks to a $1 billion gift from Bloomberg Philanthropies, a longtime donor to the university whose school of public health is named after Michael Bloomberg. The generosity is striking, but even combined with other recent steps to free future doctors from crushing medical debt, the move may not translate into improvements in the broader health care system, experts say.

According to to the announcementPart of the gift will go toward increased tuition support for health care students, other than future physicians, such as public health and nursing. For future physicians who attend the school, the impact will be greater. All medical students from households earning less than $300,000 per year are eligible for free tuition, and students from households earning less than $175,000 per year may have fees and living expenses covered. Nearly two-thirds of currently enrolled students will receive one or both of these benefits.

“As the U.S. struggles to recover from a troubling decline in life expectancy, our country faces a serious shortage of doctors, nurses and public health professionals – and yet the high cost of medical, nursing and graduate school continues to keep students from attending too often to register,” said Michael Bloomberg in a statement. (Bloomberg Philanthropies supports STAT’s reporting on chronic health problems; it is not involved in decisions about our journalism.)

Johns Hopkins joins a few other medical schools that have become tuition-free in recent years, including NYU Grossman School of Medicine, Kaiser Permanente Bernard J. Tyson School of Medicine and, most recently, the Albert Einstein’s College of Medicine.

But while these types of programs can have a huge impact on the lives of students, they are likely to have limited impact on the broader medical system — whether it’s expanding the health care workforce or moderating the price of medical services — experts told STAT.

Rather, some said the move could be a response to an increasingly competitive medical education market. “Johns Hopkins has had to compete with a few other places that have recently gotten these big donations and free tuition. And this is an attempt to compete with them and attract the best [future] doctors,” says Joshua Gottlieb, a health economist at the University of Chicago.

The outcome of the policy could be to impact the top candidates, rather than actually expanding the pool of physicians, because the total number of available spots would not grow. It is also not expected that the number of places to stay, which is already insufficient to accommodate the current, limited number of graduates, will increase. “Without increasing the number of doctors, you have no impact on the downstream labor market. It’s not going to be more affordable to find a doctor, it’s not going to be easier to find a doctor,” Gottlieb said.

However, some say this type of competition could ultimately lead to meaningful changes in the student population. “To the extent that this encourages more schools to say, ‘we need to try to address this problem of high debt’… I think it can actually help reach that more diverse pool of applicants, and not just shift to wherever those top candidates choose to go.” said Atul Grover, the executive director of the Association of American Medical Colleges Research and Action Institute, who teaches at the Johns Hopkins Bloomberg School of Public Health. There are potential medical students, he said, who cannot make the choice to become doctors because they come from low-income backgrounds and are expected to help support their families, and who cannot even imagine that years after have to wait for their graduation to become graduates. can pay off their debts.

Again, these are students who may not have grown up with the specific expectation that entering a medical career equates to high earnings, and so if they were to gain access to a medical degree, they might also be drawn to specialties with lower earning potential , Grover said.

But even on a larger scale, if there were free education for all, or most, medical students, it would not necessarily eliminate the predicted physician shortage, nor is it likely to increase the chances that physicians will choose less rewarding specialties such as primary care.

It is also unlikely that eliminating tuition will reduce the cost of physician services. Although their salaries are only about 10% of the country’s total healthcare costs, a reduction in their fees would still reduce overall medical expenditures. But “the cost of medical school does not explain the higher salaries of physicians in the U.S.,” says Gottlieb, arguing that rather it is the scarcity of physicians, and Medicare-set reimbursement rates, that determine these salary levels. Although student debt is often cited as justification for high medical bills, total school debt is so minimal compared to a physician’s lifetime earning potential — $6 million to $10 million on average — that it is not a factor in determining its affordability.

When it comes to choosing a specialty, the cost of medical school hardly matters, Gottlieb said. This is why he believes that even low-reimbursement specialties like family medicine allow doctors to make more than enough money to repay any student loans, and that having no debt to repay “doesn’t mean anything.” changes the fact that you can make two or three times as much in both surgery and general medicine,” said Gottlieb. Thus, physicians who respond to higher earning potential would continue to do so, with or without tuition. “The amount of debt being on the order of one, maybe two years of income… that’s not that big of a difference compared to earning two or three times as much over your entire career,” he said.

Of course, free medical school makes a difference for today’s students. It opens up opportunities for students who do not have the financial means to apply (for example, students who need to help support their families), especially if no tuition comes with living expenses coverage. Still, “it’s a poorly targeted solution,” says Jason Abaluck, an economics professor at Yale. “Because what it does is it makes people who are rich throughout their lives even richer.” And while it’s true that doctors make most of their money later in their careers, there may be other solutions to help them when they’re just starting out in the profession – for example, funds where older doctors pay a portion of their salaries that young people can access can receive additional income, to pay this money back later in their career.

And when it comes to increasing diversity of access, providing free education to the majority of medical students, even with loose income requirements, does not maximize the potential to help those who need support to attend school, not even in the form of scholarships. , Abaluck said. “It just seems like it’s a big mistake to say, ‘Let’s give that to everyone,’” he said, “as opposed to ‘Let’s give that to the people who really need it.’”