The Atlantic, The Perverse Consequences of Tuition-Free Medical School:
The latest philanthropic trend, no matter how well intended, might be making health-care inequality worse.
Six years ago, the New York University Grossman School of Medicine, in Manhattan, announced that it would become tuition-free for all students. The change was made possible in part thanks to a $100 million donation from Kenneth Langone, a Home Depot co-founder, and his wife, Elaine. “It would enable graduates to pick lower-paying fields like primary care and pediatrics, where more good doctors are desperately needed, without overwhelming debt to force them out,” Kenneth said in an interview at the time. In a triumphant report, the school declared, “The ultimate success of this tuition-free initiative will be measured over time by the clinical and research achievements of future graduates, as well as the improvements in diversity of the physician ranks.”
The school’s shift to a tuition-free model has no doubt been a tremendous boon to those students fortunate enough to gain admission. But judged against the standards set out by the Langones and NYU itself, the initiative has been a failure.
The percentage of NYU medical students who went into primary care was about the same in 2017 and 2024, according to an analysis by Chuck Dinerstein, the medical director at the American Council on Science and Health. The locations of the hospitals where students do their residencies—often a clue about where they will end up practicing long-term—also remained essentially unchanged. And although applications from underrepresented minority students increased by 102 percent after the school went tuition-free, the proportion of Black students declined slightly over the following years, according to data from the Association of American Medical Colleges and provided by Jared Boyce, a medical student at the University of Wisconsin. (The share of Latino students grew by a few percentage points.) Perhaps most alarming of all, doing away with tuition appears to have made the student body wealthier: The percentage of incoming students categorized as “financially disadvantaged” fell from 12 percent in 2017 to 3 percent in 2019.
Despite the lackluster results, bankrolling tuition-free medical education has become a popular social cause of the über-wealthy. This past February, Ruth L. Gottesman, the widow of the billionaire investor David Gottesman, donated $1 billion to make the Albert Einstein College of Medicine, in the Bronx, tuition-free in perpetuity. In July, Michael Bloomberg gave $1 billion to Johns Hopkins University, though his gift will cover tuition only for students whose families make less than $300,000 annually. The Langones gave another $200 million last year to NYU’s Long Island School of Medicine to make that campus tuition-free too. Each of these donations has been hailed as a game changer for the medical profession. They may well allow for the medical education of some brilliant doctors who might otherwise never have entered the field because of financial obstacles. But health economists are nearly unanimous that such gifts, no matter how generous and well intended, will do little to achieve their broader stated aims—and might even be making health-care inequality worse. …
So far, the most obvious beneficiary of tuition-free policies might be the schools themselves. In 2017, NYU Langone was ranked the 11th-best medical school in the country for research by U.S News & World Report. Five years and $100 million later, it was the second-best. (The rankings are based in part on students’ standardized-test scores and undergraduate GPAs, which improved as the top students were lured by the promise of a free ride. This year, U.S. News replaced its numbered list with a tiered ranking system. Some medical schools, including NYU, declined to participate.) “That’s really the margin where this seems most relevant, is one med school competing with another med school,” Gottlieb told me. This is the irony of elite medical schools going tuition-free. A public-spirited policy intended to help disadvantaged people and benefit society ends up giving more benefits to those who were already ahead. Medical schools that are already prestigious jockey for even higher rankings. Students from wealthy families get an extra leg up. And the whole thing gets wrapped up in the language of social justice.
In NYU’s statement about making history, the school wrote: “And while we are fortunate to be the first top-ranked medical school to offer full-tuition scholarships to all of our medical students, it is our sincere hope that we will not be the last.” Perhaps it should have been.
Inside Higher Ed, Are 3 Years of Medical School as Good as 4?:
The number of accelerated medical degree programs has tripled over the past decade. New research shows that outcomes are similar to those of four-year programs.
Even in medical school, sometimes less is more.
Three-year medical degree programs are becoming increasingly common, and now new research shows that student outcomes in at least one such program are on par with those at traditional, four-year programs.
“For the great majority of students, with the right mentoring and level of shadowing that can happen earlier, they can easily graduate in three years,” said Dr. Joan Cangiarella, director of the accelerated medical degree pathway program at New York University’s Grossman School of Medicine, which has offered a three-year program since 2013.
“The general medical world has been stuck on the four-year [curriculum] for 100 years,” she said, noting that because three-year programs aren’t the norm, some residency directors may be skeptical of graduates of accelerated programs. “We want to make sure people know that these [three-year] students are just as good.”
Emerging data appears to back that up, according to a study of NYU’s medical program that Cangiarella and a team of other researchers published in the peer-reviewed journal Academic Medicine last month [Outcomes of Accelerated 3-Year MD Graduates at NYU Grossman School of Medicine During Medical School and Early Residency].
In examining seven years of student outcomes, researchers found that graduates of NYU’s three-year medical degree program performed similarly to their four-year peers in medical school and early residency, including on licensing exams.
In fact, the three-year students scored on average about one percentage point higher on their pre-clerkship exams than those in the four-year program, according to the study.
And while accelerated students scored slightly lower on Step 1 and 2 medical licensing exams—which assess basic scientific and clinical knowledge—and on a portion of the comprehensive clinical skills exam, they received comparatively higher scores on the Step 3 exam, which assesses in-depth clinical knowledge.
The study also found that compared to interns in the internal medicine residency who graduated from the four-year program, interns from the three-year pathways performed slightly better on milestones set by the Accreditation Council for Graduate Medical Education, including those related to patient care, medical knowledge and professionalism.
“The clear success of our fast-tracked system has prompted major changes in our overall curriculum,” Dr. Elisabeth Cohen, co-author of the study, said in a news release, noting that as of 2023, NYU enables “all students to graduate in three years if they choose, whether they proceed directly to a residency here or get matched elsewhere.”
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