Free Money? Really? by Pat Conrad MD

Here is what I can’t figure out…

Awesome story!!!  “New York University medical students received life-changing news on Thursday — the School of Medicine will cover full tuition going forward for all current and future students, regardless of need or merit.”  Hey, that is super.  This story reports that 75 % “of all doctors” graduated with medical school debt.  That sounds pretty low to me, but fine.  We all know that the educational debt burden for new physicians is significant, averaging $202,000 on graduation.  Welcome to pediatrics in lesser East Nowhere, doc!  Nah, I don’t think so.

NYU needs a little over half a billion dollars to keep the scholarship fund rolling over, and honestly, I think it’s a pretty cool idea.  If a medical school – or any other, for that matter – can snag the endowments, promises, grants, and whatnot to bring the students in, then why not?  The article also mentions that NYU can graduate its newbies more cheaply with an accelerated 3-year program.  We have argued this here before, with good arguments on both sides of the 3- versus 4-year routes.  I still favor the 4-year plan, for purposes of extra reflection and training.  Yeah, yeah, pass boards Part 2 and we all know all you have to do is fog a mirror to get out of the fourth year, and it is additional expense.  I still favor it, so if you don’t, let me have it.

“The goal (of the free tuition) is to allow aspiring physicians ‘from all walks of life’ pursue their passion with less stress.”  And I think that is a really cool goal as well.  But I wonder…

– Are there any strings attached?  “School officials worry that rising tuition and soaring loan balances are pushing new doctors into high-paying fields and contributing to a shortage of researchers and primary care physicians.”  I’ve known of other programs that had reduced admission requirements, or tuition burdens, with the expectation that more graduates would go into primary care.  The results are still that most graduates are to smart to be taken in by the PriCare scam and opt to specialize in the ‘burbs for mo’ money.  Moreover, I think it would be just fine if a given medical school attached debt forgiveness to in-demand specialties or underserved areas.  I wonder if NYU has any such guidelines?

– Where are these endowments from, exactly?  If the money if from private benefactors, graduates, and so forth, then I’m all for it.  But if the funds come from Uncle Sam, Kaiser-Blue-Aetna-HCA, or Big Pharma, then we have to ask, “What’s the catch?”  Is this just a tax write-off, or is there more afoot behind the curtain?

Every major cable news and interweb outlet is celebrating this move by NYU, and maybe it is as really generous as it sounds.  But I am cynical enough to have learned that there is really no such thing as free money.  So I what I can’t figure out is, what strings are attached?  What’s the catch?

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  4 comments for “Free Money? Really? by Pat Conrad MD

  1. Robert
    August 19, 2018 at 7:52 pm

    My father’s a doctor so I grew up around a lot of doctors. In my experience, not many doctors become doctors for the money, a few, but not a lot. It doesn’t hurt, I’m sure, that not many doctors are wondering where to find their next meal, but it is generally not a road to fabulous riches. So yeah, many will still go into a specialization because that’s their area of interest, but without the huge debt I can definitely see a few more going into primary and other less glamorous and less well paying areas because that is where they’ll find personal satisfaction. I have no idea if this program has any strings or additional incentives to push people in those directions, but even without them, they’ll get a few more.

  2. PW
    August 19, 2018 at 12:41 pm

    While they may get a free education, these poor students will realize once they get out they will still be just basically glorified data entry clerks.

  3. Mike Lesniak, MD, MPH
    August 19, 2018 at 9:21 am

    The NHSC has a program for those that know they want to go into primary care, and a payback model if you already went that route and want loan assistance. Have to work underserved and if you choose it after you already are primary care, it’s a lottery system. It does help with tuition for a lot of docs. I won’t do it because I don’t want to be owned, and I didnt do it in med school because I didn’t know I would love FP so much. I do wish I knew what I wanted to be back then as I would have done it. I’d be done with payback and debt free…instead I am down to $244k in student loans.

  4. Seneca
    August 19, 2018 at 8:55 am

    As you said, just because these students graduate with little or no debt, they will still want to make as much money as they can, just like anybody else. I cannot see programs like this as a boon for primary care specialities. Until the patients have a financial interest in their care, physicians and patients will continue to support a specialist dominated system.

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