What is the Real Cost of Educating a Medical Student: We have NO Idea?

We know in precise detail what medical students are charged and the debt they assume, but the actual cost to teach them remains a mystery. In 2019 there were in the U.S. 85 public and 56 private medical schools, admitting 21,622 students averaging 153 students in each entry class.  Increases in enrollment over the previous 13 years was 30%, during the same period Osteopathic schools increased 164%, in 2019 admitting 8,124 students. During the 2019-2020 academic year the average tuition for public medical schools for those living in state was $37,556 and for non-residents $61,858.  For private schools, in state tuition was $60,665 and $62,230 for non-residents. A decade earlier, for the 2010-2011 academic year these costs were considerably less; public medical schools for those living in-state was $26,532 compared with $47,738 for non-residents.  Private medical school costs were, in-state, $44,594 and $49,898 for out-of-state students. 
     In 2020 eighty percent of graduating medical students had debt averaging $251,600 that takes approximately 13 years to repay as interest accumulates during residency.  In contrast, the class of 1999-2000 had an average medical school debt upon graduation of $127,500. It appears that 4 out of 5 medical students have exhausted their family’s education savings during their undergraduate years (Ref.1&2).
       In 2018 NYU Grossman School of Medicine initiated free tuition to all students regardless of ability to pay. The new Kaiser Permanente medical school in California is doing the same. Others, Geisinger, Stanford, Washington University, Weil-Cornell, Ican-Mt. Sinai, offer students free tuition under varying circumstances (Ref.3).   
        The AAMC (American Association of Medical Colleges) publishes the financials of their members.  These reports reflect the financial activity of the entire medical center of multiple billions of dollars. The specific cost of teaching medical students is NOT included. However, tuition and fees represent on average about 3% of incoming funds for the entire entity. Endowments represent on average, 1.7% and gifts 1.9% (Ref.4). Thus, medical school funding affiliated with large medical centers represent a small fraction of the budget.
     The state of Washington legislature in 2017 financed a study of the cost of a year teaching at their two medical schools. There were many caveats as reports to state legislatures are frequently exaggerated to maximize funding; gifts and clinical income were not included. They estimated that at the established school the yearly cost was $90,600/student (Ref.5).  
      Modern medical school curriculums have the basic sciences in the first two years integrated with clinical instruction. The faculty is a mix of basic scientists and physicians. The average salary for basic science Ph.Ds. is about $100,000/year. An academic pathologist earns about $250,000/year and a general internist about $200,000/year; all require about a half-time commitment. Multiple time and motion studies would have to be done to find average costs. Also needed would be accounting for administrative and building costs. Does the school have costs for the third and fourth years? Actually no, attending physicians, residents and fellows do the teaching as part of their clinical responsibilities.  I suspect medical schools calculate their finances as part of the medical center so as to ascribe costs to the third and fourth years.
    The actual costs of teaching medical students is a mystery.  Rather, tuition is based on what students are willing to pay with increases of about 2%/year.  

1.     The MD Journey, True Costs of Medical Schools in U.S.A., 2020, available at: https://themdjourney.com/true-cost-of-medical-schools-in-usa-complete-guide/ (Accessed March 5, 2021)
2.    Matt Carter, Average Student Loan Debt for Medical School, March 27, 2020, available at: https://www.credible.com/blog/statistics/average-medical-school-debt/ (Accessed March 1, 2021)
3.    Accepted, Tuition Free Medical School: Every Thing You Need to Know in 2020-21, April 5, 2020, available at: https://blog.accepted.com/tuition-free-medical-school-everything-you-need-to-know-in-2020-21/ (Accessed March 2, 2021)
4.    AAMC, U.S. Medical School Revenues, Table 1, 2019, available at: https://www.aamc.org/data-reports/faculty-institutions/report/us-medical-school-revenues  (Accessed March 2, 2021)
5.    The Spokesman-Review – Jim Camden, State study says it will cost $125,000 a year to educate WSU medical students (at the new school, at the established school, $90,600), Aug. 25,2017, available at: https://www.spokesman.com/stories/2017/aug/24/state-looks-at-medical-school-costs-for-wsu-uw/  (Accessed March 3, 2021)

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