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)
When I was coming up at the very end of the 70’s in college (I.B.C. class of ’78) GMENAC
said something ridiculous that there was going to be an excess of physicians in the near future!
(I don’t remember exactly but I think they were saying in the late 80’s or in the 90’s.)
I think anyone who is trying to predict the physician requirement for the U.S. or the world is a
#ickhead. I believe it’s extremely hard to do so. I was dissuaded for going into a specialty as there was going to be “too many surgeons out there in 1982” though I made the attempt anyway. Wished I would have been more selective on specialty choice and stuck with it.
The cost of medical training at a state university (U of Il.) was dirt cheap back then. The government had capitation grants at state U’s and I believe it was something like $1,600.00 a quarter which was cheaper than my undergrad at Illinois Benedictine College.
(Now Benedictine University and a great place to go for undergrad no matter what one wants to do in life.)
My Dad took me aside at age 15 and said, “You’re going to college and your mother and I are going to pay for it.” I quietly said, “Yessir.” I recognized a gift horse immediately.
My Dad suggested engineering as a profession as I think he wanted to do that. Instead, he dropped out of college, was married, I came along and he started a business that catered to engineers and companies that had a lot of engineers developing “new stuff”. It took off as he had great ideas and the company did well. Still does as my siblings run it now.
I told Dad I was thinking of medicine (again at age 15) and God bless him, with my Mom they were like, “That’s good too.” I graduated from Med school with zero, I mean “0” debt and remember getting a $500.00 check from my mom once a month to take care of expenses while going to school. With rent being $140.00 a month in my small apartment, I was able to take care of everything, rent, food car insurance, books and incidental expenses.
When I got into a residency, I told them to stop sending the checks as I was going to get paid $1500.00 a month which due to the fact I was in the same small apartment and was still unmarried was more than enough to deal with expenses. Again, I had no debt whatsoever so it was easy to live on that in the early 1980’s as a single “unencumbered” guy.
Unfortunately, Med school costs have gone through the roof now and I believe most won’t get out without significant debt. At least that will encourage them to move toward the higher paying specialties and stay away from primary care. I do remember though in the past, many hospitals were willing to pay off med school debt if an M.D. was willing to serve in an under served area by that hospital for so many years. Most of the M.D.’s who came to my area under that guise did their 4 years then left. Me? I only was wined and dined by the hospital CEO with my girlfriend who became my wife at a nice restaurant and I accepted the position as it was nearby to her hometown and mother. They did pay $250.00 to get me moved from one town to the locality though!
One nice thing about that was I wasn’t obligated to stay there for 4 years as the hospital didn’t pay for my education. I could have left after one year without issue if I wanted to though I stayed for over 30 years and had a decent family as could be had under the circumstances before EHR.
I was truly blest,
Kurt Savegnago
Perhaps the “control group” to consider is the cost of training medical students at the Osteopathic college in Yakima. Pacific Northwest University of the Health Sciences.