On most days, I am really excited about the fact that I’m going to medical school next year. On other days, I fixate on the fact that medical school is going to put me at least $200,000 in debt. That number freaks me out. In fact, that number was probably the greatest deterrent to medical school for me. I almost went down the nurse practitioner route to avoid accruing that much debt. Almost.
Medicine continues to be an incredibly inaccessible career for the poor due to the length and cost of training. Data from the AAMC’s annual Matriculating Student Questionnaire show that first-year medical students in the United States primarily come from wealthy families. The median parental income of 2009 matriculants was $110,000. Almost 60% (60!!!) had parents who earned a gross income of >$100,000. Only 16.1% had parents who earned less than $50,000. I wonder how many nurses and physician assistants out there would have been doctors if not for the enormous price tag that comes with an MD.
My debt panic is somewhat assuaged by the existence of the National Health Service Corps. It offers a scholarship and loan repayment program for certain health professionals who are willing to practice in medically underserved areas. Funding comes from the federal government, which provides enough money for 39 new scholarships and 977 new loan payments per year. With extra funding from the stimulus bill during 2009-11, there will be 114 new scholarships and 3,300 new loan repayments. I’m hoping to be one of those 114! The scholarship covers tuition and all school-related fees and provides a monthly living stipend. It’s like getting paid to go to medical school! Once you’re accepted as an NHSC scholar, you can stay in the program until you’re done with medical school, up to four years. For this support, scholars must work for 2-4 years in a medically underserved area after they finish their residency training.
I wish the federal government would invest more money in the scholarship program. The loan repayment program is also wonderful, but the financial benefit is not nearly as great. Permanently expanding the NHSC scholarship would be one good way to motivate future physicians to pursue a career in primary care. I think few people going into medicine know about this opportunity, and the general public certainly is even less aware of it. But I bet that you all know the more common way to get medical school paid for: MD/PhD. By my count, there are 82 MD/PhD programs offered at US medical schools. The vast majority of them are fully funded. Most MD/PhD programs, those designated as MSTP, have funding from the National Institutes of Health. (MSTP = Medical Scientist Training Program.) Physicians with MD/PhD degrees generally have careers in research and academia. Many do practice medicine, but it’s probably fair to say that the amount of time they spend seeing patients is minimal compared to their research time and compared to other physicians. In 2009, there were 601 new MD/PhD matriculants, and enrollment in MD/PhD programs has been increasing every year. Like NHSC scholars, MD/PhD students who are fully funded get tuition and fees paid for as well as a living stipend for every year of their academic training. Imagine if instead of 39 new NHSC scholarships per year, we had 601. It would be a huge PR boost for primary care and careers that focus on the underserved. It would not address all the issues that make primary care a less attractive specialty, but it would go a long way, especially in motivating students from disadvantaged backgrounds to consider medicine in the first place. Here’s hoping.
