I'll probably be downvoted on a forum like this, but I worry about the most successful universities using their funds to subsidize those who would be fine without it. I was actually made aware of this by a wealthy Stanford alumni which has a fairly broad program for undergraduate tuition assistance. Graduates of mid/low tier universities seem more and more likely to have to compete with better credentialed people with lower debt.
Don't get me wrong, this is fantastic on an atomic level, and the levels of debt required to get an MD these days is insane (have a lot of family in the field). Also, it's not like this is a unique structural disadvantage, just a new one.
This is amazing. I graduated from medical school two years ago with $300,000 in debt. I'm a software developer on the side and would love to stop residency to try a healthcare startup and/or pursue a research, but the risk is too great - I need the attending salary to pay off the debt.
I’ve started thinking of the obligation to stick in industry to pay off my loans as an analog to having an organization like the US military pay for my degree. I have a few friends in the military studying at university for free. Their payment for those degrees essentially consists of X number years of obligatory post-degree military service, in addition to whatever military obligations during their study. [1]
It’s an imperfect analog I think, but it’s helped me contextualize my situation and remove some feelings of bitterness towards the debt I still owe.
[1] I’m not military so I don’t know 100% how that works - open to corrections
If I may ask, how exactly do you have the time to be both a resident and a software developer? There aren't enough hours in the day. Do you even sleep?
I think the debt level is crazy. But it sounds like you wish you’d had a free medicine degree so that you could be free not to practise medicine. I’d think if you get the degree for free then you almost should feel more obligated to practise.
> I'm a software developer on the side and would love to stop residency to try a healthcare startup and/or pursue a research, but the risk is too great - I need the attending salary to pay off the debt.
This is exactly why I pressed a giant pause button halfway through my MD to get a PhD in computer science. There was no other time I could do it. After 4th year? Too much debt; also looks bad for residencies to take time off. After PGY-1? Too much debt; would hurt me if I wanted to do a full residency. After residency? Too much debt; also that forces me to wait quite a few more years before pursuing my research/software dev ideas.
Right now I can manage the debt from the first two years with my graduate stipend + summer internship gigs in the industry. If I had waited even one more year to do this, the debt would have been be prohibitive.
Geniune question: why does a degree cost that much? Is it the teaching staff salaries? Is it extremely state of the art equipment? Is it possible to disrupt that?
But it would be a total waste for society if they paid your education in full and you did not practice.
One related challenge of inexpensive education is the 'brain drain'. I am Canadian and hold a PhD in Engineering. Tuition was about 3,000 CAD a year throughout my education, with scholarships I ended up no dept at all. Now the temptation is move to the US or Europe is pretty strong, but I am still far from having 'repaid' the gouvernement's 100s of thousands of dollar (with ~160,000$ of in-pocket scholarships) investment in me.
I think free or near-free education is great, but it's a bit of a gamble.
What a surreal discussion about something obvious: University and college should be free for everyone. First, this is a great equalizer in the positive way: it does not depend on how wealthy your parents are, so you get an equal opportunity. Second: the society as a whole benefits from well educated people. Accounts need well trained doctors, doctors need well trained accountants, both need an engineer to craft them a reliable car, etc etc...
Countries like Germany show that university/med school can both be free and high quality. Od course also in Germany some private elite universities exists where you have to pay (it is ok, I like diversity). But to get a perfect career, a state run university is all you need.
I do not live in the US and therefore I am not sure why medicine has been singled out as a worthy profession to receive subsidy over many others? Don’t those in the medical profession get paid reasonably well over there? Aren’t there other professions equally necessary for a functional society that don’t get compensated as well as they should like teachers, social workers and those in the voluntary sectors who would be better off with this money? I personally think this is a misjudged priority in the grand scheme of things.
I hope this helps to decrease the costs of medical care in the US to some extent as it removes one pressure for doctors to earn extra money charging for things that might not need to be needed.
edit: Just so I am clear I know that there are lots of other influences on healthcare costs and doctor debt isn't the only pressure they face. Doctors do have some influence on cost (if not large) and if pressure on them is removed in any way some of them may choose to spend that extra time helping their patients money go further. Small early influences can have large effects on a system so I am hoping that this kind of influence might change attitudes enough to have a large longer term change.
Hospitals in America aren't actually a free market. You cannot choose not to buy, and in emergency situations you can't actually compare prices between sellers. Hospitals charge whatever they can get away with and insurance companies get a discount because they have some leverage- but you and I don't.
All this would really do is help lower the medical providers costs. Likely it will give them additional funding to lobby against socialized health care.
This is awesome! So many medical students are kinda forced into more profitable healthcare practices than ones which people need more desperately (e.g. plastic surgery vs rheumatology).
I especially love that this was done with private fundraising over government funding. Philanthropy can be effective, often far more so than governments!
I predict this will have the opposite effect. This will increase the appeal of NYU leading to stronger students applying/accepting offers of admission who go on to get into higher paying specialties.
Plus anything that can be done to juice the supply side of the healthcare curve is a big benefit. Cheaper school means more doctors means lower labor costs means cheaper healthcare.
I would hardly say it shows the effectiveness of philanthropy - this is just one college and has very limited effects on the healthcare system as a whole. In Germany for instance higher education is free everywhere, I don't see how this could work with private fundraising.
As an European I always find the dichotomy "government vs people" strange. If the state pays for something, it's solidarity, not communism.
Huge. I went private for my medical school education and came out of it with about $190K in debt. Fortunately I didn't have any undergrad debt.
But I liked family practice, and I like public health, and I'm proud to work in those fields. I definitely understand the push to go to higher-paid specialties with a burden like that, though.
> 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 think this is only partially true, because it misunderstands the motivations of many would-be doctors. Sure, the cost of medical education factors into specialty decisions, but as long as derm and ortho are regarded as more _prestigious_ than family med and general peds, you're going to see similar residency application numbers. There's still a social hierarchy within the medical profession, which the price of tuition doesn't immediately change.
Still, this is great for people set on primary care as a career. Interestingly enough, my general observation has been that students who need the money the _least_ (i.e. people whose families are paying for their educations) are the ones who are gunning for the highest paid (and typically most prestigious) specialties.
In my experience, the people who go for the extra money in derm and ortho don't need it from a wealth perspective, but often need it from a social and self-worth perspective.
Over time this dynamic translates into to the prestige gap.
Is anyone not going to med school because of debt? Not sure what problems this solves.
For the long commitment that doctors make and the debt they take on, they receive basically guaranteed highly paying employment for as long as they wish.
There's also a shortage of medical school spots, we can't create enough doctors.
I think this is probably an attempt to compete with other medical schools for top students. NYU is pretty well respected bit probably loses a lot of candidates to Harvard, Yale, etc.
Perhaps as a back of a line thing - not those about to enter it. It is already infamously grueling. Graduating and being six figures in debt could try the patience of many. "Staying in school in a high stress environment till near my thirties is bad enough without being in debt practically big enough for a house for years afterwards. I'll just go into banking after four years so I can actually enjoy the money while I am young." Whether you want doctors with such am attitude is another question.
This is great! Now lets please do the same for nurses and social workers who pay exorbitant tuition rates, too, yet get paid peanuts to be on the frontline of health care.
> Now lets please do the same for nurses and social workers who pay exorbitant tuition rates, too, yet get paid peanuts to be on the frontline of health care.
I would not say nurses get paid "peanuts". Not many jobs would let you earn close to $100k in New York City with only a bachelor degree (or in some cases only a two-year associate degree)
Especially social workers. I have literally no idea why anyone would go to grad school for an MSW and take on the kind of debt required to do so, then enter a profession with the combination of low salaries and horrible work environment that social work has. The same goes to a slightly lesser extent for secondary and elementary school teachers.
They need warm bodies (residents are cheap labor) to run the hospital (the money machine that gets thousands of dollars per xray, per drug, etc). A steady supply of med students who are already situated in NYC saves them the cost of recruiting residents from afar. And who knows how much money they save by cutting the bureaucracy to administer tuition, loans, Sally Mae compliance, etc.
This is probably the other piece of the puzzle regarding the implementation of single payer healthcare.
Because who in their right mind wants to sacrifice 16 years of earning potential, take on 500K of debt only to become an MD with long work days and now prices that are fixed with no other form of negotiation leverage in sight.
Does anyone know if the single payer models we use in the US keep Dr. salaries on par? I've only heard of savings from negotiated drug prices, and insurance overhead; but, if Dr. salaries are also decreased, OP's got an interesting point.
>Because who in their right mind wants to sacrifice 16 years of earning potential, take on 500K of debt only to become an MD with long work days and now prices that are fixed with no other form of negotiation leverage in sight.
Asians/Indians make most MDs in the US because being a doctor is valued a lot in their communities even if you've infinite debt, you still get respect.
Second, most doctors come from doctor families. They've already transversed the path once, and their kids can reuse the knowledge and connections.
So yea, my father is MD and he can easily support 16 years of MD education for me. If you don't have a family with similar resources, obviously either you can take debt which comes with enourmose stress/worries which decrease your chance to complete or not compete at all!
Individualistic people aren't going to find it easier to compete with community backed people.
Included in the list of perhaps not totally intended consequences: I think this may allow some MD students to think twice about practicing and take less traditional (potentially less secure) career routes. I may be biased, having effectively not practiced for a couple years now myself, but I think this could be a good thing to an extent.
I work with 3-4 MDs that chose not to practice who are now working on defining software/ML product feature requirements; their MD experience makes them solid product specialists for clinical solutions that hopefully will help a lot of people...not having to stare down the barrel on loan payments may help people make these kind of career moves that may ultimately progress the system.
All that being said, we (obviously) need good docs at the bedside.
I just wish there was a middle ground here. The problem is that tuition is too high, not that it exists at all. Lowering tuition would solve the problem just as effectively, and could be done for more students.
>"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."
It's worth noting that NYU tuition for regular undergrad is $50K before room and board and $68K with room and board [1].
The cynic in me has to wonder if they share the same concern for the rest of the legion of debtors they are churning out every year.
I'm not doubting the importance of research and primary care physicians in our society. But six figure debt loads for university are commonplace in the US. And are likely causing skew in career choices in non-medial fields as well.
I also have to think that there's something in this arrangement for NYU and that there are motives outside of just societal altruism here. I just don't know what those are. Research money? 501(c)(3) maintenance? Something else?
I wonder if they will cover the tax if the irs decides to call it income to the student.
But good to see. Doctors have been getting squeezed pretty hard recently. Something has got to give. Radiology had around 80 unfilled residency spots a few years ago because of poor career outlook.
for nyu to make tuition go away means that they are already having a large cost processing loans/grants/discounts along with the compliance costs for sallie mae,etc. NYU is a PRIVATE university as well so they can be super selective in whom they accept - and now they become even more selective - admitting those with legacy contacts, etc. Finally, the truth is that they need warm bodies to run the hospital and if the cost of living in NYC is so high that nobody wants to do residency there (training after med school), then how are they going to get PCPs? They'll need to pay an arm and a leg to get them (dark pun?) By having a steady supply of med students who are already situated in NYC, they assure a steady supply of residency candidates.
[+] [-] sf_rob|7 years ago|reply
Don't get me wrong, this is fantastic on an atomic level, and the levels of debt required to get an MD these days is insane (have a lot of family in the field). Also, it's not like this is a unique structural disadvantage, just a new one.
[+] [-] aabajian|7 years ago|reply
[+] [-] pandler|7 years ago|reply
It’s an imperfect analog I think, but it’s helped me contextualize my situation and remove some feelings of bitterness towards the debt I still owe.
[1] I’m not military so I don’t know 100% how that works - open to corrections
[+] [-] glitchc|7 years ago|reply
[+] [-] mprev|7 years ago|reply
[+] [-] cartoonfoxes|7 years ago|reply
[+] [-] gachavez|7 years ago|reply
[+] [-] kendallpark|7 years ago|reply
This is exactly why I pressed a giant pause button halfway through my MD to get a PhD in computer science. There was no other time I could do it. After 4th year? Too much debt; also looks bad for residencies to take time off. After PGY-1? Too much debt; would hurt me if I wanted to do a full residency. After residency? Too much debt; also that forces me to wait quite a few more years before pursuing my research/software dev ideas.
Right now I can manage the debt from the first two years with my graduate stipend + summer internship gigs in the industry. If I had waited even one more year to do this, the debt would have been be prohibitive.
[+] [-] 0xcafecafe|7 years ago|reply
[+] [-] jpambrun|7 years ago|reply
One related challenge of inexpensive education is the 'brain drain'. I am Canadian and hold a PhD in Engineering. Tuition was about 3,000 CAD a year throughout my education, with scholarships I ended up no dept at all. Now the temptation is move to the US or Europe is pretty strong, but I am still far from having 'repaid' the gouvernement's 100s of thousands of dollar (with ~160,000$ of in-pocket scholarships) investment in me.
I think free or near-free education is great, but it's a bit of a gamble.
[+] [-] alrehn|7 years ago|reply
[+] [-] Improvotter|7 years ago|reply
[+] [-] trhway|7 years ago|reply
according to TV series residents don't even have time to sleep :)
[+] [-] geff82|7 years ago|reply
Countries like Germany show that university/med school can both be free and high quality. Od course also in Germany some private elite universities exists where you have to pay (it is ok, I like diversity). But to get a perfect career, a state run university is all you need.
[+] [-] brtknr|7 years ago|reply
[+] [-] retbull|7 years ago|reply
edit: Just so I am clear I know that there are lots of other influences on healthcare costs and doctor debt isn't the only pressure they face. Doctors do have some influence on cost (if not large) and if pressure on them is removed in any way some of them may choose to spend that extra time helping their patients money go further. Small early influences can have large effects on a system so I am hoping that this kind of influence might change attitudes enough to have a large longer term change.
[+] [-] mabbo|7 years ago|reply
Hospitals in America aren't actually a free market. You cannot choose not to buy, and in emergency situations you can't actually compare prices between sellers. Hospitals charge whatever they can get away with and insurance companies get a discount because they have some leverage- but you and I don't.
All this would really do is help lower the medical providers costs. Likely it will give them additional funding to lobby against socialized health care.
[+] [-] wpasc|7 years ago|reply
I especially love that this was done with private fundraising over government funding. Philanthropy can be effective, often far more so than governments!
[+] [-] hooloovoo_zoo|7 years ago|reply
[+] [-] padobson|7 years ago|reply
[+] [-] hexhex|7 years ago|reply
As an European I always find the dichotomy "government vs people" strange. If the state pays for something, it's solidarity, not communism.
[+] [-] classichasclass|7 years ago|reply
But I liked family practice, and I like public health, and I'm proud to work in those fields. I definitely understand the push to go to higher-paid specialties with a burden like that, though.
[+] [-] neonate|7 years ago|reply
[+] [-] gerpsh|7 years ago|reply
I think this is only partially true, because it misunderstands the motivations of many would-be doctors. Sure, the cost of medical education factors into specialty decisions, but as long as derm and ortho are regarded as more _prestigious_ than family med and general peds, you're going to see similar residency application numbers. There's still a social hierarchy within the medical profession, which the price of tuition doesn't immediately change.
Still, this is great for people set on primary care as a career. Interestingly enough, my general observation has been that students who need the money the _least_ (i.e. people whose families are paying for their educations) are the ones who are gunning for the highest paid (and typically most prestigious) specialties.
[+] [-] hectorr1|7 years ago|reply
Over time this dynamic translates into to the prestige gap.
[+] [-] adpirz|7 years ago|reply
[+] [-] MrEfficiency|7 years ago|reply
There are doctors of physical therapy who make 60-100k.
Physicians have a government monopoly on prescription and referrals.
The scarcity in MD and DO licenses drives up the cost due to the power granted by the license.
[+] [-] cncrnd|7 years ago|reply
For the long commitment that doctors make and the debt they take on, they receive basically guaranteed highly paying employment for as long as they wish.
There's also a shortage of medical school spots, we can't create enough doctors.
I think this is probably an attempt to compete with other medical schools for top students. NYU is pretty well respected bit probably loses a lot of candidates to Harvard, Yale, etc.
[+] [-] Nasrudith|7 years ago|reply
[+] [-] rrcaptain|7 years ago|reply
[+] [-] BurningFrog|7 years ago|reply
But what do they get from these top students? Clearly not tuition anymore!
[+] [-] kaitari|7 years ago|reply
[+] [-] chimeracoder|7 years ago|reply
I would not say nurses get paid "peanuts". Not many jobs would let you earn close to $100k in New York City with only a bachelor degree (or in some cases only a two-year associate degree)
[+] [-] pmiller2|7 years ago|reply
[+] [-] dawhizkid|7 years ago|reply
[+] [-] s0rce|7 years ago|reply
[+] [-] tribesman|7 years ago|reply
[+] [-] bawana|7 years ago|reply
[+] [-] aantix|7 years ago|reply
Because who in their right mind wants to sacrifice 16 years of earning potential, take on 500K of debt only to become an MD with long work days and now prices that are fixed with no other form of negotiation leverage in sight.
[+] [-] nappy-doo|7 years ago|reply
[+] [-] tribesman|7 years ago|reply
Asians/Indians make most MDs in the US because being a doctor is valued a lot in their communities even if you've infinite debt, you still get respect.
Second, most doctors come from doctor families. They've already transversed the path once, and their kids can reuse the knowledge and connections.
So yea, my father is MD and he can easily support 16 years of MD education for me. If you don't have a family with similar resources, obviously either you can take debt which comes with enourmose stress/worries which decrease your chance to complete or not compete at all!
Individualistic people aren't going to find it easier to compete with community backed people.
[+] [-] markmichalski|7 years ago|reply
I work with 3-4 MDs that chose not to practice who are now working on defining software/ML product feature requirements; their MD experience makes them solid product specialists for clinical solutions that hopefully will help a lot of people...not having to stare down the barrel on loan payments may help people make these kind of career moves that may ultimately progress the system.
All that being said, we (obviously) need good docs at the bedside.
[+] [-] cwp|7 years ago|reply
I just wish there was a middle ground here. The problem is that tuition is too high, not that it exists at all. Lowering tuition would solve the problem just as effectively, and could be done for more students.
[+] [-] Havoc|7 years ago|reply
I mean I love this, but who is footing the bills on this & are we sure they won't taint the results with ulterior motives...
[+] [-] bogomipz|7 years ago|reply
It's worth noting that NYU tuition for regular undergrad is $50K before room and board and $68K with room and board [1].
The cynic in me has to wonder if they share the same concern for the rest of the legion of debtors they are churning out every year.
I'm not doubting the importance of research and primary care physicians in our society. But six figure debt loads for university are commonplace in the US. And are likely causing skew in career choices in non-medial fields as well.
I also have to think that there's something in this arrangement for NYU and that there are motives outside of just societal altruism here. I just don't know what those are. Research money? 501(c)(3) maintenance? Something else?
[1] https://www.investopedia.com/articles/personal-finance/01091...
[+] [-] naveen99|7 years ago|reply
[+] [-] karmajunkie|7 years ago|reply
[+] [-] bawana|7 years ago|reply