Sizable donations to medical schools that enable universities to waive tuition fees may widen the aperture of students' specialty considerations, given they will not have hundreds of thousands of dollars in loan debt as a factor in their decisions.
On July 8, Bloomberg Philanthropies announced a $1 billion donation to Baltimore-based Johns Hopkins University, making medical school free for students from families earning less than $300,000 a year. The new tuition policy, which will take effect this fall, also covers living costs for students from families earning less up to $175,000. In reacting to the news, several leaders said they believe such gifts may affect how young physicians choose specialty and practice sites.
"Some students as they move through their education certainly consider debt that's incurred, and it does have a degree of impact on what they are going to be doing after medical school and the specific specialty," David Marcozzi, MD, chief clinical officer and senior vice president at Baltimore-based University of Maryland Medical Center, told Becker's.
While there are many nuanced factors that influence medical students' specialty choice, data has indicated education debt levels play a key role. Over the years, the share of medical school graduates who say educational debt has a strong or moderate influence on their choice of specialty has remained consistent. Between 2007 and 2012, about 25% said debt has a strong or moderate influence on their decision. The same was true in 2023, according to survey data from the American Association of Medical Colleges.
Major donor gifts to medical schools remain relatively rare and thus attract public interest when they occur.
The median debt of graduating medical students for the class of 2023 was approximately $200,000. Meanwhile, compensation is among the factors that contribute to the nation's shortage of primary care physicians, with more new physicians choosing to go into higher-paying specialties. However, more students may consider entering primary care if they know from the outset that they will not be saddled with educational debt.
"Not having that as an additional complexity to decision-making allows for a greater opportunity to think about what specialty would you like to go into that you enjoy and have an expertise in, and you feel as though you'll contribute to healthcare overall most optimally," Dr. Marcozzi said.
Loan forgiveness programs likely would not have as much influence on specialty decisions, given they are more of a reactive approach. James Reilly, MD, senior vice president of academic affairs and interim chief of academic internal medicine at Pittsburgh-based Allegheny Health Network, called them a "mixed bag."
"Preventing debt in the first place might allow trainees to consider a greater number of options from the beginning of their training," he said. "Institutions like ours at AHN will want to stay in tune with the factors that drive specialty and site choice if financial considerations happen to fall down the list of priorities."
Overall, Dr. Marcozzi said he sees Bloomberg Philanthorpies' gift as having positive implications far beyond free medical school education for students.
"An investment in medical and public health education impacts us all and improves our ability to have healthier lives," he said. "One in six of our physicians [across the University Maryland Medical System] are Hopkins grads, so this is an investment in Baltimore, Maryland and candidly, our nation. There's no downside here."