Making medical school free for students has been hailed as a way to encourage more graduates to pursue specialties that are less lucrative and practice in underserved areas. Yet evidence suggests that free medical education has not achieved either outcome.
In an Oct. 21 piece for The Atlantic, Rose Horowitch examined how the growing philanthropic trend may actually exacerbate healthcare inequality issues by making prestigious medical schools even more selective.
In 2018, the New York University Grossman School of Medicine, part of New York City-based NYU Langone Health, announced it would cover full tuition costs for all medical students regardless of need. The change followed a $100 million donation from Kenneth and Elaine Langone.
"The school's shift to a tuition-free model has no doubt been a tremendous boon to those students fortunate enough to gain admission," Ms. Horowitch wrote. "But judged against the standards set out by the Langones and NYU itself, the initiative has been a failure."
The percentage of the school's medical students who went into primary care was mostly unchanged between 2017 and 2024, according to an analysis The Atlantic cited by Chuck Dinerstein, MD, medical director of the American Council on Science and Health. Data also suggests going tuition-free did not have much of an effect on where graduates did their residencies.
Health economists generally agree that generous, well-intended gifts to make medical school free have not delivered on stated aims to increase the number of students choosing primary care over more lucrative specialties. Instead, tuition-free initiatives may inadvertently make it more difficult for low-income and underrepresented minority students to get into medical school. According to Ms. Horowitch's reporting, the number of applicants to NYU School of Medicine jumped nearly 50% in the year after the tuition-free policy took effect, but the number of slots did not increase proportionately, which made admissions more competitive.
Tuition-free programs undoubtedly improve the lives of students who might not otherwise have pursued medicine. However, some experts argue that more targeted approaches — rather than blanket policies for all students — may better support low-income students and encourage more to pursue primary care. Many experts also agree philanthropic dollars would be better spent on establishing new schools or on lobbying efforts to expand caps on student and residency slots — a key component of the nation's physician shortage.
In a statement to The Atlantic, a spokesperson for NYU said going tuition-free was a "moral imperative" to ensure students from all backgrounds interested in medicine can pursue those passions. Meanwhile, Theodore DeWeese, MD, dean of the medical school at Johns Hopkins University, said financial-aid investments have improved diversity. In July, Bloomberg Philanthropies donated $1 billion to the Baltimore-based university, making medical school free for students from families earning less than $300,000 a year.
"We don't know for sure whether making medical school tuition-free — with living expenses covered for the neediest students — will lead graduates to return to their communities or choose to serve in lower-paying specialties, but we know they are less likely to do this without significant assistance," Dr. DeWeese told the publication.
Read the story in full here.