User login
Free Med School Alone Won’t Boost Diversity
This transcript has been edited for clarity.
We need more diverse students — more students from disadvantaged and underrepresented backgrounds in medical school. That is not a controversial take. That’s not even a new thought.
What is a hot take, however, is that free medical school alone is not going to accomplish this goal. In fact, based on data and what people think and are saying, that’s just reality.
I recently chatted about whether or not free medical school would motivate more students to pursue primary care. That was New York University’s (NYU’s) goal. If you haven’t seen that video, check it out. Now I want to explore whether free medical school would actually create a more diverse medical student body.
This topic is especially important now because, in 2023, the Supreme Court ended affirmative action for college admissions, and this naturally has a downstream effect when it comes to getting into medical school. Right now, about 6% of US physicians are Black or Hispanic/Latina, and around 0.1%-0.3% identify as Indigenous Americans, Native Hawaiians, or Pacific Islanders.
Is free medical school the answer? Well, that’s based on a huge assumption that the cost of medical school — incoming debt — is the single greatest barrier for students from diverse backgrounds, as if every single student from every background had the same level of resources in the same opportunity and were all equally competitive prior to applying, and just the prospect of debt is what caused the disparity. I don’t know if that’s reality. Let’s take a look at NYU.
After the free tuition announcement, total applications to the medical school went up nearly 50%. And from underrepresented groups, it was 100%. In 2019, the associate dean for admissions said, “A key driver was to remove a financial disincentive that dissuades people from pursuing a path in medicine.” But the acceptance rate stayed under 3%, and the average Medical College Admission Test (MCAT) and grade point average (GPA) to get in went up. Basically, the school just became more competitive.
I will always commend anyone, anywhere, who is making medical school more affordable and more accessible. With NYU, it seems a tuition gift just made it harder for students from disadvantaged backgrounds to actually get in. I mean, congratulations, you got more applications. This probably helped in ratings, and you got mentioned in news headlines, but are you actually achieving your mission?
At NYU, over the last few years, Black students made up about 11% of the medical school class, which is actually down from 2017 before the tuition gift. Students from low-income backgrounds, whom this would really benefit, used to make up around 12% of the class prior to the free tuition announcement, and now it’s around 3%-7%.
According to students from underrepresented backgrounds, the outreach and the equal opportunity need to start way earlier. The K-12 process needs to be addressed, as do mentorship opportunities and guidance throughout college, MCAT prep, resources for interviews, research opportunities, and so much more.
The following quote is from an interview with an interventional cardiology fellow who came here as a refugee: “For me, growing up, basic necessities like a quiet study space, high-speed internet, healthy meals and proper sleep were luxuries of which I could only dream. After resettling in the US as a political refugee, I lived in circumstances where such comforts were out of reach, and my path to medical school seemed insurmountable.”
I also spoke to a friend in pediatric cancer, Michael Galvez, MD, who was outspoken about the need to improve representation in medicine, about what he thought would actually work to diversify medical schools. He mentioned adversity scores or looking at the distance traveled for applicants, as well as efforts to recruit from local, state, and community colleges, which often reflect local underserved populations.
Dr. Galvez also agreed that although such metrics as GPA and MCAT are important, medical schools should also consider the impact applicants may have had for local, underserved communities and life experiences that may represent significant potential contributions applicants can make for public health.
The effort needs to start early. If we take a look at one of the most diverse medical schools in the country, UC Davis, we can see how this makes a difference. At UC Davis, in the class of 2026, about half of the 133 students come from underrepresented backgrounds in medicine. I’m taking a look at their website from the Office of Student and Resident Diversity, and it lists:
- K-12 outreach programs
- Undergraduate and community college programs
- Specific plans for postbaccalaureate students
- Support systems
- Resources for students that extend far beyond just premedical students
My home institution, Stanford School of Medicine, has similar programs as well, with similar ways for students from underrepresented backgrounds to find support and mentorship. This all makes a huge difference.
Regarding the actual admissions process for medical school, I’ll highlight the Johns Hopkins School of Medicine and the adaptions they’ve made to create a more fair and holistic process. It includes:
- A clear mission statement about diversity enhancement
- Anonymous voting
- A larger group to avoid bias
- Not showing academic metrics to interviewers
- Implicit association tests and trainings
- Removing photos from applications
- Appointing women, minorities, and young people with less implicit bias to the committees
Does this seem like a lot? It is, because a comprehensive approach is what it takes to build a more diverse US physician workforce, which will provide more culturally competent care, empower future generations, break down barriers and disparities in health care, and ultimately improve public health. Free tuition is awesome. I’m jealous. But on its own to solve these problems? This all feels like a misguided attempt.
Dr. Patel is clinical instructor, Department of Pediatrics, Columbia University College of Physicians and Surgeons, and pediatric hospitalist at Morgan Stanley Children’s Hospital of NewYork-Presbyterian, New York, and Benioff Children’s Hospital, University of California, San Francisco. He disclosed ties with Medumo Inc.
A version of this article first appeared on Medscape.com.
This transcript has been edited for clarity.
We need more diverse students — more students from disadvantaged and underrepresented backgrounds in medical school. That is not a controversial take. That’s not even a new thought.
What is a hot take, however, is that free medical school alone is not going to accomplish this goal. In fact, based on data and what people think and are saying, that’s just reality.
I recently chatted about whether or not free medical school would motivate more students to pursue primary care. That was New York University’s (NYU’s) goal. If you haven’t seen that video, check it out. Now I want to explore whether free medical school would actually create a more diverse medical student body.
This topic is especially important now because, in 2023, the Supreme Court ended affirmative action for college admissions, and this naturally has a downstream effect when it comes to getting into medical school. Right now, about 6% of US physicians are Black or Hispanic/Latina, and around 0.1%-0.3% identify as Indigenous Americans, Native Hawaiians, or Pacific Islanders.
Is free medical school the answer? Well, that’s based on a huge assumption that the cost of medical school — incoming debt — is the single greatest barrier for students from diverse backgrounds, as if every single student from every background had the same level of resources in the same opportunity and were all equally competitive prior to applying, and just the prospect of debt is what caused the disparity. I don’t know if that’s reality. Let’s take a look at NYU.
After the free tuition announcement, total applications to the medical school went up nearly 50%. And from underrepresented groups, it was 100%. In 2019, the associate dean for admissions said, “A key driver was to remove a financial disincentive that dissuades people from pursuing a path in medicine.” But the acceptance rate stayed under 3%, and the average Medical College Admission Test (MCAT) and grade point average (GPA) to get in went up. Basically, the school just became more competitive.
I will always commend anyone, anywhere, who is making medical school more affordable and more accessible. With NYU, it seems a tuition gift just made it harder for students from disadvantaged backgrounds to actually get in. I mean, congratulations, you got more applications. This probably helped in ratings, and you got mentioned in news headlines, but are you actually achieving your mission?
At NYU, over the last few years, Black students made up about 11% of the medical school class, which is actually down from 2017 before the tuition gift. Students from low-income backgrounds, whom this would really benefit, used to make up around 12% of the class prior to the free tuition announcement, and now it’s around 3%-7%.
According to students from underrepresented backgrounds, the outreach and the equal opportunity need to start way earlier. The K-12 process needs to be addressed, as do mentorship opportunities and guidance throughout college, MCAT prep, resources for interviews, research opportunities, and so much more.
The following quote is from an interview with an interventional cardiology fellow who came here as a refugee: “For me, growing up, basic necessities like a quiet study space, high-speed internet, healthy meals and proper sleep were luxuries of which I could only dream. After resettling in the US as a political refugee, I lived in circumstances where such comforts were out of reach, and my path to medical school seemed insurmountable.”
I also spoke to a friend in pediatric cancer, Michael Galvez, MD, who was outspoken about the need to improve representation in medicine, about what he thought would actually work to diversify medical schools. He mentioned adversity scores or looking at the distance traveled for applicants, as well as efforts to recruit from local, state, and community colleges, which often reflect local underserved populations.
Dr. Galvez also agreed that although such metrics as GPA and MCAT are important, medical schools should also consider the impact applicants may have had for local, underserved communities and life experiences that may represent significant potential contributions applicants can make for public health.
The effort needs to start early. If we take a look at one of the most diverse medical schools in the country, UC Davis, we can see how this makes a difference. At UC Davis, in the class of 2026, about half of the 133 students come from underrepresented backgrounds in medicine. I’m taking a look at their website from the Office of Student and Resident Diversity, and it lists:
- K-12 outreach programs
- Undergraduate and community college programs
- Specific plans for postbaccalaureate students
- Support systems
- Resources for students that extend far beyond just premedical students
My home institution, Stanford School of Medicine, has similar programs as well, with similar ways for students from underrepresented backgrounds to find support and mentorship. This all makes a huge difference.
Regarding the actual admissions process for medical school, I’ll highlight the Johns Hopkins School of Medicine and the adaptions they’ve made to create a more fair and holistic process. It includes:
- A clear mission statement about diversity enhancement
- Anonymous voting
- A larger group to avoid bias
- Not showing academic metrics to interviewers
- Implicit association tests and trainings
- Removing photos from applications
- Appointing women, minorities, and young people with less implicit bias to the committees
Does this seem like a lot? It is, because a comprehensive approach is what it takes to build a more diverse US physician workforce, which will provide more culturally competent care, empower future generations, break down barriers and disparities in health care, and ultimately improve public health. Free tuition is awesome. I’m jealous. But on its own to solve these problems? This all feels like a misguided attempt.
Dr. Patel is clinical instructor, Department of Pediatrics, Columbia University College of Physicians and Surgeons, and pediatric hospitalist at Morgan Stanley Children’s Hospital of NewYork-Presbyterian, New York, and Benioff Children’s Hospital, University of California, San Francisco. He disclosed ties with Medumo Inc.
A version of this article first appeared on Medscape.com.
This transcript has been edited for clarity.
We need more diverse students — more students from disadvantaged and underrepresented backgrounds in medical school. That is not a controversial take. That’s not even a new thought.
What is a hot take, however, is that free medical school alone is not going to accomplish this goal. In fact, based on data and what people think and are saying, that’s just reality.
I recently chatted about whether or not free medical school would motivate more students to pursue primary care. That was New York University’s (NYU’s) goal. If you haven’t seen that video, check it out. Now I want to explore whether free medical school would actually create a more diverse medical student body.
This topic is especially important now because, in 2023, the Supreme Court ended affirmative action for college admissions, and this naturally has a downstream effect when it comes to getting into medical school. Right now, about 6% of US physicians are Black or Hispanic/Latina, and around 0.1%-0.3% identify as Indigenous Americans, Native Hawaiians, or Pacific Islanders.
Is free medical school the answer? Well, that’s based on a huge assumption that the cost of medical school — incoming debt — is the single greatest barrier for students from diverse backgrounds, as if every single student from every background had the same level of resources in the same opportunity and were all equally competitive prior to applying, and just the prospect of debt is what caused the disparity. I don’t know if that’s reality. Let’s take a look at NYU.
After the free tuition announcement, total applications to the medical school went up nearly 50%. And from underrepresented groups, it was 100%. In 2019, the associate dean for admissions said, “A key driver was to remove a financial disincentive that dissuades people from pursuing a path in medicine.” But the acceptance rate stayed under 3%, and the average Medical College Admission Test (MCAT) and grade point average (GPA) to get in went up. Basically, the school just became more competitive.
I will always commend anyone, anywhere, who is making medical school more affordable and more accessible. With NYU, it seems a tuition gift just made it harder for students from disadvantaged backgrounds to actually get in. I mean, congratulations, you got more applications. This probably helped in ratings, and you got mentioned in news headlines, but are you actually achieving your mission?
At NYU, over the last few years, Black students made up about 11% of the medical school class, which is actually down from 2017 before the tuition gift. Students from low-income backgrounds, whom this would really benefit, used to make up around 12% of the class prior to the free tuition announcement, and now it’s around 3%-7%.
According to students from underrepresented backgrounds, the outreach and the equal opportunity need to start way earlier. The K-12 process needs to be addressed, as do mentorship opportunities and guidance throughout college, MCAT prep, resources for interviews, research opportunities, and so much more.
The following quote is from an interview with an interventional cardiology fellow who came here as a refugee: “For me, growing up, basic necessities like a quiet study space, high-speed internet, healthy meals and proper sleep were luxuries of which I could only dream. After resettling in the US as a political refugee, I lived in circumstances where such comforts were out of reach, and my path to medical school seemed insurmountable.”
I also spoke to a friend in pediatric cancer, Michael Galvez, MD, who was outspoken about the need to improve representation in medicine, about what he thought would actually work to diversify medical schools. He mentioned adversity scores or looking at the distance traveled for applicants, as well as efforts to recruit from local, state, and community colleges, which often reflect local underserved populations.
Dr. Galvez also agreed that although such metrics as GPA and MCAT are important, medical schools should also consider the impact applicants may have had for local, underserved communities and life experiences that may represent significant potential contributions applicants can make for public health.
The effort needs to start early. If we take a look at one of the most diverse medical schools in the country, UC Davis, we can see how this makes a difference. At UC Davis, in the class of 2026, about half of the 133 students come from underrepresented backgrounds in medicine. I’m taking a look at their website from the Office of Student and Resident Diversity, and it lists:
- K-12 outreach programs
- Undergraduate and community college programs
- Specific plans for postbaccalaureate students
- Support systems
- Resources for students that extend far beyond just premedical students
My home institution, Stanford School of Medicine, has similar programs as well, with similar ways for students from underrepresented backgrounds to find support and mentorship. This all makes a huge difference.
Regarding the actual admissions process for medical school, I’ll highlight the Johns Hopkins School of Medicine and the adaptions they’ve made to create a more fair and holistic process. It includes:
- A clear mission statement about diversity enhancement
- Anonymous voting
- A larger group to avoid bias
- Not showing academic metrics to interviewers
- Implicit association tests and trainings
- Removing photos from applications
- Appointing women, minorities, and young people with less implicit bias to the committees
Does this seem like a lot? It is, because a comprehensive approach is what it takes to build a more diverse US physician workforce, which will provide more culturally competent care, empower future generations, break down barriers and disparities in health care, and ultimately improve public health. Free tuition is awesome. I’m jealous. But on its own to solve these problems? This all feels like a misguided attempt.
Dr. Patel is clinical instructor, Department of Pediatrics, Columbia University College of Physicians and Surgeons, and pediatric hospitalist at Morgan Stanley Children’s Hospital of NewYork-Presbyterian, New York, and Benioff Children’s Hospital, University of California, San Francisco. He disclosed ties with Medumo Inc.
A version of this article first appeared on Medscape.com.
Would Making Tuition Free Address the Primary Care Shortage?
This transcript has been edited for clarity.
Would free medical school encourage more students to pursue primary care? Overpriced medical training in this country definitely contributes to burnout and the physician shortage, and all that debt may influence what type of specialty somebody goes into.
Assumptions Behind Free Tuition Initiatives
Now, this question is based on an assumption that there already is a large group of medical students who want to go into primary care, and the reason they’re not or the reason they’re reluctant to is because of tuition. If you take that stress away, you fix the problem.
This was at least part of the assumption made when NYU announced free tuition for all medical students back in 2018. One goal was to encourage more students to go into primary care. The other was to broaden the application pool to include more diverse students from different socioeconomic and racial backgrounds. We›ll get back to that.
Quick numbers. In NYU’s 2022 match, the first tuition-free class, about 25% of students matched into a primary care specialty— internal medicine or pediatrics — and there were zero matches into a family medicine residency. I can’t find the data, but anecdotally that 25% is a slight increase from prior years.
Primary Care Match Rates Post–Tuition Waiver
There’s some fine print to consider. Some of the residents who matched into internal medicine or pediatric programs may subspecialize and not work in outpatient medicine at all. Also, a majority of students matched in major urban areas such as New York, Boston, or Los Angeles. We know that historically, people tend to work where they train, so that’s not looking too great for recruitment to rural communities or underserved areas.
There is some hope. In 2024, slightly more students from NYU matched into primary care specialties, including to family medicine. This is amidst a new record in family med residency matches nationwide. Rightfully, in the beginning, NYU was applauded for this tuition-free decision, but there was some criticism about who should be prioritized for financial assistance. Consider a future surgeon from a wealthy family vs a first-generation student committed to rural primary care.
NYU said, “No, equality for all.” Even acclaimed physician and bioethicist, Dr Ezekiel Emanuel weighed in and suggested “forgiving medical school debt for students who commit to a career in primary care in an underserved area. Two years of service for each year of free tuition.” At least this would allow resources to be focused only on building a primary care pool.
Also, after the tuition-free announcement, applications to NYU increased by almost 50%, and from underrepresented groups, 100%. Not that surprising. The average MCAT score and GPA also increased, but the acceptance rate stayed at around 2%.
How much difference will this tuition-free program really make in the future? Time will tell, but I do think that NYU set an important precedent here. Medical schools should be critically looking at where tuition money goes and what financial incentives could be used to attract a more diverse student body, with more hopefully going into primary care.
Let’s take a look at NYU’s Grossman Long Island campus. They have an accelerated 3-year program, tuition-free, primary care focused, and 67% of their graduates went into primary care.
In California, Kaiser Permanente School of Medicine, which is also tuition-free and focused, had 38% of their graduates go to primary care.
What are these programs doing differently? Well, they’re tuition-free, they have focused tracks, and they have enough accredited sites so that students can get a realistic and broad look of what it’s actually like to practice primary care.
Attracting Med Students to Primary Care
This leads to a broader question: How do we create an environment beyond tuition that encourages more students to go into internal medicine, pediatrics, or family medicine?
Right now, across those three specialties, the average salary is $250,000, which is lower than in other subspecialties. There’s a high amount of administrative workload, loss of autonomy, and plenty of burnout. You want to get more students to go into primary care? We need to fix primary care.
That involves many factors. Get ready for this. I actually had to make a list based on what I’ve read in articles and heard from my colleagues.
If we want to attract more students to primary care, we need to talk about:
- Improving reimbursement;
- Better mental health support;
- Highlighting the importance primary care plays in public health;
- Expanding care teams;
- Creating more medical students and training sites in rural and underserved areas;
- Expanding the use of telehealth services;
- Creating early exposure programs for high school and college students; and
- Paying attention to how local policies and statistics, such as crime, housing, and abortion bans, may push people away from practicing in certain areas or states.
Clearly, this is a large number of considerations that goes far beyond the altruistic tuition-free gifts.
Look, it’s no surprise we have a physician shortage that affects multiple specialties, but it is alarming that by 2034, there’s going to be an estimated shortage of 50,000 primary care doctors.
Stay Tuned
What do you all think? Is free tuition enough to actually move the needle in the long term, or should NYU have made a more focused gift? Comment below.
I know what you’re all wondering why I didn’t talk about tuition waivers in terms of diversifying the student body. That’s because that deserves its own video. Stay tuned for part 2.
Dr. Patel is a pediatric hospitalist, television producer, media contributor, and digital health enthusiast. He splits his time between New York City and San Francisco, as he is on faculty at Columbia University/Morgan Stanley Children’s Hospital and UCSF Benioff Children’s Hospital. He hosts The Hospitalist Retort video blog on Medscape.
Dr. Patel has disclosed the following relevant financial relationships: serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for Medumo Inc.
A version of this article appeared on Medscape.com.
This transcript has been edited for clarity.
Would free medical school encourage more students to pursue primary care? Overpriced medical training in this country definitely contributes to burnout and the physician shortage, and all that debt may influence what type of specialty somebody goes into.
Assumptions Behind Free Tuition Initiatives
Now, this question is based on an assumption that there already is a large group of medical students who want to go into primary care, and the reason they’re not or the reason they’re reluctant to is because of tuition. If you take that stress away, you fix the problem.
This was at least part of the assumption made when NYU announced free tuition for all medical students back in 2018. One goal was to encourage more students to go into primary care. The other was to broaden the application pool to include more diverse students from different socioeconomic and racial backgrounds. We›ll get back to that.
Quick numbers. In NYU’s 2022 match, the first tuition-free class, about 25% of students matched into a primary care specialty— internal medicine or pediatrics — and there were zero matches into a family medicine residency. I can’t find the data, but anecdotally that 25% is a slight increase from prior years.
Primary Care Match Rates Post–Tuition Waiver
There’s some fine print to consider. Some of the residents who matched into internal medicine or pediatric programs may subspecialize and not work in outpatient medicine at all. Also, a majority of students matched in major urban areas such as New York, Boston, or Los Angeles. We know that historically, people tend to work where they train, so that’s not looking too great for recruitment to rural communities or underserved areas.
There is some hope. In 2024, slightly more students from NYU matched into primary care specialties, including to family medicine. This is amidst a new record in family med residency matches nationwide. Rightfully, in the beginning, NYU was applauded for this tuition-free decision, but there was some criticism about who should be prioritized for financial assistance. Consider a future surgeon from a wealthy family vs a first-generation student committed to rural primary care.
NYU said, “No, equality for all.” Even acclaimed physician and bioethicist, Dr Ezekiel Emanuel weighed in and suggested “forgiving medical school debt for students who commit to a career in primary care in an underserved area. Two years of service for each year of free tuition.” At least this would allow resources to be focused only on building a primary care pool.
Also, after the tuition-free announcement, applications to NYU increased by almost 50%, and from underrepresented groups, 100%. Not that surprising. The average MCAT score and GPA also increased, but the acceptance rate stayed at around 2%.
How much difference will this tuition-free program really make in the future? Time will tell, but I do think that NYU set an important precedent here. Medical schools should be critically looking at where tuition money goes and what financial incentives could be used to attract a more diverse student body, with more hopefully going into primary care.
Let’s take a look at NYU’s Grossman Long Island campus. They have an accelerated 3-year program, tuition-free, primary care focused, and 67% of their graduates went into primary care.
In California, Kaiser Permanente School of Medicine, which is also tuition-free and focused, had 38% of their graduates go to primary care.
What are these programs doing differently? Well, they’re tuition-free, they have focused tracks, and they have enough accredited sites so that students can get a realistic and broad look of what it’s actually like to practice primary care.
Attracting Med Students to Primary Care
This leads to a broader question: How do we create an environment beyond tuition that encourages more students to go into internal medicine, pediatrics, or family medicine?
Right now, across those three specialties, the average salary is $250,000, which is lower than in other subspecialties. There’s a high amount of administrative workload, loss of autonomy, and plenty of burnout. You want to get more students to go into primary care? We need to fix primary care.
That involves many factors. Get ready for this. I actually had to make a list based on what I’ve read in articles and heard from my colleagues.
If we want to attract more students to primary care, we need to talk about:
- Improving reimbursement;
- Better mental health support;
- Highlighting the importance primary care plays in public health;
- Expanding care teams;
- Creating more medical students and training sites in rural and underserved areas;
- Expanding the use of telehealth services;
- Creating early exposure programs for high school and college students; and
- Paying attention to how local policies and statistics, such as crime, housing, and abortion bans, may push people away from practicing in certain areas or states.
Clearly, this is a large number of considerations that goes far beyond the altruistic tuition-free gifts.
Look, it’s no surprise we have a physician shortage that affects multiple specialties, but it is alarming that by 2034, there’s going to be an estimated shortage of 50,000 primary care doctors.
Stay Tuned
What do you all think? Is free tuition enough to actually move the needle in the long term, or should NYU have made a more focused gift? Comment below.
I know what you’re all wondering why I didn’t talk about tuition waivers in terms of diversifying the student body. That’s because that deserves its own video. Stay tuned for part 2.
Dr. Patel is a pediatric hospitalist, television producer, media contributor, and digital health enthusiast. He splits his time between New York City and San Francisco, as he is on faculty at Columbia University/Morgan Stanley Children’s Hospital and UCSF Benioff Children’s Hospital. He hosts The Hospitalist Retort video blog on Medscape.
Dr. Patel has disclosed the following relevant financial relationships: serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for Medumo Inc.
A version of this article appeared on Medscape.com.
This transcript has been edited for clarity.
Would free medical school encourage more students to pursue primary care? Overpriced medical training in this country definitely contributes to burnout and the physician shortage, and all that debt may influence what type of specialty somebody goes into.
Assumptions Behind Free Tuition Initiatives
Now, this question is based on an assumption that there already is a large group of medical students who want to go into primary care, and the reason they’re not or the reason they’re reluctant to is because of tuition. If you take that stress away, you fix the problem.
This was at least part of the assumption made when NYU announced free tuition for all medical students back in 2018. One goal was to encourage more students to go into primary care. The other was to broaden the application pool to include more diverse students from different socioeconomic and racial backgrounds. We›ll get back to that.
Quick numbers. In NYU’s 2022 match, the first tuition-free class, about 25% of students matched into a primary care specialty— internal medicine or pediatrics — and there were zero matches into a family medicine residency. I can’t find the data, but anecdotally that 25% is a slight increase from prior years.
Primary Care Match Rates Post–Tuition Waiver
There’s some fine print to consider. Some of the residents who matched into internal medicine or pediatric programs may subspecialize and not work in outpatient medicine at all. Also, a majority of students matched in major urban areas such as New York, Boston, or Los Angeles. We know that historically, people tend to work where they train, so that’s not looking too great for recruitment to rural communities or underserved areas.
There is some hope. In 2024, slightly more students from NYU matched into primary care specialties, including to family medicine. This is amidst a new record in family med residency matches nationwide. Rightfully, in the beginning, NYU was applauded for this tuition-free decision, but there was some criticism about who should be prioritized for financial assistance. Consider a future surgeon from a wealthy family vs a first-generation student committed to rural primary care.
NYU said, “No, equality for all.” Even acclaimed physician and bioethicist, Dr Ezekiel Emanuel weighed in and suggested “forgiving medical school debt for students who commit to a career in primary care in an underserved area. Two years of service for each year of free tuition.” At least this would allow resources to be focused only on building a primary care pool.
Also, after the tuition-free announcement, applications to NYU increased by almost 50%, and from underrepresented groups, 100%. Not that surprising. The average MCAT score and GPA also increased, but the acceptance rate stayed at around 2%.
How much difference will this tuition-free program really make in the future? Time will tell, but I do think that NYU set an important precedent here. Medical schools should be critically looking at where tuition money goes and what financial incentives could be used to attract a more diverse student body, with more hopefully going into primary care.
Let’s take a look at NYU’s Grossman Long Island campus. They have an accelerated 3-year program, tuition-free, primary care focused, and 67% of their graduates went into primary care.
In California, Kaiser Permanente School of Medicine, which is also tuition-free and focused, had 38% of their graduates go to primary care.
What are these programs doing differently? Well, they’re tuition-free, they have focused tracks, and they have enough accredited sites so that students can get a realistic and broad look of what it’s actually like to practice primary care.
Attracting Med Students to Primary Care
This leads to a broader question: How do we create an environment beyond tuition that encourages more students to go into internal medicine, pediatrics, or family medicine?
Right now, across those three specialties, the average salary is $250,000, which is lower than in other subspecialties. There’s a high amount of administrative workload, loss of autonomy, and plenty of burnout. You want to get more students to go into primary care? We need to fix primary care.
That involves many factors. Get ready for this. I actually had to make a list based on what I’ve read in articles and heard from my colleagues.
If we want to attract more students to primary care, we need to talk about:
- Improving reimbursement;
- Better mental health support;
- Highlighting the importance primary care plays in public health;
- Expanding care teams;
- Creating more medical students and training sites in rural and underserved areas;
- Expanding the use of telehealth services;
- Creating early exposure programs for high school and college students; and
- Paying attention to how local policies and statistics, such as crime, housing, and abortion bans, may push people away from practicing in certain areas or states.
Clearly, this is a large number of considerations that goes far beyond the altruistic tuition-free gifts.
Look, it’s no surprise we have a physician shortage that affects multiple specialties, but it is alarming that by 2034, there’s going to be an estimated shortage of 50,000 primary care doctors.
Stay Tuned
What do you all think? Is free tuition enough to actually move the needle in the long term, or should NYU have made a more focused gift? Comment below.
I know what you’re all wondering why I didn’t talk about tuition waivers in terms of diversifying the student body. That’s because that deserves its own video. Stay tuned for part 2.
Dr. Patel is a pediatric hospitalist, television producer, media contributor, and digital health enthusiast. He splits his time between New York City and San Francisco, as he is on faculty at Columbia University/Morgan Stanley Children’s Hospital and UCSF Benioff Children’s Hospital. He hosts The Hospitalist Retort video blog on Medscape.
Dr. Patel has disclosed the following relevant financial relationships: serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for Medumo Inc.
A version of this article appeared on Medscape.com.
Residents Unionizing: What Are the Benefits, the Downsides?
This transcript has been edited for clarity.
Hospital administrators and some department heads have been vocal about the potential for unions to affect both the attending-resident relationship and the ability for residents to directly discuss concerns and educational plans.
Sometimes, there are institution-specific issues as well. One example was at Loma Linda. They argued that unionization would go against their religious principles. They filed a lawsuit. That didn’t go through, and the residents won a few months later.
I know there’s always that one senior, older doctor who says, “Back in our day, we just worked, and we never complained.”
Look at the current situation that residents are facing now, with housing and rent prices and increasing costs of childcare. Sprinkle in some inflation, poor hospital staffing, increasing workload, and add in the fact that the average first-year resident salary in 2023 was around $64,000.
Now, if you look back to 2012, the average salary was around $55,000. If you adjust that for inflation, it would be around $75,000 today, which is more than what the average resident is getting paid.
Then, there are hospital administrators who say that the hospital does not have the money to meet these demands; meanwhile, hospital graduate medical education (GME) offices receive about $150,000 of Medicare funds per resident.
Obviously, there are additional costs when it comes to training and supporting residents. In general, unionizing freaks out the people handling all the cash.
There’s also the threat of a strike, which no hospital wants on their public record. A recent highly publicized event happened at New York’s Elmhurst Hospital, when 160 residents went on strike for 3 days until a deal was made.
Critics of unionizing also cite a particular study in JAMA, which included a survey of 5700 general surgery residents at 285 programs. It found that while unions helped with vacation time and housing stipends, the unions were not associated with improved burnout rates, suicidality, job satisfaction, duty hour violations, mistreatment, educational environment, or salary.
Now, granted, this isn’t the strongest study. It only sampled one group of residents, so I wouldn’t generalize these findings, but it’s still commonly cited by anti-union advocates.
Another potential downside, which is purely anecdotal because I can’t find any data to support this, is potential retaliation against residents or harm to the attending-resident relationship.
I’m an attending. I don’t really understand this one. I don’t exactly own stock in my hospital, nor am I making millions of dollars by siphoning GME money. I’m just trying to focus on educating and supporting my residents the best I can.
Dr. Patel is Clinical Instructor, Department of Pediatrics, Columbia University College of Physicians and Surgeons; Pediatric Hospitalist, Morgan Stanley Children’s Hospital of NewYork–Presbyterian, and Benioff Children’s Hospital, University of California San Francisco. He disclosed ties with Medumo Inc.
A version of this article first appeared on Medscape.com.
This transcript has been edited for clarity.
Hospital administrators and some department heads have been vocal about the potential for unions to affect both the attending-resident relationship and the ability for residents to directly discuss concerns and educational plans.
Sometimes, there are institution-specific issues as well. One example was at Loma Linda. They argued that unionization would go against their religious principles. They filed a lawsuit. That didn’t go through, and the residents won a few months later.
I know there’s always that one senior, older doctor who says, “Back in our day, we just worked, and we never complained.”
Look at the current situation that residents are facing now, with housing and rent prices and increasing costs of childcare. Sprinkle in some inflation, poor hospital staffing, increasing workload, and add in the fact that the average first-year resident salary in 2023 was around $64,000.
Now, if you look back to 2012, the average salary was around $55,000. If you adjust that for inflation, it would be around $75,000 today, which is more than what the average resident is getting paid.
Then, there are hospital administrators who say that the hospital does not have the money to meet these demands; meanwhile, hospital graduate medical education (GME) offices receive about $150,000 of Medicare funds per resident.
Obviously, there are additional costs when it comes to training and supporting residents. In general, unionizing freaks out the people handling all the cash.
There’s also the threat of a strike, which no hospital wants on their public record. A recent highly publicized event happened at New York’s Elmhurst Hospital, when 160 residents went on strike for 3 days until a deal was made.
Critics of unionizing also cite a particular study in JAMA, which included a survey of 5700 general surgery residents at 285 programs. It found that while unions helped with vacation time and housing stipends, the unions were not associated with improved burnout rates, suicidality, job satisfaction, duty hour violations, mistreatment, educational environment, or salary.
Now, granted, this isn’t the strongest study. It only sampled one group of residents, so I wouldn’t generalize these findings, but it’s still commonly cited by anti-union advocates.
Another potential downside, which is purely anecdotal because I can’t find any data to support this, is potential retaliation against residents or harm to the attending-resident relationship.
I’m an attending. I don’t really understand this one. I don’t exactly own stock in my hospital, nor am I making millions of dollars by siphoning GME money. I’m just trying to focus on educating and supporting my residents the best I can.
Dr. Patel is Clinical Instructor, Department of Pediatrics, Columbia University College of Physicians and Surgeons; Pediatric Hospitalist, Morgan Stanley Children’s Hospital of NewYork–Presbyterian, and Benioff Children’s Hospital, University of California San Francisco. He disclosed ties with Medumo Inc.
A version of this article first appeared on Medscape.com.
This transcript has been edited for clarity.
Hospital administrators and some department heads have been vocal about the potential for unions to affect both the attending-resident relationship and the ability for residents to directly discuss concerns and educational plans.
Sometimes, there are institution-specific issues as well. One example was at Loma Linda. They argued that unionization would go against their religious principles. They filed a lawsuit. That didn’t go through, and the residents won a few months later.
I know there’s always that one senior, older doctor who says, “Back in our day, we just worked, and we never complained.”
Look at the current situation that residents are facing now, with housing and rent prices and increasing costs of childcare. Sprinkle in some inflation, poor hospital staffing, increasing workload, and add in the fact that the average first-year resident salary in 2023 was around $64,000.
Now, if you look back to 2012, the average salary was around $55,000. If you adjust that for inflation, it would be around $75,000 today, which is more than what the average resident is getting paid.
Then, there are hospital administrators who say that the hospital does not have the money to meet these demands; meanwhile, hospital graduate medical education (GME) offices receive about $150,000 of Medicare funds per resident.
Obviously, there are additional costs when it comes to training and supporting residents. In general, unionizing freaks out the people handling all the cash.
There’s also the threat of a strike, which no hospital wants on their public record. A recent highly publicized event happened at New York’s Elmhurst Hospital, when 160 residents went on strike for 3 days until a deal was made.
Critics of unionizing also cite a particular study in JAMA, which included a survey of 5700 general surgery residents at 285 programs. It found that while unions helped with vacation time and housing stipends, the unions were not associated with improved burnout rates, suicidality, job satisfaction, duty hour violations, mistreatment, educational environment, or salary.
Now, granted, this isn’t the strongest study. It only sampled one group of residents, so I wouldn’t generalize these findings, but it’s still commonly cited by anti-union advocates.
Another potential downside, which is purely anecdotal because I can’t find any data to support this, is potential retaliation against residents or harm to the attending-resident relationship.
I’m an attending. I don’t really understand this one. I don’t exactly own stock in my hospital, nor am I making millions of dollars by siphoning GME money. I’m just trying to focus on educating and supporting my residents the best I can.
Dr. Patel is Clinical Instructor, Department of Pediatrics, Columbia University College of Physicians and Surgeons; Pediatric Hospitalist, Morgan Stanley Children’s Hospital of NewYork–Presbyterian, and Benioff Children’s Hospital, University of California San Francisco. He disclosed ties with Medumo Inc.
A version of this article first appeared on Medscape.com.
RVUs: A fair measure of your productivity?
This transcript has been edited for clarity.
The other day, I received a flowery, elaborate email from none other than a physician recruiter: “Beautiful parks, hiking, great schools, blah blah blah, worked RVU production bonus on top of base pay.”
That last part – RVUs. I’m lost. I hear mixed reviews from physicians who work in RVU-based systems. The entire thing seems overly complex and confusing, so let’s clear it up. I did my research, and I’m going to explain RVUs.
Types of RVUs
RVUs, or relative value units, are a standard set by Medicare, used to measure physician productivity and ultimately determine compensation. There are three types:
- Work RVUs (basically everything that happens during a patient encounter).
- Practice expense RVUs.
- Professional liability insurance RVUs.
Now, envision this equation. All three of those RVUs are each multiplied by a geographic practice cost index to come up with a total number, and then that is multiplied by the Medicare conversion factor, which right now is around $33 to $34, to come up with a total dollar amount.
Work RVUs make up the bulk of total RVUs and they get their value from CPT codes. That value is determined by CMS. The AMA’s Relative Value Scale Update Committee, or RUC, which is made up of 32 people from various medical and surgical subspecialties, regularly meets and makes recommendations on the value of various CPT codes.
Is specialty representation fair and balanced?
CMS historically has accepted a high percentage of RUC’s recommendations, so this is a very influential committee. This is also why RUC has led to some controversy, with some stating that there is a lack of primary care representation, and perhaps this is why CPT codes related to procedures tend to reimburse higher.
How does one weigh the value of an hour-long palliative conversation against the quick removal of a benign skin lesion? That’s a loaded question.
This is especially important if your salary, or at least part of it, is determined by total RVUs. You want to have a sense of the pros and cons of working in an RVU system and how this relates to your specialty, your practice, and your schedule.
An RVU-based system provides an objective measure on complex patient encounters, volume, and procedures, and it’s a somewhat unified measure. The cons are pretty clear because these models favor you seeing many patients and billing a lot, and often this favors employers over physicians.
Dr. Patel is a clinical instructor, department of pediatrics, at Columbia University, New York, and a pediatric hospitalist at Morgan Stanley Children’s Hospital of New York–Presbyterian. He reported a conflict of interest with Medumo.
A version of this article first appeared on Medscape.com.
This transcript has been edited for clarity.
The other day, I received a flowery, elaborate email from none other than a physician recruiter: “Beautiful parks, hiking, great schools, blah blah blah, worked RVU production bonus on top of base pay.”
That last part – RVUs. I’m lost. I hear mixed reviews from physicians who work in RVU-based systems. The entire thing seems overly complex and confusing, so let’s clear it up. I did my research, and I’m going to explain RVUs.
Types of RVUs
RVUs, or relative value units, are a standard set by Medicare, used to measure physician productivity and ultimately determine compensation. There are three types:
- Work RVUs (basically everything that happens during a patient encounter).
- Practice expense RVUs.
- Professional liability insurance RVUs.
Now, envision this equation. All three of those RVUs are each multiplied by a geographic practice cost index to come up with a total number, and then that is multiplied by the Medicare conversion factor, which right now is around $33 to $34, to come up with a total dollar amount.
Work RVUs make up the bulk of total RVUs and they get their value from CPT codes. That value is determined by CMS. The AMA’s Relative Value Scale Update Committee, or RUC, which is made up of 32 people from various medical and surgical subspecialties, regularly meets and makes recommendations on the value of various CPT codes.
Is specialty representation fair and balanced?
CMS historically has accepted a high percentage of RUC’s recommendations, so this is a very influential committee. This is also why RUC has led to some controversy, with some stating that there is a lack of primary care representation, and perhaps this is why CPT codes related to procedures tend to reimburse higher.
How does one weigh the value of an hour-long palliative conversation against the quick removal of a benign skin lesion? That’s a loaded question.
This is especially important if your salary, or at least part of it, is determined by total RVUs. You want to have a sense of the pros and cons of working in an RVU system and how this relates to your specialty, your practice, and your schedule.
An RVU-based system provides an objective measure on complex patient encounters, volume, and procedures, and it’s a somewhat unified measure. The cons are pretty clear because these models favor you seeing many patients and billing a lot, and often this favors employers over physicians.
Dr. Patel is a clinical instructor, department of pediatrics, at Columbia University, New York, and a pediatric hospitalist at Morgan Stanley Children’s Hospital of New York–Presbyterian. He reported a conflict of interest with Medumo.
A version of this article first appeared on Medscape.com.
This transcript has been edited for clarity.
The other day, I received a flowery, elaborate email from none other than a physician recruiter: “Beautiful parks, hiking, great schools, blah blah blah, worked RVU production bonus on top of base pay.”
That last part – RVUs. I’m lost. I hear mixed reviews from physicians who work in RVU-based systems. The entire thing seems overly complex and confusing, so let’s clear it up. I did my research, and I’m going to explain RVUs.
Types of RVUs
RVUs, or relative value units, are a standard set by Medicare, used to measure physician productivity and ultimately determine compensation. There are three types:
- Work RVUs (basically everything that happens during a patient encounter).
- Practice expense RVUs.
- Professional liability insurance RVUs.
Now, envision this equation. All three of those RVUs are each multiplied by a geographic practice cost index to come up with a total number, and then that is multiplied by the Medicare conversion factor, which right now is around $33 to $34, to come up with a total dollar amount.
Work RVUs make up the bulk of total RVUs and they get their value from CPT codes. That value is determined by CMS. The AMA’s Relative Value Scale Update Committee, or RUC, which is made up of 32 people from various medical and surgical subspecialties, regularly meets and makes recommendations on the value of various CPT codes.
Is specialty representation fair and balanced?
CMS historically has accepted a high percentage of RUC’s recommendations, so this is a very influential committee. This is also why RUC has led to some controversy, with some stating that there is a lack of primary care representation, and perhaps this is why CPT codes related to procedures tend to reimburse higher.
How does one weigh the value of an hour-long palliative conversation against the quick removal of a benign skin lesion? That’s a loaded question.
This is especially important if your salary, or at least part of it, is determined by total RVUs. You want to have a sense of the pros and cons of working in an RVU system and how this relates to your specialty, your practice, and your schedule.
An RVU-based system provides an objective measure on complex patient encounters, volume, and procedures, and it’s a somewhat unified measure. The cons are pretty clear because these models favor you seeing many patients and billing a lot, and often this favors employers over physicians.
Dr. Patel is a clinical instructor, department of pediatrics, at Columbia University, New York, and a pediatric hospitalist at Morgan Stanley Children’s Hospital of New York–Presbyterian. He reported a conflict of interest with Medumo.
A version of this article first appeared on Medscape.com.