Debt-free medical school a financial blunder for doctors?

Education can be expensive. Higher education can be even more expensive.  Even partial scholarships can be deceptive as one might opt for a more expensive school for the sake of redeeming “free money”.  As a student, I had no financial understanding of return of investment when I was considering higher education.  All in, I plowed through more than a quarter million dollars in my college and medical school after substantial scholarships and grants.  And that was a long time ago.  If you are finishing medical school today funded solely on loans, you’ll likely owe slightly south of $200,000—if you attend a private school expect to add in another $100,000 to the tab.

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Fast forward to today.  My medical school alma mater recently announced that it will become completely tuition/debt-free for all students. That’s right. Zilch. You don’t have to be surviving on subsistence living either.  No need to strategize on Public Service Forgiveness Loans either.  If you are admitted, your education will be free.

The cynical side of me says that the medical school did well for itself: enough of its alumni have become hotshots so that its scholarship fund is big enough to fund its future graduates.  That’s a nice pot of money, especially since tuition today is over $65,000 a year.  Getting into medical school itself is challenging enough; going through it without paying a dime is like winning the lottery.  The rarity of this windfall is akin to that of Qatar discovering oil and natural gas…big.

The motivation for a debt-free medical school

The elimination of educational debt confers significant advantages for medical students. Remember the Hippocratic oath? It mentions nothing about prepayment, prior authorizations, Bugatti’s, or care contingent upon reimbursement.  We chose to become doctors in order to care for others.  That is how medical education was intended. The reality, however, is that we also have to make decisions based on practicality.  Imagine going through medical school supporting a family with 1.5 kids and studying nearly every waking moment of your day?  Your spouse wants to go back to work, but you contribute nothing to the cost of day care.  Many medical students contact me simply to ask about the compensation and lifestyle of a particular specialty. Many of those students are drowning in debt. You’d better believe that if you’re half a million dollars in the hole, you probably aren’t going to be tooting the virtues of pediatrics, no matter how much you love children.

If you wipe out educational debt from the picture, you might be more inclined to choose a potentially less lucrative but more enjoyable career path for the long haul.  Perhaps you’d end up realizing your calling as a geriatrician and do great work for the elderly.

Debt-free medical school lifts a psychological burden as well.  As a medical student, I was always torn between budgeting my time and saving money.  Do I study an extra hour and buy take-out for dinner, or do I need to sacrifice precious study time in order to cook dinner?  Do I spend my Sunday mornings buying budget groceries for the week or enjoying my limited free time?  Without the big price tag attached to medical education, we might even have happier students.

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A happier person makes a happier doctor.  Do happier doctors make healthier patients?  If you love what you do, you’ll likely be a better doctor.  When educational debt is eliminated from the picture, society benefits from having a better doctor.

Debt-free medical education is bad

How can free ever be detrimental?

Because free implies the absence of cost.  Free is easy.  Easy doesn’t fire the synapses in our brains.  And we all know that our brains need to fire in order to learn.  Remember the college chemistry exam that you didn’t study for because you thought the class was too easy?  You’d bet your tail that you remembered to study for the rest of that semester.  No matter how conscientious we try to be, human nature dictates that we are less alert if we are in a comfortable situation.

Free medical education will make you complacent.

Being in debt allowed me to understand the importance of finance and how much doctors are worth.  Society does not value doctors adequately.  It is appalling to compare my medical school experience with one of my friend’s business school experience.  My research job the summer after my first year of medical school granted a $3000 stipend for three months of living expenses.  My business school friend secured a two-month internship with a salary of $10,000 and free meals!  Neither of us were truly viable in our respective professions as students, yet society was able to value a business trainee much higher than a healer in training.  Would I have cared if medical school didn’t come with a big bill? Maybe not.  If weren’t already financially invested in medical school, I might have jumped ship straight to a business degree.

Paying for medical school teaches you how much you are worth

As service professionals, doctors exchange their skills and time for money.  Fundamentally that is the only way that we are compensated (side hustles and real estate aside).  Our earning power is limited by time.  And healthcare is constantly devaluing our time.  You don’t earn more by spending an extra two hours of your day charting.  Quality metrics are great in principle, but the goal of our profession is to provide emphatic expert care.

Having been in debt makes you hungry to succeed in life.

I don’t think that I would have such a profound opinion of the value of our medical skills if medical school did not come with a price tag. Knowing that I invested a significant portion of my youth and finances towards medical knowledge has allowed me to negotiate a fair salary for my time and experience.

The cost of medical school teaches frugality 

After digging myself in a hole of student loan debt, I knew not to crank up my luxurious expenditures when I started making good money as an attending.  I wanted no chance of reliving those days.  Would I have become as conscientious about money if medical school were free? No way.

Obviously medical school debt isn’t the only way to learn frugality, but medical students frankly don’t have many opportunities to learn it. Most doctors never hold a real job before becoming a high-income doctor.  Our training is arduous and takes many years.  Sometimes the only thing that gets me through my long days of surgery is the thought of buying an overpriced outfit or car. What often reels me back to reality is remembering that medical school came with a big price tag that took a lot of effort and sacrifice to repay.

Do you agree on the principles of a free medical education?

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