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A medical degree from one of America’s elite private medical schools adds prestige to a new doctor’s resume. But it can also come with a significant impediment to society: Because of the exorbitant tuition these schools charge, it’s extremely difficult for their new doctors to help patients in underserved sections of the country who would greatly benefit from their skills, knowledge, and passion.

Among last year’s U.S. News list of the 10 most expensive private medical schools, the average annual tab was $67,214. After adding in costs like room, board, and other fees, the four-year bill exceeds $338,000. While the median loan balance for 2020 graduates of private medical schools was $215,005, that figure is certainly higher for newly minted doctors who attended the premier — and costly — private schools.


Paying off this debt, which takes an average of 13 years, is especially challenging for new doctors from lower socioeconomic backgrounds who graduated from elite private universities. It forces them to focus their match efforts on residency programs located in major metropolitan areas that offer top salaries. Even if these doctors wanted to bring their abilities to America’s health professional shortage areas and medically underserved areas, the size of their debt makes a lower-paying career path difficult to follow, if not outright impossible.

The need for doctors in these areas is well-documented. According to the Association of American Medical Colleges (AAMC), 60% of the more than 7,200 federally designated health professional shortage areas are in rural regions. And though 20% of Americans live in rural communities, just 11% of physicians practice in them.

Many medical schools across the country have recognized the shortage problem and are trying to help remedy it by offering residency programs in rural medicine. Yet among more than 120 such programs compiled by the University of Illinois reveals, only one of U.S. News’ top 10 most expensive private medical schools — the Dartmouth Geisel School of Medicine — offers such opportunities to its students.


While state medical schools and less-expensive private ones may not have the prestige of elite private medical schools, their graduates typically have smaller loans to pay off. New doctors with less debt have greater career choices than their more debt-encumbered peers. They’re also able to provide a much-needed societal benefit by matching for residencies in shortage and underserved areas. According to a study by the AAMC, primary care physicians with less than $100,000 in absolute medical education debt were more likely to locate in health professional shortage areas than those with greater debt. Physicians with no debt were three times more likely than those with any debt to begin practicing in a shortage area.

Controlling the costs — and by extension reducing the tuition — at America’s most expensive private medical schools would be one solution to this dilemma. But there are also other ways to make residencies in rural, shortage, or underserved areas (as well as the potential for long-term employment) attractive and affordable for graduates of these schools:

  • Elite schools can provide debt reduction grants to its graduates who commit to careers in shortage and underserved areas — not just in rural regions but in urban/inner-city regions as well. This would affirm these schools’ commitment to addressing the challenge by creating an achievable on-ramp for its graduates to deliver essential medical services in underserved areas.
  • Major employers in shortage and underserved areas can provide debt reduction grants to new doctors who commit to careers in the locales where they are headquartered. This would position the companies as good corporate citizens by improving the health/wellness outcomes of its neighbors as well as its employees.
  • States and the federal government can increase the number of loan-forgiveness programs, and the amount of repayment assistance, available to new doctors who commit to careers in primary care in shortage and underserved areas.
  • Private lenders can reduce and cap interest rates for new doctors who commit to careers in primary care in shortage and underserved areas.

The majority of students who invest the time, energy, and money to become doctors do so because they want to help people, regardless of a patient’s economic status. If these students are fortunate enough to be accepted by one of America’s brand-name medical schools, their decision to attend shouldn’t make it difficult for them to do social good and help those who need their talents the most: the millions of U.S. residents who live in health professional shortage areas and medically underserved areas.

David Lenihan is the CEO of Ponce Health Sciences University and Tiber Health, a St. Louis-based medical education company.

  • The elite-educated usually do not want to serve other types of population. What the nation and its people need are affordable access to affordable medical schools. These certainly are not by definition “less” than the costly elite versions, but they would fulfil very existing dire needs – for prospective great new doctors, and for under-served populations. An equalizer in the medical field – delivering good doctors for everyone.

  • The med school dd attended was not “elite” but her four year all-in cost was still over $300k. Her roommates bill was paid in full by the US military (plus a monthly stipend). All that was required of her was to commit to four years of military service. A similar program for under-served communities would certainly be attractive.

  • I concur with your solutions to address the medical services in underserved areas.

    However, I take exception with your limiting the discussion to “elite” private medical schools as the only ones that
    A. Leave graduate doctors with crushing debt and
    B. Are the only medical schools where we need to encourage new MDs to practice rural or inner-city medicine medicine.
    C. Are possibly superior to MDs that went to public institutions
    If a high percentage of nee Docs that are not burdened with any or significant debt choose to practice in backwater communities one can consider that family wealth enabled them to avoid debt and, along with an undeniable altruistic intention, created a circumstsnce for them to forego the large remuneration in the big cities.

    Even public medical schools can leave residents with a staggering debt. My son attended a state school. His tuition averaged over $48,000 a year. Supplies, food and housing added over $20,000 leaving him with a $300,000 debt. Plus the accruing interest.
    The point I’m making is that nearly all medical schools graduate physicians that would be welcomed in poorer communities, not just graduates of “elite” one and that once you cross a certain debt threshold that is a burden to all young doctors.

  • If there was a global medical school imitative where students would learn interactively online with other students and perhaps other medical helping professions the cost would decrease and medicine would be learned in yo-yo together around the world. This would lessen the need for developing countries influx of students to Western zMedicine education and also allow Indengenious youth and other non representative groups in medical training a more level playing field.
    Most two years medical school is science and the rotation locations and firms work start in the third year. This could be done locally and or a cross section of more geographic transitions.
    Big Pharma should or could use their advertising monies ( always much bigger than R and D) into support of this program process because it is an international enterprise.
    Ethical workshops and internships should also be part and parcel of this.
    Perhaps First Do No Hatm may actually become not a mere verbal phrase but truth in action.
    Win/ Win/ Win for all. Imagine!

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