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Medical School Uncovered

Kennady Lang

Florida State University

ENC 2135

Professor Cregsy

July 30, 2021

Introduction

Choosing a career path is a life changing moment in many young adults lives. Some may

have felt a calling to the subject or field since childhood. Or higher education might have

introduced a subject of interest to individuals without access. Many kids may have dreams of

becoming a doctor to fulfill the desire of helping people. As these kids grow up the reality of this

dream can come crashing down. Medical school is one of the most expensive career paths

nowadays, sometimes leaving students hundreds of thousands dollars in debt. When most people

learn this information, regardless of upbringing, it is shocking. This information can deter

students from pursuing this career path due to worries about paying off that type of debt for

decades. Doctors are needed now more than ever because of the realities the COVID-19

pandemic revealed: doctors are a necessary line of defense for the public. These financial

concerns may negatively affect the future of the medical field and need to be addressed.

Financial concerns aren't the only issue doctors face. Mental illness is at an all time high in the

field. This could result from multiple things such as their debt or workload, but they are not

getting the help they deserve. After intensive research into this topic the true reasons that medical

school is so costly have been revealed: well rounded training involves many organizations and

instructors. Even though the training can be worthwhile, the cost can significantly compromise

the mental health of physicians. Now, this stress can be reduced with new programs and types of

financial aid to help relieve this debt off of doctors. Without this relief some doctors may take

drastic measures to help relieve themselves from this burden, some going as far as suicide. If

these issues are not taken care of then the medical field may become one of the most undesirable

fields for college students.

Discussion

For most aspiring doctors the decision to attend medical school is a large commitment. It

can be both very time-consuming and financially draining. The Covid-19 pandemic not only

showed the importance of physicians, regardless of field, but also the significant need for them to

accompany the growing population. When most people think of doctors they think of the large

income they receive, but there is much more to being a doctor than income. For most physicians,

medical school debt is a plague that has no cure. It starts when they first attend medical school,

but does not disappear until years later. A roundup of the latest statistics show average medical

school debt now exceeds two hundred thousand dollars. While medical school graduates can

generally expect to earn six-figure salaries, nearly half plan to apply for student loan forgiveness

(Carter, 2021, para. 2). It is not only student loans that most medical students have to pay for, but

other necessities to live independently. Most medical students have to factor in other payments

such as rent, living expenses, and personal expenses. This financial situation can add a lot of

stress to an individual, especially one who is in school full time.

Most students can not afford to pay for medical school out of pocket. It may be cheaper

for students to attend a school that is in state rather than out of state, but where a person decides

to attend medical school counts. Some students find it is worth paying a higher tuition if it means

they get a good residency. Usually a medical student will take loans because most can not pay for

tuition with other large expenses involved. On average a student will have anywhere between

one hundred fifty thousand and three hundred thousand dollars in medical school debt, with

35.7% of graduates falling in the two hundred thousand to three hundred thousand dollar range

(Carter, 2021, Figure 2). Most think that since the average physician makes at least three figures
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that it should be a breeze to pay off. That is incorrect. There are multiple things that should be

taken into account when having to pay off loans, such as interest. Having a large amount of debt

may affect large goals most people have such as owning a house or starting a family. This

amount of debt can affect a person’s mental health and well being. Stephanie Smith,

president-elect of the Canadian Federation of Medical Students, believes that less debt could

positively impact the mental health of doctors. She explains,

“I think the financial pressure does have a significant impact on people’s burnout,” she

said. “If you’re not getting much time to yourself, and you’re feeling pretty exhausted, it

can help if you know you can take the weekend off and go somewhere nice” (Glauser,

2018, para. 9).

When mental health is not a top priority, no matter what field an individual is in, every part of

their life seems like a chore. Mental illness should be taken seriously in this field as it can affect

the doctors behavior with coworkers and patients. A survey of more than three thousand medical

students in the U.S. found that students with higher debt loads than their peers reported more

incidences of feeling callous toward others (Glauser, 2018, para. 10). Negative feelings and

actions can interfere in doctor-nurse relationships, creating an environment that is detrimental

for both staff and patient.

Some of these negative feelings may manifest into something uncontrollable if not taken

care of properly. With high levels of stress, anxiety, and depression doctors are committing

suicude in record breaking numbers. New research shows that 28 to 40 per 100,000 of physicians

commit suicide (Anderson, 2018). This is more than twice that of the general population. This

staggering rise in suicide should be an indicator to the rise in mental illness in this feild, but goes

untalked about for the most part. Deepika Tanwar states, “Doctors who die by suicide often have
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untreated or undertreated depression or other mental illnesses, a fact that underscores the need

for early diagnosis and treatment” (Anderson, 2018). Without raising awareness or even

providing the doctors with the help they desperately need, these numbers will not go down but

only increase. This rise in both depression and suicide makes physicians have the highest suicide

rate in any profession. Without providing help communities will continue losing loved ones and

professionals that keep each other safe.

When entering medical school some students have their specified field already picked

out, but others may feel influenced by money. Some doctors will choose higher paying

specialties rather than what they are drawn to to help with loan payments. Pediatrics and family

medicine are some of the lowest paid specialties nationwide. While that may not be a concern to

some, others will choose to go into a field that has a higher annual income that is larger than the

amount of debt they will accumulate. This leaves these very important fields with a shortage

having a higher patient to doctor ratio than other specialties. Micheal Railey, a practicing

physician, states his concerns for the future,

“I expect a trend to develop soon in which primary care, especially family medicine, will

be overlooked for more glamorous high paying specialties. The thinking will be that if

you are going to be in debt, you ought to be at least in a specialty that carries a high

profile and esteem” (Setness, 2001, pg. 16).

This just emphasizes how the trend of picking a career based on income is slowly becoming a

popular option for medical students.

Even though medical students are willing to pay large sums of money for school, some

may not know what exactly they are paying for. Most medical schools have three main sources

of income: endowment, federal funding, and tuition. The Alliance for Academic Internal
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Medicine estimated that the total cost to train a resident is one hundred eighty-three thousand

four hundred sixteen dollars per year (Kelley, 2019, para. 14). To fully train a medical student, it

would cost around seven hundred forty thousand dollars for the institution. Although as stated

earlier, it may be cheaper to stay in state for medical school rather than attend out of state. Also,

colleges have to take into account the cost of residency per student. Residency is when medical

students train in hospitals or clinics to gain experience and training in different fields. Residency

has more expenses than just training for students. There is everything from hospital call rooms,

to residency program administrators’ salaries, to the salaries of faculty to cover teaching time

(Kelley, 2019, para. 16). These fees are helping pay for more than just classroom education.

They are paying for real life experiences that will shape students interests and career paths.

Although the cost has risen greatly over the years it is with reason. Medical school is an

investment. It molds a student into a well-rounded physician with critical thinking skills. In the

long run, a well trained capable doctor is worth the cost of medical school. They help the public

stay safe and healthy, creating a better community.

A large majority of students take out loans to help pay for their schooling. It may not be

the best choice, but it is the only choice available to them. In the past there have not been many

other financial aid options other than taking out large loans and spending decades paying them

off. This is not the case anymore. After the Covid-19 pandemic the need for doctors is evident

now more than ever. With the cost of medical school discouraging people from all backgrounds

to enter pre-med, many organizations have come together to combat this problem. The United

States Military and it’s different branches are beginning to offer tuition-free schooling. Kowarski

(2021) explains,
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According to the school, it’s students earn more than seventy thousand dollars per year

during their four years of medical school, which includes housing and subsistence

allowances, and in return they commit to at least seven years of active-duty service after

completing their medical residency (para. 5).

This offer can be very enticing for many people. It gives students the ability to pursue the career

path of their choosing without having the burden of loans. It can be a great option for students

that want to travel the world. Doctors are needed on U.S. bases all across the globe, from Japan

to Germany. Another benefit of joining the military for medical school is that there is no required

specialty to receive free schooling. These bases need all kinds of doctors because they cater to

many demographics. The men on base might need general practice physicians for their problems,

while their wives and children need gynecologists and pediatricians. All specialties are needed in

the military, and they are willing to pay for the services.

Even though free medical school for military service is a great option for the public, it

may not be the best fit for some individuals. Luckily, other options are starting to become

available. Prestigious colleges such as New York University and the Cleveland Clinic are

offering free tuition for admitted medical school students, with no criteria required to receive this

aid. This can be helpful to the select few chosen into the program, but not the vast majority of

medical students. Other schools such as Columbia University and The University of California

Los Angeles, among other nationally ranked institutions, offer aid to students of academic merit

or financial need (Pentis, 2020, Figure 1). This can help students in lower income areas afford

tuition, bringing more diversity into the workforce. If some students are not able to obtain entry

into these tuition free programs there are still other ways for them to receive aid. There are

scholarships and grants that are available for students willing to apply. These scholarships can
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come from the university itself or from private/public corporations. The “Physicians of

Tomorrow Awards” and the “Tylenol Future Care Scholarship Program” are just a few examples

of scholarships for medical students (Pentis, 2020, para. 36). Student aid is a significant way that

less fortunate communities are able to afford higher education programs. Doctors Lachs and

Choi (2020) state the following:

High tuition is a significant barrier for less affluent students, hindering diversity in the

physician workforce. This perpetuates racial disparities because quality of care is better

when doctor patient dyad is concordant, and biomedical research has systematically

overlooked underrepresented minority populations (pg. 279).

It is no secret that the staggering tuition of medical schools obstructs the inclusion of lower

income communities. Some may not know about the options available to help them. They may

only know about the obstacles blocking the path of their success. The availability of this

knowledge can significantly impact the amount of students applying to medical school from

these communities. Socio-economic status may also affect the amount of advertising to inform

the public of these new opportunities available. With a wider outreach to these communities new

talent will enter the field. More people will be able to offer their medical knowledge and better

the community.

With all of these issues coming to light, medical school applications are starting to

decrease compared to the past. Students are beginning to hear about the other problems

associated with the field other than just hard curriculum. Another reason is that tuition is rising

while the availability of loans and scholarships is diminishing. Also, the projected surplus of

physicians and concerns about career possibilities may discourage some prospective applicants

(Fruen, 1983). Just a few of these reasons are leading to a trend in applications. The same thing
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has happened in the past as well. The figure below shows the statistics for applications of the

past.

Figure 1

TABLE 1Medical School Applicant Data, 1961/62 to 1980/81

First-year Class Number of Applicants Accepted Applicants Percentage of Total Applicants Accepted

1961/62 14,381 8,682 60.4

1962/63 15,847 8,959 56.6

1963/64 17,668 9,063 51.3

1964/65 19,168 9,043 47.2

1965/66 18,703 9,012 48.2

1966/67 18,250 9,123 50.0

1967/68 18,724 9,702 51.8

1968/69 21,118 10,092 47.8

1969/70 24,465 10,547 43.1

1970/71 24,987 11,500 46.0

1971/72 29,172 12,335 42.3

1972/73 36,135 13,757 38.1

1973/74 40,506 14,335 35.4

1974/75 42,624 15,066 35.3

1975/76 42,303 15,365 36.3

1976/77 42,155 15,774 37.4

1977/78 40,569 15,977 39.4

1978/79 36,636 16,527 45.1

1979/80 36,141 16,886 46.7

1980/81 36,100 17,146 47.5

1981/82 36,727 17,286 47.1

SOURCES: Medical education in the United States, 1980–1981 and 1981–82. Journal of the American Medical
Association 246:2893–3044, 1981 and 248:3223–3328, 1982.

Although this information is from the past, it could tell a lot about the future. Applications

dropped substantially from 1974 to 1980. This is a trend that very well take place today if things

do not change. Students want some form of help from these schools and corporations. Something

that will help either their mental or financial state. Helping students will ease the stress load and

lead them to focus more on their schooling. This will create better and smarter doctors that will

love their job rather than feel trapped in the profession.

Conclusion

Although at first glance it may look like a daunting amount of negatives in the field, but

things are starting to change. These issues are beginning to be talked about more, bringing

awareness to the public and other career fields. With this information going public there are

many companies, communities, and colleges that want to help. Help is coming in formats of

financial aid and mental health counseling. These are not the only ways doctors are being helped,

but they are the most prevalent to the issues they face. Future physicians should set the example

for upcoming generations of aspiring doctors that it is possible to attend medical school, no

matter the hardship. They will better the world because of it.

References

Anderson, P. (2018, May 8). Doctors' suicide rate highest of any profession. WebMD.
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ny-profession .

Carter, M. (2021, May 28). Average Student Loan Debt for Medical School . Credible.
[Link]

Fruen, M. A. (1983, January 1). MEDICAL school admissions. Medical Education and Societal
Needs: A Planning Report for the Health Professions.
[Link] .

Glauser, W. (2018). How medical school debt shapes the health workforce. Canadian Medical

Association Journal, 190(29), E894–E895.

[Link]

Kelley, R. (2019, December 9). Why Has the Cost of Medical School Skyrocketed? Savvy Pre
Med.
[Link]
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Kowarski, I. (2021, March 30). How to Attend Medical School for Free . U.S. News & World
Report.
[Link]
017-07-13/how-to-attend-medical-school-for-free.

Lachs, M. S., & Choi, A. M. K. (2020). Eliminating Medical School Debt: A Dean and

Geriatrician’s View From Opposite Ends of the Training Pipeline. Annals of Internal

Medicine, 172(4), 279–280. [Link]

Pentis, A. (2021, February 9). 7 Top Medical Schools With Tuition-Free Programs. Student Loan

Hero. [Link]

Setness, P. A. (2001). Letters from the front. Responses provide true-life stories of medical
school debt and its effects. Postgraduate Medicine, 109(4), 13. EBSCOhost,
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