The U.S. has fewer practicing physicians per capita than other wealthy, comparably sized countries, yet the road to becoming a doctor has never been more academically difficult—or costly.
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For as long as she can remember, Toyo Adeleke has wanted to be a doctor. She’s also known the path to attaining that goal would cost a lot of money. Growing up in Nigeria, Adeleke, 26, always had ambition: She wanted to pursue an occupation that bettered not only her life but her family’s, she says. When she was 11-years-old, her family moved to the United States, due, in no small part, to her urging, she says. “I pushed my parents to come here for a better life.”
That better life included pursuing medicine. Education was the first battle. High school was easy, Adeleke says, and biology came naturally to her. Undergrad was more tenuous since she didn’t take her classes seriously; she saw her bachelor’s degree as one requisite stop on the way to physician-hood. Then came medical school applications, which proved challenging for reasons beyond academics. Not only did she have to study, pay for, and pass the standardized Medical College Admission Test, known as the MCAT, (a fee of $320) but then she had to create an application through a centralized application processing service (which costs $170 as of 2022) and pay secondary application fees for each specific school she wished to apply to — of which there were 20. All told, Adeleke estimates she spent around $5,000 to apply to medical school.
Now a third-year medical student at New York Medical College in Valhalla, New York, Adeleke—who hopes to become a regenerative pediatric surgeon—has only seen her expenses, and debt, grow. Aside from tuition ($56,925 per year), she has to factor in costs for housing, transportation, books, and medical supplies. Her first year of medical school, her parents covered the costs. Since then, she’s taken out loans to pay for schooling. “Medical school is really about money,” Adeleke says. “Race plays a factor. You see a lot of people of caucasian background making more, I guess because they have more financial support than their counterparts. At the end of the day, it does come down to who can afford to pay for it and who can’t afford to pay for it.”
Three years into a pandemic crippling the American medical system, the country faces an ongoing shortage of doctors. The United States has fewer practicing physicians per capita than similarly large and wealthy countries, per an analysis by Peterson-KFF Health System Tracker. According to the Association of American Medical Colleges’ study ”The Complexities of Physician Supply and Demand: Projections from 2019-2034”, the United States could see a shortage of 40,000 to 60,000 physicians this year, with the deficit potentially growing to 124,000 by 2034.
For a nation so in need of doctors, the cost to become one is prohibitively high. On top of the price of an undergraduate education, current medical students are paying anywhere from $39,237 to $63,630 per year, according to data from the AAMC. After eight years of postsecondary education, doctors carry anywhere from $200,000 to $250,000 in debt, a figure that has grown more than 94 percent since the late 1970s. Newly minted physicians then move onto residency training, a job that pays an average of $64,000 a year — which, after living expenses, leaves very little for residents to put toward loan repayment. Depending on the specialty, residencies can last anywhere from three years for family practice residencies to seven years for thoracic surgery residencies. After four years of accumulating debt during medical school (often on top of loans from undergrad), residents then struggle to pay basic cost-of-living expenses on a $64,000 a year salary, which doesn’t get you far in expensive cities like New York or San Francisco. What might seem like standard living expenses to non-physicians, rent, utilities, groceries, and miscellaneous entertainment can quickly eat away at a paycheck. And still, prospective and current doctors shoulder the costs for a dream that supports the greater good.
Jason Budzi has long been fascinated by the machinations of the body. He distinctly remembers dismembering chicken legs at the table as a kid, trying to determine the anatomy of his dinner. In high school and college, Budzi, now 28, worked as a gymnastics coach and eventually landed on pediatrics as a career. With no one in his family who had gone down the path of medicine before him, Budzi felt unprepared for what lay ahead. The first time he applied for medical school, he wasn’t accepted. The following year, he applied again and was accepted to American University of the Caribbean School of Medicine in St. Maarten where he is currently a third-year medical student. Budzi estimates he spent around $1,000 each year when he applied to 10-15 medical schools.
Budzi says tuition ran him $25,000 per semester for his first two years without factoring in housing, insurance, or the cost of shipping his belongings to an island; the final two years will cost $1,800 a week in tuition. He’s moved eight times on the island during the last year for clinical rotations, which he says isn’t cheap. “It’s a running joke among us that every time we have to pay another $20 for something or have to buy a piece of equipment, it’s just a drop in the bucket of the endless debt,” Budzi says. To pay for medical school, his family has taken out loans from the bank and pooled money together.
Sometimes, when he thinks about friends who work in other fields, Budzi gets discouraged: Not only is he spending a ton of money for his education, but he won’t see a return on that investment for years after he graduates. “A lot of us think if I stop now and do another field, it would be so easy to make this money back,” he says. “I’ve already spent so much to get this far, I’ve got to keep pushing for the rest of it.”
Megan Daniels, a second-year emergency resident at Temple University Hospital in Philadelphia, has had similar realizations. With $328,600 worth of medical school debt from Drexel University College of Medicine, she says she feels financially behind her friends who began working and investing immediately after undergrad. “A lot of the personal finance books that I read are for people who went straight out of college, have student loan debts, and are probably going to make the same amount of money with gradual increases over the next 10, 20 years of their careers,” Daniels, 29, says. But how should she, a person whose salary will increase exponentially over the next decade, approach money, she wonders? “What do I invest in? No one’s going to tell you what to invest in. An index fund? What is that?” she says. “I went into this wormhole the other night on cryptocurrency. It seems like an inherently bad decision but why is it a bad decision?” Currently, Daniels doesn’t pay any money toward her medical school loans.
While the cost of medical school may be exorbitant, it isn’t insurmountable, says Julie Fresne, the senior director of student financial and career advising service at AAMC. Income-driven repayment programs help new physicians to manage their debt during their low-earning residency years, and the public service loan forgiveness program allows doctors working for a U.S. federal, state, local, or tribal government or not-for-profit organization loan forgiveness. “What we all need to do is help people understand earlier that they can, in fact, afford medical school, that there are ways to pay for it,” Fresne says.
By placing sole responsibility on the student to cobble together a plan for financing medical school, this only creates a higher barrier to entry, especially for potential doctors from marginalized backgrounds. “It’s putting more burden of work on a population of people who are already working really hard,” Daniels says.
Considering medical school’s reputation as a costly endeavor, only a specific class of students will be drawn to the field: Those whose families can afford tuition. Between 2010 and 2017, the number of medical school students who graduated with debt decreased by nearly 12 percent. While this may seem like an indicator of medical school’s affordability, the reality is less optimistic. More students come from backgrounds where they don’t need to take out loans — and often those families are white. Black parents contribute less to their children’s college tuition than white families. This, in turn, has an effect on who can afford to become doctors. According to a 2021 study, nearly 44 percent of physicians and surgeons are white men. As of 2018, just over 5 percent of physicians were Black (2.6 percent Black men and 2.8 percent Black women), per a 2021 UCLA study. “They had other resources, which could be lots of things, but I’m going to guess family support,” says David A. Asch, a professor of medicine, medical ethics and health policy, and health care management, and the executive director of Center for Health Care Innovation at the University of Pennsylvania. “If you could put a child through medical school without acquiring debt, you have to be pretty resourced — and that means that medicine is going to become a profession mostly skewed to rich people.”
Research shows patients are more likely to rate their physicians favorably when they share the same race or ethnicity. While socioeconomic concordance has not been studied in doctor-patient relationships, Asch believes class diversity “intuitively seems like a social good.”
But how can the pipeline to physician-hood become more equitable? In order to address the high cost of medical school, some institutions, like New York University Grossman School of Medicine, offer free admission. The issue, Asch says, is that some of these admitted students likely could afford to pay for tuition, or at least some of it. “It diverts philanthropy toward a particular purpose in a way that isn’t as efficient,” he says. Instead, medical schools could focus on standardizing some general courses that all students must take and posting those lectures online.
Budzi believes if high school and college educators prepared future medical school students for the reality of the MCAT, applications, the rigorous schooling and training — and the cost of it all — young people, especially those who aren’t rich, would feel more empowered to pursue medicine. He recalls a doctor he worked with during one of his rotations who visited schools in underserved populations in Miami. “One of the kids was like, ‘You can become a doctor?’” Budzi says. “He had to explain to the kid, yeah it’s doable.”
Ravi Goel, an ophthalmologist in Cherry Hill, New Jersey, remembers the exact date he paid off his medical school debt of $130,000: July 19, 2012, 15 years after he graduated medical school. Until 2010, he wasn’t driven to pay down his loans, and had $100,000 left to pay off. Looking for advice in an online financial forum, Goel explained his financial situation and the response was a wakeup call. Virtually all the anonymous users responding to his comment suggested he pay off his loans in lieu of investing extra cash. “I decided that I was going to prioritize my student loans,” he says. “If I had extra money, I would pay a $5,000 balloon payment.” Two years later, his days of student loan payments were behind him. “The stress level went down as soon as I paid it off.”
Two years after that, in 2014, Goel endowed a scholarship — the same one he had gotten 25 years earlier as an undergrad at Yale. Goel says he always viewed himself as “a financial aid kid” and paying into the scholarship that helped him decades ago is his way of paying it forward. “Individuals should be able to pursue their dream of a medical education or a nursing education,” Goel says, “without this huge albatross that’s going to affect them for the next two or three decades.”
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