Four years ago, with much-deserved fanfare, NYU’s School of Medicine ended tuition for its students. That class just graduated – giving us the first opportunity to see what changes free tuition may have made.
“This decision recognizes a moral imperative that must be addressed, as institutions place an increasing debt burden on young people who aspire to become physicians.”
Robert Grossman, Dean NYU Medical School, CEO NYU Langone Health
The decision to end tuition was a self-described moral imperative meant to end the “fundamentally reshaping the medical profession in ways that are adversely affecting healthcare.” Reducing the cost of this higher education to zero was felt to have several effects.
- To decrease the number of physicians that “shun primary care in favor of highly paid specialties” – reducing the incentives for expensive care and treatment
- To increase the diversity of applicants to medical school by eliminating its cost
There is no doubt that physicians leave school with significant debt. The average student owes nearly $250,000, which translates into more than $350,000 when interest is added and is a debt service of almost $2,500 a month once school ends and those debts kick in. Of course, with a median income of $208,000 after training, many would claim these concerns are overblown. More importantly, that median hides the wide range in salaries; specifically, pediatrics and family medicine are the lows at roughly $221K and $236K, respectively, and orthopedic surgeons and cardiologists at the top at $511K and $459K respectively.
Black students make up 11.3% of the class of 2025, Hispanic 12.7%, Native Americans 1%, Asian 21%, White students 44%, and women 55%. [1]
So, with a context in hand, let us see how free tuition worked out in year one. Now, the announcement of free tuition was made after the class of 2022 was accepted. To understand how the applicant pool changed, we need only look to the following year's class, 2023. While overall applications to medical school rose 2%, those to NYU rose by 46% - the power of free. Applications by “under-represented” minorities doubled. Of course, those increased numbers of applicants made it even harder to get in; NYU’s acceptance rate is about 2.5%
We have no data on the racial composition of NYU’s classes, but for the same period, acceptances for Black students rose by 0.22% - 294 additional potential physicians; Hispanic students by 0.014% (294), Native Americans decreased slightly, Asians increased by 0.3% (616), and White students declined by 486 or 1.3%
Primary or Specialty Care
The class of 2022 seemed, for the most part, to continue to choose specialty care. Here is the data, along with some information on median salaries.
There was a slight increase in pediatrics and primary care. We might also include internal medicine, but this is a gateway residency to additional training in medical specialties like cardiology and gastroenterology, so the actual percentage remains as solely internal medicine specialists is unknown. There is also a doubling of those students going on to pursue psychiatry. Overall, roughly 25% of the class is pursuing a possible primary care role, so perhaps free tuition does nudge students. The remaining 75% continued pursuing and competing successfully for lucrative, highly competitive specialty training.
I have also matched the residency choices with their geographical locations. Over half of the class stayed in New York; when you add in Boston and LA, almost 75% chose a large urban center for additional training. Residents staying in the states where they train vary with both specialties and states, but for New York and Massachusetts, the retention rate is 51%, and for California, 77%.
We are left with many questions, some of which will be answered as we see the choices of NYU’s graduates over the next few years. A tuition-free medical school has clearly reduced the student debt burden and significantly increased an already competitive admission process. We have no data on the changing diversity of the class. There are some increases in graduates entering primary care specialties, but certainly not in the percentages that will resolve a shortage of “primary care physicians.” Finally, based on the geographic locale of residency training, free tuition at NYU has not influenced students to return to rural areas.
I have suggested that the choice of career path is not influenced solely by potential income. Debt relief is welcome, but I do not think it will move these highly competitive, over achieving students away from the creature comforts we all desire, including an active cultural life and a good education for our families. I would be happy to be proven wrong, and the NYU experiment may provide better answers in a few years.
[1] For those having to keep track of possible inequalities, Blacks make up 13.4% of the US population, Hispanics 18.5%, Indigenous Americans 1.5%, Asians 5.9%, and Whites 60.1%. Women represent 50.8% of the population.
