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Instead of tuition, medical schools should get cut of doc's salary

bu005290As physicians, you are well aware of the problems associated with medical school debt.  Here are some numbers to ponder: Eighty-seven percent of medical students graduating in 2008 carried debt, with the median debt of students at public schools being $145,000 and $180,000 at private schools. Twenty-five percent of students had a debt of $200,000 or greater.

From 2001–2006, debt of students attending a public school had increased at the rate of 6.9% per year and 5.9% per year at private school. From 2004–2007, the interest rate of the federal Stafford loan increased from 2.82% to 6.8%, an increase of more than 140%. However, analyzing physician compensation over a similar period, primary care physicians had an annual rate of salary increase of 2.6% and specialists a 4.3% increase.

In an article published in the American Journal of Obstetrics & Gynecology, doctors have proposed a system designed to eliminate debt and allow doctors to choose their specialty based on desire rather than ability to pay back loans.  The program is called SAFE — Strategic Alternative for Funding Education — and it proposes that medical schools entirely cut tuition and fees while students are in school and instead collects a fixed rate of income for the first 10 years of practice.

The rate for docs in public schools would be 5% of income; and 10% for those who go to private schools.  These rates are across all specialties.  “Students who are financially successful in lucrative specialties will return more financial support to their medical school, whereas those in primary care specialties, public health professions or charity work will pay less,” according to the authors.

Having this program in place eliminates the need to constantly increase tuition and removes the economic impact on medical schools from the loss of tuition if a future decision is made to shorten the length of medical education. This proposal would remove the stress felt by medical students who are currently accumulating debt at an alarming rate.  It’s an interesting proposal.  What are your thoughts?


  1. How will this plan be initiated? Won’t there be at least a 4 year gap in which medical institutions will not be receiving any money at all, since money doesn’t start coming in until these students begin practicing? What’s the proposal for solving this issue?

    Also, what will medical schools do for those rare cases when a student drops out or changes careers? How will the medical school be compensated for all the resources invested in this student? Also, as mentioned above, some medical practitioners choose philanthropic courses, not all of which shoulder the financial burden of tuition debt. Will these gaps be filled by increasing the income seized from other graduated practitioners?

    By offering a debt-free option, I think many young people who would be cowed by the financial responsibility of debt will not fully think through their decision to attend medical school; applications will increase, and drop-out rates may also increase if the student is not personally, financially invested in their education.

    I believe that SAFE has promise, but its long-term consequences must be fully considered. I am sure these issues are being addressed by the advocates of the system.

  2. Project MedSend, (I am Pres. Emeritus) has been sending volunteers for career medical service since 1995 by taking over the educational debt for nearly 450 medical missionaries of all kinds.

    The proposed scheme is fine, but anyone called to serve the poor on both domestic and foreign fields of service, will be delayed for tenyears, whence most will have their call deflected or co-opted.

    Further thought is required to accommodate and encourage the selfless impulses of idealistic health professionals who care about the poor.

    I would be happy to dialoge with those who have obviously given themselves to this kind of service.

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