Medical school current events

Top Medical Schools Take on Student Debt in Bid to Increase Diversity and Encourage Broader Specialty Selection

Recently, Washington University in St. Louis announced that it was going to commit $100 million over the next ten years for scholarships for medical students and to “enhance and modernize the school’s medical education program.” Up to half of the program’s future students will be able to attend the school tuition-free, with many others receiving partial tuition support. The program will begin with the 2019-20 entering class.

Washington University is the latest in a string of schools working to reduce the student-debt burden associated with medical school. Last August, New York University Medical School shocked and delighted students when it announced that all current and future medical students would be attending tuition-free. Kaiser Permanente, the following February, made a similar offer for its first five graduating classes. Additional schools, including Columbia University’s Vagelos College of Physicians and Surgeons and the David Geffen School of Medicine at UCLA also have created substantial scholarship funds to ease student loan burdens.

The rising cost of medical school debt negatively impacts not only medical students but also the greater public. Students graduating from public medical school programs carry a mean debt of just under $189,000, while those graduating from private medical schools have a mean debt closer to $209,000. This debt load can impact many aspects of public health, including deterring promising students from entering medical school, encouraging those in medical school to opt for higher paying specialties post-graduation, and creating higher stress and lower wellbeing for physicians and those in training. In late April, the AAMC published updated physician shortage numbers, with the projected shortfall of primary care physicians, a lower-paying specialty, ranging between 21,100 and 55,200 by 2032.

The schools offering reduced and tuition-free opportunities for their students believe that reducing student debt will encourage a more diverse applicant pool as well as empower graduates to pursue a broader range of medical specialties. “For most medical students, debt is a significant factor in selecting a school and a career path,” said Eva Aagaard, MD, Senior Associate Dean for Education and the Carol B. and Jerome T. Loeb Professor of Medical Education at Washington University in St. Louis. “We want to help alleviate that financial burden and instead focus on training the best and brightest students to become talented and compassionate physicians and future leaders in academic medicine….This is an investment in our students and in our institution, as well as in the health of St. Louis and the greater global community.”

 While many schools have adjusted their admissions processes to attract more minority applicants, using a combination of pipeline programs, more holistic admissions standards, and a focus on diverse representation on admissions committees, the problem has thus far remained. “From 2014 to 2018, the percentage of black students enrolled in medical school rose from 6 percent to 7.12 percent, according to the AAMC. Additionally, Latino medical students increased from 5.3 percent to 6.4 percent of total enrollment while Native Americans still account for less than one-half of a percent of all medical students.”

While it is still too early to gauge success, NYU has seen promising results in its first application wave since it eliminated tuition. While overall applications to medical schools in the United States have increased by 47 percent, African American, Hispanic and American Indian applicants only increased by two percentage points. At NYU, however, almost 9,000 applications were submitted for the 102 seats in the 2019 incoming class. There was a 103 percent increase from the previous year in applicants who self-identify as disadvantaged, a 140 percent increase in black applicants and a 40 percent increase in Pell Grant recipients. Dr. Rafael Rivera, Associate Dean for Admission and Financial Aid at NYU said, “The accepted pool that we have thus far reflects increased diversity in socioeconomic status, which is an important facet of diversity in the physician workforce that hasn’t gotten the attention it deserves.”

 The other objective of tuition-free and reduced medical school programs is the freedom that it affords graduates to select less lucrative specialties or career paths. The relationship between student debt and specialty preference is well-documented. An article reviewing research on the impact of student debt on primary care physicians, included references to a 2012 study that showed students with larger amounts of student debt are “more likely to switch their preference for a primary care career to a high-income specialty career over the course of medical school” as well as a 2016 qualitative study which found that, “students described their debt as making them feel more cynical, less altruistic, and entitled to a high income.” These findings suggest that reducing the debt, through reduced tuition or increased scholarships, will positively impact graduating students’ ability to select a specialty based on preference rather than need.

 Though only time will fully show the impact of these schools’ commitments to reducing student debt on the physician workforce, there is reason for optimism about the benefits that will be seen for medical students, physicians, as well as the public.

Medical Schools Limited on Use of Race in Admissions Decisions but Still Seek to Promote Diversity

Last week, The Wall Street Journal reported that the U.S. Education Department is requiring the Texas Tech University Health Sciences Center medical school to discontinue its practice of factoring race into its admissions decisions. The medical school agreed to a deal with the Education Department in order to end the long-running federal investigation into its use of affirmative action. In 2003, after the Supreme Court ruled that race was admissible as a factor in admissions decisions in Grutter v. Bollinger, the Texas Tech University Health Sciences Center resumed use of race as a criteria in admissions decisions. In 2004, the Center for Equal Opportunity filed a complaint against the school, and the next year the Education Department began the investigation, which this agreement concludes.

Texas Tech had previously ceased using its affirmative action policy for admissions in the pharmacy school in 2008 and for undergraduate programs in 2013. However, the medical school contended that, “It must continue weighing race in its admissions process because a cohort of doctors from different backgrounds could best serve Texas’ racially and ethnically diverse communities.” However, the recently signed agreement stipulated that the school was not providing an annual review of the necessity of race-based admissions and therefore could not rule out that other factors may provide similar diversity-levels. The agreement also suggested that the medical school use other “race-neutral factors” to meet diversity aims, “such as recruiting students from low-income areas and favoring bilingual or first-generation college students.”

Earlier this week and just following news of this agreement, Kaplan Test Prep released survey results showing that 80 percent of 245 pre-med students surveyed in January 2019 say that “It’s important for the American medical profession to be more demographically representative of the general patient population.” Among the students who agreed with this statement, one commented, “While it is certainly possible to be empathetic and ‘tuned in’ to your patients despite differences in language, culture, etc., it is important for patients to feel like they can relate to and trust their clinician…If American clinicians were more demographically representative of the population as a whole, patients would likely find it easier to connect with a care provider they are most comfortable with.” Those in the 20 percent who did not agree with the statement were more likely to focus on the importance of drive and technical ability in becoming an effective doctor.

Additionally, an earlier Kaplan study with medical school admissions officers showed that many felt competent with their school’s diversity efforts. When the admissions officers were asked to grade his/her medical school on diversity, the majority gave themselves a B (35 percent) or C (34 percent), while fewer rewarded themselves with an A (18 percent) and even fewer a D or F (5 percent).

While it is clear that prospective medical students and doctors see the value in diversity in medical school admissions, the process by which the schools will implement these diversity goals is changing based on the views of the current administration. And these changes should be noted, especially by prospective medical students.

For future applicants: Overall, it is wise to seek experiences that improve your ability to work with others, particularly those unlike yourself. And throughout your application, you will want to speak to these experiences in a manner that showcases your commitment to serving a diverse population of patients, highlights areas where you will bring diversity into the program, and show how you have thrived and what you have learned in diverse environments in the past.

The Opioid Crisis and Medical Education: Adequately Preparing Students is an Ongoing Struggle at Most Medical Schools

There are approximately 91 people per day who die from opioid overdose. And each year, an economic burden of $78.5 billion—a result of healthcare costs, lost productivity, addiction treatment, and criminal justice fees—is associated with the opioid crisis. So why aren’t medical schools adequately preparing students to deal with addiction? A recent New York Times article quotes Dr. Timothy Brennan, the director of an addiction medicine fellowship at Mt. Sinai Health System, who compares combating the opioid crisis with the current provider work force to “trying to fight World War II with only the Coast Guard.” Further, Dr. Kevin Kunz, executive vice president of the Addiction Medicine Foundation, notes that while most medical schools now offer some education about opioids, the content varies widely in terms of depth. Additionally, only about 15 of 180 American medical programs teach addiction as it relates to alcohol, tobacco, and other drugs.

Earlier this week, the AAMC put out a Key Issues statement on the opioid epidemic that linked to a January 2018 survey where AAMC researchers asked Medical School deans about their current or anticipated plans for dealing with the opioid crisis. Almost all, 97 percent of respondents, noted the challenges of teaching and/or assessing students’ knowledge of prescription drug abuse. They referred most frequently to a deficiency in faculty expertise, a lack of time within a crowded curriculum, and difficulty assessing students’ mastery.

Attempting to overcome the named challenges, The University of Massachusetts, Tufts University, Harvard University, and Boston University have committed to using a set of ten competencies to drive their opioid education programs.  At Boston University, addiction education is incorporated into all four years of training and the school has partnered with Dr. Bradley M. Buchheit, an addiction medicine fellow, to train students in assessing and talking with patients about substance abuse.

Other schools are following suit. The University of Central Florida College of Medicine enhanced its curriculum to include both preclinical and clinical education on pain management, addiction risk mitigation, the use of prescription drug monitoring systems, naloxone training, and the CDC’s new voluntary guidelines for opioid prescribing. Martin Klapheke, MD, assistant dean for medical education and professor of psychiatry at UCF noted that “students are taught to fully engage patients and their families in discussing the risks and benefits of different pain therapies.”[i] At NYU, medical students have always received training in chronic pain and addiction, including a week-long pain management curriculum. And now the school is adding additional elements including a pain assessment and management training for all students going into residency programs, as well as a lecture on alternative pain management techniques.

Learn more about the battle against opioids:

[i] https://www.aamc.org/newsroom/newsreleases/464576/medical_schools_confront_opioid_crisis_08042016.html