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One of the best private med schools: the University of Colorado

In the mail today was an envelope from Richard Krugman, chair of the AAMC and dean of my medical alma mater, the University of Colorado School of Medicine.

It contained good news and bad news. The good news: CU placed 15th among medical schools in the AAMCs ranking of NIH research expenditures, the school placed 4th among public medical schools in its research earnings, and the school just received a $6 million private research grant for a stem cell biology program. It sounds as if the medical school's budget is healthy, at least from a research perspective, and the state of Colorado ought to be proud of its accomplishments.

But, um... the bad news is that the state legislature continues to withhold its support from the school's educational mission. Less than 2% of its operating budget comes from the state, and because research dollars can't be used to support educational activities, tuition has increased to cover the shortfall. The average debt of CUs graduating students is now over $100,000 (although this is probably in line with the median debt of all public medical schools).*

I've posted about medical school tuition and debt before (1, 2). It is reasonable to assume that high med school debt makes primary care careers less attractive to new graduates relative to specialties like interventional cardiology (some studies cited here). Given that we all keep complaining about the rising costs of medical care, and that these costs are in part driven by an oversupply of high-cost specialist physicians relative to an undersupply of primary care doctors, high medical student debt should bother us.

The question we have to answer has never been whether or not to spend tax dollars on the public good called "physician training." Rather, the question is when should we pay, and how much. Right now, we've decided to pay later -- cutting funding for medical education up front and paying for the consequences of increased student debt at the end. We subsidize the medical care provided by high-cost specialists -- through medicaid, SCHIP programs, and tax breaks, among other things. We continue to contemplate some kind of national health care system. We fund loan-forgiveness programs for new graduates who elect primary care despite the relatively paltry incomes that these fields offer.

But we ought to wonder whether we might get a bigger bang for our buck if we paid more up-front to ensure that medical school tuition at public medical schools was reasonable. We might save a lot of money by eliminating the administrative waste that accompanies loan-forgiveness programs if new M.D.s didn't start out with staggering debt to begin with.

The letter I got from Dean Krugman says that a current student will call me soon to ask for my contribution to the school. I'm looking forward to talking with that student about some of these things, and about the new curriculum that (finally!) is in place at Colorado.

Here's some more materials about the debt issue from the AAMC.

* Jolly, P. Medical school tuition and young physician indebtedness. Health Aff. 2005; 24:527-35.

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