Eliminating medical student-loan burdens for future physicians with financial needs can create a more diverse medical school applicant pool, student body and health care workforce, says a JAMA Health Forum article examining the impact of efforts at a New York medical school.
The article, "Debt-Free Medical Education—A Tool for Health Care Workforce Diversity," looks at Weill Cornell Medicine's commitment to making medical education debt-free, which started in 2019, and the early results that it has produced.
To understand the impact of this program on the incoming Class 2024, Weill Cornell compared medical student applicants and matriculants in 2020 with those from the 4 previous years (2016-2019). In 2020—the first full admissions cycle in which the program was in place—Weill Cornell Medical College's applications rose 11%. "Among matriculating students we observed statistically significant increases in the percentage of students from groups underrepresented in medicine (from 20% to 29%)," wrote the authors, Yoon Kang, MD, and Said A. Ibrahim, MD, MPH, both of Weill Cornell Medicine.That equates to a 45% increase.
The state of debt
Cornell's program is being funded with an initial $160 million endowment. The article points out that additional funding will be necessary to keep the program intact in perpetuity.
The program's aim of eliminating medical student-loan burden is ambitious. Three out of four 2019 medical school graduates had debt, according to data from the Association of American Medical Colleges cited in the article. The median education-related debt—including application fees, fees for testing and test preparation, and expenses for professional attire and travel to medical school and residency interviews—was $200,000, and those numbers were more daunting for certain underrepresented groups, with the article noting that "not only did a higher proportion of Black students graduate with debt (91% of Black students vs. 73% of all students), but the median debt was higher ($230,000 for Black students vs. $200,000 for all students)."
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Addressing debt, physician representation
Cornell's program aims to offer all attendees a debt-free education. Although many schools have offered full tuition scholarships to under-represented students, Cornell's debt-free program goes a step further to include costs of attendance—tuition and living expenses, such as housing and health insurance. A survey of students entering the medical school indicated that they were aware of the program and counted it as a factor in their decision to apply.
About three-quarters of incoming students in Cornell's most recent class qualified for the debt-free program, which is based on financial need. The authors offered the early returns on the program as, at the very least, anecdotal evidence that debt-free medical education can help meet the needs of the patient population.
"Our preliminary observations indicate that the implementation of a debt-free medical education program for students with proven financial need might offer yet another potential approach to help to diversify medical school enrollment," the authors wrote. "This is an essential step in addressing socioeconomic and racial/ethnic disparities in health care."
The article's lead author said that decreasing the debt burden is a first step in expanding the diversity of the physician body.
"Effective diversification of the physician workforce requires a "long-lens" approach," said Dr. Kang, Cornell's senior associate dean for education. "We need increased focus on the early stages of the pipeline into medical school and increased diversification of the applicant pool."
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Making physician diversity a priority
The AMA is looking to address physician diversity on several fronts. The AMA Accelerating Change in Medical Education Consortium has worked with Morehouse and other member medical schools to share strategies for enhancing recruitment, fostering viable pathways into medicine, promoting holistic admissions processes and creating inclusive learning environments. The ultimate goal is to generate a physician workforce that more closely resembles that of the nation.
The group has shared a process of institutional diversity and inclusion self-study and issued a statement to protect diverse learners during educational disruptions related to COVID-19.
The AMA Doctors Back to School™ program, meanwhile, introduces children to professional role models and shows kids of all ages from underrepresented racial and ethnic groups that a career in medicine is attainable for everyone. Learn more about the AMA Minority Affairs Section, which gives voice to and advocates on issues that affect minority physicians and medical students.
Launched last year, the AMA Center for Health Equity has a mandate to embed health equity across the organization so that health equity becomes part of the practice, process, action, innovation and organizational performance and outcomes.
