Medical Education and Societal Needs A Planning Report for Health Professions (1983) / Chapter Skim
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8. How the Medical Student Finances Educational Expenses
8. How the Medical Student Finances Educational Expenses
Pages 198-223
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From page 198... ...
Aspiring medical students could be discouraged by the prospect of large debts and a less certain future, and thus the entry of economically disadvantaged applicants, including minorities, could decline. Financial concerns could affect medical school performance, the medical graduate with higher debts may need to select a more lucrative career field, and the practicing physician may adopt a practice style that assures sufficient income.
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From page 200... ...
However, because of financial pressures on the institutions and declining direct federal support of medical education, students' tuition and fees have * Current Association of American Medical Colleges (AAMC)
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From page 201... ...
It is anticipated that many medical schools will be forced to make especially high tuition raises as other funding diminishes. Individual Student's Tuition Costs, Indebtedness, and Sources of Support Tuition Tuitions vary widely across medical schools.5 Private schools, with a median tuition in 1981/82 of $9,337, are substantially more expensive than are state-supported public schools with a median tuition of $2, 458 for residents (Table 2 ~ .
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SOURCES: Data provided by Association of American Medical Colleges staff; calculated from Medical School Admission Requirements, and Economic Report of the President for CPI figures.
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Until the 1960s, medical students and their families paid most of their educational expenses, negotiating private loans if necessary.7~8 Since that time medical education costs have escalated rapidly, and medical students have increasingly relied upon loans and scholarships from outside sources. Table 4 summarizes results from surveys of how the individual medical students financed their education between 1963/64 and 1977/78.
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0 v A, a, a, 'e v a, A: a; At: en u~ r_ ~ - ~ en o ~ 1_ en ~ to ~ 0 ~ v o ~ I' o a)
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A ma jor shif t in the philosophy of student assistance programs recognized concern that physicians were maldistributed geographically and by specialty despite growing physician supply.1O Therefore, provisions of student loans and scholarship programs were geared toward improving access to physicians' services. Public Health Service and National Health Service Corps (NHSC)
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~ ~ ~ ~ ^ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ to · e e e e e e e O ~ ~ ~ O ~ _ _.
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SOURCE: Medical education in the U
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Secre tary of Health and H''n'~ n Services Schweiker sort rized the administration's position on financial aid for medical students as follows: 208
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The Guaranteed Student Loan (GSL) is a federally insured, subsidized loan program with nine percent interest for new borrowers.l5 Strictures have been added to this program, so borrowers wl th family incomes over $30,000 must show financial need; the maximum loan available*
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From page 212... ...
For this reason, the HEAL program has been considered ache financing source of last resort f or medical students . In 1981/82, $200 million was committed for HEAL guarantees, of which medical students' loans constituted roughly half.20 Under existing law, the limits for federal guarantees of HEAL for FY 1983 is $225 million; however, the administration budget would cap the guarantees at $80 million.2i Estimates of the need for HEALs by medical school adminis trators totaled $117 million, a figure corroborated by AAMC estimates.
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From page 213... ...
Increased minority enrollments resulted f ram attempts to broaden the socioeconomic diversity of entering medical classes and to expand educational opportunities for racial ethnic groups underrepresented in medicine.23 Special programs were instituted for minorities and other disadvantaged applicants, to recruit them, to provide exposure to medical careers, and to address educational deficiencies.24 Financial aid was also very important in eliminating financial barriers to medical school entry for minorities and others from less affluent families. The number of underrepresented minorities enrolled in first-year classes increased more than five times, rising from 292 in 1968 to 1,548 in 1980 (Table 10~.
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Annual Reporta -- 1978 and 1981; Association of American Medical Colleges, Office of Minority Affairs.
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Ef fects of Higher Medical Education Costs on Admissions Hadley25 reviewed the available research on the ef fects on medical school application rates of the rate of return to investment .
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Ayers and colleagues studied the impact of very high tuition at Georgetown University School of Medicine on applicants and enrolled medical students.26 The quality of applicants and enrollees, as evidenced by science grade point averages and Medical College Admission Test scores, remained stable despite tuition increases much more rapid than those at most other medical schools. Overall, the sudden rise in tuition and corresponding financial aid requirements caused little change in socioeconomic diversity of matriculants.
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with 13.2 percent minority enrollment. Some medical schools will be particularly hard hit, including predominantly black Heharry Medical College with 159 scholarship recipients and Howard University with 95 recipients (Table 13~.
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San Juan . Jefferson Medical College, 86 9,700 Pennsylvania Boston University 71 11,100 School of Medicine, Massachuse tts SOURCES: NESC Scholarship award data from Fifth Annual Report to the Congress on ~ ~ Services Administration, 1982.
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Income levels in such areas have traditionally been relatively low. However, this question is complicated, because market factors related to growing physician supply may in part counterbalance the relatively low incomes in undernerved geographic areas.l2 Data are needed on the relationship of physician location choices to medical education indebtedness.
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From page 220... ...
The implications are particularly great for aspiring minority medical students because of their frequent economic disadvantage, their recent disproportionate reliance on NHSC scholarships, the aversion of some to undertaking large debta' and the attraction of alternative career choices that offer immediate income. Data on the parental income and occupational levels of recent entering classes should be analyzed, and these studies should be repeated periodically as debt burdens increase.
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11. Graduate Medical Education National Advisory Committee Final Report to the Secretary ~ DlIHS.
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18. Heal th prof essions student loan program.
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31. Bough, D
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