News broke this week of a $1 billion donation to the Albert Einstein College of Medicine, a gift that’s earmarked to pay for tuition for all future students at the Bronx, New York, institution. It’s the latest big philanthropic gift to address one of the central problems that aspiring physicians face: the high cost of medical school tuition.
Such costs often saddle new doctors with up to hundreds of thousands of dollars in loans — tuition at Einstein, prior to the gift, was around $60,000 per year. Aside from tuition, medical students also need to come up with living expenses, and may well have big undergraduate student loans. All that debt is not only a burden for the individual physicians who need to pay it off, but has also impacted public health more broadly by disproportionately driving doctors into higher-paying specialties and away from vital primary care and other needed areas. It’s a problem that runs deep in the profession, even as philanthropy has sought to staunch the bleeding for years now.
This latest donation came from Ruth Gottesman, 93, who has been connected to the Einstein medical school since 1968. She was a professor there — a pioneering specialist in children’s learning disabilities — and later, a board member. She’s also the widow of finance industry billionaire David S. Gottesman, who died in 2022; he’d amassed a major portion of his wealth through early investment in Warren Buffet’s Berkshire Hathaway stock. The Gottesmans had long been major philanthropists and big benefactors of Einstein, including a $25 million gift in 2008 to establish a stem cell research institute at the school, among other important support.
So while the new gift is head-spinning in size, it follows a familiar pattern of megadonors serving as longtime patrons of a particular educational institution. It also tracks a tendency among donors to ramp up their support as they age and an overall ballooning of philanthropic gifts in recent years. Not so long ago, a nine-figure donation was staggering; now, we’ve entered the era of the billion-dollar check.
This new gift also isn’t the first to ease the high cost of medical school tuition, though it is evidently the largest. Back in 2012, entertainment industry billionaire David Geffen gave $100 million to UCLA’s medical school for tuition. In 2020, Stanford Medicine received $55 million from billionaire alum John Arrillaga. Also in 2020, Mike Bloomberg’s Bloomberg Philanthropies gave $100 million to cover tuition for students at four HBCU medical schools, a gift that was specifically intended to increase the number of Black doctors.
Given the high cost of tuition and living expenses, many new physicians start their medical careers with hundreds of thousands of dollars in loan debt. This might not seem so important — after all, doctors have high earning power, right? And it is indeed possible to make a lot of money as a doctor, the kind of money that would enable someone to pay off those loans. But that drives many physicians to enter higher-paying specialties, such as plastic surgery or cosmetic dermatology, in which patients typically pay their bills out of pocket. Many specialties aren’t so well remunerated: family and general practitioners, pediatricians and other crucial specialties are typically reimbursed at much lower rates by insurance.
This has contributed to diminishing access to doctors for many Americans: Most everyone has likely experienced this firsthand when they call their doctor to find the next available appointment months away.
The country is already facing an overall physician shortage, projected to worsen in the coming decade to as many as 124,000 fewer doctors than needed, according to the Association of American Medical Colleges. It will be exacerbated over the coming years as the population ages — seniors tend to require more medical care — and as currently practicing doctors retire. Doctor burnout, too, is also a real problem, heightened during COVID-19, that has been accelerating retirements.
Removing the heavy burden of medical school debt, the thinking goes, will enable more physicians to choose to work in the lower-paid specialties that the majority of people need. It will also enable more doctors to take work in underserved communities, such as rural areas, where they can make the biggest difference in the overall health of the country.
And then there’s the diversity of doctors themselves. In news reports, Ruth Gottesman said she hoped that removing the burden of tuition would encourage more students to pursue careers as doctors — students who, because of their economic status, might not have dreamed of going to medical school, with its associated high cost.
It’s a worthy goal, but like so many problems that plague higher education in the U.S., this one is bigger than philanthropy. There are about 190 medical schools in the country. Although some have comparatively lower tuition costs, it’s hard to imagine that enough billionaires and foundations will take on the tuition at a sizeable segment of them. Government and public policy will need to play a role — perhaps the leading role. In an editorial last summer, for example, four U.S. senators promoted their bill to address the physician shortage by increasing the number of resident physicians that Medicare can support. It’s a start.
At the same time, higher education costs generally are out of control. Many types of college, graduate and professional degrees carry high price tags. If we’re suggesting that physicians should have a way to obtain their training without incurring life-altering debt in order that they might better address the public’s health needs, then shouldn’t we say the same to young people who want to be teachers?
These recent, giant philanthropic gifts to make medical school tuition free are laudable in the extreme and will provide an outsized benefit to the public. While billions in philanthropy goes toward biomedical research for the development of hoped-for future cures, something that saves lives today is being able to see a doctor when you need to. That’s a need that’s going to be increasingly out of reach for Americans unless we make it easier for more medical students to enter primary care and other important specialties, and to work in every community.
