Why don't millionaires fund medical students?

The physician shortage in the U.S. is common knowledge. Why don't more donors put their money toward tuition for people to become physicians? 

It happens. Every once in a while, an anonymous donor makes the decision to fund full tuition for an entire medical school class. 

In 2018, the University of Houston College of Medicine received an anonymous $3 million gift to cover its inaugural class of 30 medical students. In 2022, an anonymous donation to Texas Christian University School of Medicine in Fort Worth funded the full tuition for the third year of education for the 60-person class of 2024. 

"Student debt is the No. 1 deterrent for students when applying to medical school," Renu Khator, PhD, president of the University of Houston, said at the time of the gift. "This generous gift will allow such students an opportunity to attend and ultimately lead the future medical workforce."

Gifts like these draw more attention and public interest than many other charitable donations, even those of larger dollar value or from famous benefactors. But they happen less frequently than one might expect. Donors' financial backing of medical students is relatively unique compared to other causes they decide to fund. 

"I'm not really sure why there's not more philanthropy around that," said Marschall S. Runge, MD, PhD, dean of University of Michigan Medical School and CEO of Michigan Medicine. While some donors have asked about funding tuition for an entire class, he said the system has seen a moderate amount of activity from donors toward such a cause. Gifts in smaller increments, once combined, can cut the tuition burden by 40 to 50 percent.

Any charitable gift is just that — a gift. Gifts should not be expected, and it's poor form to scrutinize others' generosity. But the rarity of funds to support medical education is somewhat surprising given how widely recognized and felt the physician shortage is nationwide.

Americans face an average wait of 26 days for a medical appointment as a new patient. This will only intensify as the U.S. stares down a forecasted deficit of up to 124,000 physicians by 2034, according to the Association of American Medical Colleges. Shortages that have long been felt most acutely in rural and underserved urban areas will become more common elsewhere. It is a looming public health crisis with concerning effects on patient safety, care quality, health outcomes and equity.

Today, problems with physician numbers and access affect almost everyone in some way. Estimates are that around 83 million people in the U.S. live in areas with a shortage of primary care providers. The well-connected may fare better than the average American when it comes to snagging an appointment with the right physician in a timely fashion. That type of advantage can feel life-saving if the recipient is you, maddening if it is not, and systemically broken regardless in light of health inequities and disparities.

Telehealth, remote patient monitoring and other tech tools may help reduce wait times depending on patient need, but the mode of care delivery doesn't sustainably solve for the growing shortage of people who provide it. 

Donors, especially those behind large, multimillion-dollar gifts, ink checks with their own motivations, goals and reasons to fund a cause. Some decide to put their money toward brick-and-mortar infrastructure that bears their name on a hospital campus or toward the research of breakthroughs for a disease that took the life of a loved one. Some look to enhance their connection to the community, institutions or certain stakeholders out of trust and benevolence, perhaps with the remote possibility of goodwill returned down the line. 

More giving is always better than less. And the choice to let medical students graduate as debt-free physicians seems destined to make a needed and palpable impact. In 2020, the debt of graduating medical students averaged around $207,000. This burden can deter students from pursuing medical education altogether, or from lower-paying specialties that touch the most people like family medicine and pediatrics. 

"It will make it more challenging for a person to enter a primary care field if they are looking at a big debt," Dr. Runge said. "That can be used as a mortgage for a house, and take them a long time to pay off." 

Approximately 700 students work toward their medical degree at University of Michigan each year. Dr. Runge, who has led the medical school as dean since 2016, said philanthropy around tuition and education would not only be meaningful from a practical standpoint, but also provide a tremendous morale boost.

"I think it'd be great for the health of the United States. It's stressful being in healthcare. There are people who are feeling burned out and wonder about their career choice. I think being able to take away the mental stress of knowing you are accumulating a bigger debt that you'll have to pay off, eventually, is really important. There are a whole host of people who want to come to medical school and think twice about it because they worry about the expense of it. I think that can be transformational." 

I shared the argument for greater philanthropic support toward medical school tuition with Scott Becker, publisher of Becker's Healthcare, who for years has vehemently stated that the United States needs more physicians. His response? 

"I do hear you," Mr. Becker said. "And I see the reasons why so few people make that choice." 

He outlined a number of reasons donors may hesitate to fund medical students' education. They may not receive the credit, press or recognition they would like from such a gift, for one. 

"Two, if you're giving money, most people don't want to give money used to relieve medical school tuition of a family that would pay for it anyway or someone who is going into a highly lucrative specialty," said Mr. Becker. "No one wants to be the person who pays for four years of medical school for Doctor X to become an orthopedic surgeon or gastroenterologist who will make a living that makes that $207,000 [average debt] a reasonable amount."

Specialists in orthopedics and gastroenterology, on average, earn $573,000 and $501,000 annually, according to the latest figures from Medscape

The third reason shared by Mr. Becker might be the most vexing, as it's not one that can be accounted for by purse strings about use of funds based on student need, practice area or specialty. Rather, it's one that would take years to confront. 

"I wonder if people feel like giving to medical school tuition is such a small amorphous drop in the ocean that it's hard to sort of get excited about it," Mr. Becker said. "You feel like you are playing such a game of whac-a-mole, where there are so many people who need this, and medical school tuition is not even the problem as much as it is more residency spots. There are so many problems.

"Other countries are turning out doctors in essentially three years of med school and three years of residency, whereas we are taking four years of med school, four years of residency plus fellowships," Mr. Becker said. "I think there is resentment that you are funding into a system that essentially is antiquated and so out of date. It turns out great doctors, but in a horribly inefficient way compared to other countries." 

Accelerated medical education isn't a novel idea born from the physician shortage. In Canada, two schools — McMaster University and the University of Calgary — have graduated physicians in three years for decades. In the U.S., accelerated medical education dates back to the 1970s, when the U.S. government urged medical schools to cut education short by one year to help fill looming physician shortages. 

The 1971 Comprehensive Health Manpower Training Act provided a bonus of $2,000 per student graduating in three years. About a third of medical schools trimmed education by one year by 1973, but did not stay open for long. Programs were discontinued for traditional 4-year programs when shortages eased, federal funding declined and a not insignificant portion of students voluntarily signed on for an additional year to the three they originally committed to. One lesson learned from this time is that redesigning medical school requires far more than compressing curriculums designed for four years into three. 

Today, donors may feel as though they are maintaining a bureaucratic and broken system by putting funds toward students' medical tuition opposed to other healthcare and medical causes that may be seen as highly transformational, revolutionary or lofty. Philanthropists may see the status of the latter as more attractive to associate themselves with. 

"I hear the issue, and I get it," said Mr. Becker. "I also talk to lots of chiefs of philanthropy who would like to have this happen, but the people who want to give bigger gifts typically aren't giving it here. I think there probably is some resentment toward it being so ridiculously expensive and antiquated." 

What are your thoughts on where philanthropy comes in or can add the most value in light of the country's physician shortage? Please share your thoughts with mgamble@beckershealthcare.com.

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