The perverse consequences of tuition-free medical school

From the article:

[I]n practice, eliminating tuition at elite medical schools is a terribly designed solution based on an intuitive but false premise. Rising tuition is not really the cause of the medical profession’s problems. Although medical students take out hundreds of thousands of dollars of loans, even the bottom quartile of physicians by income can expect to earn about $6 million in their lifetime. “Even for primary-care physicians, tuition is a fairly small share of their lifetime income,” Maria Polyakova, a health economist at Stanford, told me. Her research finds that the overall income differential between specialties—primary-care physicians can expect to make about $200,000 a year, compared with more than $500,000 for a specialist—is what dictates which fields people enter. The argument that making med school free would cause many more students to go into primary care “is just not supported by the data,” she told me.

The donations also appear unlikely to affect where people practice medicine. The schools that have gone tuition-free are all prestigious programs in major cities. None of them ranks even in the top 100 medical schools with the most graduates practicing in underserved areas. “You can’t take somebody that grew up in the suburbs and transfer them into New York City as a medical student and really expect that they’re going to take a job in Iowa,” Dinerstein told me. “Some will, but just not in general.” Although there’s plenty of need in the areas surrounding elite medical schools, making tuition free doesn’t create any new incentives for students to opt for community health centers over distinguished hospitals. “The medical schools that have gone tuition-free, they take strivers,” Dinerstein said. “And strivers, for all the things they had to do to get to medical school, are not going to stop now.”

In fact, tuition-free status could perversely be making it harder for low-income and underrepresented minority students to go to medical school. In the year after NYU went tuition-free, the number of applicants shot up by 47 percent. Because the number of slots did not increase proportionally, this made getting admitted dramatically more difficult. High-income applicants have extensive advantages at all levels of higher-education admissions, so making a school more selective virtually guarantees that its student body will become more wealthy, not less, which is exactly what happened at NYU.

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Philanthropic money would be better spent expanding class sizes, establishing new schools, or lobbying Congress to allocate more federal funding to increase residency spots, instead of subsidizing demand.

More generally, maybe studying what's effective beats billionaires making large donations based on vibes.