by Sally C. Pipes
Another medical school has gone tuition-free. Johns Hopkins University announced last month that it will waive tuition for all students from families earning less than $300,000 starting this fall, thanks to a $1 billion gift from former New York Mayor Michael Bloomberg.
Bloomberg hopes free tuition will enable more applicants from diverse backgrounds to pursue their dreams of becoming doctors — and help address America’s physician shortage in the process.
It’s a worthy goal. But our dearth of doctors is not a function of the cost of medical school. We’re short on physicians because there aren’t enough residency slots where they can complete their training. Philanthropists looking to address the physician shortage — and improve patient access to care — ought to consider funding additional residencies.
More than 74 million Americans live in federally designated primary care shortage areas.
Consider that 20% of the U.S. population lives in rural areas, but only about 11% of doctors practice there. That could help explain why rural Americans suffer greater rates of chronic diseases than their urban counterparts.
The Association of American Medical Colleges predicts that we’ll need up to 86,000 more physicians by 2036 to meet the demands of our growing and aging population.
The problem stems, in part, from legislation that’s more than a quarter-century old. The Balanced Budget Act of 1997 capped federal funding for residencies. So the number of residency slots available to aspiring doctors was essentially stuck at 1996 levels for nearly three decades.
Congress increased funding to expand the number of residency slots in 2020 and 2022. But it hasn’t been enough to catch up to the growth in medical school enrollment. While there were just under 71,000 students pursuing M.D.s in 2004, there were nearly 98,000 in 2023 — a roughly 40% increase.
The resulting mismatch can make it difficult for medical students to secure a residency after they graduate. This year, there were more than 44,800 doctors applying for just over 41,500 residency positions across the country.
In other words, there’s plenty of demand for a medical school education. And yet, philanthropists are subsidizing that demand further with their gifts to medical schools. Bloomberg’s is only the latest.
Earlier this year, the Albert Einstein College of Medicine received a $1 billion gift from Ruth Gottesman, a former professor. The donation will ensure that all four-year students receive a tuition-free education come fall.
In 2018, Kenneth and Elaine Langone started a $100 million endowment fund to ensure all current and future medical school students at New York University Grossman School of Medicine receive free tuition. And just last year, they donated another $200 million to the NYU Grossman Long Island School of Medicine to provide free tuition for medical school students there, too.
Those donations will no doubt change the lives of many aspiring doctors. But imagine if some of those millions had gone toward creating more residency positions.
Consider the example of the University of Texas at Tyler School of Medicine, which recently received a gift of $900,000 from Texas Mutual Insurance Company to expand the school’s occupational and environmental medicine residency program. While the program currently accepts just four residents annually, it will expand to five annually for at least the next six years, thanks to the donation.
The University of Nevada, Reno School of Medicine received a $500,000 donation from the E.L. Wiegand Foundation in late 2023. The money helped to establish a new pediatrics residency program, which will eventually train up to 12 providers. The school expects the program will increase the number of pediatricians in the surrounding area by at least 17%.
Philanthropists with an interest in supporting the next generation of physicians should not limit their ambitions to making medical school more affordable. Our nation’s residency infrastructure could benefit from their largesse, too.
