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NYU Makes Tuition Free for All Medical Students

• retbull 8y ago
  I hope this helps to decrease the costs of medical care in the US to some extent as it removes one pressure for doctors to earn extra money charging for things that might not need to be needed. edit: Just so I am clear I know that there are lots of other influences on healthcare costs and doctor debt isn't the only pressure they face. Doctors do have some influence on cost (if not large) and if pressure on them is removed in any way some of them may choose to spend that extra time helping their patients money go further. Small early influences can have large effects on a system so I am hoping that this kind of influence might change attitudes enough to have a large longer term change.
  • umanwizard 8y ago
    I hope so too, but I can't see why it would. The market forces would be the same. I have no student debt but I still would take a higher-paying job, all else being equal. Not sure why it would be different for doctors. I'm not an economics expert so please let me know if this is a well-studied question and I'm just talking out of my ass.
    • retbull 8y ago
      Sure you might take a higher paying job but you might not take one that goes against your values just for money if you don't need it.
    • classichasclass 8y ago
      I think, and would hope, that medical school interviews would help to weed out those who are just in it for the money. Even in highly-paid specialties, you have to want to do the work you do. Were there people in my class who were in it largely for the prestige, etc.? Sure. Those people tended to go into high-profile specialties like plastics. But they were the minority, and I think that schools recognize in general these types of students are bad for the profession.
    • vlasev 8y ago
      It's not so much about how much you can make but more about how much you need to make to stay afloat. It's a very different story depending on whether you have $0k in debt or $300k in debt.
    • scarface74 8y ago
      Not on that scale. But I know plenty of teachers who chose not to be administrators because they enjoyed what they do. I also know many first level software development managers who “self demoted” to become software developers and took a pay cut. Other developers I know took a pay cut and contracted half the year. You can make those choices if you don’t have outrageous expenses- including student loans.
  • gk1 8y ago
    From my (limited) understanding, the high cost of malpractice insurance that doctors must pay is what drives up the cost of healthcare, more so than their student debt.
    • trhway 8y ago
      >high cost of malpractice insurance results from high cost of malpractice. So instead of treating the symptom - insurance, one has to treat the original condition - malpractice. To continue the analogy - the trial lawyers in case of malpractice is just like the immune system. When infection (malpractice) happens you see the heavy effects of immune system acting like high fever, yet it would be a grave mistake to suppress immune system instead of dealing with the original cause - infection (malpractice).
      • Bjartr 8y ago
        Malpractice suits are brought over 3x as often in the US as in Canada, and malpractice insurance can cost more than an order of magnitude more. However, in the US there is a much greater incentive to sue. About 21% of malpractice suits that pay out, pay out over $1,000,000. Something that elsewhere would merely net you enough to handle the medical fallout, in the US nets you a lottery jackpot. Because the money on the line is so high it incentives both layers and plaintiffs to aggressively maximize the payout. Like so many other aspects of the US health system, other countries do it better. * All claims were the results of a few minutes of research on Google, I would be interested in learning of evidence that contradicts my claims.
      • scarface74 8y ago
        Sometimes things happen. There are commercials on TV all of the time where lawyers are soliciting people to sue doctors for birth defects like cerebral palsy. I’m glad that my parents spent my childhood focused on therapy, motivation, etc to help me deal with cerebral palsy than placing the blame on the doctor. Yeah my case is relatively minor in the grand scheme of things.
    • karmajunkie 8y ago
      This has been conclusive disproven by comparing what happened in different states that enacted tort reform for medical malpractice. The cost of insurance dropped a bit, but there has been no effect the cost of healthcare provisioning.
  • chimeracoder 8y ago
    > I hope this helps to decrease the costs of medical care in the US to some extent as it removes one pressure for doctors to earn extra money charging for things that might not need to be needed. Physician earnings account for about 7% of total spending on healthcare. Of that 7%, the fraction due to student debt specifically is significant from the physician's perspective, but negligible from a systemic picture. This is, of course, assuming that physicians are charging for services that are not be needed in order to boost their earnings, which happens in some cases, but is not as systemic or widespread as people often think, due to the shift away from fee-for-service payment models and towards capitated care, and the opacity of the payment model to the physician at the point-of-care in many care delivery situations.
    • Eridrus 8y ago
      I'm really interested in this info, can you tell me where you got the 7% from? Are there good in depth breakdowns of this?
      • chimeracoder 8y ago
        It's a fairly easy statistic to find; here's the first hit on Google: https://www.medicalbag.com/finance/examining-physician-salaries-in-the-united-states/article/710038/ https://www.medicalbag.com/finance/examining-physician-salar... One caveat is that oftentimes you'll see higher numbers (in the range of 15-20%) cited, but that's usually because they're not distinguishing between doctors (MDs) and other clinical staff (nurses, physicians' assistants, etc.). In the aggregate, the latter account for about half, or in other words, roughly equal to what doctors in total pull in. As that article notes, this also doesn't mean that all of that money goes to the physicians themselves. Some portion is taken by the practices and groups that employ them, and a huge chunk of physicians' take-home pay is allocated towards business expenses[0]. For the context of the original article, only MDs are relevant, not what NPs, RNs, and so forth make. [0] Unlike software developers, who generally have their business expenses covered by their employer, physicians are typically expected to cover all of theirs out-of-pocket, which means that the seemingly-high salaries that you often see listed aren't directly comparable to salaries in many other fields, where the out-of-pocket expense are much lower.
  • blang 8y ago
    Changing how compensation is structured, would probably be the most effective way to discourage things that might not be needed.
  • acomar 8y ago
    Doctor's pay is not the driving factor behind increasing medical bills... administrative expenses at providers in insurance, opaque and arcane cost structures negotiated as deals between providers and insurance companies, and record profits at both insurance companies and providers point to a system that's cannibalizing itself. This will do nothing to costs even if implemented universally as it does nothing to address the actual causes of rising medical expenses.
    • karmajunkie 8y ago
      There's no single bogeyman behind rising medical costs but it's ridiculous to say that provider compensation has nothing to do with it. The single biggest driver, IMHO, is fee for service and medical supplies, but every aspect of the medical industry plays some role.
    • beat 8y ago
      I'm convinced that it's the cost structure, implemented by many-to-many negotiation between providers and insurers, that drives the uniquely high cost of the US health care system. (Unique as in twice as much per capita as the rest of the industrialized world.) Japan's system is structurally very similar to ours - employer-provided private insurance - with one key difference. In Japan, pricing for all medical goods/services are set by a government agency, with an eye to keeping the industry functional/profitable while keeping costs under control. There are no "networks". Everyone knows what it's going to cost, everywhere.
      • chimeracoder 8y ago
        > I'm convinced that it's the cost structure, implemented by many-to-many negotiation between providers and insurers, that drives the uniquely high cost of the US health care system. (Unique as in twice as much per capita as the rest of the industrialized world.) Japan's system is structurally very similar to ours - employer-provided private insurance - with one key difference. In Japan, pricing for all medical goods/services are set by a government agency, with an eye to keeping the industry functional/profitable while keeping costs under control. There are no "networks". Everyone knows what it's going to cost, everywhere. In the US, Medicare pays for 40% of the market, and they set prices unilaterally. In addition to providers are legally required to charge private insurers more, Medicare has no mandate to keep the industry profitable, and in fact their reimbursement rates are about 7% lower than COGS. In other words, providers are (in the aggregate) losing money on Medicare patients on a per-patient basis, even before they account for overhead (building maintenance, staff wages, etc.). Medicare knows this and admits as much - not just in their annual reports, but because they actually have a number of different stipend programs that provide extra money to providers who see a lot of Medicare patients, because otherwise they would literally go bankrupt and close their practices (ie, if they don't see enough privately-insured patients to be able to make up the gap, they will go out of business). Medicare is, actually, the biggest beneficiary of price opacity in the American healthcare system today, but that opacity is not going anywhere.
  • pastor_elm 8y ago
    why would doctors willingly give up making extra hundreds of thousands of dollars?
    • robotresearcher 8y ago
      Why would a university willingly give up millions of dollars in tuition? Some people and institutions optimize for other things once they have enough money. Alas, this couldn’t have a large effect on health costs anyway, since costs are dominated by things other than doctor pay.
      • karmajunkie 8y ago
        They're not giving it up—it's being paid by the interest on a rather large endowment.
        • naveen99 8y ago
          They are giving up interest on a rather large endowment.
          • stevenwoo 8y ago
            From the article they are 450 million into a roughly estimated 700 million needed to fund this new initiative.
          • amdavidson 8y ago
            An endowment that wouldnt exist except for the free tuition.
            • robotresearcher 8y ago
              Part of this money could only have been raised by a free tuition program. But many top med schools have somehow accrued huge endowments without offering free tuition. So that part may not be enormous. It’s an awesome program for these students.
  • mabbo 8y ago
    Why would it? Hospitals in America aren't actually a free market. You cannot choose not to buy, and in emergency situations you can't actually compare prices between sellers. Hospitals charge whatever they can get away with and insurance companies get a discount because they have some leverage- but you and I don't. All this would really do is help lower the medical providers costs. Likely it will give them additional funding to lobby against socialized health care.
    • mbostleman 8y ago
      Generally speaking, when exactly can you compare prices in a non-emergency situation? I have gotten to the point that every time I see my doctor, I ask for the costs because I enjoy the awkward and ultimately unanswerable question and I like bringing the problem to the surface rather than pretending it doesn't exist.
      • ksdale 8y ago
        It's truly ridiculous how hard it is for hospitals to answer this question sometimes. We've occasionally received the answer that they won't know the price until after the appointment because they won't know which code to charge until they've provided service. Then you ask what the cost of the likely codes are and they still have no idea.
        • mbostleman 8y ago
          Right. There's too many levels of abstraction. It's like trying to find the implementing code and all you keep finding is interfaces.
      • deleted 8y ago
        [deleted]
      • pandler 8y ago
        The cost of what? The end-user cost that you’re billed or their costs to provide the service?
  • mbostleman 8y ago
    If the subsidies are private it would be a great way to solve the "free education" for everyone promise that is gaining traction (I'm assuming education will also be pitched as a right if it hasn't already). But as long as health is not a free market, then the price isn't going to necessarily go up or down in response to costs. The price will continue to be function of political power and monopolistic practices as it is now.
  • jxf 8y ago
    Doctors have very little influence on the overall cost of care, especially where drugs are concerned. Do you think that when Mylan raises the price of EpiPens from $50 to $500 that it's a market-based decision, for example? No; that's just an exercise of monopoly power.
• aabajian 8y ago
  This is amazing. I graduated from medical school two years ago with $300,000 in debt. I'm a software developer on the side and would love to stop residency to try a healthcare startup and/or pursue a research, but the risk is too great - I need the attending salary to pay off the debt.
  • glitchc 8y ago
    If I may ask, how exactly do you have the time to be both a resident and a software developer? There aren't enough hours in the day. Do you even sleep?
    • blang 8y ago
      There is time for life outside of residency. My wife started residency with a 5 month old and had another child half way through, this delayed her graduation a total of 4 weeks.
      • CindyCarlson 8y ago
        While that's very encouraging to hear, that depends wildly on what program and specialty you are in. West coast vs East Coast plays a role too. Peds/OBGYN/IM/Derm and most female dominated specialties you see this. Neurosurgery, Ortho, Gen surg, etc not so much.
      • yawz 8y ago
        I have outmost respect for this type of dedication. Amazing!
      • glitchc 8y ago
        Good work supporting her. I'm sure that played a large factor. I suspect a single mom would have a much tougher time.
    • rcdmd 8y ago
      Heh, I'll chime in as I did residency at a busy program and advanced my coding skills on the side. Even working 80hr+ weeks you find downtime. Some of that you use for sleeping and studying. With whatever's left, some of my co-residents liked to read. Others had sort of social lives outside the hospital. For me, I coded with most of my freetime. It helped scratch an itch-- problems are solved with 100% certainty, errors can be found with testing preventing many mistakes before they actually affect people, you can build something with your creative juices and get a level of independence not possible in medicine... The list goes on. But my point is, residency is demanding, but you still have a little downtime here and there.
• classichasclass 8y ago
  Huge. I went private for my medical school education and came out of it with about $190K in debt. Fortunately I didn't have any undergrad debt. But I liked family practice, and I like public health, and I'm proud to work in those fields. I definitely understand the push to go to higher-paid specialties with a burden like that, though.
• neonate 8y ago
  http://archive.is/3qiUo http://archive.is/3qiUo
• wpasc 8y ago
  This is awesome! So many medical students are kinda forced into more profitable healthcare practices than ones which people need more desperately (e.g. plastic surgery vs rheumatology). I especially love that this was done with private fundraising over government funding. Philanthropy can be effective, often far more so than governments!
  • padobson 8y ago
    Plus anything that can be done to juice the supply side of the healthcare curve is a big benefit. Cheaper school means more doctors means lower labor costs means cheaper healthcare.
    • RightMillennial 8y ago
      Cheaper medical school tuition isn't going to lead to more doctors. The limiting factor is the number of available seats and residency positions, not the cost.
      • chimeracoder 8y ago
        > Cheaper medical school tuition isn't going to lead to more doctors. The limiting factor is the number of available seats and residency positions, not the cost. Bingo. Also, even if we somehow forced all doctors to work for free and magically ended up with the same quality of care, we'd still only reduce total spending by about 7%. That's a hard upper bound on the effects that increasing the supply of physicians can have.
      • dragonwriter 8y ago
        > Cheaper medical school tuition isn't going to lead to more doctors. No, but it might mean more doctors in the kind of practices and specialties that are socially useful but not serving the wealthiest of private pay clients, because the necessity of chasing the maximum returns is reduced.
  • hooloovoo_zoo 8y ago
    I predict this will have the opposite effect. This will increase the appeal of NYU leading to stronger students applying/accepting offers of admission who go on to get into higher paying specialties.
• dugluak 8y ago
  But who is going to pay off that $450 million ?
  • pastor_elm 8y ago
    law students
  • dugluak 8y ago
    Not sure about the down votes, I didn't mean to ask a rhetorical question. But someone has to pay if not students. Or is that not how it works in this case? Disclaimer: I couldn't read the whole article because I don't have a login to the website.
    • scarface74 8y ago
      Donations. And if you don’t mind going through Facebook (no login required) https://www.fullwsj.com/articles/nyu-offers-full-tuition-scholarships-for-all-medical-students-1534433082 https://www.fullwsj.com/articles/nyu-offers-full-tuition-sch... On a meta level. Can you really be accused of not RTFM if it’s behind a paywall - that doesn’t seem fair.
      • alexives 8y ago
        Weird, still gives me a paywall through that link.
    • blang 8y ago
      The $450 Million was the amount of money they already raised through donations, it's nothing they have to pay back.
  • imcoconut 8y ago
    As another user commented, the total cost per year is around ~$34 million which is roughly 5% of the total $600 million they're looking to raise. That 600 million will be invested to target some annual return and as long as that return is expected to be a couple of percentage points over 5% (which is not an unreasonable expectation) then they should be able to more than cover the cost every year, without even touching the principal amount. Looks like they're raising the total amount via donations
• jczhang 8y ago
  How do they have the money to do this, sustainably?
  • pcurve 8y ago
    By creating a giant endowment that can be used to generate cash. In this case, $600 million lump sum.
    • scarface74 8y ago
      While I’m glad that billionaires are donating, why should colleges be dependent on the largess of private benefactors to ensure that our healthcare system is sustainable?
      • naveen99 8y ago
        we want the most capable doctors. This will help keep more of top candidates from choosing other careers.
        • scarface74 8y ago
          I didnt mean to imply that the donors were doing anything wrong, but that the government should do more to make sure that there are enough qualified general practitioners and obstetricians. There is far more of a need for those specialties than higher paying plastic surgeons.
  • the_economist 8y ago
    One possibility is paying for it from their endowment. NYU's endowment is $4.1 billion. They make 7.5%/year on that according to this report: https://www.nyu.edu/content/dam/nyu/investmentOffice/documents/2017-08-31%20NYU%20Endowment%20Fact%20Sheet.pdf https://www.nyu.edu/content/dam/nyu/investmentOffice/documen... That's $300 million/year in growth, not counting donations. Their medical school apparently has 679 students. At $50k/year each, that's $34 million a year. Or approximately 10% of the appreciation in their endowment.
  • 8y ago
• sf_rob 8y ago
  I'll probably be downvoted on a forum like this, but I worry about the most successful universities using their funds to subsidize those who would be fine without it. I was actually made aware of this by a wealthy Stanford alumni which has a fairly broad program for undergraduate tuition assistance. Graduates of mid/low tier universities seem more and more likely to have to compete with better credentialed people with lower debt. Don't get me wrong, this is fantastic on an atomic level, and the levels of debt required to get an MD these days is insane (have a lot of family in the field). Also, it's not like this is a unique structural disadvantage, just a new one.
  • mbostleman 8y ago
    The paywall hits for me before the source(s) of the subsidies is identified (assuming they are identified). So how much is public and how much is private?
    • classichasclass 8y ago
      "NYU raised more than $450 million of the roughly $600 million it estimates it will need to fund the tuition package in perpetuity, including $100 million from Home Depot founder Kenneth Langone and his wife, Elaine." Sounds largely private.
      • gt_ 8y ago
        That is a shame. I wonder what the stipulations are. Of course, we will never be sure. But there’s no doubt private money is ruining science enough as it stands. A far more humane system would not be giving wealthy people so much influence on what people learn at school.
  • btian 8y ago
    What are you worried about?
    • caymanjim 8y ago
      Indeed. Some of these universities (Stanford, Harvard) are so filthy rich that they could provide free tuition for everyone and still watch their endowments grow from investment returns alone. Not to mention the enormous gifts they receive from successful alumni. Harvard has received hundreds of millions from the likes of Bill Gates and Mark Zuckerberg.
• kaitari 8y ago
  This is great! Now lets please do the same for nurses and social workers who pay exorbitant tuition rates, too, yet get paid peanuts to be on the frontline of health care.
  • chimeracoder 8y ago
    > Now lets please do the same for nurses and social workers who pay exorbitant tuition rates, too, yet get paid peanuts to be on the frontline of health care. I would not say nurses get paid "peanuts". Not many jobs would let you earn close to $100k in New York City with only a bachelor degree (or in some cases only a two-year associate degree)
    • CindyCarlson 8y ago
      4 year bachelor + 4 year md + 3-7 year residency ( hourly pay is ~ 1/4 a nurses on an hourly basis) + (optional) 1-4 year fellowship (cardiology, surg-sup specialties like trauma, hand surgery, etc) + (optional) 4 year PhD (20%+ of rad onc physicians have a PhD too.
      • amdavidson 8y ago
        Parent was referring to nurses...
  • pmiller2 8y ago
    Especially social workers. I have literally no idea why anyone would go to grad school for an MSW and take on the kind of debt required to do so, then enter a profession with the combination of low salaries and horrible work environment that social work has. The same goes to a slightly lesser extent for secondary and elementary school teachers.
• ngngngng 8y ago
  Off topic, but I love how WSJ let's you through without a subscription as long as your referer header is set to Facebook.
  • findjashua 8y ago
    or twitter (and likely other social media platforms as well)
  • kk123789 8y ago
    how do you change the header?
    • ngngngng 8y ago
      On my phone I literally just post it to my facebook under "only me" privacy and then click it from there. On my laptop i've got a chrome extension that I made a rule to add that header whenever i'm on certain sites.
• cwp 8y ago
  Bravo! I just wish there was a middle ground here. The problem is that tuition is too high, not that it exists at all. Lowering tuition would solve the problem just as effectively, and could be done for more students.
  • pc86 8y ago
    Lowering med school, law school, and undergrad tuition by 8% across the board doesn't quite get the publicity that eliminating med school tuition does, though.
    • blang 8y ago
      It's also easier, NYU med school has ~530 students, NYU undergrad has ~26,000 students
    • InitialLastName 8y ago
      Especially when they've probably raised it by at least that much just in the last few years.
• naveen99 8y ago
  I wonder if they will cover the tax if the irs decides to call it income to the student. But good to see. Doctors have been getting squeezed pretty hard recently. Something has got to give. Radiology had around 80 unfilled residency spots a few years ago because of poor career outlook.
  • karmajunkie 8y ago
    I think this has more to do with ML advances putting radiologists out of a job.
    • naveen99 8y ago
      No. I think it was just a large drop in compensation along with increase in productivity targets making radiologists less likely to sell radiology to MED students. Radiology job market improved since then, residency spots are not going Unfilled anymore. ML may put radiologists out of a job, but it will take some time I think. Lots of changes will happen by then. Radiology is a nice place to be for hacker types in medicine. It’s actually a fun place to do ML research which I do also (radiologist / AI researcher) Edit: Medicare has walked back some compensation cuts for medical imaging (for multiple procedures on the same day). My tin foil hat theory is the cost cutters got spooked by the prospect of no more us graduates in radiology.
• gerpsh 8y ago
  > School officials worry that rising tuition and soaring loan balances are pushing new doctors into high-paying fields and contributing to a shortage of researchers and primary care physicians. I think this is only partially true, because it misunderstands the motivations of many would-be doctors. Sure, the cost of medical education factors into specialty decisions, but as long as derm and ortho are regarded as more _prestigious_ than family med and general peds, you're going to see similar residency application numbers. There's still a social hierarchy within the medical profession, which the price of tuition doesn't immediately change. Still, this is great for people set on primary care as a career. Interestingly enough, my general observation has been that students who need the money the _least_ (i.e. people whose families are paying for their educations) are the ones who are gunning for the highest paid (and typically most prestigious) specialties.
  • MrEfficiency 8y ago
    Its important to clarify these arent 'doctors', these are Physicians. There are doctors of physical therapy who make 60-100k. Physicians have a government monopoly on prescription and referrals. The scarcity in MD and DO licenses drives up the cost due to the power granted by the license.
  • hectorr1 8y ago
    In my experience, the people who go for the extra money in derm and ortho don't need it from a wealth perspective, but often need it from a social and self-worth perspective. Over time this dynamic translates into to the prestige gap.
  • adpirz 8y ago
    Is derm really about prestige? Or is it about a relatively high salary with little to no on call time and mostly 9-5 hours?
• dhbradshaw 8y ago
  That's an easy way to become the most competitive medical school in existence. Of course, no tuition doesn't mean no debt in a town like NYC. But what a difference!
• x2f10 8y ago
  Idea: What if tuition was initially free for all students and universities collected a percentage of the graduate's pay for a fixed number of years?
  • nwienert 8y ago
    Question: Why would you want to obscure the real cost of college even further?
  • tootie 8y ago
    Universities would probably stop offering humanities and push kids to professional courses.
  • winslow 8y ago
    That's the idea behind lambda school. Interesting podcast interview from Indie Hackers[1]. They only collect if your salary is above $55k if I recall correctly and there is a max amount that they take in total. [1] https://www.indiehackers.com/podcast/046-austen-allred-of-lambda-school https://www.indiehackers.com/podcast/046-austen-allred-of-la...
  • naveen99 8y ago
    Just s/university/federal student loans currently. But that’s not really free.
• nameisu 8y ago
  will international students get any?
• patagonia 8y ago
  I left my career path in local government partially due to financial concerns related to undergrad debt. This is not strictly a medical sector issue.
  • MrEfficiency 8y ago
    I have a hard time understanding if this is bad. Economics says that things are designed to work this way. You have felt the economic indicators and made changes accordingly. The economy(you, your friends, your community, the world) benefits when you make profit. If your prior path was burdened with massive debt with little way to repay it, it sounds like a bad decision. I cant imagine too many situations where doing something that pays significantly worse and puts you in more debt is better for society.
    • patagonia 8y ago
      I didn’t say massive debt. I said it was a part of my decision. And I was able to repay it, eventually. Your assumptions show you are biased in how you read my comment. Also, I think you’re missing some variables. Or, as they might be called in economics, externalities. The less money we spend on prisons the better for state and federal coffers, in the short run. The less a company pays a prison guard for their services, the better for the share holders. But what about everything that happens on the day an inmate is released back into society? Are their neighbors happy they were incarcerated by near minimum wage persons with little guidance or oversight and perhaps a bit too much enthusiasm? Are their employers happy they were not given access to higher education or the ability to learn a trade? Or let’s talk about educators. Or defense attorneys for the indigent. I’ll leave the remaining examples to be worked by the student. Seriously though, as someone that graduated with dual degrees in political science and economics, worked for a couple years in local government, then went to Manhattan to work in the financial markets for 5 years, and is now working a “tech” job. Sorry I don’t have patience for this.
• mbrumlow 8y ago
  I feel like all the collage should be free people are not thinking far enough ahead to what that actually means. 1) A free collage will end up being more like extended high school. 2) At some point new institutes of for pay higher education will pop up. They just won't be called colleges. People who can afford them will clearly have a advantage and top companies will start to seek out people who attended these organizations. 3) The quality of the education will drop. It already has at a lot of schools with the introduction of loan for everybody gig. While this will reset thing for a while. Maybe even a generation of two. We will end up again with people wanting the next level of education free. EDIT: now that I am not trying to type on a tiny phone. The problem with free is it will then need to cater to the LCD. Right now we we have a filter on the LCD because there is some effort and risk required by the person going to school. There is something special about buying something, and owning it. You tend to tend for it better, give it the attention it needs and ensure it last a long time. If we bypass this step we will end up with masses going to school doing the same thing they do in high school today. This might be hard to visualize as the HN crowd is a fairly smart crowd and probably took advantage of the offerings of their high school, and likely were not aware of those who did not. This won't be as big of an issue for those who are "gifted" as they will be sheltered in their special classes slotted away with like minded ilk. But for the less "gifted" student the expense will be dragged down to the LCD. So if you are not lucky, smart enough, or had the right coaching from parents to get into those gifted classes you will be left with a much worse education.
  • chimeracoder 8y ago
    To an extent, this is what's already happened. If you actually look at a lot of college curricula - including at the top schools, but especially at the rest - a lot of that is dedicated to making up for the failings of K-12 education, particularly high school. To a degree, expecting college education of people is really just filtering for the baseline that we would like a high school degree to guarantee, but which it isn't.
  • WhompingWindows 8y ago
    I don't think anyone is suggesting all private institutions should be tuition free. NYU chose to do it for medical school, however the progressives in USA just want public college to be tuition free. I doubt those outcomes will come to pass. Tuition used to be basically free in the USA, and it already is in many European nations, and we didn't/don't see those outcomes that you worry about.
• bawana 8y ago
  for nyu to make tuition go away means that they are already having a large cost processing loans/grants/discounts along with the compliance costs for sallie mae,etc. NYU is a PRIVATE university as well so they can be super selective in whom they accept - and now they become even more selective - admitting those with legacy contacts, etc. Finally, the truth is that they need warm bodies to run the hospital and if the cost of living in NYC is so high that nobody wants to do residency there (training after med school), then how are they going to get PCPs? They'll need to pay an arm and a leg to get them (dark pun?) By having a steady supply of med students who are already situated in NYC, they assure a steady supply of residency candidates.
• bawana 8y ago
  They need warm bodies (residents are cheap labor) to run the hospital (the money machine that gets thousands of dollars per xray, per drug, etc). A steady supply of med students who are already situated in NYC saves them the cost of recruiting residents from afar. And who knows how much money they save by cutting the bureaucracy to administer tuition, loans, Sally Mae compliance, etc.
  • chimeracoder 8y ago
    > They need warm bodies (residents are cheap labor) to run the hospital (the money machine that gets thousands of dollars per xray, per drug, etc). A steady supply of med students who are already situated in NYC saves them the cost of recruiting residents from afar. And who knows how much money they save by cutting the bureaucracy to administer tuition, loans, Sally Mae compliance, etc. This is a rather elaborate conspiracy theory, and one that falls apart entirely once you think about the actual costs of residency programs, the mechanics of matching students, and the real ROI that they would make in the process. It's absurdly out of proportion with what would be needed to make this theory work.
    • CindyCarlson 8y ago
      > This is a rather elaborate conspiracy theory I wish it was. > and one that falls apart entirely once you think about the actual costs of residency programs What are the `actual` costs of residency program? > the mechanics of matching students As someone who has seen how the sausage is made ... the junior attendings (usually paid like shit because it's an academic institution) sort through a few thousand ERAS applications who narrow it down to a few dozen candidates. We hold a few interview dates and have a dinner at somewhat nice place. We have a meeting. We make a rank list. An algorithm matches our residents. That's it. Consider that what the average applicant spends on traveling for interviews (I'd guess ~5-15k, more if couples matching or competitive specialty; many take out loans for this)... I don't feel bad for the programs holding a few interview dinners. > real ROI that they would make in the process What are you basing this on? Most teaching hospitals would fall over without cheap resident labor. In practice, my experience is that residents function like extremely cheap, slightly-more capable mid-level providers.
• aantix 8y ago
  This is probably the other piece of the puzzle regarding the implementation of single payer healthcare. Because who in their right mind wants to sacrifice 16 years of earning potential, take on 500K of debt only to become an MD with long work days and now prices that are fixed with no other form of negotiation leverage in sight.
  • nappy-doo 8y ago
    Does anyone know if the single payer models we use in the US keep Dr. salaries on par? I've only heard of savings from negotiated drug prices, and insurance overhead; but, if Dr. salaries are also decreased, OP's got an interesting point.
    • s0rce 8y ago
      I don't think doctor salaries are substantially lower in Canada.
      • aantix 8y ago
        I couldn't find the original study that these articles are based off of.. "Canadian doctors still make dramatically less than U.S. counterparts: study" https://nationalpost.com/news/canada/canadian-doctors-still-make-dramatically-less-than-u-s-counterparts-study https://nationalpost.com/news/canada/canadian-doctors-still-... US doctors earn much more than peers, study says https://bangordailynews.com/2011/09/09/health/us-doctors-earn-much-more-than-peers-study-says/ https://bangordailynews.com/2011/09/09/health/us-doctors-ear...
    • rohanshah 8y ago
      From my understanding of Bernie's "Medicare For All" bill (S. 1804) [1] payment to providers would be fixed at the, well, Medicare rate. Medicare rates are about 40% lower than private insurance (about 56% of national healthcare spending is private), but it's also higher than Medicaid and obviously higher than what the uninsured pay. All-in-all, from the figures I've seen [2], this specific single-payer plan would lead to about a 10.6% [3] overall reduction in payment to providers (some of which will be ameliorated by a reduction in costs that maintain complicated insurance administration work at hospitals) but I imagine providers will generally take some percent hit to payments which would in turn affect physician salaries (albeit not drastically) [1] https://www.congress.gov/bill/115th-congress/senate-bill/1804 https://www.congress.gov/bill/115th-congress/senate-bill/180... [2] https://www.mercatus.org/system/files/blahous-costs-medicare-mercatus-working-paper-v1_1.pdf https://www.mercatus.org/system/files/blahous-costs-medicare... [3] https://www.peoplespolicyproject.org/2018/08/15/provider-payments-only-fall-by-10-6-in-mercatus-study/ https://www.peoplespolicyproject.org/2018/08/15/provider-pay...
• dawhizkid 8y ago
  How terrible would you feel if you just graduated from NYU and sacked with $500k-$1m in debt?
  • s0rce 8y ago
    Or any other medical school really...
  • tribesman 8y ago
    In social settings, absolutely no one asks how much debt you have but everyone asks which university you went to.
• justonepost 8y ago
  So 650M is enough for NYU. The top 10 universities have endowment funds > 10B. Shouldnt they all be full rides for everyone as well?
  • conanbatt 8y ago
    They are private institutions, you can try to persuade them of that at any point.
• elliotec 8y ago
  All school should be free, period. This is a great step but a long way to go.
• mixmastamyk 8y ago
  Always wondered why everything medical is either absurdly expensive, or free. Why not a reasonable price?
• milesdyson_phd 8y ago
  This is all an effort to attract the best applicants, much like Mayo and the Cleveland Clinic med schools.
• bogomipz 8y ago
  >"School officials worry that rising tuition and soaring loan balances are pushing new doctors into high-paying fields and contributing to a shortage of researchers and primary care physicians." It's worth noting that NYU tuition for regular undergrad is $50K before room and board and $68K with room and board [1]. The cynic in me has to wonder if they share the same concern for the rest of the legion of debtors they are churning out every year. I'm not doubting the importance of research and primary care physicians in our society. But six figure debt loads for university are commonplace in the US. And are likely causing skew in career choices in non-medial fields as well. I also have to think that there's something in this arrangement for NYU and that there are motives outside of just societal altruism here. I just don't know what those are. Research money? 501(c)(3) maintenance? Something else? [1] https://www.investopedia.com/articles/personal-finance/010915/cost-studying-new-york-university-nyu.asp https://www.investopedia.com/articles/personal-finance/01091...
• brtknr 8y ago
  I do not live in the US and therefore I am not sure why medicine has been singled out as a worthy profession to receive subsidy over many others? Don’t those in the medical profession get paid reasonably well over there? Aren’t there other professions equally necessary for a functional society that don’t get compensated as well as they should like teachers, social workers and those in the voluntary sectors who would be better off with this money? I personally think this is a misjudged priority in the grand scheme of things.
  • hn_throwaway_99 8y ago
    There are a couple arguments: 1. This isn't an "either/or" proposition. This is one university that is making medical education free. There are other universities and programs that have free or low cost programs for the jobs you discuss. 2. Medical school education is phenomenally expensive in the US, unlike training for the other jobs you give as examples, and this expense has a structural impact that negatively impacts our health care system. The high cost of education is one reason that so many doctors opt for higher paying specialties that have higher salaries but don't necessarily result in an overall healthier society.
  • Broken_Hippo 8y ago
    The expense of medical school makes going unreachable for a portion of people. The pay comes later, after all the schooling is complete, and then paying back the loans can still be a burden. From what I have seen, anyway. And yes, there are other professions equally necessary. To be fair, though, most of those jobs don't require the same level of debt either, and are more obtainable by folks with lower incomes pre-schooling.
  • dionidium 8y ago
    It's also the case that medical students are a pretty good risk. Graduation rates are very high [0] compared to the broader population of undergrads [1]. We sometimes talk about college as a binary -- "Did you go to college? Yes/No? Should we pay for college? Yes/no?" -- but there are enormous differences in experiences and outcomes across majors and institutions. [0] https://www.aamc.org/download/379220/data/may2014aib-graduationratesandattritionfactorsforusmedschools.pdf https://www.aamc.org/download/379220/data/may2014aib-graduat... [1] https://nces.ed.gov/fastfacts/display.asp?id=40 https://nces.ed.gov/fastfacts/display.asp?id=40
• Havoc 8y ago
  How? Medical is one of the most expensive courses to provide. I mean I love this, but who is footing the bills on this & are we sure they won't taint the results with ulterior motives...
  • rubicon33 8y ago
    Seriously. I don't understand how this is possible. Nothing in life is free... Someone, or something, is footing this bill - no?
    • drak0n1c 8y ago
      It will be paid for in the form of reduced class size growth and its endowment funded by billionaire alums - maybe they are betting on future alum donations as well. Unclear if that's sustainable.
• markmichalski 8y ago
  Included in the list of perhaps not totally intended consequences: I think this may allow some MD students to think twice about practicing and take less traditional (potentially less secure) career routes. I may be biased, having effectively not practiced for a couple years now myself, but I think this could be a good thing to an extent. I work with 3-4 MDs that chose not to practice who are now working on defining software/ML product feature requirements; their MD experience makes them solid product specialists for clinical solutions that hopefully will help a lot of people...not having to stare down the barrel on loan payments may help people make these kind of career moves that may ultimately progress the system. All that being said, we (obviously) need good docs at the bedside.
• true_tuna 8y ago
  Medical school may be free, but the WSJ isn’t.
• fipple 8y ago
  I can't think of anyone who needs free tuition less than medical students. When they finish their residency they enter a highly protected, highly paid workforce and can easily pay back their loans. Yeah it sucks until you're a doctor but NYU could fund only the interest so that graduates could start paying back their loans when they're 35 or so.
• anonymous5133 8y ago
  I think the kicker here is...how many actual students do they accept? Usually when I see stuff like this I think that the amount of students they accept is very low.
  • dmoy 8y ago
    NYU med has <1k people at any given point in time
• daveheq 8y ago
  Finally someone putting education before money; maybe these kids can get educated without having to worry about taking crap jobs outside of their career taking up their time to pay for loans that will tank them otherwise instead of looking for a job in their career or ramping up as an intern.
• cncrnd 8y ago
  Is anyone not going to med school because of debt? Not sure what problems this solves. For the long commitment that doctors make and the debt they take on, they receive basically guaranteed highly paying employment for as long as they wish. There's also a shortage of medical school spots, we can't create enough doctors. I think this is probably an attempt to compete with other medical schools for top students. NYU is pretty well respected bit probably loses a lot of candidates to Harvard, Yale, etc.
  • Nasrudith 8y ago
    Perhaps as a back of a line thing - not those about to enter it. It is already infamously grueling. Graduating and being six figures in debt could try the patience of many. "Staying in school in a high stress environment till near my thirties is bad enough without being in debt practically big enough for a house for years afterwards. I'll just go into banking after four years so I can actually enjoy the money while I am young." Whether you want doctors with such am attitude is another question.
    • cncrnd 8y ago
      Banking and tech aren't guaranteed the way medicine is. Other fields are result based, and it's often easy to get fired and be replaced. A risk averse person would rather stick to what they know (student life, exams) for a guaranteed reward. The debt isn't really that much. Probably the average is 200k. You can pay that off within about 1-2 years of residency, and interest rates tend to be low since they're low risk loans for banks to give out.
      • aesclepius 8y ago
        > The debt isn't really that much. Probably the average is 200k. You can pay that off within about 1-2 years of residency, and interest rates tend to be low since they're low risk loans for banks to give out. Please try looking at the numbers again. Assuming you pay off undergraduate loans, a private medical school will cost $30-45k a year (not including living costs, so tack on another $30k a year), so assuming ($150-$300,000) will be total assumed debt (not including books, unexpected expenses, etc) during those 4 years. Residency salary is basically stuck at around $50k/yearly for 3-5 years (based on residency type), you can contribute back to loans but there's not a chance you're paying that off in residency. (source: current medical resident)
• JungleGymSam 8y ago
  Why is it so popular to call for free college? Why not something more reasonable like 50% less?
• jeandejean 8y ago
  That's an amazing news! Being aware that education costs a lot is important, but being able to afford education is paramount. Having to sacrifice 10 years of first jobs savings to reimburse the student loan is just insane. Especially considered tuition is skyrocketing without any meaningful reason: education is not better in that proportion than 10/15 years ago.
• geff82 8y ago
  What a surreal discussion about something obvious: University and college should be free for everyone. First, this is a great equalizer in the positive way: it does not depend on how wealthy your parents are, so you get an equal opportunity. Second: the society as a whole benefits from well educated people. Accounts need well trained doctors, doctors need well trained accountants, both need an engineer to craft them a reliable car, etc etc... Countries like Germany show that university/med school can both be free and high quality. Od course also in Germany some private elite universities exists where you have to pay (it is ok, I like diversity). But to get a perfect career, a state run university is all you need.
  • avip 8y ago
    Always replace "free" with "I'm paying for you". I don't know what's "obvious" about me paying your tuition fees. For once, I may be happy to fund your auto-mechanic studies as I know I'll need you to fix my car. But if you're studying ancient Akkadian I'm less inclined to pay your bills.
    • orbifold 8y ago
      If you are not super rich most likely you are paying a tiny fraction towards the higher education of someone else's child. Plus if you have kids you benefit from the same system. I actually know several people with useless degrees that now have well paid jobs here in Germany, one studied Ancient Greek and Latin and is now at Germanies federal reserve the other studied art history and is now a SAP consultant. Those degrees are also much cheaper than training everyone in STEM fields.
      • hayd 8y ago
        Math is pretty cheap too.
        • orbifold 8y ago
          Good luck training more than 2% of your population in math without significantly degrading the difficulty, I studied math and probably half of the people dropped out after the first semester.
• ralmidani 8y ago
  Why medical school and not, say, engineering or economics or math? I value having good physicians (my father is one), but medicine is not the only worthwhile human endeavor. Edit: Also, at least in my state (Michigan) there seems to be no shortage of medical students (we went from 4 med schools to 7 earlier in the decade). The real bottleneck is residency programs.
  • aquamongoose 8y ago
    Maybe because PhD programs in those fields already are free at every university (in fact, they pay you a stipend).
    • ralmidani 8y ago
      In exchange for that stipend, you work insane hours as an RA and/or TA.
• jmh530 8y ago
  Upon graduation, these free tuition doctors will be taking jobs in a competitive market. Some doctors they compete against will have debt, some won't. But it really isn't like the amount they charge for services will decline. This just means that some doctors will get a little bit richer...
  • Dowwie 8y ago
    That is NYU's intent and it's been up front about that. Primary care physicians don't earn as much as other physicians do. This program creates economic incentives for students to pursue the field.
• exegete 8y ago
  Can't read the article. Will students be obligated to pay anything to the school in the future after they start earning? Who is funding this?
• throwawaymanbot 8y ago
  This is welcome. But something has to give for all US students, Coming out of college 300K in debt must be a horrible nightmare. (Or whatever NYUs fees are for medicine over the years you are there) Europe can educate their best and brightest without the insane prices US colleges have, so why should US student suffer undue (ridiculous) burden?
• JoeAltmaier 8y ago
  NYU already has an endowment large enough to accomplish this ($3B). They are not $400M donations on the way to $600M before this can happen. They just want more money, and they want Alumni etc to pay for it. I've been confused why so many large-endowment colleges still charge tuition. It seems pointless, gathering crumbs from students each year. It creates institutional obstructions to whole classes of student etc. Is it just tradition?
  • ejstronge 8y ago
    I suspect that NYU, like many universities, has separate endowments for its academic units. Thus, the med school endowment may indeed be too small to support their free tuition goal.
• EGreg 8y ago
  Glad to see my Alma Mater leading in things like this. Now NYU medical school will be an even more sought-after destination. Still I look forward to a world where this scarcity of ivy league schools, news organizations, self-driving car software etc. is a thing of the past and everyone collaborates on a growing snowball of knowledge. I believe universities will eventually turn into centers for labs, certification and socializing, while information delivery (the commodity) would be done entirely online and students would form their own groups. Then, school would be much cheaper - and we could even have free subsidized tuition for all!