How is this very different than applying for and accepting a scholarship? Wouldn't this have approximately the same downsides as people that get full ride schol

How is this very different than applying for and accepting a scholarship? Wouldn't this have approximately the same downsides as people that get full ride scholarships to University? I trust the medical school admission process to select good students for their program. I'm sure with free tuition they'll have more than enough promising candidates.