NYU School of Medicine has made big headlines recently by promising free tuition for all its current and future medical students, regardless of merit or ability to pay. With a tremendous grant of $100 million and eventual goal of $600 million, their aim is to relieve the debt burden on students, thereby attracting a more diverse and inclusive student population from low income families. They also hope that their offer of free tuition will encourage more students to go into historically lower paying specialties like family medicine, to address the shortage of primary care physicians in the medical workforce. However, their decision of free tuition for all has not been without critics, who point out that a) doctors, who are among the top 20% of earners in this country, are hardly the ones who need a windfall of more money and b) student debt does not hugely influence one’s decision to go into a lower paid specialty therefore free tuition might not necessarily produce more primary care doctors.

So, what does influence students to go into their respective specialties? What can the medical community and medical schools do to attract students to primary care?  According to a 2013 research article¹ on what factors are important to first year medical students, students ranked “enjoying the work I do” and “having control of the work schedule” as their top 2 reasons for choosing a specialty. Financial compensation was ranked near the bottom. On the other hand, there has been studies² showing that medical students with high student loan debt are more likely to have higher levels of stress, delay getting married, having children, buying houses and may also be more likely to choose a specialty with a higher income.

As a 4^th year medical student preparing to apply to into family medicine residencies, I can only offer my own narrow experience of choosing a specialty. Although I had expressed an interest in primary care early in medical school, I had originally wanted to be a general pediatrician. I found that choosing a specialty depended on experiencing various clerkships during third year.  For me and many of my peers, especially those who were undecided, experiencing how lifestyles and type of work differed from rotation to rotation ultimately attracted us to a certain specialty. I enjoyed the outpatient setting, longitudinal patient relationships, and having relatively easier hours compared to other rotations. However, the support I received from the MAFP, AAFP, and excellent mentors from my medical school is really what drove my enthusiasm to family medicine. Thus, it is the school environment and advisor attitudes that make all the difference. Schools that encourage students to engage in community service, offer mentorship, provide student leadership opportunities, and have advisors who support and encourage decisions to go into primary care, rather than deter them, will foster early interest in primary care. Strong family medicine departments and excellent faculty can guide undifferentiated students into family medicine will champion the upbringing of new generations of family physicians.

If NYU is seriously committed to bringing in more low-income students, they must ensure their selection process prioritizes student’s backgrounds and desire to help low income communities. In addition to relieving student debt, if NYU (or any school) hopes to turn out more family physicians they must carefully evaluate their own curriculum’s engagement with community service within underserved populations, as well as how their faculty and advisors view family medicine as an essential part of delivering healthcare. While free tuition would be a dream for any medical student, the reality of deciding what kind of doctor we want to be for the rest of our lives is much more complicated.

………..

Sources:

• Clinite, Kimberly L., et al. “Primary care, the ROAD less traveled: what first-year medical students want in a specialty.” Academic Medicine10 (2013): 1522-1528.
• Rohlfing, James, et al. “Medical student debt and major life choices other than specialty.” Medical education online1 (2014): 25603.

………….  . . .