Tuesday, April 10, 2012

Medical school tuition. Follow the money?

You may have missed this New York Times story from the other day. For several years, St. George’s University Medical School has been paying New York City’s public hospitals to teach its third- and fourth-year students. Now the school has established a scholarship fund that it will use to try to entice its students to train as primary care physicians and work in the city hospital system.

St. George’s also is offering the public hospitals more money if they will allow more St. George’s students to do their clerkships at those institutions.

So, you say, what’s the problem? It seems that New York City’s medical schools are upset about all this.

Here’s an excerpt from the Times article: “The deal seemed likely to increase friction with the New York City area’s medical schools, which have already complained that St. George’s is squeezing out their own students because it is willing to pay for clinical training. That training has traditionally been perceived as part of the mission of teaching hospitals, to be offered without charge.”

To clarify this. Medical schools like Cornell, Columbia, New York University and Mount Sinai must farm students out to other hospitals because their main medical school hospitals cannot provide enough clinical material for the number of students they have in each class. These venerable schools, with tuitions & fees of nearly $50,000/year, do not pay a single penny to the affiliated hospitals or their teaching physicians. In fact, the hospitals actually pay for the privilege. It’s about the prestige.

We are talking about 50% of a medical student’s tuition over four years. Let’s do some math. Let’s say 150 students at $50,000/year. That’s $7,500,000/year or $15,000,000 for the two years. That does not count the fees that the affiliated hospitals pay the schools.

Note please that this situation is not limited to New York City. To the best of my knowledge, almost all U.S. medical schools have similar arrangements with affiliated hospitals.

A recent editorial in JAMA called for shortening the length of medical school by a year. Somehow I don’t see that happening soon.

Question: Where does that tuition money go?


Anonymous said...

I am starting medical school at UCSD this fall and boy did this get me upset! I was accepted to Cornell and one of the reasons I turned them down was negative opinions about their clerkships! This just makes it worse. I would be very upset if as a M3 at Cornell I was losing clinical exposure to an IMG.

Skeptical Scalpel said...

I didn't mean to upset you, but this is a reality.

Cornell is one of the schools that shares at least one affiliated hospital site with St. George's.

//.amanda.eleven. said...

Faculty, staff, administration, administrative assistants, support staff, technology, physical building... etc. It's really expensive to run a medical school in the U.S...

Skeptical Scalpel said...

Yes. I understand that, but the schools are receiving free teaching and support services from the affiliated hospitals, which do not see any of that money.

Most of the third- and fourth-year students are not on the med school campus or in its hospital.

It seems unfair to me.

//.amanda.eleven. said...

My understanding is that medical schools cannot operate solely on medical student tuition -- even if we did the math of a total of 600 students at a time paying 50k/year that is 30 million per year from tuition. Considering that there are likely at least 50 faculty members at say 100k/year, that's already 5 million. Add some higher ups making more than let's say 200k/year, administrative assistants (there are *soooo* many of them now), building costs and I'd guess you're closing in on 10 million per year. Now, consider the fact that just about every major medical school has at least 1 shiny new building to boast "state-of-the-art" facilities + the newest technology and we're looking at 100s of millions... and that's where the rest of our money and generous donations can go.

This is all hypothetical, but that's my best guess.

Skeptical Scalpel said...

Med schools have many sources of income of which tuition is a small part. To name a few: faculty practice, donations, endowments, revenue from clinics & hospitals, investments.

Anonymous said...

Medical school tuition pays for medical student education (a small fraction of the tuition payment for this) and the rest goes to the medical school itself. A medical student spends perhaps 20 hours a week in class during the first two years (at many schools this has been reduced to one year). For this the class pays $2.5 million, per year. I don't know what kind of professor get that kind of money for 20 hours per week, but no one at my medical school does. Where I teach, professors teach students less than five hours a year each. Most of our time is spent doing research which has no benefits to the student. Yet somehow, our entire salary is attributed to the cost of the students' education. This is a total rip off for the students. Worse, during the clinical years, the studnets are lucky to get 5 hours a week for their formal education. The rest of the time is informal education, for which the student will often have to work extremely hard for the hospital. In short, a medical class pays $10 million dollars for 1200 hour of preclinical education and 400 hours of clinical education. This amounts to $8,333 per hour of education. Doesn't seem right, does it?

Skeptical Scalpel said...

I agree. It doesn't seem right, but I expect that tuition will continue to rise at a rate far above inflation.

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