I always doubted my ability to enter the field of medicine. I was never quite sure where this unease came from, but I’ve carried it with heavy shoulders. I suppose a large sense of this feeling came from my respect for the field and the sheer number of hours and hard work one needed to put in to become a physician. It was only after I received my MCAT score that I started to feel there might be a place for me in medicine, and even then, the doubt remained throughout medical school.
My MCAT score was merely a number, but it sent a message to medical school admission committees that I was a safe candidate. I was accepted to a respected non-profit state school and was initially awestruck by the quality of education I received. My preclinical lectures were presented by experts in the field, and during my clinical years, I rotated through a top-ranked cancer hospital and a 1,000-bed academic hospital. I was one of the lucky ones; for thousands of others, a poor MCAT score keeps them from obtaining a quality medical education.
For students with poorer academic performance, the door to becoming a doctor isn’t necessarily shut. In recent years, entering medical school has become easier. Class sizes are up across the board, and the number of applicants to MD institutions has actually declined. New medical schools continue to be built across the country, and accreditation standards for DO schools have allowed many satellite campuses to be established. Amid the medical education expansion, a new school model has arisen that preys on students with weaker academic records. One where the stated goal is to make money for investors, and where students are the customers.
For-profit medical education isn’t a new phenomenon, but its history is a rather telling one. For-profit schools were the lay of the land prior to 1910, when the Flexner Report was published and led to the reform of medical education. The accreditation standards laid out by this report were unable to be met by for-profit schools, and relatively quickly, this model disappeared. Only non-profit schools, many established by state legislators, could meet these standards. In the 115 years since this report, medicine has radically changed. We’ve gone from a profession that endorsed bloodletting and trepanation to one with adherence to the germ theory of disease and the biomedical model. The rigorous standards of medical education pushed the envelope forward.
A turning point came in 2007. A new for-profit medical school was chartered and soon obtained pre-accreditation status by the Commission on Osteopathic College Accreditation. The success of this school led to the opening of another for-profit, and then another, and another. Today, if satellite campuses are included, there are ten for-profit medical schools in the U.S.
Companies that are established as for-profits dominate the medical landscape. Many times, cutting-edge advancements in medicine wouldn’t have been made if the profit motive didn’t exist. Zolgensma, a gene therapy for infants with spinal muscular atrophy, very likely wouldn’t have been engineered without its $2.1 million price tag. EPIC, the intuitive EMR, likely wouldn’t have been developed if shareholders couldn’t have made a profit. For-profit institutions in health care aren’t necessarily a bad thing, and they can improve the lives of patients and the work environment of physicians.
Medical schools don’t exist in the same realm as pharmaceutical, medical device, or medical software companies. These companies only succeed if they manage to push the needle forward. For-profit schools don’t have to push this needle forward; they merely have to meet the bare minimum expected by their accrediting bodies. They will always have customers, as long as the number of applicants to medical schools exceeds the number of available spots. These customers will always be able to pay, as long as they have access to student loans. For this reason, these schools can also get away with charging students more than many state schools. For investors, for-profit medical education may seem too good to be true.
As new physicians demand better work-life balance, the physician shortage will remain. The answer to this shortage is to train more doctors, more NPs, and more PAs. Lowering the standards of training or encouraging the development of institutions that seek to barely meet pre-existing standards is not the answer. As for-profits start to dominate the landscape of medical education, advancements will become stagnant, and progress will reverse. It’s a no-win situation for students and their future patients.
Solutions exist. State governments could allocate funds to the building of new state medical schools. Simultaneously, the federal government could clamp down on aid available to for-profit institutions. Instituting tuition caps would prevent these schools from charging significant sums for tuition and essentially billing this to the Department of Education when students take out federal student loans. The profit motive should not exist in medical education, and steps must be taken to prevent investors from taking advantage of young adults who want to pursue our profession. Otherwise, I fear the landscape of medical education will be radically different for the next generation of practitioners.
What affect do you think for-profit schools have on medical education? Share in the comments.
Dr. Lachlan Shiver is a resident physician at University of Mississippi Medical Center. His interests include neurological research, medical humanities, and running. He has been a Doximity Op-Med Fellow since 2022.
Views and opinions expressed do not necessarily represent the author’s employer/residency program.
Image by Deagreez / Getty
