The One Big Beautiful Bill Act (OBBBA) changes which began earlier this year will have a profound impact on future medical education. Medical education is a long and arduous route, and it can take anywhere from 12–16 years after high school. The average tuition cost of medical school is $40,000 a year, with schools like Midwestern and Western Michigan charging near $100,000 a year for tuition alone. This long journey to get an education in medicine already dissuades many from pursuing this path. However, with the new limitations in loan borrowings capped at $200,000 for professional school, this will basically put an end to average people being able to pursue medicine and only allow students from rich families to be able to attend medical school.
I matriculated into medical school at the age of 36, years after having a stable career and a reliable source of income working in the technology sector. Even then, I did not have enough savings to cover the cost of tuition at many of those schools I applied to without taking out federal loans.
Now halfway through my third year of medical school, I look back and I cannot point to anything strikingly different that my medical school curriculum has provided me with. I have no edge over students from other schools I have interacted with on my rotations, nor do I feel less prepared than others. The reason for that is simple. Most students do not rely on traditional school lectures. In fact, one of the first search results for studying in medical school is a Reddit page with resources, which lists not a single university professor's lecture. The same goes for top YouTube videos for USMLE Step 1 preparation. They all guide students to use online platforms where students can learn on their own.
Yet, we pay thousands of dollars a year for tuition. Normal markets drive prices based on their demand, availability, and value. However, most medical schools whose tuition is more than the average national medical school tuition in the U.S. are not necessarily the best schools for research or clinical care in the country. For medical students during their clinical years, they spend most of their time at the hospital learning clinical medicine. However, we pay similar tuition rates for pre-clinical compared to clinical years. I have wondered to myself why I would be paying so much money to my school when all they are responsible for is coordination with the hospitals and ensuring we are hitting appropriate milestones, taking our shelf exams, and doing well on rotations. They are an additional intermediary, which (in my opinion) do not add anything to my education other than another hoop to jump through. Back in summer 2016, I took a 150-hour hands-on course to become a licensed and certified Emergency Medical Technician Basic (EMT-B) in Illinois while working full-time for a nominal cost. Looking back at that experience, I wonder if students should be allowed the ability to study on their own using the resources of their choosing at their own pace, and then be allowed to take standardized medical licensing exams like the USMLE Step 1 or the COMLEX Level 1 — without attending a medical school. I imagine it would be a huge savings in tuition and also lower the bar to entry to the medical profession.
Students could learn about the skills of physical exam through open-source video resources like Stanford 25, and then attend bootcamp style rigorous in-person physical exam skill courses. They could then be assessed using previously established standardized clinical skill exams like the USMLE Step 2 CS exam or the COMLEX Level 2-PE exam. This would drastically lower the cost of undergraduate medical education and make the medical profession accessible to a larger number of people solely based on competency without lowering any standards of training. This would lower the current barriers for students to pursue primary care medicine and allow people from minority backgrounds to study medicine. I imagine, in theory, this solution should be acceptable to anyone regardless of their political affiliation.
Students who meet above standards could then pay the hospitals directly, rather than the universities or medical schools, to allow them to rotate at hospitals in their local area. The hospitals could utilize some of this fee from students to partly compensate their resident doctors. Following clinical rotations, the students would apply for residences/jobs at different hospitals and study on their own to complete the remaining steps of the medical licensing exams, much like they already do.
The profession of medicine requires lifelong learning and updating skills. It is not suited to a fixed number of years of learning as different learners learn using different approaches and at different paces. The extra cost of tuition also doesn’t seem justified, especially with improvement in AI technologies that now allow you to create personalized tests, audio or video summaries, flashcards, infographics, and quizzes on the topics of one’s choosing in a matter of minutes. So while OBBBA makes it challenging for future medical students to pay for medical school, the large expenses in the first place are not justified. Self-studying may not be for everyone, but if the school’s role is just to provide structure, then the cost should be similar to online board exam preparation courses (like $399 for two-year access to Boards & Beyond Videos & QBank and $579 for 360 days access to UWorld for Step 1 question bank) and not in excess of $40,000 per year. So I urge the academic administrators and leaders in the field to challenge the price of medical school attendance rather than solely challenging the OBBBA. The issue is the higher cost of medical school attendance and the barrier is OBBBA. Our goal should be to address the issue rather than solely focus on the barrier.
Ankit Jain, MS is a third-year medical student who is completing clinical rotations in Rochester, NY. He holds a master's in electrical engineering and has worked for close to six years each in the IT industry and as a clinical trials coordinator at a medical school. He is passionate about comprehensive care for the underserved and medical education. He has previously published on approaches to improving medical education and rural care.
Image by Moor Studio, Getty Images
