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In 2018, New York University became the first U.S. medical school to go tuition free. Since then, a handful of others have followed with many more considering similar programs. One hope for free tuition endeavors is that lower post-graduation debt will increase the number of med students who choose lower-paying, desperately needed careers in primary care and pediatrics. But free tuition programs are not necessarily delivering on that promise.

In this episode of the First Opinion Podcast, University of Pennsylvania oncologist and researcher Ezekiel Emanuel and Matthew Guido, a project manager in the Healthcare Transformation Institute, discuss their original research on tuition-free programs with former host Pat Skerrett, who is filling in while Torie Bosch is on maternity leave. They make the case that medical school debt is only one of many factors that influence new doctors to choose less-popular specialties and geographic locations for their residencies. Other factors including prestige, the lifetime earning potential of higher-pay specialties, which can add several millions dollars over a career, can have more sway than student debt alone. This is especially important, they say, as needs for patients with chronic illnesses are rapidly outpacing the number of primary care physicians available to give that care.

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“We have undervalued both philosophically and also financially the complications of managing chronic illness,” Emanuel says. “Can we rebalance the payment system that rewards the improvements in health and therefore the attention to chronic illness through primary care?”

You can read more about Emanuel and Guido’s opinions in their essay “Free med school tuition won’t solve the shortage of primary care physicians.”

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