Free college won’t solve U.S. doctor shortage

by Sally C. Pipes

Another medical school has decided to waive tuition. Johns Hopkins University announced last month that it would waive tuition for all students from families earning less than $300,000 starting this fall, thanks to a $1 billion donation from former New York City Mayor Michael Bloomberg.

Bloomberg hopes that free tuition will allow more candidates from diverse backgrounds to pursue their dreams of becoming doctors — and help address the shortage of doctors in the United States.

This is a worthy goal. But our shortage of physicians is not due to the cost of medical school. We lack physicians because there are not enough residency spots where they can complete their training. Philanthropists seeking to address the physician shortage and improve patient access to care should consider funding additional residencies.

More than 74 million Americans live in federally designated primary care shortage areas.

Considering that 20% of the U.S. population lives in rural areas, only 11% of physicians practice there. This may explain why rural Americans suffer from higher rates of chronic disease than their urban counterparts.

The Association of American Medical Colleges projects that we will need 86,000 additional physicians by 2036 to meet the demands of our growing and aging population.

Part of the problem is legislation that is more than a quarter-century old. The Balanced Budget Act of 1997 capped federal funding for residencies. As a result, the number of residency spots available to future doctors has remained essentially stuck at 1996 levels for nearly three decades.

Congress increased funding to expand residency slots in 2020 and 2022. But it wasn’t enough to catch up with the growth in medical school enrollment. While there were just under 71,000 students pursuing medical school degrees in 2004, there were nearly 98,000 by 2023, an increase of about 40%.

The resulting mismatch can make it difficult for medical students to secure a residency position after graduation. This year, more than 44,800 physicians applied for just over 41,500 residency positions across the country.

In other words, the demand for medical education is very high. And yet philanthropists continue to subsidize this demand by donating to medical schools. Bloomberg is just the latest.

Earlier this year, Albert Einstein College of Medicine received a $1 billion gift from former professor Ruth Gottesman that will provide free tuition to all fourth-year students in the fall.

In 2018, Kenneth and Elaine Langone launched a $100 million endowment to ensure that all current and future students at NYU Grossman School of Medicine receive free tuition. And last year, they donated an additional $200 million to NYU Grossman School of Medicine on Long Island to provide free tuition to medical students there as well.

These donations will undoubtedly change the lives of many future doctors. But imagine if some of those millions had gone to create more residency positions.

Consider the University of Texas School of Medicine at Tyler, which recently received a $900,000 gift from Texas Mutual Insurance Company to expand its occupational and environmental medicine residency program. While the program currently accepts only four residents per year, it will increase to five per year for at least the next six years, thanks to this gift.

The University of Nevada School of Medicine in Reno received a $500,000 grant from the E.L. Wiegand Foundation in late 2023. The money helped establish a new pediatric residency program that will eventually train up to 12 providers. The school hopes the program will increase the number of pediatricians in the region by at least 17%.

Philanthropists who want to support the next generation of doctors should not limit their ambitions to making medical school more affordable. Our country’s residency infrastructure could also benefit from their generosity.

Sally C. Pipes (X: @sallypipesis) is President and CEO of the Pacific Research Institute.