Medical Examiner

Improving Diversity in Med School Needs to Start Well Before Matriculation

NYU’s decision to waive medical school tuition is well-intentioned, but the problem goes much deeper.

The gray buildings of NYU Langone Medical Center.
NYU Langone Medical Center as seen from across the East River. Kenneth Wilsey/Wikimedia Commons

New York University made the surprising announcement last week that it would be making its medical school tuition-free forever, for all of its students, with no strings attached. According to the school’s press release, the program’s primary goals are twofold: to recruit a more diverse class of future physicians and to encourage more of its students, unencumbered by sticker-shock levels of debt, to pursue lower-paying careers in primary care and similar specialties.

As a medical student myself (disclaimer: my views don’t represent those of my institution), I’m openly biased in favor of a free medical education and hope that other schools will follow. It also makes sense as a shrewd business move (and a nice excuse for the school’s key donor, Ken Langone, to get a sizable tax deduction): The school will likely gain a competitive advantage in terms of rank and reputation against its peer institutions.

I am skeptical, however, that a tuition-free medical education alone will achieve either of NYU’s stated goals. To me, NYU’s objective ultimately boils down to improving the diversity of its classes—whether that diversity is racial, socio-economic, or even geographic (which is important because underserved rural and urban areas are where the physician shortage is expected to be at its worst, and people who are from those places are more likely to return to them as primary care clinicians). Slate’s Jordan Weissmann has a good breakdown of how the measure is not the most efficient way to make gains in diversity in the two areas NYU has stated it will help. To add to his points, I’d argue that from what I’ve seen over the past few years, the battle to create a diverse class is lost well before anyone sends an application to NYU, or any other medical school.

For a moment, let’s consider Taylor, a hypothetical, socio-economically disadvantaged college freshman with an interest in medicine, who has already overcome many structural barriers to make it this far in her education. Early on in college, Taylor will have to start building her résumé for medical school applications. She’ll need to look around on her own and network with professors to find a research position, taking on a project during the year or maybe during one of her summers (which would pay little, if anything at all). She’ll also have to find ways to stay engaged with extracurriculars and student life on campus, scope out volunteer opportunities to pursue, and find physician-mentors whom she could shadow in a clinic or hospital—all while doing well in the science courses she needs to complete for medical school requirements.

If Taylor still thinks medicine is for her, she’ll need to eventually take the Medical College Admission Test, or MCAT, which can require a semester’s (or a summer’s) worth of studying while juggling other obligations and often necessitates enrolling in a test prep course costing thousands of dollars. Taylor will have to do well on this test—the average admitted student had a score above the 80th percentile last year, and your score goes a long way in determining the strength of your application.

Provided that Taylor clears all of these hurdles, she’ll need to gather letters of recommendation and research what schools should make it onto her application list. She might have access to an adviser at her college, but she may have to do this research on her own, which could involve following internet forums like Student Doctor Network that can devolve into rumor mills, or buying the online guide published the Association of American Medical Colleges.

And when Taylor is finally ready to apply, she’ll need to be ready to pay a processing fee to the AAMC for each school she applies to (unless she qualifies for a fee-assistance program, which covers a mere 16 schools), along with a separate fee, which can range from $100 to $200, paid to each school. She’ll have to invest time to write an additional one or two essays for most schools she applies to, and if she’s invited to interview in person, she’ll have to pay her way to get there and take time off from school or work.

On top of all of that actual work, there’s some psychological work she’ll have to do, too. Just applying to medical school can be intimidating, and I say this as someone whom the medical school admissions game is designed to favor. I attended a college known for sending scores of students off to medical school, had access to great advisers and physician-mentors, and have two parents who are practicing physicians. I personally cannot imagine taking on that task without the support I’ve been lucky enough to have, or without the privileges of money and time afforded to me. Considering all of these obstacles, which, frankly, favor students like me, it really should be no surprise that the diversity of students applying to medical school is remarkably similar to the pool of students who matriculate into one.

If NYU and other medical schools are serious about tackling diversity and the looming physician shortage in primary care, it would behoove them to invest in other, subtler (and perhaps even cheaper) interventions alongside headline-grabbing ones like offering a tuition-free medical education. They could offer online MCAT preparation courses that are free to the public, subsidize more positions for paid undergraduate research projects, waive all application fees, standardize essay requirements across schools, offer to pay for transportation for students they select to interview in person, and take more active steps to recruit potential students from underserved communities. Within their admissions criteria, they could experiment with scoring mechanisms that account for socio-economic data (if they are not doing so already) and openly commit to taking more lower income students. To their credit, many schools (including NYU) sponsor programs that aim to intervene earlier in the educational pipeline. But more can be done, and indeed, more must be done to expand these programs and actually institutionalize changes that make medical school a more accessible reality for anyone willing to work hard, regardless of their background.

NYU’s decision last week is an innovative one. It also demonstrates that fixing the diversity problem facing medical education isn’t a simple and straightforward task. A tuition-free medical education alone is not the silver bullet for creating a generation of physicians who better reflect the populations they aim to serve. Alongside other interventions, however, it could be a good start.