Friday, February 3, 2012

The Cost of Higher Education

A few days ago I received a begging letter from my medical school Alma Mater, the University of Utah. The letter really pissed me off on several levels. First it was written by a U of U med school alumnus who spent one paragraph bragging about his wonderful accomplishments, of course attributable to the wonderful medical education he received at said school. The second and more important thing was the current tuition--$29, 663 per year for Utah residents and a whopping $55, 318 per year for non-residents. According to the American Association of Medical Colleges the average tuition for in state students was $25,000 in 2010-2011 at state(public) schools , and for non-residents it was $43,000; the average tuition for private schools was $42,000.

What is the actual cost of educating a physician? This appears to be a very difficult question to answer. Much of the answer depends on accounting methods, etc. but in fact no one who might be in the know(med schools) seems to be willing to answer it. Someone looking for this information on the internet commented it appeared that there was a concerted effort not to let this information be known. The only estimate that I was able to find was testimony before the Texas Legislature in 2009. Clifford Moy, MD testified for the Texas Medical Association that the cost of medical school and residency was approximately $100,000 per year. That means that the cost of making a pediatrician(7 years) is about $700,000. Damn! I never knew I was worth so much!

Another question is how has med school tuition changed over time and is the change due solely to inflation? From 1959 to 1963 I attended the U of U med school. I know this seems like ancient history, but it is my personal experience. A basket of goods that cost $20.00 in 1963 cost $141.00 in 2011( This is a factor of about 7. My tuition all four years was $480.00 per year. Based solely on inflation tuition now should be $3,360.00 per year. In other words $26,000 of increase cannot be accounted for by inflation.

There are a couple of other things going on here. One is that state legislatures have chosen to decrease funding to medical schools. For example, the Utah legislature decreased med school funding last year by $2.5 million dollars. Another is the belief by some that the student should pay a greater portion of the actual cost. As of now the estimate would be that the student would be paying about 29-30% of the actual cost. Why not jack it up some more? How about 50, 75 or 100%? Hell, get the state out of the business altogether.

I can hear some saying that physicians make a lot of money and student loans are available, so stick it to them. The average U of U med grad now has $158,000 in student loans, and may need to borrow more money to get through a residency(minimum 3 years). Slightly over 50% of medical students are now women. The medical students are thrown together at the ripe marrying age and are marrying each other, so the couple at graduation may well have student loan debt of over $300, 000.( Plus under grad debt—see below.) Great way to start life. These debts are having an effect on specialty choice, with fewer and fewer choosing primary care, such as family practice and pediatrics, due to the lower pay of these specialties. Orthopedics, for example, has a median income of about $400,000 per year, versus $150,000 for pediatrics.

The net result of all this may well be a significant change in who is attracted to medical school. More and more wealthy students and fewer and fewer average Joes and Jills will apply, thus eventually changing the makeup of physicians in the US. It is already changing the makeup of the specialties for the worse. It seems to me that society has an interest in this and needs to get the state legislatures to get their collective heads out of their butts and stop this nonsense.

Now lets take a look at under graduate education costs. The Arizona State Constitution, which incidentally is now 100 years old, states in Article 11, Section 6 “The University and all other State educational institutions shall be open to students of both sexes, and the instruction shall be as nearly free as possible.” As near as I can tell this provision has not been changed. So how are we doing? In 1956, my first semester at the University of Arizona, for a full load of 18 credits I paid a total of $17.00. I still have the canceled check. In 2011 the $20.00 of goods from 1956 would cost $165.40, a factor of 8.2. Based on inflation alone, the semester tuition for a full load would now be $139.40. It is actually about $4600 per semester, or $9200 per year. The same thinking seems to apply to this as applies to Medical education, despite what the Constitution says. A bill has been introduced into the legislature, HB 2675, that stipulates that state university students must pay $2000 of their tuition unless they have a full ride scholarship based on academics or athletics, thus eliminating need-based full ride scholarships and limiting other scholarships of this nature that are affiliated with the university. Undergraduate debt at Arizona universities is now $21,158 per student. The sponsor of the bill says an additional $8000 in student loans isn't much for a college graduate who will be earning so much more than a high school graduate. Sound familiar? The bill came about because at the House Appropriations Committee last year lawmakers were told that 48 per cent of ASU in-state undergraduates do not pay any tuition whatsoever. The bill's sponsor, John Kavanaugh said:” This is not right. Our taxpayers shouldn't be paying toward free tuition in these difficult times. When students are paying nothing many don't take the classes seriously, and we have created a perverse incentive for students who may not be academically prepared for universities.”(Source: East Valley Tribune, January 29, 2012, page 11). Really? What happened to the State Constitution? Wait a minute. If I'm not going into debt for higher education it doesn't mean anything?

Another thing is lost in all this—the ability to work and pay your own way. I lived at home, worked, paid my own way through undergrad and medical school. Believe me I would have loved to have had a free ride in school. I might have gotten better grades and more out of school than I did. Never occurred to me I should have gone into debt. It was both possible and necessary for me to work and pay my own way. It would not be possible with the tuition charges of today. That is very sad.

These issues are societal in nature and need to be discussed by society as a whole. Decisions by legislatures, boards of regents and other leaders need to be made on what is best for society in the long term, not on what is expedient.