I am back after a busy summer of getting our medical students situated for this semester. With an entering class of 328 students and over 1315 medical students overall, there is always the question on how did or does someone choose a medical school; is cost a determinant?
In the past 22 years, I have been engaged in discussions with prospective medical school applicants who are trying to decide where to apply and eventually attend medical school. There are currently 134 allopathic medical schools in the U.S. (and potentially growing). Many medical school applicants use rankings in selecting medical schools by Top-tier/Dream Schools, Competitive Schools and Safety Schools. Top-tier schools have high admissions standards based on MCAT and GPA, Competitive Schools are schools where the applicant numbers are going to make them competitive and have they have a reasonable expectation of being admitted, and Safety Schools are schools where looking purely at numbers the applicant should definitely be invited for an interview and accepted. Having said this, medical school admissions are never a clear-cut process and many factors go into the equation. There are many stories of applicants getting rejected from competitive schools while getting into top-tier schools and vice-a-versa. Once they get accepted the discussion on how to pay for it ensues.
So, for the sake of discussion, I have made up the following scenario. Student A has been accepted to numerous schools and has narrowed the options to two, a private school and a public school. While the private school is ranked more highly than the public school according to US News and World Report, the public school ranks respectively. The annual tuition and fees at the private school is approximately $15,000 more than the public school. Choosing the private school over the public school would cost Student A approximately $70,000 additional in tuition and fees over the 4 years of medical school and another $4,000 per year because the cost of living is higher than at the public medical school. Student A expressed two factors: 1) ranking and 2) really liked the private school better. Also, Student A wants to get away from their home state. They graduated from a state institution and now want to experience something different.
My advice is generally the same. If you are paying for medical school yourself, unless the private school is offering scholarships, then consider going to the least expensive school at which you get accepted. Why? Well, I am under the opinion that medical school is medical school. This may be over simplifying it, but in my observations, how one performs in medical school (and on USMLE exams) is just as important in landing a competitive residency as where one attended medical school. I am sure there are others who may disagree with me.
Granted, it is without saying that a bottom-of-the-class student at Harvard will likely have more opportunities than a bottom-of-the-class student at a low-reputation (public or private) medical school, but the top students at nearly any school will likely have similar access or be competitive for the most competitive residencies. It seems to be just as important how one does in medical school than where one does it. This is why rankings can be deceptive and readers should not be too heavily influenced by them. A medical school may be highly ranked based on the how much NIH funding the institution garners and those numbers may not be meaningful for the applicant.
We all know that primary care physicians don’t make the big bucks that specialists make, and some of us have heard of would-be primary care physicians who ended up pursuing more highly-paying specialties. The perceived reason is (although not supported via any empirical studies on this topic) because of their perceived inability to manage their medical school debt burden on a primary care salary.
You often hear medical students mention getting a lot of advice from specialists to go to the best medical school that you can get into and that the money will take care of itself. If your dream is to be an orthopedic surgeon where the competition for residency slots is fierce and where you will likely be making a lot of money when you are in practice, then maybe it’s worth $100k to go to a more highly-ranked medical school to give you that tiny edge in achieving your dream. But if your dream is to be a primary care physician, then it seems to me that an additional $100k in debt may be a significant deterrent to achieving your dream, given that financial burden you’ll face repaying loans.
Medical school can be very expensive. I believe that for anyone contemplating medical school it is important to consider one’s goal and how the cost of medical school might impact reaching that goal.
