Peter Bach and Robert Kocher: make medical school free but charge specialists for their training

Peter B. Bach of the Center for Health Policy and Outcomes at Memorial Sloan-Kettering Cancer Center, and former special assistant to President Obama on health care and economic policy Robert Kocher, both MDs, have laid out a cogent, persuasive case for government-paid general practitioner training, with specialties coming at a cost. Among the claimed benefits: more general practitioners, avoidance of personal debt as a driving force behind the excessive pursuit of specialties at the expense of the public good, and the program would pay for itself by charging doctors for specialty training. Incremental versions of some of this are already happening:

Many states have loan forgiveness programs for doctors entering primary care. The health care reform law contains incentive programs that will include bonuses for primary care doctors who treat Medicare patients, and help finance a small increase in primary care training positions.

Free education would also increase the quality of applicants, the doctors claim, and would reflect the already symbiotic relationship between medical training and taxpayer money.

Critics might object to providing free medical education when students have to pay for most other types of advanced training. But the process of training doctors is unlike any other, and much of the costs are already borne by others. Hospitals that house medical residents and specialist trainees receive payments from the taxpayer, through Medicare. Patients give of their time and of their bodies in our nation’s teaching hospitals so that doctors in training can become skilled practitioners.

Some letters to the editor expressed skepticism that this would encourage more medical students to become general practitioners when people could just borrow money to become specialists, but I can see how at least some low-to-medium income students would choose the general path and avoid the debt. It might also encourage people, say, in their 20s to pursue new careers in medicine after they see how bleak a lot of other options are right now.