Financial Implications of Increasing Medical School Class Size
Toffler WL. Medical education—the challenge of distinguishing actual costs versus charges (tuition). Perm J 2012 Spring;16(2):73-4. To the Editor, During the last 50 years or more the cost of an undergraduate college education has consistently grown at a rate that exceeded inflation. Some potentially contributory factors include the decreased time commitment of the average college professor to classroom teaching as research activities became more important to career advancement and the variety of subsidies, such as college loan programs, work-study arrangements, etc, that partially insulate the process from true economic market forces. Given the perceived value of a college education, there has been little pressure for colleges to be truly competitive on pricing for their students. Most economists will agree that if something is subsidized one tends to get more of it. One has to assume these same forces are also part of the rising cost of medical school. It is hard to tell if this article took that perspective into account or started with the underlying presumption that the present medical school cost structure was appropriate. As long as classes are filled and the admission process is so competitive, there is little incentive for schools to seriously address their cost structure and faculty time commitments. Paul Bellamy, MD Pulmonary and Critical Care Medicine Kaiser Permanente, Woodland Hills Response from Richard A Culbertson, PhD; Danny A Schieffler Jr, PhD; and Marc J Kahn, MD, MBAWe are pleased to receive Dr Bellamy's comments on our paper and his observations regarding price inflation as represented by tuition in higher education in general and medical education in particular. We did not address the issue he raises regarding the appropriateness of the cost structure of the medical school, confining ourselves to the question of the relationship between tuition revenues received for increasing class size and the added cost of providing education for a larger class. As Bellamy correctly observes, classes are indeed full and the admission process is indeed competitive. Economists might well argue that this scenario represents an opportunity for profit generation, much as universities have done in recent years with their schools of law and business.1 The fact remains that students are still willing to apply to medical school, and medical school represents a firm prospect of good financial return to the student,2 which would seem to encourage the charging of higher tuition without discouraging applicants. Medical education is often thought to have a relative inelasticity of demand, such that the demand for a seat in a medical school class is not particularly sensitive to price. The irony of the current situation is that public policy makers, who might be logical sources of revenue for public schools, are encouraging the expansion of schools to meet projected deficits in the supply of available physicians. It is the schools themselves that must cover the gap between available revenues and added costs. Seldom does the state government provide the funds for what represents an "unfunded mandate." As Dr Bellamy observes, if the problem cannot be addressed through added revenues, then the logical alternative is reduced expense. The take-away question is whether this will produce a diluted educational experience that is in the interest of neither good public policy nor the student. Richard A Culbertson, PhD Danny A Schieffler Jr, PhD Marc J Kahn, MD, MBA References1. Caplan L. An existential crisis for law schools [monograph on the Internet]. New York: The New York Times Sunday Review; 2012 Jul 14 [cited 2012 Oct 10]. Available from: www.nytimes.com/2012/07/15/opinion/sunday/an-existential-crisis-for-law-schools.html?_r=0.
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