Symposia

Financing Medical and Health Care Education

Moderator:
Bruce Kelly, Director of Government Relations, Mayo Clinic

Panelists:
Colleen Conway-Welch, Ph.D, professor and dean, Vanderbilt University School of Nursing
Darrell Kirch, M.D., president and CEO, Association of American Medical Colleges
Steve Shannon, D.O., M.P.H., president, American Association of Colleges of Osteopathic Medicine

Bruce Kelly and panel members reviewed how medical and health care education is currently funded in the United States and agreed that financial transparency must be one goal of a reformed medical education system.

While funding for nursing and osteopathic medicine is predominantly tuition-based, medical school financing comes from a complex blend of tuition, state support, industry support, endowment and cross-subsidization from health care services.

"All the dollars are mixed together and used by the school," said DarryKirch, M.D. "So it's difficult to open up the books and figure out how much it costs to educate a medical school student. We need to be more accountable."

Dr. Conway-Welch brought up a number of ideas that could help reduce education costs and serve students better: for example, promoting part-time study with on- and off- ramps for flexibility, offering work-study options (such as residency) for a variety of professionals and changing the academic calendar year.

"Why does it have to take four years to get a B.A. degree ... four years to get a medical degree?" she questioned. "Why are there two semesters in an academic year? Three semesters would be much more efficient. We can compress time to reduce tuition costs."

In addition, she suggested that insurance companies and health plans — which are highly dependent on skilled graduates to care for their members — should allot a portion of their margin to support health and medical education.

Dr. Shannon also proposed the concept that medical education should be considered a fundamental social good and that students should complete some level of service in return for educational support they receive from the government.

Participants took 30 minutes to brainstorm ideas about how the health care education financing system could be changed to develop the type of health professionals that we need for the future. Top responses follow:

• Require transparency of educational costs across health care disciplines.
• Compress and consolidate the curriculum for medical school and other health professions with competency certification replacing years spent in training. Shift funding to increase the training of other health care professionals to assume more of the current responsibilities of physicians.
• Financial incentives must be increased for medical students to go into primary care.
• Increase availability of the National Health Service Corps with creative pay-back incentives (either full or part-time payback.)
• Provide government-funded reimbursement for public service. This could either be an upfront commitment (as with the military) or paying down debt through public service.