Hacker News Reader

Comment by legitster | Hacker News Reader

I'm not opposed to free tuition, but I kind of question the utility of a grant like this.

It's not like there's a requirement here that the doctors are going to work in the non-profit sector. It's not going to make the field less overworked and toxic. The students at this school have the same demographics as every other medical school.

Given that nearly all of the students who graduate from a medical program end up in the top 10% of wage earners, this seems like a temporary alleviation of financial problems for a very small cadre of well-to-do.

I am happy Dr. Gottesman felt such an affinity for her former employer, but it kind of strikes me as an ... uncreative(?) deployment of a billion dollars.

View on HN

Doctors who graduate without loans have more leverage when deciding their next position. They can immediately go for research or volunteer work that otherwise wouldn’t recoup their costs.

My wife is a physician, and of the friends we made when she was in medical school, only one went to serve underserved populations. A big part of the reason he did so was because they would pay off his loans!

So maybe this will actually lose an effective lever at getting doctors to serve those populations?

I don't think money is entirely the reason that doctors don't serve underserved populations. Many states with underserved populations like Missouri already pay more due to supply shortages [1].

The reality is doctors have the ability to practice anywhere and tend to choose desirable places to live like NYC, LA, etc because they are humans with wants and needs, too. Anecdotally, living in NYC, many doctors and dentists tell me they could make more elsewhere, but they love living in the city.

[1] https://comphealth.com/resources/physician-salary-report-202...

See this comment in case you did not get context on "only one went to serve underserved populations"

https://news.ycombinator.com/item?id=39517637

By the dictates of capitalism, this can never make a dent. If it does, it must be undermined.

Kinda, the big thing is residency which pays peanuts..

But there are tons of programs that will pay off your medical student loans if you go work in an undeserved area. Some states offer free tuition if you promise to work in that state for a few years after. The hope with that is that the person will establish roots and not leave.

Not to mention the 10 year Federal forgiveness for working in a qualified institution (aka nonprofit hospital/academic)

> Not to mention the 10 year Federal forgiveness for working in a qualified institution (aka nonprofit hospital/academic)

Public Service Loan Forgiveness requires 10 years of making student loan payments.

> Some states offer free tuition if you promise to work in that state for a few years after.

for example, the Georgia program offers up to $25k per year for up to 4 years max [1]. It requires application and takes into account health outcomes, specialty, debt, etc so it seems its not automatic acceptance. With an average medical school debt of over $200k this is not free tuition.

[1] https://healthcareworkforce.georgia.gov/loan-repayment-schol...

Here is the list of programs for those interested.

https://www.whitecoatinvestor.com/not-so-common-debt-forgive...

> They can immediately go for research or volunteer work that otherwise wouldn’t recoup their costs

So why not structure it so the tuition is completely forgiven if someone does this rather unconditionally free?

I don't see why someone who goes to this medical school, only to become a cosmetic surgeon who ultimately makes millions a year doing discretionary procedures should have free tuition.

There seems to be some shift going on in society. Like we've acknowledged a world with "haves" and "have nots" is unavoidable, so we might as well just focus on diversifying the "haves" and give everyone an equal shot at winning the lottery.

I guess that's better, but it's a sad thing to settle for.

They don't have to though. It would have been nice if they did something like it's free if you go work in an inner city/rural area/volunteer/etc etc but if you go into plastic surgery in Beverly Hills we're going to ask you to repay your tuition

My view: unless other top schools follow along, the donation will immediately and uniquely make Einstein interesting to top applicants who never otherwise would have considered it. The prospect of top students makes it more interesting to potential research staff, and the combination of top students and staff makes it more interesting for foundations and capital. Einstein right now is a circa top 50 medical school. Were there a futures market for this, I would bet in 10 years it will be top 25.

At the very least it will provide a really good real-world case study on deploying large sums of money to solve problems in society with seemingly no thought given to second and third order consequences. Definitely appears praiseworthy from first glance - really one of the major themes of our times.

Not just top 10%, most physicians end up in top 1% incomes:

https://www.npr.org/sections/money/2014/10/16/356176018/the-...

Seriously. I wonder if a billion dollars could have been used as a small step towards unfucking the byzantine middleman parasitic corrupt insurance-centric healthcare system instead.

Diminishing returns based on outcomes you can change in elections to put reps into Congress who will fix healthcare legislation. Sometimes you can, some races/districts you just have to wait out demographics.

Michael Bloomberg spent almost $1B trying to become president, and didn't even move the needle. That's capital inefficient; you want to target spend for maximum outcome return. This is a win, enjoy the hope for a moment, it's a long slog ahead.

Obligatory https://runforsomething.net/ and always vote PSA.

Reply on news.ycombinator.com