Implications of the Cost of Medical Education in the United States: Perspective 2024

It appears to be widely believed that medical school debt is not only a pervasive source of anxiety and distress among young American physicians, but that this distress is inordinate, inappropriate, and harmful. This concern is not only unfounded, but may also have perverse implications. The idea that medical school—a guaranteed gateway to at least the upper middle class—should be free of any debt or service requirement fosters a sense of narcissistic entitlement. The idea has no moral basis, especially when working Americans must pay for their health care, and because other professions and jobs whose financial rewards are comparatively meager are offered no similar entitlement (e.g., teachers). In addition, the idea that medical training should incur no personal sacrifice promotes its commodification and transformation into a mere technical skill, thus degrading any notion that the traditional physician–patient relationship is anything special, let alone “sacred.”