‘The debt burden of these students is unsustainable in the 21st century’

NYU School of Medicine sent shock waves across the industry in August 2018 when it announced that all current and future full-time students won’t have to pay to attend

Dr. Robert Grossman, medical school. the dean of NYU School of Medicine and CEO of NYU Langone Health, said it was a moral imperative to relieve medical students of their debt burden. Since that time, a number of other medical schools have announced similar plans to offer free or discounted tuition. Grossman would like to see a broader national conversation about the debt load facing future physicians. He spoke with Modern Healthcare Managing Editor Matthew Weinstock. The following is an edited transcript.

MH: Did anything stand out or surprise you about the medical school applications following the free tuition announcement?

Grossman: I don’t think it was surprising, but we did see a significant increase in the number of applications. We went up 47% in our number of applications— up to 8,932 applicants. The year before, it was nearly 6,069.

MH: For how many spots?

Grossman: 100.

MH: As you looked through those 8,932 applicants, did you identify trends in terms of minorities or other areas?

Grossman: Yes. Let’s start with those who self-identify as African American, black, Afro-Caribbean. (Applications from those groups) went up 142% to 1,062 this year; it was 438

last year. And there was about a 102% increase from individuals who self-identify as a member of a race or ethnicity that is underrepresented. That means there were 2,020 individuals this year and 1,000 last year.

MH: Do you have a certain percentage of spots for people from those classifications?

Grossman: No, we don’t have a quota system. But, our metrics are really amazing. The median grade point average is 3.96, and MCATs 522, which is the 99th percentile.

MH: How do you staff for reviewing that large of an increase in applications?

Grossman: It’s very easy because over the past years we’ve developed artificial intelligence to prescreen all the applicants.

We have algorithms and

it’s actually quite interesting and much better than having screeners, because screeners all have biases. They all have good days and bad days and sometimes they’re tired, sometimes they’re not. Whereas, our AI program—and we tested this for a year—we defined success in many ways, and then that learning process was inputted into the program. There’s continuous learning of the program. Then we decide who gets interviews.

MH: How long have you been doing the AI?

Grossman: Two years, but this year we used it exclusively. Then we use multi-mini-interviews, MMI. It’s a structured interview. There is a particular situation that the applicants have to discuss and every room is different and applicants move from room to room, and it’s a five-minute discussion. Then each interviewer writes their comments and scores. We have nine or 10 (interviews) plus the psychiatrist.

MH: We’ve seen some other medical schools follow NYU to look at free tuition. Do you expect to see a groundswell of this movement to minimize students’ debt burden?

Grossman: It’s very hard to do. It took us 12 years and we were totally focused on this. As I’ve said in the past, it was a moral imperative about debt.

We did this as an endowment and the endowment kicks off X amount of revenue every year, which sustains the medical school. But, you have to do it as an endowment. You can’t do it as a spend down.

MH: What kind of conversation would you like to see happen nationally about medical school debt?

Grossman: It is a situation that needs to be addressed. The debt burden of these students is unsustainable in the 21st century.

The burden creates undue

anxiety and decreases wellness in the physician population.

Nobody talks about that. One of the greatest things we saw in our students was the lower anxiety level, which speaks about wellness.

MH: In this first class of students, you saw that?

Grossman: Yes, in all the classes, because all of a sudden they don’t have this debt burden. One of the issues is that the biggest burden is borne by the middle class, not the poor. Poor people usually get the scholarships.

But even doctors’ families, children of doctors’ families going to medical school, the families and the students are under this debt burden. So this helps everybody, and that’s why we did it for all. You have to understand the context of need. Families could have means, but the students still need the relief, frankly.

MH: How much do you think this will help mitigate burnout in the future?

Grossman: It’s very significant because you’re saving them $200,000 in after-tax money, which they would have as a mortgage, which they wouldn’t be able to pay back, and that’s growing at compound interest rates from three to seven to eight-plus years in their residency.

I think that’s hugely significant and enables them to have financial stability to be able to buy a house, maybe have kids, do the things that they would otherwise be questioning because they had this additional debt burden.

MH: Where else are you making shifts in medical education?

Grossman: One of the things that we have done is a three-year MD program; we took one year out, and for a select cohort of our students, that’s been a huge hit. And, that’s about 20% of the class.

We thought that the fourth year was the suboptimal year. We thought we can fast-forward you in three years into one of our residencies where day one in medical school you get better mentoring because you’re aligned with your career choice.

And, No. 2, residency training is long. If you can take one year out of residency training, that also financially is useful and gets you moving faster into your ultimate practice. It is very satisfying, and we found there’s no difference between three- and fouryear students. ●

“One of the greatest things we saw in our students was the lower anxiety level, which speaks about wellness.”