How wealthy is too rich to qualify for free medical school tuition?
That's the question raised by Bloomberg Philanthropies' $1 billion donation, announced Monday, to Johns Hopkins University to cover the tuition of most medical students.
The donation puts the charity founded by former New York City Mayor Michael Bloomberg in line with a $1 billion donation from Ruth Gottesman, a longtime professor at the Albert Einstein College of Medicine in the Bronx and widow of a Wall Street tycoon. Ms. Gottesman donated to Einstein in February, promising that medical students there would never have to pay tuition again. And NYU School of Medicine, backed by a $100 million gift from Home Depot co-founder Kenneth G. Langone and his wife, Elaine, began covering student tuition in 2018.
But the programs have one key difference. Bloomberg The scholarships are means-tested and awarded only to students with annual family incomes of $300,000 or less. The Einstein-NYU program is open to all medical students, regardless of income, need, or merit.
Before Bloomberg's donation, tuition at Johns Hopkins was roughly $65,000 a year for four years, a steep price even for families earning $300,000 a year: The school estimates the total cost of attendance, including living expenses and tuition, at more than $102,000 in the first year.
Why is $300,000 an appropriate threshold, and why should medical students, even if they are well-off, have to rely on their parents for tuition?
Bloomberg aides say the threshold was carefully adjusted to account for the total amount of donations ($1 billion) and their maximum impact.
“The idea of ​​the program is that families who can pay should pay,” Howard Wolfson, who runs Bloomberg's education charity, said in an interview.
“I think you can have an academic debate about whether such a system should be universal,” he says, “but generally speaking, he thinks there should be some means testing. If you come from a wealthy family, you should pay. But $300,000 doesn't mean there's a $50,000 cap.”
Bloomberg said his humble upbringing inspired him to get a college scholarship and set him on the path to becoming a billionaire.
The university's president, Ronald J. Daniels, described the program as consciously anti-elitist. Part of the endowment is set aside to expand financial aid to students in nursing, public health and other graduate programs. It also offers future doctors free tuition and a living stipend for students with family incomes up to $175,000. Either way, the endowment reaches nearly two-thirds of medical students, the university said.
“Free tuition is obviously a big plus,” Daniels says, “but the cost of living is not cheap.”
He said the charity and universities had put a lot of thought into creating “simple standards” that students could easily understand.
The donation announcement doesn't use the word “diversity” even once, instead talking about attracting people from “the broadest and deepest range of socio-economic and geographic backgrounds.”
But even so, Daniels said there's hope that removing financial barriers will make students more likely to follow their heart into underserved fields and areas of the country.
Ellie Rose Mattoon, 21, will be a first-year student at Hopkins University School of Medicine this year and qualifies for free tuition under the terms of the donation. Her aid package has increased by $47,291 a year, and she's grateful. “I don't have to take out loans anymore, which is really wonderful,” she said.
Her parents are both in real estate and their income fluctuates from year to year, she said, and when asked if the $300,000 limit made sense, she said she didn't think medical students should have to rely on their parents' financial situation.
“I was really lucky to have a lot of support from my parents for college,” she says. “At the stage in their lives, they should be worrying about retirement, worrying about supporting their older parents. There are a lot of other things they can spend money on besides sending their kids to graduate school.”
The jury is still out on how free tuition will affect medical school programs.
A March article in STAT, a medical, science, and health news site, said that after New York University's medical school made tuition free, it saw a surge in applicants, especially from underrepresented groups, but that the admissions process, which already favors wealthy families, became even more competitive.
And contrary to expectations that graduates would have the financial flexibility to pursue primary care rather than more lucrative specialties, few students from the first tuition-free class went on to pediatrics or family medicine, the article reported.
Daniels of Johns Hopkins said there's no guarantee that students who get tuition relief will choose primary care, but it gives them “one less reason” not to choose it.
Steve Littea, a spokesman for NYU School of Medicine, said the goal was never to increase the number of attending physicians. It was to ease the stress for students struggling with how to pay for their education while in medical school, as well as to help “that little bit in between who don't necessarily qualify for all the loans.”
Johns Hopkins University said in a statement that the $300,000 cutoff would exclude roughly the wealthiest 5 percent of Americans.
Daniels said the donation follows a $1.8 billion gift from Bloomberg in 2018 to provide financial aid to low- and middle-income undergraduate students at the university.
Johns Hopkins University said the number of undergraduates who are from low-income backgrounds or who are the first in their families to attend college has increased 43% since the 2018 donation and now accounts for nearly a third of its undergraduate students.
Wolfson said the donation blended the former mayor's belief in the value of education with his passion for public health, an initiative under which he banned smoking in bars and restaurants, removed trans fats from restaurants and required chain restaurants to post calorie counts.
“Like many people, he's very concerned that life expectancy in this country is going backwards and our health care system has been under considerable strain, particularly since the COVID pandemic,” Wolfson said.
Kirsten Noyes and Kitty Bennett contributed to the research.
