The dilemma of managing financial stress along with the demands of preparing for a career in medicine is a theme that spans the generations. As Ashish Patel describes in the preceding commentary, most of today's students are saddled with many tens of thousands of dollars of debt. It is a serious problem and a story that should resonate with many Yale School of Medicine alumni/ae.

And while figures from the 1940s might seem quaint today, some alumni/ae of that era can recall $600 tuition bills that they could not afford to meet. After all, these were the war years and the economy was still coming out of the Great Depression. The scholarships they received got them through medical school and into the medical profession. It is not surprising that when it comes to directing their gifts to the school, many alumni/ae—from all eras—want to support financial aid. There is probably no more pure vessel into which an alumnus can choose to pour a contribution. Today, with tuition rates rising, the pressure on students to finance their medical education can seriously affect the course of their careers, starting with their choice of medical schools. Yale's own research shows that students who prefer to come to Yale are accepting offers from other medical schools because of better financial aid packages. On the national level, research indicates that when burdened by a large debt, many young physicians forego a promising career in research and teaching in order to make an income that will enable them to pay off their heavy loans much sooner. Dean David A. Kessler, M.D., is working with a student-run committee to address the need for providing more financial aid. At a meeting of the Association of Yale Alumni in Medicine in October, he made it clear that this is an urgent priority.

"We have about $1.4 million available from endowment for financial aid," Dr. Kessler said, "but that is not nearly enough. We need to raise more to stay competitive with other medical schools." Yale School of Medicine is among the best in the world, but in the category of scholarships and loans available to students, it falls short compared to other prominent institutions such as Columbia, Johns Hopkins, Stanford and Harvard. Each of those schools has approximately three times as much funding available for financial aid. Yale admits students strictly on merit and offers financial aid solely based on need. Schools that can offer students a tuition-free education make it difficult to compete for the best and the brightest.

To help celebrate their 50th reunion, members of the Class of 1944 combined several major gifts to initiate a scholarship endowment. The Class of 1959 did the same for its 35th reunion. A gift of $75,000 is needed to establish a named scholarship fund, although many are at much higher levels. Recent examples of new named funds include the Freshwater/Class of 1972 Scholarship Fund and the Donna and Jack Ogilvie Scholarship Fund. "We need to make sure that the best and brightest candidates are not dissuaded from attending Yale because of the prospect of a large debt," Felix Freshwater, M.D. '72, wrote in an appeal letter to his classmates. "When tuition rose during my years as a student, Yale gave me a loan so I could afford to continue my studies and graduate," said Nicholas Passarelli, M.D. '59. "My classmates and I are attuned to the needs of today's students and we want to perpetuate the tradition of giving."

The legacy of a Yale medical education is passed on in many ways, through teaching and training. A legacy of gratitude and generosity also connects students and alumni/ae across the generations. The aspiration to become a physician, and the deep feeling of gratitude for the opportunity, remain a common experience. The students who benefit from scholarship funds regularly communicate with our donors. The following is an excerpt from a letter sent to Dr. Passarelli, that was shared with fellow members of the Class of 1959 who contributed to the class scholarship fund. The student grew up determined to help humankind, but she lacked the financial means to attend college and medical school without help.

Since I was a young child, my dream was always of medicine-and Yale. You have provided me with much needed scholarship funding in the quest of my dreams. You have done this while requesting nothing in return. However, I offer you this promise: I intend to return scholarship money to Yale University School of Medicine once I become financially situated. I know that there are others like myself who want only to be given the means to obtain their dream.