Debt-free Medical Education: YSM’s Vision for the Future

For those who dream of becoming a doctor, the price tag can be a harsh reality. Across the United States, steep increases in the cost of medical education have left the majority of recent medical school graduates burdened with overwhelming debt.

At more than half of all U.S. medical schools, the full cost of a four-year medical education, including living and other non-tuition expenses, hovers around $300,000, according to the Association of American Medical Colleges (AAMC). A typical MD graduating with debt owes about $200,000 in education loans—excluding debt from undergraduate education.

At Yale School of Medicine (YSM), financial aid has traditionally helped ease the burden of crushing student debt. Through the generosity of donors, most MD students in the class of 2024 at YSM with need-based aid will graduate with debt around $60,000. However, with the upward trend in education costs and living expenses for its students, YSM is responding to the changing financial landscape by embarking upon an ambitious—yet necessary—move in its approach to financial aid.

To ensure that YSM continues its legacy of attracting the strongest applicants as future physicians, the school is preparing to make its medical education even more affordable—establishing a debt-free program by enhancing its financial aid to cover 100% of a family’s demonstrated need with scholarship.

Nancy J. Brown, MD, Jean and David W. Wallace Dean of Medicine and C.N.H. Long Professor of Internal Medicine, recently announced that the school has set a goal of raising $100 million in new endowment for medical student scholarships to fund this new initiative.

“To excel as one of the nation’s most selective medical schools—and to attract students whose potential and passion align with our mission—Yale School of Medicine must compete with other elite institutions that are offering increasingly generous financial aid to students,” she explained. “This is also important beyond competing with our peer institutions,” said Brown. “It allows our graduates the latitude to choose any career path, including areas of medicine that require superbly educated leaders, but offer lower compensation despite their importance to society.”

For the past several years, YSM has consistently reduced the amount of debt that its students owe upon graduation. The amount of the unit loan, or required borrowing for students receiving financial aid, was reduced by 50% in a two-year period—dropping from $30,000 per year in 2018-2019, to $15,000 per year in 2020.

These steps were taken after YSM Dean Robert J. Alpern, MD, whose 15-year tenure ended in 2019, stated that his goal was to not just reduce, but to eliminate, student debt. During his 2019 annual address, Alpern shared his vision for the future. “To me, the goal is a unit loan of zero,” he said. “Which means that any student could come to Yale School of Medicine without debt. I think debt-free should be our mantra.”

To help augment YSM’s debt-free goal, Yale University recently pledged that it will create endowment funds totaling up to $50 million to match endowment funds raised from current and future donors. The Yale School of Public Health and Yale School of Nursing will also receive up to $50 million each in matching funds from the university. “Raising philanthropy to advance our goal of reducing student debt is a priority,” said Brown. “These matching funds will inspire our donors.”

YSM joins a handful of other medical schools that have created different types of financial aid programs to help mitigate the enormous expense of attaining a medical education in the United States.

In 2018, New York University’s (NYU) Grossman School of Medicine received widespread media coverage when it was announced that the school would be providing tuition-free education for its medical students, regardless of need or merit. About 400 NYU medical students paid no tuition in the ongoing program’s first year.

Kenneth G. Langone, cofounder of Home Depot and chair of the Board of Trustees of NYU Langone Health, said at the time, “Thanks to the extraordinary generosity of our trustees, alumni, and friends, our hope—and expectation—is that by making medical school accessible to a broader range of applicants, we will be a catalyst for transforming medical education nationwide.” Langone and his wife, Elaine, contributed $100 million to fund NYU’s tuition-free program.

The NYU program followed the creation of a smaller-scale tuition-free education program at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, which began in 2008 with 32 accepted applicants and is still being offered.

For former dean Alpern, however, a tuition-free program was not the answer. “Do you think we should be tuition-free for those who have the money and can afford it?” he asked the audience during his annual address in 2019. “I think we’re worth paying for if people have the money. But if people don’t have the money, we want them to come here debt-free.”

By design, a debt-free program has advantages over a tuition-free program, according to N’Kenge Haines, director of financial aid at YSM. “What we’re trying to do with financial aid is make up the difference for people who do not have the resources and can’t afford to pay,” she said, adding that tuition isn’t the only cost that must be considered. “What about living expenses? What about books? If there’s no other additional scholarship available to help with those costs, then a low-income student is still borrowing for all the non-tuition expenses.”

Other leading medical schools have established need-based programs that are billed as debt-free to ease the financial burden of attaining a medical education.

For example, the Columbia University Vagelos College of Physicians and Surgeons launched a need-based debt-free program designed to cover 100% of demonstrated need with scholarships, beginning in the 2018-2019 academic year. Dr. P. Roy and Diana Vagelos contributed $150 million toward the school’s scholarship fund endowment.

Beginning with the 2019-2020 academic year, Weill Cornell Medicine also began offering a need-based, debt-free medical education. This program was funded, in large part, through contributions from The Starr Foundation, which is directed by Maurice R. Greenberg, a member of the Weill Cornell Medicine Board of Overseers, and Sanford I. Weill and the Weill Family Foundation.

Because YSM is committed to a need-based model for its debt-free program, students who have the financial resources will be expected to contribute to the cost of their medical education.

In calculating a family’s contribution, there are realistic thresholds for income and assets, which dictate the level of financial aid that’s offered by YSM. For example, if a family’s income is $125,000 or less, no parent contribution from income is calculated in the student’s financial aid package, Haines explained.

For a family with an annual income of $125,000 to $165,000, the parent’s contribution is calculated on a prorated basis; the thresholds include allowances for the family’s tax obligations and living expenses. Therefore, depending on the family’s income and asset allowances, a student may still qualify for need-based aid at YSM even if that family has an annual income over $165,000, Haines added. Each family’s financial resources are unique and must be considered on a case-by-case basis. “We want to make sure the money is going to people from backgrounds where their families don’t have the resources,” she said.

Students who don’t qualify for need-based aid may obtain loans to help fund the cost of their medical education at YSM.

As YSM pursues its goal of covering the full cost of attending medical school, it will likely create ripple effects that will further strengthen the school’s outstanding reputation.

“I hope as it becomes more widely known that students can graduate from YSM with little to no debt, on average, it will encourage more people from different backgrounds to apply,” Haines said. “There are plenty of talented people out there who would likely thrive in medical school, but they don’t even consider it an option because of the perception that it’s unaffordable,” Haines explained. In fact, YSM may be more affordable than less expensive schools because of the generous amount of need-based financial aid that’s available.

In the end, financial aid is a gift that is given to not only create future physician leaders, but also contribute to the greater good of health care throughout the United States. “For a field as important as health care, providers should represent the public and the population they serve. If we have physicians from more diverse economic backgrounds, they’re more likely to be familiar with the health obstacles that face lower- and middle-income families and they can provide better care,” said Haines.

“If you’re admitted and you’ve demonstrated that you have the curiosity, drive, talent, and desire to want to be a physician…I think we should do what we can to make it easier for those qualified students to be here and to hopefully improve the quality of care that Yale is providing by expanding the field of backgrounds that we draw physicians from,” she said.