The New York Times last week featured commentary by senior CMS advisor Peter Bach, MD, and former special assistant to President Obama on health care and economic policy Bob Kocher, MD, on why medical education should be free. Bach and Kocher argue that argue that by making medical school free, medical students will be more likely to go into primary care (I’m not so sure about that, gents). This is important because “fixing our health care system will be impossible without a larger pool of competent primary care doctors who can make sure specialists work together in the treatment of their patients … and keep track of patients as they move among settings like private residences, hospitals and nursing homes.”

Bach and Kocher propose making medical school tuition free, continuing stipends during primary care training, but eliminating specialty training stipends to cover the tuition costs (so, specialty training would actually have a tuition attached to it -- and could be quite expensive). They write: “Because there are nearly as many doctors enrolled in specialty training in the United States (about 66,000) as there are students in United States medical schools (about 67,000), the forgone stipends would cover all the tuition costs.” This works, they write, because specialists go on to “highly lucrative” careers following the training.

The idea is worth exploring -- but, it might be just as effective to offer multi-year loan forgiveness for those who actually go into primary care practice, along with higher primary care payment. It would be cheaper and just as effective. The other issue is working to make primary care more exciting again. That said, free medical education is fairly common in other industrialized countries, and these countries are not generally experiencing the same dearth in PCPs as the U.S.

What do you think of Bach and Kocher's idea?

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