Med school prof calls for lower medical education costs

Going to medical school would be a lot cheaper if David Asch had his way.

Asch, who is a professor at the Perelman School of Medicine and the executive director of the Center for Health Care Innovation, believes that reducing the cost of medical education will help reduce the cost of healthcare in the United States. In 2010, healthcare expenditures was $2.6 trillion or 17.9 percent of the United States’ GDP, according to the Center for Disease Control and Prevention. Asch estimates that currently, around 20-25 percent of healthcare costs go to the physician.

In his opinion piece, “Are We in a Medical Education Bubble Market?” published in The New England Journal of Medicine two weeks ago, Asch compared the medical education industry to the Dutch tulip mania of the 17th century, when tulip prices suddenly soared, then crashed just as quickly.

“Medical students can take on enormous debt only because the costs of that debt can be easily passed along to others down the road,” Asch wrote in the article, saying that the high cost of medical education causes healthcare costs to be inflated.

Related: Wharton, Penn Med faculty collaborate to improve health care

To reduce the “cost structure” of medical education, Asch thinks schools could decrease the number of years required to get an MD, or turn basic lectures into massive open online courses, like the model used by Coursera. “Do we really need four years of medical school? Do we really need 140 anatomy classes?” he asked.

Asch also suggests that the high cost of tuition is a factor in the primary care physician shortage facing America.

Arthur Caplan, a professor at New York University’s Langone Medical Center and a former Penn professor, agrees. “If you saddle medical students with huge debts, they graduate and almost always head to medical specialties that pay the most and that do not serve the health of the public well. We need more primary care providers,” he said in an email.

Related: Penn hosts discussion on children’s health care

Gail Morrison, senior vice dean for education at Penn Med, does not agree with these assertions. She does not see the choice of many doctors to go into specialties as economically motivated, pointing out that out of the students they surveyed, only “20 percent say debt is making me choose what I’m going into.”

Morrison said that the lower numbers of physicians going into primary care is not necessarily negative. “Do you need to be a physician to do [primary care], or could you be a team of people working with a doctor?” she asked, suggesting that advanced nurses or physician’s assistants could be trained to do much of the work currently relegated to family doctors.

She said she does not see medical school tuition as the cause of the high costs of healthcare. “I’m not sure how cutting tuition helps. That will not cut the cost of medical care in the country.”

Instead, Morrison sees the current American “fee for service” health care system, where physicians are paid for the quantity of procedures rather than the quality of care, as the main culprit in high health care costs.

But Asch believes that whatever side of the medical debate someone supports, even Republicans and Democrats can agree that “it’s a natural good, no matter what, to lower the cost of education.”

He does not support federal regulations to lower the cost of education though, calling government policies “a little heavy-handed.” Instead, he suggests that schools voluntarily lower their tuition. “Let’s say Penn became a less expensive school. That would show leadership.”

Please note All comments are eligible for publication in The Daily Pennsylvanian.