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Albert Einstein famously said, “If I had only one hour to save the world, I would spend fifty-five minutes defining the problem, and five minutes finding the solution.”
In late February, Dr. Ruth Gottesman, chairman of the board of trustees and professor emeritus in pediatrics, gifted $1 billion to make the Albert Einstein College of Medicine tuition-free. But the question is, “What problem does this solve?”
NPR quotes a source from the school saying that this gift “radically revolutionizes our ability to continue attracting students who are committed to our mission, not just those who can afford it.” Read that again. Is it naive to think a billion dollars might still be enough to “radically revolutionize” medical education in a way that creates new, better, and different possibilities?
As co-founder of a startup I certainly believe I could change the world with “just” a billion. Our organization MedReimagined Inc., exists to save Black and brown lives by creating paths for scholars from communities with the greatest need to become physicians.
For us, radical and revolutionary is teaching four to eight years of summer, afterschool, and elective medical school beginning in middle school and sticking with our scholars until they get their white coats. I’m honored to work with many brilliant and committed Black doctors and educators. I turned to a few of them to understand what a billion might do to “radically revolutionize” doctor preparation.
The Mathematics of Medical School
Dr. Antonio Graham is a Black geriatrician, educator, and part of the startup team behind what is anticipated to be only the nation’s fifth historically Black medical college. Dr. Graham recently relocated to Baltimore to be the inaugural chair of clinical medicine at the College of Osteopathic Medicine at Morgan State University, set to open in 2025.
This innovative venture aims at two seemingly competing targets. On one hand, it will operate as a for-profit public-private partnership without burdening students with excessive debt. On the other hand, it aims to produce physicians who will practice in much-needed primary care specialties and areas of greatest need. Dr. Graham explained how the new medical school was exploring ways to maintain reasonable tuition rates while serving the most debt-sensitive population of aspiring physicians. We thought, who better than him to help us better understand the mathematics of medical school? You know, for the next time, a billionaire has a billion to fix medical education.
Despite comprising 14% of the population, Black physicians make up only 5.5% of doctors. Anyone who has struggled to find a primary care doctor or felt uneasy about the choices of OBGYNs, or perhaps you’ve faced the frustration of trying to get an urgent appointment for a sick child to see their pediatrician knows the struggle. All these situations are much harder for Black patients who would like a doctor who shares their background and life experiences. The lack of Black doctors has a serious impact on every measure of health outcomes for the Black community. In America, the healthcare system has a cold, but communities of color have the flu.
The conversation about doctor shortages in certain specialties often revolves around the high cost of medical school and the staggering debt burden faced by aspiring physicians. The hope is that without this financial strain, more doctors would choose to practice in underserved areas. However, the reality is more complex.
One of the most surprising points was that tuition is just one piece of the puzzle. Medical schools rely heavily on federal research grants. Over 80% of the National Institute of Health’s $48 billion budget in medical research is awarded through almost 50,000 competitive grants to more than 2,500 universities, medical schools, and research institutions. Johns Hopkins University led all U.S. institutions in 2021 NIH funding with $825 million. In comparison, Hopkins’ 120 medical students pay $65,000 annually, making revenue from tuition amount to $7.8 million, less than 1% of NIH funding.
The Role of HBCUs
This fact sparked ideas about how these large funding allocations might be repurposed to create not only tuition-free schools, but also programs that could further the mission of an HBCU medical school — healthier communities without discrimination.
One might argue that all medical schools have a mission to create healthier communities. But the data doesn’t bear this out. The lack of Black doctors and health disparities in the medical system are not new problems, nor are they trending in the right direction. As we’ve seen recently, diversity and equity initiatives can be easily discarded when opinions shift, so it’s important as ever to build and strengthen these institutions at their core. Historically Black Colleges and Universities (HBCUs) have long been champions of equity in education, despite facing resource disparities themselves.
HBCU institutions with a mission to uplift communities underserved by the current healthcare system, might redirect a fraction of research funding to create a tuition-free system. But he would go further. Dr. Graham explained how Morgan State’s proposed medical college would have centers of excellence that could support additional innovative approaches to medical equity.
These include: Federal and state health-policy advocacy to improve compensation and incentives to enter high-need fields; fellowships to encourage more Black physicians to become medical school faculty, improving the experience of Black medical students around the country; a network of leading Black physicians that would help aspiring physicians become more skilled at the business and practice of medicine.
HBCU medical schools can be at the forefront of reshaping the physician workforce to better serve diverse communities and fix some of the fatal flaws designed into the American medical system. There are examples like Morehouse Medical School pioneering satellite medical school campuses in rural areas with high need. But it seems that HBCUs, like most Black institutions, always have to fight so hard for just their fair share. Let’s hope this one remains on track and people like Dr. Graham are given the opportunity to prove what excellence can do with abundance.
Free tuition is nice, but it is the least we can do. We appreciate it. I’ll save the “there’s no such thing as a good billionaire” skepticism for another discussion. But all this throwing around of billions has made me see that there’s so much more we might be able to accomplish than just maintain the status quo. And now that I’ve studied the problem a little closer, it really makes me want to be a billionaire so freaking bad.
Khalid Rudo Smith is designer, facilitator and founder of things that affirm faith and dismantle injustice. Khalid is cofounder of MedReimagined, a maker of biomedical kits, summer and afterschool camps and curriculum that help scholars from communities with the greatest health disparities become the medical doctors their communities need most.
