ON THE COST OF EDUCATING A MEDICAL-STUDENT

The cost of educating a medical student has been an issue of intermitt ent public concern for must of the twentieth century, beginning in 191 0 with the Flexner Report. The issue is now reemerging as a topic of h igh public and political interest, for several reasons, including conc ern about medical schools and their financing. Estimates of medical st udent education costs appear to vary widely; but such variations deriv e from the different ways the question has been framed. Costs can be c ategorized as instructional costs and total educational resource costs . Instructional costs, which can be distinguished further as marginal costs or proportionate-share costs, are those costs that can be relate d directly to the teaching program and its support. Total educational resource costs are those costs supporting all faculty deemed necessary to conduct undergraduate medical education in all their activities of teaching, research, scholarship, and patient care. The authors review studies spanning a period of more than 20 years and find that instruc tional cost estimates of medical student education, when adjusted to a standard base year (1996 dollars), fall within a fairly narrow range: most are between $40,000 and $50,000 per student per year. Estimates of total educational resource costs show greater variation, but four o f six estimates fall between approximately $72,000 and $93,000 per stu dent per year. The authors note that present directions of curricular innovation -- small-group learning, investment in information technolo gy and clinical education in ambulatory sites--offer little solace to those concerned with mitigating the costs of medical student education . Several proposals have been advanced to restructure medical student education in the name of efficiency and cost-effectiveness, but many a re simply maneuvers to transfer responsibility for costs to other enti ties. Only by a net reduction of the medical school curriculum might c osts truly be reduced. Yet the medical knowledge base continues to inc rease, as does the range of information and skills required of medical students. Unless society is prepared to change dramatically its conce pt of the well-educated physician, opportunities for significant reduc tions in the costs of medical student education are difficult to visua lize.