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America has priced itself out of higher education.
That is why over the last few decades the United States has fallen from number one to number 10 in the percent of young people who obtain a college degree. It is also why the U.S. does not train enough physicians, nurses, pharmacists, or physical therapists to meet its own needs. Yes, the high debt burdens of students result in a higher proportion of upper-income students, but what is most concerning and what is contributing to the health worker shortage is the overall cost of medical education.
Every year, U.S. medical and nursing schools turn away tens of thousands of qualified applicants and thousands of American students instead study at overseas medical schools. Every year the U.S. Department of Education provides over $300 million in scholarships for U.S. citizens to study at medical schools overseas.
In general, American higher education has increased at a rate triple that of inflation and wages. But the high cost of health worker education is also a reflection of the fact that the U.S. values research over care. Our medical and nursing education leaders have lost track of the true purpose of clinicians—to serve. Although we spend more money per capita on health care than any other country, our health system is ranked 37th globally.
Unless changes are made in the U.S. education system, we will have an even more severe health worker shortage at the same time that America has 10% unemployment. We do not need more regulation or more government investment. In fact, one could argue that the over-regulation of nursing and medical schools by research and sub-specialty-minded academics have driven up the cost of education. What we need is to remove the barriers that prevent accreditation of more community-based training programs, which are more affordable and train more of the types of health workers we need. Osteopathic medical schools, for example, cost about 70% of what allopathic medical schools cost. The graduates of these osteopathic programs are more likely to practice primary care and more likely to serve in under-served communities.
We also need to focus on building the clinical skills of students rather than focusing so heavily on research. For many cadres, we need to reverse the “credential creep” which has further driven up the cost of education, reduced the output of students, and put this type of education out of reach for most. For example, registered nurses (RNs) used to be able to practice after completing a two-year certification. Now, there is a strong push from nursing leadership to make a bachelor’s the minimal degree required for RNs. This is especially concerning since the majority of nurses from underserved communities—rural, Latino, and African-American communities—enter through these two and three-year programs. End these programs, and risk cutting these underserved communities’ access to health care.
The U.S. also needs to create new financing mechanisms to expand the number of medical and nursing slots. I propose that the government create a system through which any funder, such as a charity or community, could create an additional slot for students from underserved communities in return for that graduate agreeing to serve in their community.
Without immediate action to make health worker education more affordable and to produce more health workers, expect to see the number of health workers the U.S. imports grow every year.
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