ARTICLE: Is There Merit in Merit Aid?

AUTHORS: Roy C. Ziegelstein, Charles G. Prober, Lloyd B. Minor, George Q. Daley, Paul B. Rothman, and Edward M. Hundert

JOURNAL: N Engl J Med. 2017 Oct 25. doi: 10.1056/NEJMp1713146. [Epub ahead of print]

In 2016, the average cost of attending medical school (including tuition and fees) in the United States was $253,720 for in-state graduates and $313,897 for out-of-state graduates.1 Nearly three in four graduates had educational debt, and the median educational debt was $190,000.2 Average debt related to medical education alone was $167,172.1 These figures suggest that, without scholarship support, only students with access to substantial personal resources or students willing to incur large amounts of educational debt can hope to attend medical school.

To ensure that students with limited financial means are able to attend medical school, many schools provide need-based scholarships or low-interest loans as part of financial-aid packages. Some schools also offer selected students “merit-based aid,” which is usually not related to a student’s ability to pay. At times, these scholarships cover not only tuition, but the full cost of attendance — including room and board, books and supplies, and other expenses — for all 4 years. Because applicants receive merit-based scholarship offers from some schools and not others, each spring schools are asked by some admitted students to match offers made by other schools. Given the expense of medical education, offers of merit aid are understandably attractive to accepted applicants.

There is broad agreement that something must be done to address medical students’ increasing educational debt, especially in light of findings that greater amounts of educational debt are related to higher levels of emotional exhaustion, burnout, and lower quality of life during residency.1,3 An important question is whether merit scholarships are part of the solution or part of the problem — whether there is merit in merit aid. If schools have a finite pool of funds for student scholarships, then offering aid on the basis of factors other than financial need reduces the amount of support available for students with greater need. As a result, a higher percentage of financially needier students will incur an increased debt burden.

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