Armed with $1 billion donation from media titan Mike Bloomberg, Johns Hopkins University, Baltimore, is joining the small but growing number of medical schools that have eliminated tuition.
In this case, though, fees aren't being eliminated for everyone: Students from the wealthiest families won't get a break.
This fall, the university will allow students from families with incomes under $300,000 to attend its medical school for free with no tuition or fees. The university will also cover living expenses for students from families making less than $175,000.
Medical school debt has greatly outpaced inflation over the last several decades. The average US medical student graduate owes more than $250,000 for undergrad and postgrad student debt, according to a 2023 report from the Education Data Initiative. In comparison, the average medical school graduate student in Canada owes 19,250 US dollars.
"Removing financial barriers to individual opportunity fuels excellence, innovation, and discoveries that redound to the benefit of society," said Ron Daniels, president of Johns Hopkins University, in a statement.
Johns Hopkins University School of Medicine has 581 students, according to the Association of American Medical Colleges (AAMC). Earlier this year, Albert Einstein College of Medicine (864 students) in New York City announced that medical students will no longer pay tuition — ever — thanks to a $1 billion donation from Ruth Gottesman, a former professor at the school and widow of a Wall Street investor.
Gifts from wealthy donors have also eliminated tuition at New York University (NYU) Grossman School of Medicine (473 students) in New York City and NYU Grossman Long Island School of Medicine (74 students) in Long Island, New York.
Columbia University (642 students) in New York City, meanwhile, has eliminated student loans for those who qualify for financial aid. There are about 97,900 total current medical students, according to the AAMC.
Einstein College of Medicine and the NYU campuses don't charge tuition to any medical students. Howard Wolfson, chief of Bloomberg's educational philanthropy, explained the more limited Johns Hopkins free-tuition plan to The New York Times this way: "The idea behind it is that families who have the ability to pay should pay."
Bloomberg, a 2020 presidential candidate and former mayor of New York City, graduated from John Hopkins University in 1964 and served as the chairman of the university's board of trustees from 1996 to 2002.
"I suppose you can have an academic discussion about whether or not something like that should be universal," he told the newspaper. "But generally speaking, he believes there should be some means test. If you come from a wealthier family, you should pay. But $300,000 — it's not like we're talking about $50,000 as the cutoff."
In interviews with Medscape Medical News, physicians wondered how free tuition will affect the various crises facing medical education, such as lack of diversity and the primary-care shortage.
Robert M. Centor, MD, an internist and professor emeritus at the University of Alabama at Birmingham who continues to treat patients, said Bloomberg's donation is "admirable." But he wonders whether tuition should be entirely free. "You need to have a little skin in the game when you go to medical school," he said. "If it costs nothing, it may be a lark for some people."
The approach at Johns Hopkins is especially intriguing since it's based on need, he said. "The challenge is to understand the unintended consequences. Does this change who applies and whom they accept?"
In a 2024 commentary for the medical news site STAT, a physician and a medical student analyzed numbers at NYU Grossman School of Medicine before and after it made tuition free. They found that a 102% increase in applications from underrepresented groups didn't boost the number of Black graduates. Nor did free tuition boost the numbers of students matching into pediatrics or family medicine, two of the lowest-paid specialties.
Dr Centor said the University of Alabama found another way to encourage medical students to work in rural areas: They could get their tuition refunded in return for serving in rural communities. That, he said, seemed to be "a better use of money."
Julia Phillips, MD, MPH, professor and chair of the Department of Family Medicine at Michigan State University, studies medical school debt. She said Bloomberg's donation is a "great gift," but she also noted that free medical school tuition is still an experiment since the concept is so new and unstudied.
It's possible that the move could help relieve the primary-care crisis if more make career choices without needing to worry about student loans, she said. Free tuition may draw more diverse applicants, she added, but it will attract nondiverse applicants too.
"It really depends on how the school approaches admission decisions," she said. "That's the most important thing."
Conner Kinslow, MD, a chief resident in radiation oncology at Columbia University, benefited from the school's "loan-free" program when he was a student. A critic of free tuition for all students, he praised the Johns Hopkins strategy since "the way they're doing this is very fair and equitable."
As for whether free tuition may coax more students into primary care, he said it will depend on whether they're passionate about it. "It's helpful, but they may ultimately decide to go into higher-paying specialties regardless."
Dr Centor, Dr Phillips, and Dr Kinslow had no disclosures.
Randy Dotinga is a medical journalist and board member of the Association of Health Care Journalists.
