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TUITION FREE MED SCHOOL PROGRAM

The cost of the medical education in the United States has risen substantially over the past 2 decades. In 2007, the average tuition at public and private med schools were 20,000 and 48,000 dollars respectively. In 2004, the Cleveland Clinic Foundation and Case Western University established a new medical school and surprised the incoming class of 2008 on their first day of class with the announcement that their med school tuition would be free. I am Dr. Larry Kaskel, host of the Clinician's Roundtable and my guest today is Dr. Kathleen Franco, Associate Dean of Admission and Student Affairs at the Cleveland Clinic Learner College of Medicine of Case Western and we would be talking about the tuition free med school program that was established at the Cleveland Clinic.

DR. LARRY KASKEL:

Dr. Franco, welcome to the show.

DR. KATHLEEN FRANCO:

Thank you very much for having me.

DR. LARRY KASKEL:

Well, before we discuss the details of the program, I would like to ask the million-dollar question or really quarter million dollar question, how can the Cleveland Clinic afford to offer free medical education?

DR. KATHLEEN FRANCO:

Well, I think it was a goal that we had had for a long time and Dr. Cosgrove, our CEO, has been dedicated to finding the money and finding the benefactors to help the student. He has placed various individual enroll to develop a fund of money that we could use for this purpose and we have a fair amount in that fund, not totally covered by the foundation, but in part from the general fund because it is so important to the future of medicine to have the most highly trained physicians and the best quality education that we can give them.

DR. LARRY KASKEL:

So, that really is the goal for it attracting the best and the brightest and this way you are assured of getting them?

DR. KATHLEEN FRANCO:

Well, I think it is more to prevent them from losing sight of their goal. Our program is designed to train physician investigators. American Medicine can fall back very very quickly when we do not have enough people who are really looking at new ways to bring medicine forward. Other nations can surpass us and we can be giving much lower quality care. So one of the concerns has been why don't physicians go into areas of investigation during the time they are also taking care of clinical patient, and part of that is due to the finances. If you graduate with a huge debt and you need to pay off your loans, you are not going to go into a lower paying job where you are putting part of your time into investigations you are going to into a practice where you can bring in a lot of money and pay of this debt, so as a result they steer clear of roles where they could have a combined clinical and investigative position. Our hope is that if we can help them with that, so that they do not graduate with as a larger debt as they would if they did not go to school here that we can encourage them to follow those original dreams to do physician investigations.

DR. LARRY KASKEL:

But when you say physician investigation, is that way of saying that they are getting MD, PhD at same time?

DR. KATHLEEN FRANCO:

No. Our students will get an MD with special qualifications in research. They have the option also of fulfilling requirements for a masters in different areas, for example it could be a masters in clinical research skills and many of them are doing that, but not all of them, so they will just have the MD with special qualification in research. They all do multiple projects and have to write a thesis before they graduate.

DR. LARRY KASKEL:

So, what was the response of the students when you all announced this, where they shocked, did they not believe it, did they think it was a joke?

DR. KATHLEEN FRANCO:

They were shocked. They desperately wanted to believe it. They were very very pleased and thrilled. Many of them had come in with the information that Dr. Cosgrove was working on this, but we all thought it might be you know 10 years out and you know they probably would not have the chance to benefit from it, and I think that they will thrilled that it actually came through during their time here.

DR. LARRY KASKEL:

Dr. Franco, is there any rivalry between the other students that did not get free tuition or is it kind of retroactive?

DR. KATHLEEN FRANCO:

Well, actually it is partially retroactive not completely, but there has been formula drawn up that would partially reimburse the students for the loans that they took out to pay their tuition, so everyone is winning with this and everyone is happy because if it did not happen now there would not be any of this wonderful surprise for all of the classes.

DR. LARRY KASKEL:

And do you expect this to continue as long as you are able to fund it?

DR. KATHLEEN FRANCO:

Absolutely. I think, Dr. Cosgrove is committed to it. I think he sees it as part of our mission for the Cleveland Clinic and we have for years and years, believe that to give the best patient care you have to also provide the best education and the best research that you have to combine those together to keep the patient first and to keep the progress that we want to have here, so I do believe that he will find a way to make it continue.

DR. LARRY KASKEL:

And moving ahead, did you see a surge in applications for the next class?

DR. KATHLEEN FRANCO:

We have, how big of a surge that will be we would not really know until December, but we have seen quite a bit jump in our numbers, which is exciting for us because that means that students are hearing about this and want to see what we are all about. There are; however, quite a few schools yet that do not realize that we are out here, so we continue almost on a daily basis to find people who never known about the school and now are learning of us.

DR. LARRY KASKEL:

Dr. Franco, are there different requirements or characteristics that you are looking for when reviewing applications for admission to your school now that you are basically giving free tuition?

DR. KATHLEEN FRANCO:

Well, our requirements are staying the same as they were before we gave free tuition, but I can tell you what those are. All of the students who come to us, will have completed some research as either an undergraduate or a graduate student or have worked in a research lab after they finished their bachelors degree. So, we want to find folks that we know already have a mindset for how to combine research with clinical medicine. The students also have qualities that we would hope every physician and every school would have. We want to see students have volunteered and sacrifice their time for other people when they could have been playing video games or something else, but they went out and they helped in a shelter or a church or habitat for humanity or whatever that might be. We look for students who have some experienced shadowing in a hospital that we know they can perceive what a physician does and the vigors of that type of a lifestyle. So, we would have expected them to go to a clinic go to a hospital a variety of ways that they can shadow.

DR. LARRY KASKEL:

I was just wondering if you accept anyone from outside the United States?

DR. KATHLEEN FRANCO:

We do, if they have done at least one of the degrees in the US. They are few of them, but they would have to have either completed an undergraduate or a graduate degree in the United States.

DR. LARRY KASKEL:

Well obviously you have started a trend, which is a great trend and I am wondering if you aware has anyone else basically followed up on this in mimicking what you are doing?

DR. KATHLEEN FRANCO:

Well, there is one medical school in Florida, who is now offering free tuition and several other schools are now offering discounts.

DR. LARRY KASKEL:

Do you think it is going to fix some of the doctor's shortage problems?

DR. KATHLEEN FRANCO:

I am hoping so. The association of American Medical College is hoping that the increase numbers that some medical schools are being able to take as well as schools like ours who are either giving free tuition or others, who are giving discounts that perhaps that will make it possible for us to meet a little more of the demand at least.

DR. LARRY KASKEL:

And Dr. Franco, is there is any sort of requirement for these students when they finish med school that they have to somehow give back a little something through perhaps community service or some sort of public service commitment?

DR. KATHLEEN FRANCO:

I think the students in the heart know that they will be giving back in someway. Almost all of our students right now are giving back to the community. We have multiple initiatives going on. One is called the community health initiative where every Friday afternoon they go to one of the intercity neighborhood clinics and help the patients their learn about preventive medicine and what they can do to better care for themselves. They do blood pressure checks and blood sugar checks. They do sexual counseling. They do a whole variety of things. The community has been so responsive and have been so happy about that they have given the students more space and we are now incorporating physical exams into that particular area. Then, the student, many of them, go to the Cleveland free clinic. We have another group, who teach in the intercity elementary schools in the fourth and fifth grade about science particularly neuroscience and mental health. We have other students, who have given time to shelters, every screening possible of all kinds of groups to the minority men, screenings, and that clinic that goes along with the minority mens care. We have a Hispanic Clinic. We have a screening for Hispanics, so they do a lot of things on their weekends and anytime that they have off.

DR. LARRY KASKEL:

I am a little jealous because it would have been nice when I was med school to not have that added stress of knowing that I am going to be in debt, so what are the students, do they have any problems left anymore because they have no stressors left in their life. So have you seen a difference in the students?

DR. KATHLEEN FRANCO:

As you know, we are a very different kind of school. We do not have traditional lectures. We teach in a problem based learning format, which means that they are responsible for each other's learning. They are learners and teachers in the same movement and they actually have a very different kind of course load rather than sort of cramming for a test and than having, you know, a weekend off or just kind of kick back. These students are responsible for pieces of homework every single weekend. They have a very steady pace, but it is a fairly intense pace, so they do have stress. They have their USMLE exam and they are required to take those and pass those before they graduate. Some schools do not require that, we do. They have to write a huge thesis and defend it in front of their community.

DR. LARRY KASKEL:

Now, that type of education is that a newer phenomenon or is that something that is common in many med schools these days? I think they call it alternative curriculum when I was in med school 20 years ago?

DR. KATHLEEN FRANCO:

Yes, that is right. There are some schools that are using it, although not all. We have a competency-based programs versus a grade program, so that rather than getting As, Bs, and Cs. We determine if you have met the competencies that will be required to get you to the next level, so it is quite different from most schools. Many schools have the problem based learning small group format, but it is a small part of their curriculum. For us. it is really the backbone in the curriculum and we have anatomy longer than most schools and we really throughout the 5 years, the seminars are all based on again students coming in having prepared the readings and then get problem sets about real patients and real life, so they are always applying the basic sciences to a real life person, although they may not ever meet that person. Sometimes they get that opportunity, this is why this biochemistry is important because this person's life hinged upon that, so you do not forget the basic sciences as well as much when you have the real live reason.

DR. LARRY KASKEL:

Well, on that note Dr. Kathleen Franco thank you very much for coming on the Clinician's Roundtable.

DR. KATHLEEN FRANCO:

Well, thank you so much for asking me. It has been a pleasure to talk to you about this.

DR. LARRY KASKEL:

Dr. Kathleen Franco, an Associate Dean of Admission and Student Affairs at the Cleveland Clinic Learner College of Medicine of Case Western and we were discussing the free tuition that the med school provides there. I am Dr. Larry Kaskel and you have been listening to the Clinician's Roundtable on ReachMD program, The Channel for Medical Professionals. Please visit our web site at reachmd.com, which features our entire library through on demand podcast and thanks for listening.

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