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an online version of the magazine Fall 2008

Debt of a Lifetime

It’s time to shift from supporting buildings to people.


By Dean/CEO Edward D. Miller, M.D.


Illustration of doctor comforting patient

When you add it all up—tuition, fees, living expenses—a medical degree from Johns Hopkins has become an expensive piece of paper. It takes nearly a quarter-million dollars for students to complete our four-year MD program.

How many families can afford such an enormous outlay? No wonder 85 percent of our medical students receive scholarships and loans. But is it fair to load medical students with such a crushing debt burden? Is it good for society?

What concerns me is that students facing massive indebtedness may, for the best of reasons, make unfortunate choices. They might work nights and weekends while in medical school. This places an enormous strain on them as they deal with an intensely rigorous curriculum. It doesn’t leave much time for study and reflection.

Second, large debts can adversely affect career choices. Some students may get seduced into fields where salaries are lucrative but the work diverts them from their true interests. They may opt to pay off their IOUs, even if it means foregoing a promising career in basic research or a medical specialty.

I don’t see the cost of training doctors diminishing. Medical education today is incredibly labor intensive. Twenty-first century tools and techniques require lots of expensive manpower.

In another year, we’ll be rolling out our cutting-edge curriculum, “Genes to Society.” Our state-of-the-art Armstrong Medical Education Building opens about the same time. Both are designed to emphasize smaller, more intimate learning experiences and technology-driven teaching. Our costs are going up, not down.

So how can we lessen the financial strain? Here are some ideas:


Shift our fundraising focus from buildings to people.

Previously, I’ve concentrated on finding donors for our new clinical, education, and research buildings. The end is now in sight. It’s time to turn our attention to other unmet needs. We must ensure that the men and women who come here to study and work have sufficient financial support to take full advantage of our new facilities.

In our Knowledge for the World campaign, donors to the School of Medicine have dedicated a remarkable 22 percent of contributions to capital projects—twice the normal rate. The next challenge is for donors to give more to “people programs” that aid our younger cadre of students, fellows, investigators, and professors. They are this institution’s pipeline to the future.


Create an adopt-a-student program for donors.

There’s no better way for supporters to stay in touch with what’s happening at the School of Medicine than a one-on-one relationship with a student. Some members of our board of advisors are providing financial aid to minority medical students and are finding it immensely rewarding.

I’d like to see this concept extended to our generous alumni. What if 40 or 50 of them adopted medical students by paying part of their tuition, keeping in touch, and getting together with them regularly? I’ve done that at my own college. You establish relationships that continue for years.

This is not a new idea. Lending a hand to the next generation is embedded in Hopkins’ fabled medical history.

One of our most preeminent physician-scientists, the late geneticist Victor McKusick, says he “came to Hopkins on a shoestring” but found a financial angel in Charles S. Stevenson (Class of 1934), who in turn had received support from Howard A. Kelly, one of Hopkins’ “Founding Four” original physicians.

When Stevenson asked Kelly about paying back this debt, the famed gynecologist replied, “You are not to repay the money to me. When you start earning and get ahead enough, you must search for another needy and worthy medical student—another Charlie Stevenson—and pass it on to him.”

McKusick, for his part, continued the tradition of supporting a promising medical student to honor both Stevenson’s and Kelly’s wishes. What a compelling story. Out of it could come a Legacy Club for our alumni to inspire and support Hopkins medical students.  


Continue Hopkins’ “tax” on major gifts but direct proceeds to financial aid.

Right now, we take a small portion of every big donation our departments receive and use it to pay for some of the unglamorous infrastructure in our two clinical towers and other new buildings. I’d like to see future revenue from this levy help medical students, fellows, and young investigators.


Commit income from overseas affiliations to medical education.

Some of the dollars flowing back to Hopkins from our international affiliations could go to medical students. What we’re really selling overseas is our intellectual property, and these students represent our future brainpower. I think it’s appropriate to turn some of this money into financial support.

All of these ideas could lessen the debt load on students. The goal should be to keep Hopkins in the bottom quartile for student indebtedness, which is where we are today. Our medical students deserve additional scholarship aid. Now is a propitious time to see how we can make that happen.

 Get a Life!?
 Washing Out My Distressed Genes
 Guardians of the Heart
 Sleep Interrupted
 Circling the Dome
 Medical Rounds
 Annals of Hopkins
Class Notes
 After the Prize
 Learning Curve
Johns Hopkins Medicine

© The Johns Hopkins University 2008