To the Editor,

As a primary care physician of thirty years, I read with interest Drs Peter Bach and Robert Kocher’s Sunday New York Times op-ed piece, “Why Medical School Should be Free”. Their postulate is that if medical schools were tuition free (using federal funds), thereby eliminating the financial burden with which so many medical students assume upon graduation they would be more apt to select a career in primary care medicine. Those graduates who still wished to become specialists would need to pay (at about $50,000/year) for their post-graduate training. Although this is a good start to redirect the waves of med students, my experience tells me Drs Bach and Kocher’s incentive is insufficient.

For decades, fewer medical graduates selected a career in primary care. This is not news to medical schools or hospitals where postgraduate training takes place. Reasons for this migration away from what was the most highly sought after career track when I graduated in 1969 are many. Some of the most obvious include being required to take on more responsibility to coordinate care without a commensurate increase in compensation, lack of professional prestige and disproportionate compensation.

According to Bach and Kochler’s calculation, the difference in annual compensation between specialist and primary care is $135,000 ($325,000 minus $190,000). Over 30 years, this becomes $4,050,000. Would you forfeit 4 million dollars in the long term for the short-term investment of $50,000 for 4 years for specialized training?

Medical schools select bright college graduates, educate them for four years in the deductive reasoning of medical diagnosis and pass them on for further clinical training. The young physicians then enter a system that does rewards them for using procedures and technology rather than their most unique skill - applying intellect and knowledge to solving problems.

Only when compensation and respect for physicians whose skill is to listen, question and translate equals those whose skill is dexterity and mechanical will the trend reverse.

Ralph B Freidin, MD

57 Bedford Street

Lexington, MA