Commentary: the unsustainable cost of undergraduate medical education: an overlooked element of U.S. health care reform.

The cost of undergraduate medical education has been rising at more than twice the rate of inflation in recent years. A leveling off of the cost of medical education is unlikely to be realized any time soon. Rather, current economic circumstances are likely to further increase the upward pressure on medical schools seeking to correct budgetary shortfalls. Median student debt burden has increased by more than 50% from 1998 to 2008. All of this portends a negative impact on the diversity of the national medical student body and the ability of medical schools to meet workforce needs, including those necessary to the effective provision of primary care. As challenging as the high indebtedness issue may be, it is not insolvable. Current trends could be relieved by increasing financial assistance, improving the quality and availability of loan programs, and reducing the cost of attendance. Achieving the latter through foreshortening of the course of study is both feasible and potentially effective. All of these measures could and should be addressed as integral components of health care reform if we are to address the shortage of primary care physicians and other workforce needs.