Discussion post with at least 200 words on the specific topic in the files.

At a recent (hypothetical) meeting of government and education leaders in your state, the usual litany of problems in medical education and health care delivery was being discussed. Those present were sensitive to the large debts that most medical students incur, and understood the pressure they felt upon graduation to enter specialties and move to locations where their earning capacity would be greater than if they practiced primary care in inner-city or rural areas, where needs are greatest. Concern was also expressed about the lack of access many people have to health care.

One of the leaders at the meeting proposed an idea to try to resolve both problems. Beginning in the next academic year, the state would initiate a mandatory program—it would pay the complete education costs for all students attending one of the state’s medical schools. In return, students would be obligated to spend the first 4 years of their career in a location assigned by the state—presumably an inner-city or rural area in need of physicians. The idea is similar to the National Health Service Corps (an underfunded federal government program) and the Armed Forces Health Professions Scholarships, but differs in that it is a mandatory program.

If a state referendum were to be held on this proposal, how would you vote? Is this a creative response to the problems of large debts of medical students and the lack of health care services in certain areas? Or is the mandatory nature of the program unfair to medical students? Does the government have a right to dictate practice site to physicians even if it does pay their medical education expenses? Might other students (e.g., in law, engineering, business, education, and sociology) demand a comparable program? The state government could not afford all these programs. Is medical education and the delivery of care qualitatively different?