We are writing to express our apprehension regarding the impending 24 percent medical school tuition increase set to unfold over our remaining three years at the University of Missouri. As first-year students, our class will be the first to be affected by all three phases of the increase. Because of the disproportionate burden the proposed tuition increases will impose on our class, we urge further consideration before approving this change.

We have been told that higher tuition will result in only a small financial gain for the MU School of Medicine. However, our personal debt will increase substantially. Nearly all of us use student loans to finance our education and we expect to be paying these loans, in addition to loans from prior degrees, for decades. Most of us rely on Federal Direct PLUS loans, which currently carry an interest rate of 7.6 percent. Assuming a conservative 25-year repayment schedule beginning once we complete our medical training, the proposed $15,800 total increase in tuition during the next three years would amount to an additional repayment of greater than $111,000 per student. Cumulatively, this would mean our class will spend an extra $12.7 million repaying our medical school loans.

We are not arguing that as physicians we will be financially destitute, but there will be significant variations among our prospective salaries depending on the field of medicine we choose to enter. The university’s own Vision Statement for Medical Education places “special emphasis on the needs of rural Missouri.” These needs are largely met by primary care physicians. Many of us chose to attend the MU specifically because of its nationally-recognized excellence in primary care, and in 2019 about 35 percent of the graduating class chose to enter this field. However, primary care physicians earn on average 67 percent of what specialists earn, with family medicine physicians among the lowest paid. Many of us feel pressure to pursue higher-paid specialties in order to be certain of paying off our student loans without difficulty.

Moreover, in recent years this medical school has specifically sought out students driven to reduce health disparities in our community through primary care. Serving low-income populations and rural areas in this way means working for a fraction of the salary earned not only by specialists, but also by physicians working in more privileged areas. Poor health outcomes among vulnerable populations, compounded by a lack of primary care physicians, results in considerable medical debt that is passed on to the rest of society. By creating a financial barrier to working in primary care, and with underserved populations, socioeconomic health disparities will become more acute. We encourage you to think of the long-term well-being of Missouri citizens over a partial solution to our reduction in state funding. MU chose our diverse and socially conscious Class of 2022 to create health justice. Please do not create more barriers to health and economic stability for Missouri citizens.

Please also consider that physician income, like that of most professions, is unequal with regard to race and gender. Forty percent of our members are racial or ethnic minorities, and 53 percent are women. This diversity is certainly a boon for the medical profession. However, it means we will struggle more to repay our loans, as minorities earn on average 84 percent of what their peers earn and women only 73 percent. It is a known fact that there are already extensive financial barriers to entering the medical profession for minorities and socioeconomically disadvantaged groups. The proposed tuition changes will only widen this persistent disparity.

We recognize that maintaining MU’s high standard of academic excellence requires all members of our community to make sacrifices. However, this tuition increase places an unacceptably heavy burden on our class and disproportionately affects us because of our diversity and our commitment to providing primary care in Missouri. We ask that university officials treat our personal finances as if they were their own and pursue a more modest tuition plan than the one currently proposed.

Racy Guinan, Kelly Dougherty and Leslie Young are part of the University of Missouri School of Medicine class of 2022.