Applying to For-Profit vs. Non-Profit Medical Schools

A recent report from NPR brought up a topic that many medical school applicants don’t typically consider– whether the medical they are applying to (or are already attending) is a non-profit institution or a for-profit organization. 

Historically, for-profit medical schools have actually been banned across the United States, dating back to a policy more than 100 years old. This policy arose in the early 1900s, a time when there were wide disparities in the quality of education at US medical schools. The numerous problems with medical schools in the US were highlighted in the Flexner Report of 1910, that argued for a model of medical education similar to Germany where medical schools were affiliated with research universities, and had a science based curriculum of a standardized length taught by professional educators, and overseen by state and national regulatory bodies. The majority of medical schools in the USA closed as a result of the Flexner report. 

*It is worth noting that while the Flexner report led to increased professionalism of the medical profession, its author clearly expressed racist ideology and the report led to the closure of all but two medical schools that allowed African Americans to attend. It has been blamed for contributing to the significant disparities in access to care that the Black community suffers from to this day.

Ever since the Flexner report, US medical school growth has mostly been tied to large state and private research universities. However, starting in the 1970s, for-profit medical schools started opening in various Caribbean island nations. At the time, these schools provided opportunities to students who were unable to gain acceptance to US medical schools and also gave minority students access to a medical education they may not otherwise have had. In 1996, in the wake of continued growth of for-profit off-shore medical schools, accrediting agencies in the US were forced by a court ruling to re-evaluate the existence of for-profit medical schools. In the last decade or so, it  has caused a revival of the concept of for-profit schools. The argument is that these institutions meet the same rigorous standards and requirements as every other medical school and therefore should be allowed to exist. Additionally, these institutions are often being established in communities that otherwise could not fund them. However, many are worried that past problems will eventually return. Reddit is one place that medical students frequent to voice concerns about issues such as these and one user said about the topic:

“I went to a for-profit institution that, rumor has it, plans to open a FIFTH campus. We have sub-par clinical rotation sites at smaller regional and community hospitals that, at many times, are unable to accommodate students due to lack of available providers or limited resources. Examples like this show how these institution heads care more about the financial gain from tuition versus actually serving areas of need, providing students with valuable education that will prepare them for residency, and ensuring they match into their specialty of choice.”

In contrast, another said,

“As a DO student at one of the for profit schools, I dislike the stigma that because we are here, we aren’t as capable. I know many in my class who are extremely capable. Then there is the argument that we receive a lesser education because we have sub par faculty or aren’t associated with a teaching hospital. We have a lot of great faculty […] For profit/non profit in my opinion doesn’t matter, there are good and bad programs on both sides. I think the real problem is the residency bottleneck. If we don’t limit the number of new schools, there will be a large increase in the number of unmatched students (and the majority I think will be from these newer programs).”

Although for-profit and not-for-profit medical schools must adhere to the same accreditation standards, according to the NPR article, for-profit schools lack the same degree of transparency as their non-profit counterparts particularly in the areas of disclosing business models and reporting where tuition funds truly go. The vast majority of schools, even private ones, publicly publish their annual revenue and expenses reports while for-profit school rarely even share numbers on their websites. In addition, for-profit schools are often owned by various individual investors or private equity groups that are also involved in other ventures such as mining and real estate. For these reasons, it is mentioned that there can be unstable ownership and increased risk as students are taking out huge loans for an education that may be lacking in quality. The major problem here comes down to many for-profit schools awaiting full accreditation. Full accreditation is only conferred when the first class of students graduates from a for-profit medical school and therefore federal assistance is not an option. Students therefore must take out private loans that typically come with high interest rates, though tuition costs for for-profit medical schools are within the same range as non-profit medical schools.

In 2019, the median amount of debt for graduates of for-profit institutes was $294,780, nearly $100,000 more than the median of $201,164 for graduates of private nonprofit medical schools. Graduates of public medical schools had a median debt of $177,324. 

All this being said, for students applying to medical school, for-profit vs. non-profit status may very well be an additional factor to consider in choosing where to apply and ultimately attend. However, just as both types of schools undergo the same accreditation process, they also have the same application process and generally prioritize the same characteristics on student applications. Most medical school applicants are largely consumed with the application process, and in particular the concern about their performance on the MCAT. MCAT scores have a major role in determining an applicant’s ability to receive an offer to interview and be accepted to a medical school, and this is not different between for-profit and non-profit institutions. Beyond the choice of medical school to attend, it is unclear at this time if there are any implications of for-profit vs not-for-profit institutions affecting the graduates of these schools in their application to residency training programs or ultimate success as physicians.