title: Variability in United States Allopathic Medical School Tuition.
abstract: BACKGROUND
  Over the course of the last generation, the cost of medical school attendance and medical student debt has increased drastically. Medical student debt has been reported as high as $350,000, and the Association of American Medical Colleges (AAMC) reports that medical school tuition continues to increase annually. The increasing cost of medical education and associated financial burden is now beginning to deter potential applicants from pursuing a career in medicine. In this study we aimed to assess medical school tuition across the US. We hypothesized that the cost of medical school attendance is variable across all regions of the US, and as a result, the financial burden on medical students is inconsistent.
  
  
  METHODS
  All 123 allopathic medical schools accredited by the AAMC were assessed in this investigation. In-state and out-of-state tuitions for the year 2016 were obtained from U.S. News and World Report. Additionally, medical school size was collected. Regions were defined according to the US Census Bureau definition, with the US being divided into 4 regions: Northeast, Midwest, South, and West.
  
  
  RESULTS
  There was no difference in average medical school size among the 4 regions (P > .05). Average in-state tuition was $38,291.56 ± $9801.38 (95% confidence interval [CI], $34,658.07-$41,513.46) in the Midwest, $45,923.04 ± $9178.87 (95% CI, $42,566.28-$49,216.78) in the Northeast, $32,287.78 ± $12,277.53 (95% CI, $28,581.90-$35,378.68) in the South, and $37,745.40 ± $11,414.37 (95% CI, $30,063.28-$40,458.99) in the West. In-state tuition in the South was significantly lower than in the Northeast, West, and Midwest (P < .05). In-state tuition in the Northeast was significantly higher than in the South, West, and Midwest (P < .05). Average out-of-state tuition is $54,104.04 ± $8227.65 (95% CI, $51,207.6-$57,000.39) in the Midwest, $53,180.10 ± $3963.71 (95% CI, $51,761.71-$54,598.50) in the Northeast, $48,191.86 ± $12,578.13 (95% CI, $44,595.84-$51,787.89) in the South, and $52,920.47 ± $7400.83 (95% CI, $49,175.13-$56,665.80) in the West. Out-of-state tuition was significantly lower in the South in comparison with the Midwest and Northeast (P < .05), but was not significantly different than the West (P > .05).
  
  
  CONCLUSIONS
  Despite no significant difference in medical school size among the 4 regions of the US that were assessed, there is significant regional variation in tuition, with higher tuition in private vs public schools. This study suggests that medical schools place a variable financial burden on the medical students based on region. The ongoing increases in medical school tuition are unsustainable, as future trainees will face substantial financial stress as they attempt to pay off their debt while initiating medical practice after residency and fellowship training.
authors.affiliation: Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Gil
authors.affiliation: Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI.
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Park
authors.affiliation: Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI. Electronic address: alandanielsmd@gmail.com.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Daniels
mesh_terms: D003365:Costs and Cost Analysis / Q000706:statistics & numerical data*; D004501:Education, Medical / Q000191:economics* / Q000706:statistics & numerical data; D012577:Schools, Medical / Q000191:economics* / Q000706:statistics & numerical data; D014146:Training Support / Q000191:economics / Q000706:statistics & numerical data; D014481:United States
keywords: Medical school tuition; Medical student debt