Libby Willis
Dr. Brown
English 306
May 6, 2016
Medical
School Tuition
The
art of medicine has taken a long and twisting path to arrive at its present-day
destination. Innovations
in technology and human rights have allowed for better health outcomes and a
more diverse group of doctors to treat a broad spectrum of patients. In short,
doctoring and healthcare have come a long way in certain regards; however,
there are still pronounced difficulties that need to be fixed in order for
healthcare to be truly great for its patients. Of these issues, one of the most
pressing is the topic of soaring medical school tuition.
With
an average debt of $170,000
upon graduation from medical school (as of 2012), tuition increases have
affected students wanting to further their health education (Lorin). Between
the years of 1984 and 2003, tuition “increased by 317 percent and 152 percent”
for public and private universities, respectively (Morrison). Strikingly, this
increase cannot be explained by inflation or the rising cost of living. Most
experts blame sweeping budget cuts to state institutions, but this does not
explain rising costs at private medical schools, which do not rely upon state
funding. Either way, such dramatic increases have a lasting effect on the
healthcare system. With tuition rising out of the realm of affordability, this factor
selects for only the most affluent candidates, leaving the middle and lower
class students behind. High tuition is even a deterrent for some of these students, often
prohibiting them from applying to medical school initially. The other implication is the choice of
specialty by medical students; the large salary difference between general practitioners and specialists
can affect this. With “the average salary of a practicing physician rang[ing]
from about $146,000 for a family practice physician to a bit more than $400,000
for an invasive cardiologist,” medical students are more likely to pick a profession that will allow
them to pay off loans faster rather than choosing their field of medicine based
on interest level or talent (Morrison). This could have serious affects on the distribution of doctors,
leading to a shortage of general care and a surplus of specialists.
Decreasing
medical school tuition would benefit America’s health system tremendously.
Recently, there have been small protests in the form of lobbies in Washington D.C., where members of the
American Medical Student Association sought to influence legislation in regards
to debt loan interest rates (Lorin). While this is a great start, it
does not go nearly far enough. Only 150 medical students traveled to Washington
D.C. to help lobby Congress, a relatively small number when compared with the
total number of medical students in the entire country. Without strong
leadership and a united front, headway is never going to be made in a
reasonable time frame. This is why drastic action must be taken to speed up
reform, allowing all students interested in medicine to have a shot at medical
school.
With
the small amount of protesting that has been seen thus far on this issue, this
protest is still well within its inception. The frustration and anger by those
currently dealing with massive debt has yet to reach substantial public attention, a key factor in
the labeling of a movement (Griffin 11). This protest will aim to reduce the
cost of medical school tuition to a price that is similar to that of the 1970s
(taking into account inflation in the present day). By doing this, we will see
an increase in access to medical school for all income brackets and we will see
an increase in overall quality of healthcare for the general public. The next
step would be to bolster interest and awareness of this issue within the
medical community, specifically focusing on the premedical population. These
are the students that will be the major, but not the sole, population used in
this protest, because they are the ones who have not, but will be, taking on
the debt (the next generation).
That being said,
the movement against increasing medical school tuition will be made up of many
small protests, moving into one large gathering, and eventually concluding as a
boycott against medical school if further action is required. Because the
target population is premedical students, the small protests will take place on
large, undergraduate campuses where effort can be maximized to reach the greatest
amount of people. The large protest will take place in Washington, D.C. to visibly
show lawmakers and the members of Congress that this movement is strong,
willing to fight, and has ample support among the nation. “The location, timing, and
strategy behind [these] rallies” will be a key component to the success of this
protest because it will be challenging to encourage support for this cause from
those who believe that they will not be affected by it (Heaney & Rojas). By
strategically placing protests on campuses where students are easily
accessible, support could be gained faster by those who are medically oriented
and by those who are not. In reality, this protest cannot succeed with only the
support of the medical community. By putting pressure on the government and on
medical schools from all sides, we can achieve our goal of decreasing tuition
much faster. This means that the overall movement must cater to two identities:
those who are medically related and those who are not. When deciding which
rhetorical strategies to use, this distinction will become critical.
Logistically, the
leadership of the movement should be the Surgeon General of the United States. Often
nicknamed “America’s Doctor,” the Surgeon General will have the most credibility with the general
public, as well as with medical students. His leadership will provide definitive ethos
power to the protest on all fronts. He will be used to lead some of the smaller protests, and then he will lead the large
protest in the nation’s capital. His role is particularly useful because he will have a dual function: he will bring support
for the protest through connections in Washington, D.C. and through his position of power
within the American community.
The use of pathos
will also be important to this protest for both identities, albeit it will be
used in different ways. During each of the smaller rallies, it is essential to
make sure that the premedical students know what is at stake. To make this
clear, the speaker will list statistics for the average indebtedness and the
cost to go to medical school, followed by asking rhetorical questions like
“Doesn’t it make you angry how much they are charging you? How will you afford
this? Do YOU have $170,000 to spare?” Requiring the audience to think about the
unfairness, especially after they are made aware that their parents did not have
to take out such burdensome loans, will cause feelings of anger and frustration
within the students. These feelings can be used to spur them into action.
On the other hand,
pathos for the general public will look somewhat different. The feeling of frustration
will still be used, but it will be in a different form. It needs to be made
clear that the current rate of tuition is indecent and unjust. We need to
appeal to the public’s sense of morality. What if they had been prohibited from
following their dream as a young adult, whether that be medical or not. How
would that make them feel? If America is known as the land of opportunity,
wouldn’t they want the next generation
to have the same opportunities that the older generation had? These kinds of questions should be
asked in order to get people thinking about how their actions will affect the generation after them.
Another use of
pathos on the general public (as well as lawmakers and those in charge of
tuition) will be to appeal to their sense of human decency. By increasing debt,
they are effectively taking perfectly good primary care doctors away from rural
and impoverished areas of the United States, because these jobs do not pay as
much, prolonging the debt payoff process. Many Americans do not know that there
are still places within the U.S. that do not have access to reliable, effective
primary care. By bringing this situation to light, we can capitalize on the
feelings of sympathy that Americans will have, creating the collective identity of “American”
and bolstering protest activity (Milan 888).
Finally, logos
will be used simply because of numbers. For most of America, $170,000 of debt
is a lot of debt. It can be
effectively argued that logically, that much debt is simply unsustainable for most
people, considering that number will only continue to rise if no action is taken. Even if it
can be paid off in a lifetime, it would take years, usually on the order of
decades once interest is factored in. It is more debt than most people will
take on in a lifetime, and a person must make this decision at the young age of
22. Tuition increases cannot be continued; it will affect the entirety of the
nation.
If these
persuasion tactics do not work, a boycott of medical schools is the only
option. This is the part of the protest that is less plausible than the others.
Getting people to speak out and call for change is a relatively easy task if
you give an audience enough incentive. But asking young adults to put aside
their dreams for a couple of years is a very large issue. Is it ethical to use
this protest tactic on a generation
that did not ask for it and just happened to be born at the wrong time? That is
why it is a last resort option.
Who knows if it would even be successful, because asking for too much is a
large gamble on the part of this movement. If people do not acquiesce to this
call, the movement will lose all credibility and momentum, leading to the eventual
failure of achieving its goals. However, the boycott would be extremely
effective if done right, because it would force those in charge of tuition to
decrease it, simply because demand would drop off. The goals would be achieved
in very little time, something for which all protests strive.
If it came down to
it, I would advocate for the use of the boycott. Yes it is unfair to this generation, but sometimes
personal goals have to be compromised (if only for a little while) for the good
of your fellow man. This protest is about more than just the burden of debt on
each student, it is about the causal
effects that burden has on future healthcare choices made by that physician. No
one wants to see the quality of healthcare plummet for the nation’s most
vulnerable citizens just because a couple of people are greedy. Yes, a boycott
would be a sacrifice for some individuals more than others. But I would argue
that ultimately, that sacrifice is worth it for the good of medicine, the
patient, and the entire population.
Conclusion Purpose:
My conclusion assesses and
evaluates the ethical and effective facets of my protest. I used this type of
conclusion to argue for my use of a boycott as a last resort, because I know
that my audience might have looked at that suggestion and thought “wow, that’s
bold.” I wanted to explain that yes, I know that this type of protest comes
with risks, but in the end I think it would be the most effective method and
bring about the most change. It was a way for me to establish ethos with my
reader.
Page 4, middle paragraph is my topic string paragraph (highlighting in
purple):
1. This paragraph seeks to describe
the Surgeon General and his vital role in the protest.
2. The sole character in this
paragraph is the Surgeon General. I did this because he is a large part of the
ethos within the protest, adding credibility and common ground between the
protest and the general population of America.
3. The topic string used is
Focused.
Works
Cited
Griffin,
Leland. "The Rhetoric of Historical Movements." Readings in the Rhetoric of Social Protest, Browne, Stephen Howard,
and Charles E. Morris III, Strata Publishing, Inc., 2013, pp. 10-14.
Heaney,
Michael T. and Fabio Rojas. "The Place of Framing: Multiple Audiences and
Antiwar Protests near Fort Bragg." Readings
in the Rhetoric of Social Protest, Brown, Stephen Howard, and Charles E.
Morris III, Strata Publishing, Inc., 2013, pp. 243-259.
Lorin,
Janet. “Medical School at $278,000 Means That Even Bernanke Son Has Debt.” Bloomberg, 11 April 2013.
Milan,
Stefania. "From Social Movements to Cloud Protesting: The Evolution of
Collective Identity." Information, Communication & Society,
vol. 18, is. 8, 2015, pp. 887-900.
Morrison,
Gail. “Mortgaging Our Future—The Cost of Medical School.” The New England Journal of Medicine, vol. 352, 2005, pp. 117-119.
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