Federal Money Talks

And many medical schools would like it to shut up

A recent health education law requires that, starting next fall, America's 119 medical schools must accept as third-year transfer students some 1,500 Americans who have been studying medicine overseas. If the U.S. medical schools do not comply, they stand to lose federal aid amounting to $1,400 a student a year. The Association of American Medical Colleges (A.A.M.C.) unanimously condemned the law when it was passed last year as an unwarranted intrusion into the admissions process. Now 18 of the more famous and affluent schools--including Yale, Harvard, Cornell and Stanford--have formally notified the Department of Health, Education and Welfare that they may refuse federal funds rather than comply. Yale, for one, will lose at least $580,000 a year (about 1% of its annual operating budget), a loss the medical school is willing to take, says Dean Robert Berliner, to "stand on principle."

The schools' major objection to the law is that they will have no voice in the transfer process: HEW, in fact, will summarily assign eligible students to existing openings. Med schools rarely accept transfers anyway, since very few good students tend to drop out. Thus the schools, which A.A.M.C. says have doubled their enrollment in the past decade, will be forced to fit even more students into facilities already filled to capacity. More important, many of the foreign medical schools are considered inadequate by U.S. standards, and many Americans studying medicine there are likely to be rejects from U.S. schools, which last year took in only 15,613 first-year students out of 42,000 applicants. Furthermore, since American schools begin clinical training as early as the first two years and foreign schools do not, transfers would be hard pressed in many cases to catch up.

Some of the rebel schools will meet later this month to consider fighting the present law further on constitutional grounds. Other medical schools are pushing for new legislation. Spurred by the debate, the House Commerce Subcommittee on Health and the Environment is planning a hearing to consider possible amendments to the law. One, sponsored by the subcommittee chairman, Representative Paul Rogers of Florida, would force medical schools to expand their third-year classes by 5%--or ten students--whichever figure is greater, but would let them select the transfers themselves. Under another amendment, backed by the A.A.M.C., schools would choose their own transfer students and get paid for them as a bonus, but nobody would be required to take on third-year students.

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