the training of a needlessly vast body of inferior men, a large proportion of whom break down, or that of a smaller body of competent men who actually achieve their purpose? When to the direct waste here in question there is added the indirect loss due to incompetency, it is clear that the more expensive type is decidedly the cheaper. Aside from interest on investment, from loss by withdrawal of the student body from productive occupations, the cost of our present system of medical education is annually about $3,000,000, as paid in tuition fees alone. The number of high-grade physicians really required could be educated for much less; the others would be profitably employed elsewhere; and society would be still further enriched by efficient medical service.
The argument is apt to shift at this point. If we refuse to be moved by the "poor boy," pity the small towns; for it is speciously argued that the well trained, college-bred student will scorn them. Not sympathy for the poor boy requires us now to sacrifice the small town to him, but sympathy for the small town requires us to sacrifice the poor boy to it. Two vital considerations are overlooked in this plea. In the first place, the small town needs the best and not the worst doctor procurable. For the country doctor has only himself to rely on: he cannot in every pinch hail specialist, expert, and nurse. On his own skill, knowledge, resourcefulness, the welfare of his patient altogether depends. The rural district is therefore entitled to the best trained physician that can be induced to go there. But, we are told, the well trained man will not go; he will not pay for a high-grade medical education and then con- tent himself with a modest return on his investment. Now the six-year medical education (that based on two college years) and the four-year medical education (that based on the high school or equivalent) may, as we saw above, be made to cost the same sum. As far as cost is concerned, then, the better sort of four-year medical education must have precisely the same effect on distribution of doctors as the six-year training furnished by the state universities. If a Jefferson graduate is not deterred by the cost of his education from seeking a livelihood in the country, the Ann Arbor or Minnesota man will not be deterred, either. But a deeper question may be raised. What is the financial inducement that persuades men scientifically inclined to do what they really like?—for a man who does not like medicine has no business in it. How far does the investment point of view actually control? Complete and reliable data are at hand. The college professor has procured for himself an even more elaborate and expensive training than has here been advocated for the prospective physician. Did he require the assurance of large dividends on his investment? "The full professor in the one hundred institutions in the United States and Canada which are financially strongest receives on the average an annual compensation of approximately $2500."[1] But the scholar does not usually advance beyond the assistant professorship: what figure has financial reward cut with him? "At the age of twenty-six or twenty-seven, after seven years of collegiate and graduate study, involving not only considerable outlay,
- ↑ "The Financial Status of the Professor in America and in Germany." Carnegie Foundation for the Advancemeat of Teaching, Bulletin II., p. vi.
