When Caitlin Comfort decided to go to medical school, the Yale grad had her heart set on staying on the East Coast. But her wallet had different ideas. Facing $90,000 per year price tags for tuition, she said no thanks, and started applying to schools back home in Texas.

That’s exactly what state legislators and educators want.

In Texas, a decades-old law caps tuition at public medical colleges in a bid to bridge a doctor shortage by a) getting students like Comfort to come back, or, b) getting students like her partner, Justin Cardenas, to stay in Texas to get their degree. Right now, tuition is about $6,550 per year for in-state students.

This puts Texas medical schools at the top of rankings of cheap (as well as reputable) places to get a medical degree, and several students who spoke with STAT said it was an important, if not the deciding, factor for them.

“It was just a much better deal,” Comfort said, rattling off interest rates and payments and how much she’d owe today if she had gone to one of those $90,000 schools. “Thinking about trying to keep up with a $500,000 loan is crazy.”

Like many states in the South, Texas has a growing population. Children under age 18 make up more than one-quarter of its residents. Having enough doctors is a constant challenge, said Stacey Silverman, a deputy assistant commissioner at the Texas Higher Education Coordinating Board.

“In Texas, we have a shortage of just about everything,” she said. “We need physicians in all specialties, but especially primary care.”

Texas ranks 47th in physician-to-patient ratio. The state has often recruited foreign medical graduates to fill shortages, with about 14,000 currently in practice, according to the Texas Medical Association. But that’s not enough, so the state has also invested heavily over the last several years to build new medical schools.

All public schools abide by the tuition cap, as do some private schools, like Baylor College of Medicine in Houston, where Comfort, from San Antonio, and Cardenas, a Texas A&M graduate, are in their fourth year.

Tuition, of course, isn’t the only expense for students; there are fees, books, housing, and travel costs to consider as well. So some med students do end up with six-figure debt. But it’s typically a lot less than they would owe if they’d gone to schools elsewhere. The Association of American Medical Colleges puts median medical student debt at $180,000 for public schools and $202,000 for private schools for 2017.

“It kind of made a difference for me,” said Michael Lapelusa, a second-year student at the University of Texas Rio Grande Valley (which waived two years of tuition entirely for its inaugural class). Lapelusa, who is hoping that time spent working in Houston will qualify him for in-state tuition for years three and four, wants to work in medically underserved areas, estimates his debt will be less than $100,000 at graduation.

“With smart decisions during residency and shortly after, I think that amount of money won’t dominate my life,” Lapelusa said.

The med school building boom in Texas has drawn some questions. Namely: Where are the residencies for all these new doctors? They all need years of supervised training in a hospital after graduating from med school, and those slots can be sparse.

Texas officials see an urgency to keep newly minted M.D.s in the state for that training — about 65 percent of young doctors end up staying in Texas after residency, according the AAMC.

So the state Legislature has earmarked $97 million in the 2018-2019 budget to support residency programs and expand the number of slots, said Silverman. There are about 6,700 medical students in Texas, according to the AAMC’s 2016-2017 data, and so far, Silverman said that the state has started eight new residency programs.

But it’s unclear who will stay. One irony: The lower debt they have after graduating from med school in Texas often gives young doctors more flexibility to travel the country looking for their ideal residency instead of staying close to home.

Cardenas, for instance, will leave Baylor with about $40,000 in debt. Comfort will leave with about $200,000 in debt. The two are trying to match to residencies in the same city. They’d like to stay in Texas, Comfort said, but on the other hand, both agree that now might be the time for adventure.

“We’re looking at where’s the best programs for us and the best cities to raise a family,” said Cardenas. “And not to be eating peanut butter jelly all the time.” 

Editor’s note: This story originally appeared in STAT, a national publication focused on health, medicine and scientific discovery.

Disclosure: Texas A&M University, the Texas Medical Association and Texas Tech University have been financial supporters of The Texas Tribune. A complete list of Tribune donors and sponsors can be viewed here. 

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