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Leadership Q & A:
Debt-Defying Med School Leader Works to Improve Financial Aid

Charles Terrell, Associate Dean for Student Affairs, Boston University School of Medicine

The growing cost of higher education has raised new questions about whether lower- and even middle-income students can afford to attend the school of their choice without incurring staggering debt. Medical students, who in 1999 graduated with an average debt of $90,745, are no exception.

Charles Terrell, associate dean for Student Affairs at Boston University School of Medicine, was recently re-appointed to the Advisory Committee on Student Financial Assistance by Sen. Tom Daschle (D-S.D.). Terrell, the 11-member committee's only representative from medical education, talks about the committee's goals and its concern that the cost of higher education is hindering access for many less affluent students.

Q: The Advisory Committee on Student Financial Assistance may not be on the radar screen of many AAMC constituents. In a nutshell, how does the committee's work impact medical schools and teaching hospitals?

A: The committee was established by Congress in 1986 to serve as an independent source of advice and counsel to Congress and the Secretary of Education on student aid policy. The Department of Education appoints five committee members, while the Senate and House appoint three each. Committee members, who serve three-year terms, include student loan industry executives, college and university presidents, higher education specialists and consultants, and financial aid directors.

The essence of our work - ensuring for lower-income students access to higher education - has a profound im higher education - has a profound impact on graduate education, particularly medical education. If we can't broaden the base of participation from across our society in higher education, we can't win Project 3000 by 2000's battle to increase the number of medical students from underrepresented minority groups. We're not going to get there without the work of the committee.

Q: In your years in medical education, what has been the evolving role of financial aid? What trends have you noticed in financial aid assistance, debt incurred, and the cost of medical education?

A: The role of financial aid has become far more important in my years as an educator. Education costs have increased fairly significantly over the 25 years I've been at Boston University. Students and their families borrow much more than they did in the past. There used to be an expectation that financial aid meant a fair amount of scholarship and gift aid. Now, the reality people are stuck with is financial aid may mean just accessing the best loan program available.

I've seen the amount of medical school debt increase exponentially. I haven't seen a corresponding response from medical education; institutional aid hasn't kept pace with increased debt and increased costs. Medical school financial aid has evolved to debt management and financial planning. We provide students with the best financial mechanisms that we can find for them and try to provide them with the tools for managing repayment over the next 25 years. We often don't talk very much about traditional financial aid.

Q: Is the current level of financial aid available to medical students adequate?

A: It depends on who you are, what you need, and which school you attend. I think across allopathic medical education, there is a segment of institutions that absolutely provide adequate aid, a good part of which is scholarship aid; there is a class of institutions that provide adequate aid; and there are a number of institutions that do not provide adequate aid. It depends on tuition costs, institutional resources, and institutional priorities.

Q: Based on your experience, how can medical schools exert a stronger influence on the student financial assistance programs that affect our students and future physicians?

A: I think medical schools and the AAMC do a great job in exerting influence on student aid programs. But medical schools can exert a stronger influence on financial assistance programs by looking internally and by prioritizing institutional aid at each individual medical school. Specifically, schools should strengthen their student aid operations and ensure that the student aid voice is heard at the top where decisions are made.

Q: Is your perspective on student financial assistance different now than it was prior to joining the committee, and if so, how has it changed?

A: Yes, since I've been on the committee, I am much more aware of the political issues and nuances that are involved in every aspect of student financial aid policy and the roles of associations, educational institutions, and Congress. If anything, my commitment to accessing education for lower income students has been enhanced, because the committee is so dedicated.

Q: What do you hope to accomplish over the next three years on the committee, and what can we look forward to from the committee?

A: We hope to submit a plan to Congress very soon summarizing the state of access, particularly for lower-income students in the country. We also hope to reach a consensus throughout the higher education community to develop a strategy for improving access, because it desperately needs to be improved.

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