In light of the infamously controversial New York Times Op Ed piece, an attending colleague of mine in practice for many years prophecized that in twenty years or so, in order to deal with the physician shortage, the training process will have changed in the following way:
1) Medical school will be free
2) Residents will pay for their training, instead of vice versa. Residencies where doctors earn less will cost less or be free.
She said that it would cost the same but you'd pay money later rather than sooner. Making residents pay for their training would help fund more residency spots, which would deal with the physician shortage. And charging less for primary care spots would deal with the primary care physician shortage.
I argued that there is NO WAY this would ever happen.
In large cities like New York, residents earn upwards of $70K per year. How could you possibly take that money away and tell them that they now have to pay for training? Residency unions would never allow it. Furthermore, at the point that people are in residency, they are now in their late twenties or thirties... they are married, have kids, mortgages, etc. You can't expect all of these people to exist for 3+ years on no income and even having to PAY money. Paying for education is much easier to swallow when you're young and unattached.
And there's no way that the cost would be equivalent either:
Current model: Pay $40K/year for 4 years of med school + earn $50K/year for 4 years of residency = +$40K
New model: $0/year for med school, then pay $X/year for 4 years of residency = -$4X
Looking at it this way, under the current model, you at least come out ahead financially (although barely) at the end of your training. (Although obviously you're not ahead due to cost of living.)
This colleague of mine insisted, however, that this was a valid model and that it was likely to be implemented in the near future. I'm thinking not so much.