Page 100 - JSOM Fall 2021

Serving Those Who Served

The Yellow Ribbon Program and US Medical Education

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Christopher P. Bellaire, BA ; Joo Yeon Shin, BA ; Katrina S. Nietsch, MS ;
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Ricky M. Ditzel Jr, BSHS, CCP-C, SO-ATP *; Jacob M. Appel, MD, JD, MPH 5

The GI Bill and Post-9/11 GI Bill
While the Post-9/11 GI Bill guarantees full tuition at public
The GI Bill opened higher education to military veterans re- universities, there is often a significant shortfall in tuition re-
turning from World War II, with over 7 million Servicemem- imbursement at private institutions. For the 2020–2021 aca-
bers participating in educational and training programs in the demic year, the Department of Veterans Affairs (VA) maximum
decade that followed the introduction of this landmark legisla- tuition reimbursement rate for private academic institutions is
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tion in 1944. Since that time, however, the financial landscape set at $25,162.14. This contribution, while significant, is less
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of medical education has changed dramatically: from 1960 to than half the average annual tuition ($54,589) for the 61 pri-
2018, tuition associated with a medical degree increased by vate US medical schools belonging to the Association of Amer-
750% to approximately $300,000 on average. In 2008, in ican Medical Colleges (AAMC) in 2020.
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response to rising tuition costs and a new generation of mili-
tary veterans, the GI Bill underwent its most significant reform Financial barriers likely contribute to military veterans “miss-
with the passing of the Post-9/11 GI Bill and Yellow Ribbon ing in action” in US medical education. In 2018, the median
Program. These policies further encouraged military veterans parental income for new medical students was $130,000. In
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to pursue higher education by attempting to address rising tu- contrast, military veterans predominantly come from mid-
ition costs. dle-class families, with the majority (64%) of new recruits
coming from neighborhoods with family incomes between
For many in the Special Operations community and the US $41,692 and $87,850. The predilection of military veterans
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military, the educational benefits from the Post-9/11 GI Bill to attend USU—a tuition-free medical school with active-duty
are valued far more highly than their total income earned military pay—suggests, at least in part, that financial need
over the course of a 4-year active-duty enlistment. In 2020, plays a role in the paucity of military veterans at civilian med-
an entry-level private (E1 rank) made $19,228 in pre-tax basic ical schools.
annual pay; the noncommissioned officer—backbone of the
military (E4-E5 ranks)—earned less than $30,000; and en-
try-level commissioned officers with a college degree received Disparities in Financial Support
less than $40,000 in basic pay. As a result, the promise of the Disproportionately, this is a problem at US medical schools,
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GI Bill is a life support for veterans seeking higher education. as similar professional graduate programs have taken sig-
nificant measures to address outstanding financial need for
student veterans. According to a 2018 Journal of American
Financial Need
Medical Association study, student veterans in MD programs
However, of the 21,869 total matriculants to US medical paid significantly more out-of-pocket tuition expenses than
schools in 2019, only 131 students (0.60%) reported hav- did fellow Servicemembers in JD and MBA programs at the
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ing served in the military. Far fewer entered civilian medical same academic institutions: GI Bill funding covered less than
schools, as 77 students with prior service matriculated to the half (45%) of out-of-pocket tuition expenses for MD pro-
Uniformed Services University of the Health Sciences (USU) grams, whereas JD and MBA programs at the same institu-
to pursue careers in military medicine (J. Stearman, email tions provided 85% and 100% of median tuition expenses,
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message to corresponding author, “Re: Prior Service Matricu- respectively. In the 2019–2020 academic year, approximately
lants,” 2020). These numbers pale in comparison with the 2.7 one-third of private AAMC institutions did not participate in
million veterans between the ages of 25 and 39 in the United the Yellow Ribbon Program, while JD and MBA programs at
States in the same year. 5 these same institutions nearly universally contributed.
*Correspondence to Director, Research and Education SOM+C, Columbia University School of General Studies, 408 Lewisohn Hall, 2970
Broadway, New York, NY 10027; or ricky.ditzel@som-c.org
1 Christopher P. Bellaire is a Marine Corps veteran and second-year medical student at the Icahn School of Medicine at Mount Sinai, New York,
NY. Joo Yeon Shin is an Army veteran and first-year medical student at the Icahn School of Medicine at Mount Sinai, New York. Katrina S.
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Nietsch is an active-duty Navy pilot and accepted student to the Icahn School of Medicine at Mount Sinai, New York. Ricky M. Ditzel Jr is an
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Army Special Operations veteran and a student at Columbia University, New York. Dr Appel is associate professor of psychiatry and medical
education in the Department of Psychiatry and the Department of Medical Education at the Icahn School of Medicine at Mount Sinai, New York.
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