The real issue seems to be that donations are going to the wrong schools (at least according oo the stated goals of the donors and schools). There is one paragraph that touches on it:
> The donations also appear unlikely to affect where people practice medicine. The schools that have gone tuition-free are all prestigious programs in major cities. None of them ranks even in the top 100 medical schools with the most graduates practicing in underserved areas. “You can’t take somebody that grew up in the suburbs and transfer them into New York City as a medical student and really expect that they’re going to take a job in Iowa,” Dinerstein told me. “Some will, but just not in general.” Although there’s plenty of need in the areas surrounding elite medical schools, making tuition free doesn’t create any new incentives for students to opt for community health centers over distinguished hospitals. “The medical schools that have gone tuition-free, they take strivers,” Dinerstein said. “And strivers, for all the things they had to do to get to medical school, are not going to stop now.”
Yeah that's a pretty good assessment. There are so many ways to deal with this issue, and so many different implementations of this approach that could have worked better. Just makes you wonder what anyone was thinking here.
> The donations also appear unlikely to affect where people practice medicine. The schools that have gone tuition-free are all prestigious programs in major cities. None of them ranks even in the top 100 medical schools with the most graduates practicing in underserved areas. “You can’t take somebody that grew up in the suburbs and transfer them into New York City as a medical student and really expect that they’re going to take a job in Iowa,” Dinerstein told me. “Some will, but just not in general.” Although there’s plenty of need in the areas surrounding elite medical schools, making tuition free doesn’t create any new incentives for students to opt for community health centers over distinguished hospitals. “The medical schools that have gone tuition-free, they take strivers,” Dinerstein said. “And strivers, for all the things they had to do to get to medical school, are not going to stop now.”