For a lucky few attending UCLA’s David Geffen School of Medicine, medical school has been tuition-free thanks to a $100 million donation made in 2012 by Dreamworks co-founder David Geffen. On Monday, UCLA announced an additional $46 million gift from Geffen that will enable an additional 120 students in the future to attend its medical school for free.

In 2002, Geffen bequeathed the medical school $200 million, a move that resulted in UCLA renaming it the David Geffen School of Medicine in his honor. He has given UCLA more than $450 million over the course of his philanthropy career and today, the David Geffen Medical Scholarship Fund offers merit-based scholarships for a portion of each year’s incoming class.

Geffen’s lightening of UCLA medical student debt is a drop in the bucket of the $4 billion spent on medical school every year. With over three-quarters of 2017 medical school graduates left school with over $200,000 in debt according to a survey conducted by the Association of American Medical Colleges, medical schools are searching for any avenue to free more students of the financial burden of pursuing medicine.

Geffen scholarship recipient Allen Rodriguez told the Los Angeles Times the high costs of applying and attending medical school deter students from low-income backgrounds from pursuing a career in medicine. “It takes so much money and time to apply that many people are priced out of it,” Rodriguez said.

A survey from the Association of American Medical Colleges reflects this, reporting that over half of first-year medical students come from households where the combined income exceeded $121,000. To offset rising tuition costs and increase socioeconomic diversity, New York University’s medical school announced in 2018 it would cover the full tuition cost for all its students, regardless of need.

Tuition at the USC Keck School of Medicine for the 2019 to 2020 academic year is $64,538, according to its financial aid website. This doesn’t count the cost of room and board, but tuition alone has made it one of US News’s top five most expensive medical schools in the nation. Over four years, that pegs the total cost of a Keck medical education at a staggering $400,000 accounting for room and board. Despite USC’s total university endowment of over $5 billion, Keck has no defined fund similar to UCLA or NYU to attract the best candidates, regardless of financial need.

“We certainly have aspirations, and our plans are to fundraise,” said Donna Elliot, MD, vice dean for medical education, when asked if USC had plans to follow UCLA’s lead. Keck’s current scholarship endowment, which Elliot stated was $120 million, is enough to provide 70 full scholarships on average in any given academic year, but the school would need an endowment of $1 billion to give all its students a free education.

“Our first step would being able to offer every student something, and our next step would then be to be able to offer full tuition,” Elliot said. According to its website, more than 80 percent of Keck medical students receive some form of financial assistance, but much of that comes in the form of federal loans that students are expected to pay back after graduation. Elliot added that over the last 3 years, the dean has helped each graduating class with a debt reduction fund that’s amounted to anywhere from $750,000 to $1.7 million. This began in 2016, with the class that graduated following the departure of former Keck dean Carmen Puliafito, who was dismissed after an LA Times report was published detailing his illicit drug activity.

According to Elliot, Keck is still looking for that “sentinel donor” to provide a gift on a scale similar to what Geffen gave to UCLA, but the school is committed to fundraising enough to offer Keck students a similar scholarship fund. “People are tired of me asking about it. It’s on the radar at the highest levels of the university.”

“If not having student debt allows more of our students to go into underserved communities, pursue lower-paying primary care specialties and work in rural areas, of course we’d like to be right in the middle of that mix,” Elliot said. “But in the short term we’re just pleased that so many schools are able to do this because ultimately we are able to impact our nation’s workforce in our positive way.”