Last week’s jaw-dropping $1 billion donation from billionaire Michael R. Bloomberg to Johns Hopkins University, enabling tuition-free medical school for most students, probably kicked off a lot of celebrations from Homewood to Name-Your-City-Here. The Johns Hopkins University School of Medicine was already ranked among the nation’s best (second only to Harvard University, according to U.S. News & World Report rankings). Now, it’s also among the most affordable anywhere, with free tuition for students from families earning less than $300,000 a year, a savings of $65,000 or more annually.

Bloomberg Philanthropies has stated that the purpose is to make medical school more accessible to students coming from low- and middle-income families. The expectation is this will help allow a more diverse group of students, which should, in turn, improve medical outcomes for patients in underserved communities. In theory, that makes this a win-win for Baltimore, which not only gets a boost for one of its most important economic assets (for medical research as well as training and care) but then can, presumably, attract graduates who can better relate to residents who may not be getting adequate health care now.

Yet, we can’t help but wonder if the generous donor, a 1964 Hopkins grad and former New York City mayor who gave a whopping $1.8 billion for the undergraduate school in 2018 might have put a greater emphasis on health care. Especially primary care. There is a chronic shortage of primary care doctors now. A big part of that is economics. Primary care doctors don’t earn as much as specialists. Will free tuition at Hopkins change that? Probably not. It’s such an exclusive medical school that applicants are likely seeking it out not to be the next Marcus Welby, M.D., but to become a neurosurgeon, a radiation oncologist, a plastic surgeon, or some other specialty that offers a potential seven-figure income. Who worries about borrowing $65,000 in student loans when a salary ten times as large beckons?

Granted, this is a bigger problem than even someone as wealthy as Mike Bloomberg can tackle. But we’d sure like to see students seeking to become internists, family practitioners or pediatricians get some preferential treatment — and better compensation, too. Otherwise, we can allow Hopkins to continue to prosper and make medical school more affordable, but it won’t necessarily improve health outcomes in the communities that need it most.