Medical Student Debt:

Is it a problem, or just a shrewd investment?

By the end of his or her medical education, the average Canadian graduate will owe $71,721. That amount, which has increased by about 7.3% over the past 5 years, may seem either huge or trivial depending on your perspective and stage of life. Interpretation might be enhanced with a few more details:

  • 17.5% manage to get through medical school with no debt at all, a figure that has not changed over the past 5 years.
  • on the other extreme, 6.2% report debts of over $200,000, which has increased from 4.1% in 2010
  • 28.3% report already having debt before even entering medical school (26.4% in 2010), with an average premedical indebtedness of $7,465 or, perhaps more telling, an average of $27,094 for those who report any debt (comparing to $6,506 and $25,968 respectively for 2010).
  • 32.5% report having accumulated “non-educational debt” during medical school (eg. credit cards, car loans, mortages) averaging $23,976 (comparing with $31,455 in 2010)
  • 28% feel that the amount of financial assistance available to them fails to meet their needs (compared to 31.5% in 2010)
  • 3.7% report “no need for financial assistance” (unchanged over the past 5 years)

All this comes from the Canadian Medical School Graduation Survey, which is conducted as part of the Academy of American Medical Colleges Graduation survey and was completed (voluntarily) by 2,048 graduating students in 2014 including (I’m pleased to report) 99% of our graduating class at Queen’s.

At the same time, tuition rates appear to be on the rise (http://studymagazine.com/2011/11/01/tuition-canadas-medical-schools-rises/), currently averaging about $11,000 annually, but with considerable variability between schools, ranging from as low as about $4,000 to highs of over $25,000, according to the Canadian Medical Education Statistics published by the Association of Faculties of Medicine of Canada (http://www.afmc.ca/pdf/CMES2014-Complete-Optimized.pdf).

So, what does all this mean? Is this a problem that we and other medical schools need to engage, or are we observing what is, from a strictly financial perspective, an investment by shrewd and well- informed young people in an education that will lead to a secure, well-paying future in which they should be able to quickly dissipate even the higher levels of indebtedness?

On the “what’s the fuss” side of this argument are those who point out that medical students, once enrolled, have easy access to large loans from banks and other institutions who are confident in their success and financial prospects. They would note that almost all medical students graduate to lucrative careers (unlike most other university graduates), and that even a resident physician’s income, sensibly managed, provides the means after graduation to pay down those loans. They would further point out that there is very little post-graduation default on debts. Finally, they might make the point that these students are, in fact, adults who make conscious and highly informed career and financial decisions, and that medical schools are either their parents nor socially responsible for those decisions.

Those on the “we have a problem” side of this issue might make the following points:

  • Although manageable after medical school and a minor issue in retrospect, the perception of increasing debt during medical school is a major stressor for students during an admittedly demanding period of their training, and may therefore distract from their education
  • The high debt load may influence career decisions, prompting students to consider specialties with shorter duration of training and greater perceived long-term economic benefits.
  • High debt load may discourage students from taking up research, educational or other academic training opportunities, either in parallel with or after their core training.
  • The high costs and accumulated debt may discourage many young people from socioeconomically challenged backgrounds from even considering careers in medicine, thus establishing a further barrier to the social diversity that all medical schools and the medical education community are endeavouring to establish. To quote the AFMC’s Future of Medical Education In Canada: A Collective Vision for Medical Education in Canada:

Achieving this diversity means attracting an applicant base that is more representative of the Canadian population. This will involve, for example, addressing perceived and real barriers to medical education, such as the high debt loads of medical graduates.”

The last point is particularly vexing. It’s easy to imagine that, for a family of limited financial means and with incomplete knowledge of the financial realities, the prospect of over $20,000 in annual tuition and possibly hundreds of thousands in accumulated debt may be sufficient to quash any dreams of medical education very early in life. (see previous blog article http://meds.queensu.ca/blog/undergraduate/?p=1165&preview=true&preview_id=1165&preview_nonce=e904b6e40f&post_format=standard).

In addition, there are considerable financial hurdles a student must face to simply apply to medical school, including three to four years of pre-medical undergraduate medical education, MCAT examinations (including preparation and travel) and quite likely a sense that income-generating jobs should be sacrificed in order to pursue studies or activities deemed more “attractive” to medical school admissions officers. Although considerable financial assistance and loans are available to students once accepted to medical school, there is no similar level of assistance to those in the application process where it would arguably be of greater benefit.

daviesAt Queen’s, we are concerned about the rising profile of student indebtedness and it’s impact on both current and prospective students. To further examine this issue, we have established an Advisory Panel on Medical Student Debt, chaired by Dr. Greg Davies and supported by Brian Rutz, UG Financial Officer. The panel is populated by several current students from all years, recent graduates in residency training, not-so-recent graduates now in the early years of independent practice, and several members of faculty and the university community with interest in this issue. That group has already begun its work by undertaking a review of the Canadian medical school environment through the Graduation survey, and current literature. It is focusing on several topics:

  1. The sources of debt
  2. The impact of debt on individual students
  3. Counseling and information sources available to students as they engage financial planning
  4. Financial aid availability and access
  5. How support might be provided to young people considering careers in Medicine

Their findings and recommendations, once available, will be brought forward for wide discussion and implementation. I’m sure Greg and his committee would appreciate hearing from readers about any and all of these issues. I know I would.

 

Anthony J. Sanfilippo, MD, FRCP(C)
Associate Dean,
Undergraduate Medical Education

 

2 Responses to Medical Student Debt:

  1. Anonymous says:

    Hi Dr. Sanfilippo,

    Thank you for your analysis on the medical school debt issue. While I’ve always thought this was never an issue for physicians who easily gain employment and have some of the highest salaries in Canada, you bring up some interesting points especially for individuals with limited income.

    One thing you don’t mention is a hidden and serious cost for aspiring applicants. An applicant may spend the time, money and effort to do pre-medical education, writes the MCAT, and applies for medicine but may not “make the grade” due to the level of competition. I ask, what are they going to do for a career? As far as I can tell traditional pre-medical education prepares you for one thing; medical school and not a job offer in a different sector. You point out that there are several individuals who do not make the grade for medical school and would excel in different careers but how do you bridge the skills gap though? An employer is not necessarily going to use the same criteria as a medical school when hiring.

    One of my major problems with the current undergraduate education system when it comes to the life sciences is the fact it acts more as a screening tool to identify the very few who could enter professional school. The focus is not on learning within life sciences but trying to grade and rank a class. There is very little focus on career development, co-op placements and professionalism in the undergraduate and even graduate levels of life sciences education. Very few students are even aware of there full options in the life sciences. Frankly, the majority of life science students are left with skill sets that are unsuitable for the job market directly after undergraduate studies. They have to upgrade their skills with graduate school or post-graduate certifications.

    What are your thoughts? Do you discuss such issues with the life sciences undergraduate department? How are they approaching career development to minimize the costs of applying to medical school?

    • My consistent advice to applicants over the years has been to engage undergraduate education that is of interest to them personally, and that could lead to a fulfilling career in and of itself. I disagree with your assertion that pre-medical education prepares people for one thing only. It should provide solid grounding for a variety of careers in health sciences, medical technology, research and education. I think students who engage their university years strictly as an “audtion” for medical school do themselves a serious disservice, and do put their careers at risk. Finally, I’d point out that success in any area of study is most likely to be the product of true dedication and interest to that pursuit, and that most medical admission processes focus on the level of accomplishment, not the content area.

Leave a Reply to Anonymous Cancel reply

Post Timeline

Curriculum Committee Information – September 28, 2017
Published Wed, November 15, 2017

Faculty and staff interested in attending Curriculum Committee meetings should contact the Committee Secretary, Candace Miller (umecc@queensu.ca), for information relating to agenda items and meeting schedules. A meeting of the Curriculum Committee was held on September 28, 2017.  To review the topics discussed at this meeting, please click HERE to view the agenda. Faculty interested in reviewing the minutes of the September … Continue reading

Grade Inflation – the “dirty little secret” of academia
Published Mon, November 13, 2017

“Would any of us have gotten into medical school today?” This was the tongue-in-cheek question I posed to my classmates at our medical school reunion last year. They were rather amused by it and, being very much aware of the high academic standards required by our current admissions processes, believed the answer was an obvious “no”. I tried to raise … Continue reading

Facebook thinks I’m a doctor…
Published Mon, November 6, 2017

  And other unusual things that happen when you’re an educational developer at a medical school It’s a unique and interesting thing being one of the non-medically-trained employees who work (mostly behind the scenes) to help run the undergraduate medical education program at Queen’s. On the one hand, friends and family can sometimes think I’ve magically completed medical school in … Continue reading

Nominations open for next Exceptional Healer Award
Published Mon, October 30, 2017

Instilling the values of patient-centered care is one of our goals in the UGME program. It’s also what the Kingston Health Sciences Centre Exceptional Healer Award recognizes in physicians from both the Hotel Dieu and KGH sites. Launched earlier this year, the Exceptional Healer Award is sponsored by the KHSC Patient & Family Advisory Council. It honours a physician who … Continue reading

Students striving to make a difference in our community
Published Mon, October 23, 2017

One of the attributes that our Admissions Committee works very hard to identify in applicants is a commitment to service. This has multiple dimensions, involving service to both individual patients and communities. It’s therefore always very gratifying to learn of efforts such as that described below in todays guest article provided by students Lauren Wilson, Katherine Rabicki and Melissa Lorenzo. … Continue reading