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