Student debt dictates who enters medical field

Alexandra Lopez-Pacheco, Financial Post
http://www.financialpost.com

With medical school tuition in the $15,000-to $19,000-a-year range, a career as a physician has become a luxury many Canadian students simply can’t afford.

It wasn’t always this way. But tuition fees for medical schools have skyrocketed since the federal government cut transfers to the provinces in the mid-1990s and tuition fees were deregulated. Between 1996 and 2001, medical school tuition in Canada rose 132%.

“The government said to medical schools, ‘We’re not going to give you more money. In fact, we’ll cut you back but we will allow you to increase what you charge for tuition,” says Dr. Ruth Wilson, president of the College of Family Physicians of Canada (CFPC).

The result is 36% of medical students today expect to be in excess of $80,000 in debt when they graduate, according to the recently released 2007 National Physician Survey. Not only are students from lower-income families deterred from pursing a medical career because of the debt involved, others are also choosing their field of practice based on how best to repay the debt.

“It affects their career choice,” Dr. Wilson says. “It works both ways. For some students, they want to get that debt paid off as soon as they can, so for them going into family practice is a good choice. It’s a two-year residency and then they’re able to start practising. I think that pressure works more on older students, such as international students, who perhaps have families already, and they need to start paying down the debt quickly.”

But many others turn away from family practice and choose to specialize because a few more years of debt will garnish them a much higher income, says student Shaheed Merani, president of the Canadian Federation of Medical Students.

“People say, ‘It doesn’t matter. They’re going to be a doctor, make lots of money and pay off their debt.’ But there are bigger implications,” says resident Dr. Jonathan Kerr, chairman of the Section of Residents with CFPC. “It’s not about one person; it’s the trickle-down effect and what’s happening in the minds of students who are not going into medicine or family practice because of the debt.”

One of the implications is a shortage of medical professionals, especially family physicians. According to Statistics Canada, approximately five million Canadians, which is a staggering 17% of the total population, say they don’t have a family doctor.

“The main concern is that it is changing who goes into medicine,” Dr. Kerr says. “We know over the last few years, there are fewer people from lower economic backgrounds and fewer people from rural communities getting into medicine because the cost associated with it is too great. And it really is unfortunate because who needs doctors the most? If you look at the need across Canada, it’s not the big cities, it’s rural Canada that is desperately short of doctors.”

While students from rural communities and low-income families might be motivated to become family physicians to service their communities, they have to face the stark reality that, since deregulation, provincial student grant programs have shrivelled and student-loan programs have caps that don’t even cover the tuition costs, let alone books, supplies and living expenses.

The result is 36% of medical students today expect to be in excess of $80,000 in debt when they graduate, according to the recently released 2007 National Physician Survey. Not only are students from lower-income families deterred from pursing a medical career because of the debt involved, others are also choosing their field of practice based on how best to repay the debt.

“It affects their career choice,” Dr. Wilson says. “It works both ways. For some students, they want to get that debt paid off as soon as they can, so for them going into family practice is a good choice. It’s a two-year residency and then they’re able to start practising. I think that pressure works more on older students, such as international students, who perhaps have families already, and they need to start paying down the debt quickly.”

But many others turn away from family practice and choose to specialize because a few more years of debt will garnish them a much higher income, says student Shaheed Merani, president of the Canadian Federation of Medical Students.

“People say, ‘It doesn’t matter. They’re going to be a doctor, make lots of money and pay off their debt.’ But there are bigger implications,” says resident Dr. Jonathan Kerr, chairman of the Section of Residents with CFPC. “It’s not about one person; it’s the trickle-down effect and what’s happening in the minds of students who are not going into medicine or family practice because of the debt.”

One of the implications is a shortage of medical professionals, especially family physicians. According to Statistics Canada, approximately five million Canadians, which is a staggering 17% of the total population, say they don’t have a family doctor.

“The main concern is that it is changing who goes into medicine,” Dr. Kerr says. “We know over the last few years, there are fewer people from lower economic backgrounds and fewer people from rural communities getting into medicine because the cost associated with it is too great. And it really is unfortunate because who needs doctors the most? If you look at the need across Canada, it’s not the big cities, it’s rural Canada that is desperately short of doctors.”

While students from rural communities and low-income families might be motivated to become family physicians to service their communities, they have to face the stark reality that, since deregulation, provincial student grant programs have shrivelled and student-loan programs have caps that don’t even cover the tuition costs, let alone books, supplies and living expenses.

“A family doctor will only make about half of what an average specialist will make, so then you have the medical school full of kids who aren’t likely to go into family medicine and you pay them half as much to go into family medicine,” he says, “no one’s going to choose it.”

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