Mortgage-Sized Debt the New Normal for Medical Students
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NEWS Tuition fees: the two solitudes 458 And the vaccine winner is … 460 Mortgage-sized debt the new normal BMA targets racism 460 for medical students Counterfeit drugs in Florida 461 UK coroners face reform 461 Canada’s medical students are taking a “I married a fellow resident 3 weeks crash course in financial management ago — she is starting her second year in New WHO director general 462 because many are graduating with debts psychiatry and I had my first day in oto- Pulse: What rural bliss? 463 that look more like mortgages than stu- laryngology today,” says Dr. Benjamin News @ a glance 464 dent loans. Hoyt, a Dalhousie University graduate. The students, particularly those at- “Between the 2 of us we have $212 000 tending medical school in Ontario, say in debt, and our monthly interest pay- they have been caught in a perfect finan- ments are more than $900.” Andrea Page says economically disad- cial storm: rising tuition fees, reduced “I got my tuition bill on Friday,” adds vantaged students aren’t the only ones government support, the replacement of Andrea Page, a member of the class of facing difficulty. She managed to avoid grants with loans, and increasing re- 2006 at Western. “It’s for $15 339.62, debt before medical school by working 2 liance on lines of credit. with $10 880 due by Aug. 20. The maxi- jobs during the summer and school year, “Debt has become the stressor in mum available through OSAP [the On- but she cannot do that now because of medical school,” says Dr. Danielle Mar- tario Student Assistance Program] is the workload. tin, president of the Canadian Federa- $10 700.” “So I am on my own, with a gross tion of Medical Students. Tuition fees — one of the major dri- yearly income of $4000 from my sum- Martin, who began a residency in vers of student debt — now appear to be mer job, plus my line of credit and what- family medicine this summer, graduated on a steady upward slant everywhere ex- ever I can get from OSAP. The maxi- from the University of Western Ontario cept Quebec and Newfoundland (see mum OSAP payment for tuition [$4000] this spring with her MD and a bill for sidebar and table). does not even cover our minimum first $110 000. She is paying the $400 Fees for the 5 Ontario schools now payment [$10 880.62]. So we end up monthly interest via a personal line of range from $13 500 at Queen’s Univer- borrowing as much as we can from the credit. “I am borrowing to make my in- sity to the country’s high of $16 207 at banks, and then pay interest on it while terest payments,” she says. the University of Toronto. Tuition fees still in school, and then we end up pay- And she’s far from alone. at both Dalhousie ($10 460) and the ing the interest with the line of credit University of British Columbia ($10 272) because we have no other source of in- entered 5-digit territory this year, and come, which of course leads to exponen- Table 1: Tuition fees at Canadian the universities of Calgary ($9932) and tial growth of our debt.” medical schools, 2003/04* Saskatchewan ($9774) will probably get Page, who borrowed $20 000 during Medical school Tuition fee, $ there next year. her first year even though she had re- Dr. Irfan Dhalla, coauthor of a recent ceived $7000 in scholarship/bursary University of Toronto 16 207 CMAJ article on the impact of rising tu- funds, expects to owe “at least $100 000” University of Western ition fees (166[8]:1023-8), says he is fortu- by the time she graduates. Ontario 14 566† nate to have avoided major debt while at- Hoyt says there is already anecdotal McMaster University 14 445 tending the University of Toronto — evidence that career choices are being University of Ottawa 14 000 “mainly I’ve been very lucky to have par- affected, pointing to declining interest in Queen’s University 13 500 ents who are able and willing to support family medicine. “Many students feel it’s Dalhousie University 10 460 me financially.” simply not worth becoming a family University of British But many students aren’t as fortu- physician any more,” he says. (In the Columbia 10 272‡ nate, says Dhalla, a 2003 graduate who past 6 years, the proportion of medical University of Calgary 9932 started a residency in internal medicine students naming family medicine as University of Saskatchewan 9774 this summer. “Tuition here is now over their first residency choice has dropped University of Alberta 8539§ $16 000 a year, and add in living costs by almost 30%, to 24.8% from 34.7%.) University of Manitoba 7595¶ and an MD easily costs more than Dr. Abraham Fuks, dean of medicine Memorial University 6250 $100 000.” at McGill University and president of McGill University 3559 Dhalla worries that the increasing the Association of Canadian Medical Université de Sherbrooke 2729 cost will affect diversity in medical Colleges, says the current situation is a Université Laval 2502 school by scaring off members of some result of government deficit-fighting ef- Université de Montréal 2224 under-represented groups. “There is forts, which led to cuts in education also the issue of career choice. Are in- funding. “Canada’s medical schools can- *Students must also pay additional fees for student services, health plans, etc. For example, the total for all fees at the creasing tuition fees going to affect what not provide an education of the high University of Toronto is $17 287.50, and at McGill $5610. future graduates do? Is a career in public quality our students expect and deserve †Students in fourth year pay $10 924. ‡$8415 for students who started in 2002, $7480 for those health going to be lucrative enough to who started before 2002. pay off a 6-figure debt? What about §Tuition fee of $8539 includes $2000 differential fee. (Continued on page 458) ¶$7278 in years 2, 3 and 4. working for Médecins Sans Frontières?” CMAJ • SEPT. 2, 2003; 169 (5) 457 © 2003 Canadian Medical Association or its licensors N OUVELLES if we do not receive the financial support Dr. Albert Schumacher, a past presi- broke when they do graduate. I think required,” he says. dent of the Ontario Medical Association cutting even 1 year from the entrance Asked if increasing student debt is in- who has followed the debt issue closely, requirement would help.” evitable, he said it is not, “but a need for says more stringent entrance require- But O’Heron says student debt has to financial resources is.” ments are one reason debt is increasing. be put into perspective. “I don’t doubt Herb O’Heron, senior adviser on na- When he entered medical school at that individual debt has grown,” he says. tional affairs at the Association of Uni- Western in 1978, he had completed 2 “But what is debatable is the degree to versities and Colleges of Canada, agrees. years of a BSc, as had about 40% of his which the cost of the program and “The fees have risen because govern- classmates; 6 students had completed lifestyle choices made by the student ments generally have not been picking only 1 year. have contributed to the debt. These up the same share of costs as in the past. “Today almost all students are enter- lines of credit the students take out Even in professional programs where tu- ing with a 4-year degree, and many have cover a lot of different types of expenses, ition fees have been deregulated, the a master’s, some even a PhD,” says and not just [school] fees.” fees are covering only a fraction of the Schumacher. “Not only are they not CMA President Dana Hanson, who [true] cost.” practising as long because they are older graduated from Dalhousie in 1974, says So what can be done? when they graduate, but they are also society must make the final decision on the debt issue. “I came from a blue-col- lar family and I got through medical school with minimal financial prob- lems,” he says. “But if you turn the clock ahead, I wonder how well I would fare today. I also wonder how we are going to ensure that there’s a rich diversity within our profession.” Referring back to the debt faced by fellow Dalhousie University graduates Benjamin Hoyt and his wife, he com- mented: “They really owe $210 000? And people wonder why some of our doctors leave for the US.” — Patrick Sullivan, CMAJ Tuition fees: the two solitudes The difference in tuition fees between McGill, $3559, but it drops in subse- figure that it penalizes the faculties. Ontario and Quebec is now so large that quent years. “Quite frankly, what surprises us a lot students entering medical school in On- Low tuition fees have long been part is that we manage to keep offering a very tario in 2003/04 will have paid about of the educational landscape in Quebec, high-quality program. Our students per- $50 000 more for their tuition by the where rates for Quebec residents have form very well in the Medical Council of time they graduate. been frozen since the mid-1990s. (At all Canada exams. We look at what we re- Although fees vary somewhat be- 4 schools, students from other ceive [in government funding], and it’s tween Université de Montréal, Univer- provinces or another country pay ridiculous.” sité de Sherbrooke, Université Laval and higher fees.) “The problem is not the In mid-July, Caroline Richard, press McGill University, Quebec medical stu- tuition fees that we charge,” maintains secretary for Quebec Education Minister dents now pay about 20% as much as Dr.