Bleak financial outlook faced by medical students
Increased tuition fees in 2012-13, in addition to existing financial problems, are raising concerns over long term debt for the current intake of medical students in the UK
A BMA report published in August, entitled “First year medical student finance survey 2012/13,” has shown that this year’s intake of medical students in the UK is facing an unprecedented level of debt. The report also found “a rise in overdraft, commercial borrowing, and credit card debt for the first year medical students when compared to previous BMA medical student finance surveys.”
The report highlights long term debt as a concern. In 2012-13, annual tuition fees rose to £9000 (€10 600; $14 500) in England, up from £3290 in the previous academic year. A medical student completing a five year undergraduate course in England in 2010-11 (paying the lower tuition fees) had an average gross debt of £24 000. The report’s findings correlate with the BMA’s estimation that students completing the course under the new tuition fees could be leaving university with over £70 000 in total debt.
The majority of medical undergraduates will rely on a tuition fee or maintenance loan from the Student Loans Company (SLC)—68% of students surveyed reported some type of tuition fee debt, and 82% reported debt from a maintenance loan. But graduates choosing to study medicine as a second degree face an altogether more daunting prospect. In 2012-13, graduates who had taken out a student loan to fund a previous degree were not able to access SLC funding for tuition fees unless they were on the four year, graduate entry course and could self fund the first £3375. According to the BMA report, “although a four-year graduate entry programme is available to some graduates, this course is not available at all medical schools—therefore only 43.0% of respondents were undertaking a four-year graduate course.” Fewer than half (45%) of graduate students, therefore, funded their degree with SLC loans, with the remainder indicating the use of personal savings (67%) and parental contributions (46%). All graduate respondents were entitled to a maintenance loan from the SLC in 2012-13 regardless of the type of medical course they were on.
Many graduates who fall under the old tuition fee bracket struggle with their finances. In June, Michael Wilks—chair of the BMA charities committee—warned of the increasing numbers of medical students needing help to stay financially afloat, particularly for older students studying second degrees. He also said that the high cost and potential debt burden could put be putting off people from poorer backgrounds.
Kerris Farnworth, a third year medical student at Keele University, thinks that the struggle for graduate students to fund their degrees is largely “overlooked,” and describes her situation as “financially daunting.”
“I fully support widening participation in medicine, but there is a lack of support for graduates undertaking medicine. I was born into a working class family and am unable to rely on my parents for funding. I wake up every day with the prospect that my training may have to be terminated on a financial basis,” she says.
Damien Brown, a graduate student at Barts and The London School of Medicine and Dentistry and who is also in the lower tuition fee bracket, believes that his entry into the medical course would have been blocked by the higher fees. “I wouldn’t have been able to enter the course if the fees were so high [as £9000]—this would have been beyond my means.”
Financial pressure has other knock-on effects. Seven in 10 respondents reported that their finances negatively affect their stress levels, and more than two thirds of students (68%) were cutting down spending on essential items such as professional clothes, food, or heating to make ends meet. Two fifths of students said that they anticipated running out of money before the end of the year.
Throughout school, students such Priyana Sen, a third year student at Hull York Medical School, are compensating for their financial shortfall by taking up part time jobs. “I work every holiday and during term time. I’ve done bar work, been a shop assistant, waitressing and most recently [worked] as a clinical support worker in a hospital. I do whatever is available to enable me to earn the money I need.” Priyana is not alone. The BMA survey found that 58% of first year students were considering taking on extra work to support their studies, with 22% already working during term time. Disturbingly, 70% of students who worked during term time thought it had had a negative effect on their studies.
Steve Tran, deputy chair of the BMA Medical Student Committee (MSC), has concerns about students engaging in part time employment. “The commitment of clinical work makes it increasingly stressful to juggle both part time work and studies. However, if students are struggling they should contact their universities for more in-depth financial advice.”
The BMA has undertaken the annual survey of medical student finance for several years on behalf of the MSC. In light of the planned increase in tuition fees this year, they chose to specifically assess first year medical students, who have been first to experience the higher tuition fees. However, this means that no directly comparable data exist. In addition, the response rate was just over 11% (623 of 5199 students surveyed), which makes it difficult to draw definite conclusions from the data. BMA research analyst Kylie Lewington noted that the “disappointing” response could be down to “cost cutting,” which meant that the BMA could not send hard copies of the questionnaire to BMA members.
Although it is clearly too early to say what affect the increase in tuition fees will have on the medical student demographic, Tran believes that it is an area that needs continuing observation. “In the era of £9000 fees, those applying for medicine may start to think twice about it . . . We need to ensure that our ‘widening participation’ programmes develop; and that no student ever feels excluded from studying medicine because they cannot afford it.” This notion was echoed by joint deputy chair of the MSC, Will Sapwell, who responded to the report by asking, “How many more bright applicants are being put off purely because of their financial position?”Keir Stone-Brown, fourth year medical student , intercalated degree in science journalism1,2
1University of Manchester, 2City University London
Correspondence to: Keir.Stone-Brown.firstname.lastname@example.org
Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.
Provenance and peer review: Commissioned; not externally peer reviewed.
- BMA. First year medical student finance survey 2012/13. August 2013. http://bma.org.uk/-/media/Files/PDFs/Working%20for%20change/firstyearstudentfinancereport2012and2013.pdf.
- BMA. Medical students face increasing financial difficulty. 26 June 2013. http://bma.org.uk/news-views-analysis/news/2013/june/medical-students-face-increasing-financial-difficulty.
- BMA. Debt-ridden students forced to cut back on food. 30 September 2013. http://bma.org.uk/news-views-analysis/news/2013/september/debt-ridden-students-forced-to-cut-back-on-food.
Cite this as: Student BMJ 2013;21:f6377