Money, money, money
BY JESSICA YANG, PRESIDENT, AUSTRALIAN MEDICAL STUDENTS’ ASSOCIATION
‘Students love free food’ is a time-tested adage, often luring medical students into grand rounds. During a placement to a larger metro hospital last year, I recall marvelling at a friend who had worked out where to get free lunch every day of the week by attending different departments’ teaching sessions. While this was likely one determined student’s solution to not needing to pack lunch every day, the unfortunate reality is that many medical students are being left behind due to the financial difficulty of completing their degree.
This year, Medical Deans reported that 73 per cent of graduating medical students relied on family support for their income, an increase from 68 per cent in 2014. Additionally, 53 per cent of students were employed as they studied, an increase from 49 per cent in 2014. Students are needing to find more sources of income to study medicine.
In addition to direct course fees, medical education, along with several other health courses, entails additional costs outside the lecture theatre. Clinical placements bring a great deal of learning, often at distant satellite hospitals; unless you’re lucky enough to be placed exclusively at hospitals with reasonable public transport, a car is a necessity. In 2017, I moved to Campbelltown specifically to live across the road from my main teaching hospital, only to have six of my nine placements at least a 40-minute drive away. And good luck finding cheap parking! There are particular subsets of medical students that will face unique challenges. Students on rural placements, of variable length, run into dilemmas with housing costs: while some universities offer free or subsidised accommodation others expect the student to be solely responsible. Some students need to continue paying rent in their usual place of residence, and many will forego income from their usual job. The vast majority of medical students under the age of 22 do not qualify for independent Centrelink payments, which requires 18 months of full-time paid work; an untenable bar to achieve while studying medicine. On the other end of the age spectrum, older and/or post-graduate students are entering medicine with existing debt. Some also have partners and children to support as they study. Full-fee paying students, even with FEE-HELP, can be left paying hundreds of thousands upfront in tuition costs.
Even the cost of applying to medicine is a costly endeavour, adding together the UMAT/UCAT, GAMSAT, GEMSAS and travelling across the country for medicine interviews, especially for those who go through this process multiple years before getting into medicine.
This financial burden leads to stress and poor academic performance. 26.6 per cent of medical students respondents to a BeyondBlue survey identified finances and debt as a source of stress upon their mental health. Each exam season, I gamble on how many weeks I can take away from my part-time job before they get sick of me. During my most intensive rotation, I worked 20 hours each weekend to avoid clashing with an unpredictable clinical schedule which had supervisors asking me to stay back until 9pm on multiple occasions. Despite the hours I was pulling at the hospital, I barely passed that OSCE.
This burden also has profound implications for our future careers. As identified by The National Medical Workforce Strategy scoping framework, student debt has been identified as a confounding factor of the maldistribution of doctors rurally and across certain specialties:
Graduates are older, with more debt. The increase in postgraduate medical schools and growing tuition and study costs mean that new graduates are older and have more debt.
These doctors have less career time to pay off their debts, which may influence their desire to enter highly remunerated subspecialties and their choice of practice location.
Considering these factors, it is worrying to see some medical schools take the approach of explicitly discouraging students from seeking part-time employment. Students are often told not to bother maintaining a job especially as they start clinical years. The reasoning behind this discouragement is completely valid – completing your clinical years requires many hours of learning at the hospital and the added stress of a job may burn you out. But for many medical students who rely on part-time work as their major income, they simply do not have a choice.
Medical schools who ignore the financial demands on medical students are only perpetuating finances as a barrier to studying medicine. Doing things like ensuring consistent clinical schedules that students can plan around, or offering free accommodation for rural placements, are first steps in reducing this barrier. As the medical profession looks at areas of inequity, I hope to see medical schools take financial inequity seriously so that medical students feel more supported to access income.
Published: 02 Dec 2019