AMA Speech - AMA President A/Prof Brian Owler - AFR Higher Education Forum

12 Nov 2014

12 NOVEMBER 2014

***Check Against Delivery

Medical Degrees Being Priced Out of Reach

Thank you, I appreciate the opportunity to talk today and to express the AMA’s concerns regarding the impact of the Government’s decision to deregulate University fees.

Medicine has always been seen as an attractive career.

However, university fee deregulation will mean that medical graduates will be burdened with large debts as they enter the medical workforce as interns.

They will carry that debt with them. This will have consequences that do not seem to have been considered.

The AMA is also concerned that, at the same time as University fee deregulation, the Government is reducing funding for Commonwealth Supported Places.

So, what is the impact of the proposed changes? What will the fees be?

Well, first, many medical degrees are now graduate degrees. These are four year degrees.

There are also still a number of undergraduate degrees of five and six years.

However, let’s consider the graduate degree example.

Prior to studying medicine, students have usually completed a science degree of three years, while many others do four or five year degrees.

Before they even start medicine, they are likely to have significant debt – using fees charged to international students as a guide, this debt can be in the order of $50,000.

Medical Deans Australia and New Zealand, 

A report commissioned on Selection and Participation in Higher Education in March 2011 by the Group of Eight (Go8) revealed that low socio-economic status (SES) applicants – from the lowest 25 per cent SES bands - were under-represented at 18 per cent, and high SES applicants – from the top 25 per cent SES bands – were over-represented at 31.6 per cent, relative to their population share in terms of applications for university.

Even now, we are still under the target of 20 per cent.

Closer examination of applications for health disciplines by field of education shows a greater proportion of high SES students - 45 per cent - applying for medicine, compared to 15 per cent applying for medicine from low SES backgrounds. 

A significant number of rural students come from a low socio-economic background, and high fee levels and the prospect of significant debt will deter them from entering university.

Rural medical students already incur substantive extra costs in accommodation and travel.

To place further financial barriers to these students would result in many finding the costs prohibitive.

Aboriginal and Torres Strait Islander students may well be hardest hit and discouraged by such measures.

No matter what upfront loan assistance is provided, it will deter students from a low income background from entering medicine.

This is a real issue in medicine. We want the best and the brightest, not the wealthiest.

We want the medical profession to have the same diversity as the communities it serves.

Australia, I believe, has gained significant benefit by attracting medical students from diverse backgrounds who have entered medicine, either through graduate or undergraduate programs, based on merit.

That is something that we should continue to value, something that we should continue to benefit from, but it is something that is under threat through these changes.

In the context of this debate, some have suggested that one way to meet demand for medical school places would be to uncap places. The AMA believes this would be a recipe for disaster.

The AMA does not support the creation of new medical schools or additional places until it has been established that there are sufficient training posts and clinical supervisors to provide prevocational and vocational training for the increased numbers of students currently enrolled in Australian medical schools.

Further, any expansion of medical school places should be consistent with workforce planning and the much anticipated five-year training plan we are expecting from the National Medical Training and Advisory Network.

We must not underestimate the impact that an uncapped market would have on demand for health services either.

So, why does graduate debt matter in medicine? There’s a perception that doctors earn enough to pay for this level of debt, but the context of debt is important.

A Group of Eight report on Understanding graduate earnings, from earlier this year (July 2014),

Understanding the context of debt incurred by medical students is also important in light of the significant costs of further training required by junior doctors to achieve specialist qualification, and the loss of earning potential for up to 15 years while doing so.

Overseas evidence shows that, in relation to medicine, a high level of student debt is a factor in career choice – driving people towards better remunerated areas of practice and away from less well paid specialties like general practice. 

Areas of medicine that are better remunerated will become more attractive. Procedural specialties will be more attractive compared to general practice or areas such as rehabilitation, drug and alcohol, or paediatrics.

Ultimately, these decisions will exacerbate doctor shortages in rural and regional areas.

We do not want to move to a US-style medical training system where students’ career choices are influenced by degree of debt.

This would have a significant impact on access to services and on workforce planning.

Health Workforce Australia (HWA) has also published medical workforce projections through until 2025.

While these show that, by 2025, the overall medical workforce will be very close to being in balance, but there will be geographic shortages as well as shortages in specific specialties.

Encouraging doctors to work in these areas and specialties will be much more difficult if they are saddled with high levels of debt.

This would undermine the significant effort that has been made by the Commonwealth to expand doctor numbers, as well as attract graduates to work in underserviced communities and specialties.

Finally, I would like to mention the implications for higher degrees.

High debt levels among medical graduates will deter our best and brightest, our future leaders, from undertaking PhD programs.

The numbers of medical graduates in some Universities are significant – up to a third.

It is already a major commitment - not only in terms of the minimum three years of time, but also financially.

As a medical graduate, already with significant debt, often at the stage of life of starting a family, it would not be surprising to see commitment to further research, to science, questioned.

This is a real issue for the people who undertake such degrees - our clinician scientists, our future medical leaders. They are the doctors who lead Departments, who lead research teams, and run laboratories.

For all the talk of the Medical Research Future Fund, it is disappointing that implications such as these do not seem to have been considered.

Thank you again for the opportunity to talk here today.


12 November 2014


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 Group of Eight. Policy Note. Understanding graduate earnings. July 2014.file:///C:/Users/scross/Downloads/203R1022%20(1).PDF

 OECD (2013), Health at a Glance 2013: OECD Indicators, OECD Publishing.