Medical students expect to graduate with tens of thousands of dollars in debt, according to a survey released Monday, and student advocates say the expectation of high debt deters students from rural and aboriginal communities from seeking careers as physicians. Canada has a shortage of doctors in rural and aboriginal communities, and it is physicians who are originally from these communities that are most likely to work in them.
The National Physician Survey shows that more than one-third of medical students who responded to a 2007 questionnaire expected their debt load directly related to attending medical school to exceed $80,000. Among third-and fourth-year med students who replied, 5.5 per cent expect to have debts of more than $160,000.
“If you come from a lower socioeconomic status background, from rural Canada, from an aboriginal family, I think in a lot of those situations, that sticker shock really gets in the way,” said Shaheed Merani, a medical student at the University of Alberta, and president of the Canadian Federation of Medical Students.
“They have the drive, they have the intellectual capacity, they have the will,” he said from Edmonton. “It’s unfortunate if finances alone are what’s getting in their way.”
The federation represents just over 6,500 medical students from coast to coast. Dr. Jean-Pierre Martel, president of the Canadian Association of Interns and Residents, said that since tuition has increased, people from families that “aren’t quite as wealthy” are now less likely to enrol in medical schools.
“And we see the demographics in the medical school classes changed, and so what it means is you actually have less people from rural areas applying — because, as a general rule, they tend to be a little bit less affluent than urban centres,” he said from London, Ont., where he’s a radiology resident at the University of Western Ontario.
“We know from previous surveys and previous studies that people tend to go practise back where they came from.”
In addition, Martel noted that when doctors complete training and are faced with paying down a heavy debt, they realize it may be possible to earn a higher income in an urban centre. Merani said medical school tuition ranges from about $14,000 to $17,000 a year, except in Quebec, where there’s a cap on tuition. In Quebec, he noted, there’s still a larger proportion of students coming from low socioeconomic backgrounds compared to the rest of Canada where “we see that that proportion is very small, potentially reflected because tuition is so high.”
The survey confirmed that debt can affect the choice of specialty.
“Among medical students with debt, 23 per cent said that they would select a specialty they believed would have a high earning potential,” the report said. “Given current levels of pay, this could adversely influence students wanting to choose family medicine as a career.”
On the flip side, 16 per cent of medical students said they would choose a shorter residency program due to debt, and 20 per cent of family medicine residents said they purposely chose a short residency for that reason.
“People should be choosing what they want to do and where they’d be happy rather than having this sort of external constraint,” Martel said.
Residents are still training and earning a salary of about $40,000 when they have to begin making loan payments, said Merani. “Most of the time medical students don’t actually start paying back on the principal component of their student loans until after residency.”
On another question, the survey found that 60 per cent of medical students and 52 per cent of second-year residents said balance between work and personal life was the most important factor in determining a satisfying and successful medical practice.
Martel said it’s understandable that doctors don’t want to work every day or be on call every second night. He said physicians with healthy relationships provide better care for their patients.
“It’s something government definitely has to take into consideration when they look at the number of physicians that are being produced — that perhaps we need to produce a little more physicians.”
The survey also asked students about their motivation for entering medicine. The top three reasons were intellectual stimulation (93 per cent), professional relationships in caring for patients (83 per cent) and earning potential (42 per cent).
“To me it confirms that people aren’t doing medicine just to be looking at their earning potential,” Martel said. “The core values are still there for why people go into medicine, so that makes me very happy.”
The self-reported online survey was conducted jointly by the College of Family Physicians of Canada, the Canadian Medical Association and the Royal College of Physicians and Surgeons of Canada.
There were 2,819 medical school respondents. National level estimates based on the survey are considered accurate within 1.8 percentage points, plus or minus, 19 times out of 20. And 733 second-year residents replied, for national estimates considered accurate within 3.6 percentage points, plus or minus, 19 times out of 20.
With a report from CP