The first generation of doctors are graduating this year with much larger student loans than previous medics: those on accelerated programmes had to pay £9000 for their first year (2012-2013), then £5625 for the next three years due to contributions from the NHS Bursary reducing the total (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/276460/nhs_bursary_scheme_new_rules_ed3.pdf). Ignoring any coordinated reduction in maintenance grants (which there has been), these students paid a total of £25875 for their tuition fees, either up-front or mostly via a loan (all via a loan is not possible any more). Whether this is good value is a complex question, but it can be relatively objectively compared to what students who started their accelerated courses in 2011 paid – a grand total of £3465 in their first year (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/276449/nhs_bursary_scheme_old_rules_ed15.pdf). That means that graduate medics who are first-year foundation doctors from this August will have paid more than £22000 in tuition fees than those in the year above them. The difference is similar for those on longer degrees: 5 year medics paid £13860 under the old rules, £36000 under the new – a difference of £22100. A five or six year medical student may not incur much greater tuition fee costs than an accelerated four year medical student, but they will have additional living expenses. The first medics under the new tuition fees regime, who started in 2012, won’t graduate until this summer (4-years) and next year (5-years), but with debts as high as this already, not to mention additional debts from reductions in the maintenance aspect of the NHS Bursary, these graduates are going to be motivated by the cost of their education like none before them.
And they will not be motivated by money from a greed perspective, but out of survival; unless they are relatively successful doctors in terms of pay, that debt will grow and grow until they are over 50, and they will continue to pay a percentage of their earnings to pay it off for that whole period. An article by the Student BMJ highlights the complexity of the calculation depending on what they earn and what they’ve borrowed. If they don’t have debt, they will be at least £22000 worse off than they would have been a year earlier (for 4 year graduates this year), meaning that opportunities to buy houses and settle down will be under greater financial strain. Remember that the youngest any of these four year graduates will be is 25, and only if they just did a three year degree with no gap-years and proceeded straight onto the course. I don’t know what the average age will be, but I would guess that the mean will be comfortably above 30, when most women would have hoped to have had children if they wanted to start a family.
And that final point gets to one of the biggest mistakes of this imposed contract – most new doctors are women, and unless we want to have less able graduates becoming doctors, we need to find ways of making family life as a mother work as a doctor. I can only speak for my family, but financial pressures like those stated above will make financial incentives to go abroad that much easier to accept. I have already lived abroad, and enjoyed it very much. I envisaged my future was in the UK, but if we move abroad with young children it will be hard to see our future back in the UK. This is a very real fear that the government has to contemplate – that they are scaring off the brightest and best future UK doctors. They may be able to recruit skilled doctors from abroad, but they will be competing ina global marketplace, and given the exodus from the UK, they are unlikely to hire comparably well-qualified doctors if they could have competed for the same jobs as the UK-qualified medical graduates.
So I am not suggesting that the foreign doctors will be worse – many will be better doctors – it is just that they will also be looking globally, and will probably have other advantages over our own graduates in terms of their worldliness and their linguistic plasticity (is that a concept? Hoepfully you get my jist…). It just highlights the problems of trying to expand the remit of a system that is already running well above-capacity, without increasing funding. Obviously individual doctors cannot just work more hours for more money. Most junior doctors would gladly work less for less money, if necessary, if the system was better staffed and more efficiently managed. I have no evidence for the assertion, but I challenge anyone to think of a competing scenario that sounds plausible – They would clearly happily work less for more money! However, I strongly suspect that getting more money, but being expected to work longer hours, no matter if that more money is disproportionately higher (say double-time) is not an attractive proposition to most family-minded doctors. Of course there will be some who have no life outside medicine, and for whom more work will not be abhorrent, but they will always, thankfully, be a minority. Obsession is good for a few, but would not be healthy if it were required of doctors.
This un-edited ramble will peter out with a final observation of what the maximum loan that an undergraduate may obtain under current rules (ignoring the maintenance award that they will get from NHS Bursary) – with no maintenance loans, the total fees would £36000, which Ercolani et al. rise with compound interest to £39946, using 2014 RPI values, and assuming a five year degree. Annual maintenance loans of £4375, £5500, and £7675 give total debts (upon graduation) of £63870, £70022, and £81916 respectively. Assuming RPI of 2% (the target generally), that gives a first year interest ranging from £2000 (or ~£165 per month) for £39946 debt, to £4100 (or ~£340 per month) for those with £81916 debts. http://bmjopen.bmj.com/content/5/4/e007335.full
Students can now get maintenance loans of £8500 per year… This is a serious tax.