Volume 217 - Issue 8
Priced out of training?
Author: James Brown
Med J Aust 2022; 217 (8): 434-434. || doi: 10.5694/mja2.51723
Published online: 17 October 2022
Published online: 17 October 2022
To the Editor: Data from the United States, the United Kingdom, and Canada have highlighted rapidly rising medical education and specialty training costs as a key deterrent to diverse and lower socio‐economic medical graduates from pursuing specialty training. Australia is likely to be experiencing similar patterns, but there have been little published data or research in the domain.
For example, a study into costs of specialty surgical training in the United Kingdom and Ireland revealed that medical officers can spend up to £71000 on mandatory training costs during their Fellowship,1 on an average junior medical officer salary of £41000 pounds per year.2 This does not include the additional expected costs such as conferences and postgraduate degrees. In the background, mean debt on graduation from medical school has increased by 55%, from £17892 in 2004 to £27655 in 2014.3 A 2015 study predicted that most English medical students will be unable to repay their student loan before reaching the 30‐year write‐off.4
Australia is experiencing similar forces. When university fees were deregulated in 2014, the then Australian Medical Association president Brian Owler5 and the Grattan Institute6 predicted that full‐fee domestic places in Australian medical schools could rise by up to 270% to $70000 per annum. As foretold, a full‐fee domestic student now pays up to $77888 per year tuition, for a total estimated course fee of $335707 (Doctor of Medicine, University of Melbourne, 2022),7 which exceeds the combined HELP (Higher Education Loan Program) loan limit of $156847.8
Unlike overseas, there are no reports on medical specialty training cost trends in Australia. However, archived publicly available data give a general sense that local costs are rising much like those overseas. For example, annual training fee sums range from $483 (Royal Australian College of General Practitioners9) to $5714 (Australasian College of Dermatologists10) between colleges. This fee covers mandatory trainee subscription or membership to the college but does not include all the other mandatory costs such as exam and elevation fees, which vary between training programs. There is undoubtedly considerable difference in fee structures, and such numbers are difficult to compare between colleges. Nevertheless, without transparent data, we are unable to interrogate the concerns that have been identified in overseas studies.
The ramifications are potentially vast and varied. New Zealand data show that student loan debt is a common influence on choice of specialty and is a consideration when choosing to stay in the country to practise once trained.11 This may lead to long term consequences for the structure of the medical workforce and appropriate service delivery for patients. As a first step, it is critical that we take action to improve collection and transparency of medical training cost data in Australia.
Competing interests
No relevant disclosures.
Acknowledgements
I thank the participating Australian specialist medical colleges and the Australian Medical Association Council of Doctors in Training for formulation and data.
References
- O’Callaghan J, Mohan H, Harries R. The non‐monetary costs of surgical training. The Bulletin of the Royal College of Surgeons of England 2018; 100: 339‐344.
- British Medical Association. Pay scales for junior doctors in England [updated 18 Aug 2022]. https://www.bma.org.uk/pay‐and‐contracts/pay/junior‐doctors‐pay‐scales/pay‐scales‐for‐junior‐doctors‐in‐england (viewed Sept 2022).
- O’Callaghan J, Mohan HM, Sharrock A, et al. Cross‐sectional study of the financial cost of training to the surgical trainee in the UK and Ireland. BMJ Open 2017; 7: e018086.
- Ercolani MG, Vohra RS, Carmichael F, et al. The lifetime cost to English students of borrowing to invest in a medical degree: a gender comparison using data from the Office for National Statistics. BMJ Open 2015; 5: e007335.
- Owler BK. Medical degrees being priced out of reach. Australian Medical Student Journal 2015; 1 Sept. https://www.amsj.org/archives/4241 (viewed Aug 2022).
- Norton A, Cherastidtham I. University fees: what students pay in deregulated markets. Grattan Institute, 2015. https://grattan.edu.au/wp‐content/uploads/2015/08/830‐University‐Fees.pdf (viewed Aug 2022).
- University of Melbourne. Doctor of Medicine: fees and scholarships. https://study.unimelb.edu.au/find/courses/graduate/doctor‐of‐medicine/fees/ (viewed Sept 2022).
- Australian Government. Fee‐HELP information, 2021. https://www.studyassist.gov.au/sites/default/files/2021_fee‐help_booklet_0.pdf?v=1606886818#:~:text=It%20also%20includes%20any%20HECS,in%20one%20of%20these%20fields (viewed Sept 2022).
- Royal Australian College of General Practitioners. RACGP membership rates 2022–23 [website]. https://www.racgp.org.au/racgp‐membership/membership/membership‐rates (viewed Aug 2022).
- Australasian College of Dermatologists. Training Program fees schedule 2022. https://www.dermcoll.edu.au/publication_polices/training‐program‐fees/ (viewed Aug 2022).
- Moore J, Gale J, Dew K, Simmers D. Student debt among junior doctors in New Zealand; part 2: effects on intentions and workforce. N Z Med J 2006; 119: U1854.