Medical Student debt – time for government to change policy on doctor recruitment

As I wonder how on earth the UK government will produce enough doctors for the future, I reflect on some of the articles on Medical Student debt, and doctor recruitment, and a Welsh suggestion for addressing the shortage there:

The Guardian’s David Batty on 19th May 2012 reports: Young people ‘will be put off studying medicine by £70,000 student debts’

British Medical Association official says debts, rising pension contributions and salary freezes risk deterring potential doctors

“Student debts of up to £70,000 and increased pension contributions could dissuade young people from entering medicine, a doctor has warned.

Tom Dolphin of the British Medical Association (BMA) told the Junior Doctors Conference that medical students paying the new £9,000 tuition fees, which come into force in September, will have debts of up to £70,000 by the time they graduate.

They will also face their salaries being eroded by inflation and increased pension contributions, which deter talented students from entering medicine, added Dolphin, chairman of the BMA’s Junior Doctor Committee…..”

On 13th Jan 2014 Charlie Cooper reports for The Independent on Sunday on Plaid Cymru making an interesting pitch: Plaid Cymru would wipe out junior doctors’ student debt in order to solve Welsh medic shortage. With 26.4 doctors per 10,000 people, Wales has one of the lowest doctor per patient ratios in Europe

Junior doctors who commit to work in Wales would have their student debt wiped out under a radical proposal to solve the country’s shortage of medical professionals….

Abi Rimmer reports on this press release in the BMJ 14th Jan: Medical student debts could be paid as incentive to work in Wales, Plaid Cymru says

“Medical students who go on to work as doctors in Wales could have their debts paid off, under plans announced by Plaid Cymru. The plans also propose quotas for Welsh speakers in Welsh medical schools.

In a white paper the party said that Wales could adopt a system whereby doctors who agreed to undertake postgraduate training received a financial incentive to stay in Wales.[1] “This could take the form of having a fixed amount of student loan repaid for each year of service once a qualifying period of training has been agreed,” the white paper said.

The proposal is based on the New Zealand bond scheme, which rewards doctors who agree to work in “hard to staff” areas or specialties by making payments against the graduate’s student loan. Leanne Wood, Plaid Cymru’s leader, pledged at a recent party conference to recruit an extra 1000 doctors to Wales over two terms of government.

The Plaid Cymru document said that if the current recruitment crisis in Wales were not resolved, the Welsh NHS would not have a future. “The shortages go beyond specific specialisms,” it said. “Many services are already only just about coping and there are several challenges on the horizon that will jeopardize the ability of Wales to have a comprehensive NHS.”….

In Scotland the Glasgow Herald on 6th March reports: Doctors warn GP recruitment crisis threatens patient care

There used to be subsidised housing for new appointments into many areas of the country. This was helpful to Wales, as housing stock was insufficient, and Wales does not attract enough doctors. (Wales has a net loss of 20% of graduates annually) NHSreality has always taken the view that there are too few medical students trained in the UK, and when we do train we experience high fall out, partly because of the over representation of women, who score better when competing for undergraduate places. Graduate entry to medical school on the other hand, leads to approximately equal numbers of either sex being given places. We need to aim for over-capacity, and with a 20 year target. This means we will be short until at least 10 years at junior level, and 20 years for seniors, and therefore you can expect more medical immigration. Why not allow any student who aspires to medicine, and reaches a certain grade, to train. If we achieve overcapacity by not rationing places we may be able to export doctors! We should certainly make the perverse incentive for governments to train too few medical students overt, and decry their cynical long-term policy of overseas recruitment as unethical. The debt levels are such that social bias is inevitable, and most doctors will come from families who do not fear to fund the debt….

This entry was posted in A Personal View, Medical Education, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

13 thoughts on “Medical Student debt – time for government to change policy on doctor recruitment

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