Priced out of Irish medicine

There is growing concern about the impact of financial barriers on diversity within graduate-entry medicine. David Lynch reports

 A reduction in the availability of graduate loans could “lead to decreased socio-economic diversity” within the medical student population, the Medical Council has warned.

According to the Council’s 2023 annual report, there was also an increase in the number of medical students “availing of student supports”.

The annual returns for the academic year 2021/22 were analysed for nine medical schools and 12 programmes in 2023, stated the Council’s report.

The Council confirmed to the Medical Independent (MI) that it expressed concerns in the context of the lack of loan facilities available to graduate-entry medicine (GEM) students. The last remaining GEM loan option (with Bank of Ireland) was closed to new applicants in July 2022. 

“Without accessibility to appropriate funding options, students from lower socio-economic groups may not be able to undertake or continue a GEM programme within an Irish medical school,” stated a Council spokesperson.

This issue was discussed at the most recent meeting of the Council’s education and training committee. It will be “further discussed” at an upcoming meeting with the Irish Medical Schools Council.

The financial burden on GEM students was a major topic at the IMO annual conference in April. GP and former IMO President Dr John Cannon said the accumulation of fees and interest (where loans can be accessed) meant “generational wealth” was now realistically required to enter GEM programmes.

‘Astronomical’

More than six months on and these concerns remain.

The IMO NCHD Chair Dr Rachel McNamara told MI the fees for GEM courses have risen “astronomically” in recent years. “The fees for graduate-entry medicine are among the highest Irish or EU fees for any course in the country,” she said. Dr McNamara cited figures as high as €18,000 a year.

“That is an inordinate fee…. That alone, coupled with the lack of tailored financial support, is pricing most people out of doing it. People who would make
fantastic doctors.”

Currently, GEM students are not eligible for the Student Universal Support Ireland grant as they are pursuing a second level 8 degree course.

Dr McNamara underlined that people were not expecting ‘free fees’, but wanted an appropriate loan mechanism. “But there is just no option. They can get a loan, but they will be so crippled by the repayments before they even get to year two.” The GEM-specific loans had allowed for deferral of repayments until after the completion of studies.

Dr McNamara said that GEM students bring a wide range of experiences from different areas of life and education.

“They have experienced loads of things that will enhance their ability to be excellent doctors.”

It would make “so much sense” for the next Government to organise, sanction or mandate a viable loan product “at the bare minimum” for GEM programme students.

“So people can go down this route without completely bankrupting themselves and their families. We would also advocate that the [GEM] fees have to be reduced,” she said.

Dr McNamara said it was also significant that the Medical Council has been highlighting the matter. 

She added that health management and the Government must “re-examine” issues such as the rotational requirements on trainees. She said this is creating a significant financial burden and “loads of debt”.

A spokesperson for the Department of Further and Higher Education, Research, Innovation and Science said higher education institutions have autonomy in managing academic affairs, including determining GEM fees.

“The State provides a subsidy through the Higher Education Authority to support lower fee rates for EU GEM students. The Department also offers bursaries for socio-economically disadvantaged students, which can be retained when entering GEM programmes.”

Disquiet

However, there is growing disquiet among medical and healthcare students about the financial pressures they face.

During the General Election campaign, health science students at Trinty College Dublin held a protest on campus demanding that the next Government, the HSE, and Trinity College “stop ignoring” them.

The protest was supported by the College’s students’ union.

“If I were to summarise, I would say the two main issues are the financial burden and a general lack of respect for healthcare students and researchers,” said students’ union President Ms Jenny Maguire.

She added that while the idea of the protest was first “sparked” by nursing students, it won wider active support, including from students of medicine (Trinity has one medicine programme which is direct-entry).

“The financial burdens, referred to often as ‘hidden costs’, can set students and researchers back hundreds of euro every semester. From uniform costs, a reduction of travel expenses and vaccination costs, students and researchers are being pushed to the brim.

“Of course, the cost of living crisis on top of this has only made the issue worse. Students are finding out days before their placement that they must move to the other side of the country for six weeks, forcing many to live in Airbnbs and hotels as the cheapest option…. Many also work jobs at the weekend in order to support their studies.”

She added that “the lack of respect is felt at almost every level”.

“Ultimately students and researchers need the basic financial supports in order to get through their education. They need payment and an elimination of these hidden costs. We are throwing away our healthcare workers by showing them little or no respect during their studies. Any government serious about healthcare must look at the source of the issue and support students and researchers with haste.”

A spokesperson for Trinity College told MI that some of the issues raised by protesting students “are being actively addressed already and progress is well underway”.

The spokesperson said a “productive” meeting recently took place between representatives from the students’ union and the School of Medicine. However, they added that broader issues around “payments and accommodation can only be addressed” by Government policy and funding.