A Letter from a Reader

For some reason this comment didn't get published. Perhaps it was too long. Fortunately it reached Dr Grumble's in box because it merits a post all to itself. It says it all. I hope that any Liberal Democrat MP reading it will feel very ashamed.

Dear Dr Grumble,

Just a little food for thought on what somebody starting medicine on the £9k fees system can expect: I don't believe I have previously written about this although I have often been sorely tempted when reading about funding. I find it astonishing that the state still considers me the responsibility of my parents in my mid-20s and determines my loans on this basis. I want to contrast the situation of someone who graduated in your year with someone in mine. These are very crude, unadjusted figures and I have not been too specific, for fear of revealing myself, but give an idea of the economic problem coming soon.

I am a medical student in London, towards to end of my degree and thankfully only paying £1300/year in fees. I am able to borrow this off the student loan company.

I am also able to borrow slightly more than £4000 a year to live off. The NHS bursary of approximately £1300 for the final 2 years is of some use, although it reduces the loan available. Unfortunately, my parents work, so my funding ends there. All additional money has to be begged off them: since they graduated many decades ago, this grates on them.

I rent a tiny room in a former council house, which houses 5 students. My rent for this is £6000 per year: the cheapest I could find. My medical school is not situated in a cheap city. The costs of everything else are more variable and harder to calculate, so I will ignore them for the moment. The cost of being able to turn up to my course in the morning is, over my 6 year course, of the order of £7800 fees, £36000 rent but with £2600 bursary leading to a total of approximately £41,200 (I have not allowed for the fact that the interest is compounded). I cannot borrow this of course, as it is clear that my rent is more than my annual loan, so my parents must find £2000 a year simply for me to be able to live anywhere near the institution. For the first few years its possible to work in the summer and I saved several thousand pounds doing this, but afterwards medical students do not have the summer off.

This is before consumption of baked beans has even been contemplated. I wonder how much most people spend on gas, electric, internet, landline, food, clothes, shoes, computers (for everything is electronic these days) and so on over 6 years?

This is the situation of many on my course. However, let us consider 2 other groups: those whose parents don't work, and those whose parents are very rich.

For the rich, the equation is simple. Many of my fellow-students have had flats bought by their parents near the medical school, which they have sublet to others. With rising property prices, this has even earned them a profit measured in the tens of thousands. They have £0 debt at the end of the course, as well as a flat which they will probably continue to rent out to their colleagues upon graduation. A very desirable situation, which I wish I could arrange for myself!

For those whose parents don't work: they receive such large loans and bursaries that they are financially independent from their parents and often live in much better accommodation than I can afford. However they have even more debt than I do upon graduation - I lived with someone who could borrow over £8k/year for maintenance alone, but bursaries come into play here and this person was getting a similar amount to keep. Frightening.

Many have argued that the renumeration is worth the training. This is no longer the case. Even as a student many are paying interest at a rate of £160/month whilst still a student: this is at a time of historically low interest rates. What will happen if they go up to a reasonable 5%, or 10%, or even 15%? At what point will the interest on my student loan out-strip my wage? Will it ever be payed off?

Many cite the example of consultants and GPs. However, their tuition fees were £0, their loans were £0 and their grants were extremely significant. Most, certainly outside london, emerged with no debt whatsoever. Furthermore, a mortgage of 2.5 times their annual salary was considered a lot: now the average property price in London is in excess of 9 times the wages of an F1. And we start work 3 years behind other graduates. Some of my friends, having failed medicine, converted to other subjects went into banking and now own cars and flats. Was passing the exams the right career move?

Many have suggested that students should bear the burden of this expense themselves - this is a fallacy if we are to work as doctors in the UK. The NHS is a state-owned monopoly employer, so if the cost is going to be met whether by grants or wages the taxpayer will be meeting it. Is healthcare worth it? The politicians and NHS managers don't seem to think so, but I would dearly love to see a taxpayer vote on the subject.

If not, doctors will leave the NHS in droves (or never even join) for other avenues of employment. Not because they don't like patients, or because they have no social conscience, but because we owe £30-40,000 each and would like to, one day, buy a house. How many of those debating the rights and wrongs of this matter have no hope of ever owning a house? Getting married? Raising children?

So many commentators treat the suggestions that the debt is unsustainable lightly, but let me ask - how many reading this post managed to save £40,000 within the first few years of graduation whilst getting a mortgage on 10x their annual salary? How many can save that even when at the peak of their earning potential? The numbers simply do not add up.

Now let us consider those with £9k/year fees. A rough estimate would seem to be £90,000 for fees + rent at today's prices, without compounding. So their monthly interest, at today's low rate, will be astronomical. They must of course eat and so on as well: I would be fascinated to hear what is a reasonable figure for this. I think it is quite likely that they will be charged more interest than their salary for a large part of their career without a massive rise in wages.

It is no coincidence that many of my friends - of wildly differing social, political and religious backgrounds - are reading the USMLE books (the exam that is the gateway to america and many other countries) and wondering if its worth spending the money on the exam. I think I will be investing.



P.S. To those critical of anonymous posts - my situation is not improved if I am disciplined or not employed for not towing the party line.