04 January 2011

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.


Anonymous said...

If you think that is bad consider the computer science graduates

If you had a real passion for the subject, worked hard, what's going to happen?

Well yes you will end up with student debt and so on

But when you qualify you will find there are no jobs in the UK, or more precisely there are lots of jobs but the government has printed intra company transfer (ICT) visas like confetti and all the jobs have gone to Indian nationals. (Almost all ICT visas are issued to Indian nationals, I am not picking on India for any other reason)

There are currently many multiple hundreds of thousands of Indian nationals in this country on ICT visas. They don't pay any national insurance in their first year here, they pay significantly less tax than a British national (big tax concessions). Yet their children all get free state school places here, and their families all get free NHS.

Tata, Cognizant, Wipro, Infosys are big Indian outsourcers and they have the vast majority of ICT visas. They use these to bring masses of people into the country. And then subcontract them into other companies for less than a Brit could afford to work for. They also use them to drive the offshoring of work, that is moving prime British IT projects and intellectual property to India. So the Indian nationals in this country are just the tip of the iceberg compared to the masses of British work and IP being moved to India.

And the staff of the Indian outsourcers are treated very badly, indentured servitude, caste on caste racism, bullying, and worse. The Indian outsourcers can operate much more cheaply because they use tax avoidance to pay their taxes in Mauritius and similar, because they have to pay for zero health and safety, because there is no cost of employee rights.

And then we have the multiple hundreds of thousands of Indian nationals who originally entered this country on ICT visas who have been here so long they have been granted indefinite leave to remain or British citizenship. Permanently distorting the jobs market here.

Then we have the anti British racism and bullying practises imported with the Indian outsourcers, how do you think any Brits employed in this business are treated nowadays.

Anonymous said...

I'm a GP, qualified 20 years ago with £15 000 debt. House jobs paid £16 000 ish a year for my 84hrs a week contract so hourly rate was less than the cleaners!

So with inflation your situation doesn't seem too bad, but I do agree that increasing student fees will exclude alot of students with working parents and favour those with affluent parents.

Keep working hard it's worth it in the long run!

Anonymous said...

Of course it's not worth it. Factor in also that when you qualify you will not be treated as a member of a noble and ancient profession but as a "Health Worker", increasingly expected to implement protocols (or clinical pathways as they are cunningly re-badged) with very little clinical independence or freedom to use your own judgement, in competition with other "health professionals" with deceptive titles like "senior practitioner" which disguise their qualifications (or lack thereof) but who, having done a short course, now think themselves qualified to do your job.

And since you work for the government your pay will be used as an instrument of fiscal policy and to set an example of restraint to other public employees. If you're lucky, the way things are going, your employment will be taken over by the private contractor who submitted the lowest bid. Unfortunately they will not honour your pension rights.

If you have any sense, get the hell out of the NHS. Good luck.

Anonymous said...

Problem occured years ago with the introduction of tuition fees in the first place. Once that happened, it meant they could be raised on demand

Anonymous said...

And imagine the total debt when two newly qualified doctors marry.

Single Female Doc said...

Also a GP but qualified 17 years ago. From a working class backgorund but parents worked. Still paying off debts to this day. I never had fees but had to take the full student loan to supplement my grant which was being phased out in the last 3 years of my degree.
It's not worth it. I have a bright daughter. She know s in no uncertain terms that I will be disappointed if she wastes her life in medicine.
I have always passsed on this sentiment to medical students and 6 formers whom I teach or let sit in with me, but, at that age they often have no idea of what I am talking about - they look at me and imagine I sit on my bum all day working 9-5 earning £300K a year. Ho hum.

XYZ said...

"Keep working hard it's worth it in the long run!"

It must have been for you then, you must be either a consultant or senior GP with own business. I'm afraid junior medicine nowadays will most likely lead to the scrap heap because there are no posts at each and every level of training. Even if you make it to a CCT, you most probably will have to satify yourself with a staff or sub-consultant grade because there are no jobs! End of.

Anonymous said...

Dear reader,

your example of taking USMLE is why the labour party's proposal of a graduate tax is not workeable. Emigrate and you don't pay. With the current system the debt follows you so emigration is no escape.

But what other alternatives are there to fees? If fees were abolished and government funds used then taxes would have to go up. To get the six billion pounds required it would take another 1% on VAT on top of today. Try selling that to your neighbour. Running a bigger deficit is just taxation deferred. We are paying 35 billion in interest per year, rising to 55 billion by 2014.

The cold truth is that doctors like me will get pay freezes, reduced pension terms, the next generation (of doctors or computer programmers) will have that plus unaffordable houses and higher taxes. These are Gordon Browns chickens coming home to roost. The truth is that the sooner we get the defecit down the sooner we can all start to spend our own money.

Sam said...

Top unis have already raised their fees of postgraduate anything! An MSc now costs 20k+ and it's the same for a home student or those from abroad! ... and not everybody will be able to get funding, right? So, for 'reader' who can't afford it now and will graduate up to his ears in debt, should s/he forget about that postgrad aspiration?

Witch Doctor said...

It is helpful to read detailed accounts of the financial problems individuals face both as students and after graduation. I hope someone important from HMG reads this post.

However, it is very unlikely that politicians of all persuasions with their own university degrees and the degrees of their many advisors, have not already worked out the consequences of their actions.

The question then is, why are they choosing to diminish the medical profession and other graduates in this way?

If they did not have the wit to work out the consequences of their actions and are surprised by what the "Reader" and others are saying, then God help us all.

Sam said...

Well Witchdoc, if 'reader' to get a masters upon graduation, s/he would have to pay all his wage for a year just for the tuition fees! How is s/he supposed to live then?! ... and ok, the loan they accumulated while at med school will perhaps be deffered until s/he finishes the masters, say age 26, how much would s/he owe by then and the monthly repayment? Catastrphe if they are good enough to want a PhD, as, at least multiply cost of masters by 3 minimum, I think! So, 100k owed from med school, plus, say 40 for masters and 120 for PhD = 260k @@
... and s/he would probably be 30 years old by then! ... family and home? Can they dream of that?

Dr Aust said...

I think some kind of added subsidy for those who go into public service jobs after vocational degrees is the obvious solution - an add-on "rebate" of a portion of the fees for each year you do in a front-line public sector job.

Without that I frankly cannot see how anyone is going to go to University to get a nursing degree, or qualify as a social worker, or go into teaching, under the proposed fees regime.

I suspect people will still want to do medicine, debts notwithstanding, as everyone will believe going in that they will end up as a consultant or a GP partner. The reality, of course, will be somewhat different.

Anonymous said...

Dr Aust,

I think some rebate for public services would be untenable. Surely it would be more straightforward to give a payrise to public sector workers? Though that would be untenable also at present.

Exactly the same consequences would apply to those in non public sector jobs, whether computer programmers or bankers. High taxes (and these fees form a kind of graduate tax) drive talented people away from these jobs, and these shores. In the modern world people are very mobile, so British graduates in every field will be inclined to emigrate, while we import graduates from other parts.

I think that these fees would have the effect of discouraging aspiration, encouraging emigration, exerting downward pressure on house prices (due to loss of discretionary income) and upward presure on wage inflation (due to increased financial pressure on graduates).

I am not the only one who believes that both the last government and this one want a period of high inflation

No One said...

we are already in a period of high inflation

why do you think they have stopped selling national insurance index linked bonds?

why do you think the bank of england has moved its own staff pension fund into index linked investments?

English Pensioner said...

I know doctors are renowned for their bad writing, but I would hope for better than this. Of course, state education is to blame as spelling & grammar don't matter these days!
"To those critical of anonymous posts - my situation is not improved if I am disciplined or not employed for not towing the party line".

Myalgic Muslimah said...

Should've moved to Scotland during your GCSE years:P


"Nutty" said...

I think the cost of it is appalling and I don't think that medical students should have to be looking forward to the absurdity of £9000 a year fees.

However, this student appears to be budgetting £4000 a year to live off. If he was on benefits, he'd be getting less than that. Am I allowed to link to another site (I have no personal connection with it)? Here he can find lots of tips on saving money. http://www.moneysavingexpert.com/

Also look at this independent site for a cheap nutritious diet. Again, I have no personal connection with it. http://www.cheap-family-recipes.org.uk/index.html?opt=p3m1

It shows how to feed a family of four for less than £1200 a year, which could equally be four students.

Anonymous said...

Take a look at fees for Graduate entry medicine courses. You CAN'T get tuition fee loans for it!

If you take the 4 year course, you have to pay the first year yourself (That £9,000 UP FRONT). As the funding stands (it's under review) the NHS will then pay years 2-4.

However if you do the standard 5 years as a graduate (that's compulsory for UCL, Barts, most of KCL and others) you have to fund years 1-4 yourself! That's £36,000 UP FRONT!

More information on it can be found here:

You can apply for maintenance loans (but not grants) As well as the NHS bursary, but that's just a drop in the ocean.

Goodbye widening participation!

XYZ said...

And goodbye medicine, because career wise, no rich parents with aspiring bright children will want it anymore, given the dim career prospects due to lack of posts and the low pay.

the a&e charge nurse said...

According to the BMA entry into medicine favours the highest social classes (and always has done)

There are many ways to exclude those who have the raw talent for such a career but money (a proxy measure for class) continues to exert it's usual influence.

Mind you, some academics simply believe 'the working class' lack sufficient intelligence to make the grade.

halfanurse said...

Thanks Anonymous 8 January 2011 00:05 for your post. I am a year away from finishing my BN and really want to apply to do medicine but I have no idea how I could fund it without selling myself on street corners. I also have a previous MA but due to the follies of youth it is only at 2:2 and not good enough for entry. I am looking at another year (at least) at uni to get my Bsc Nursing before applying for medical school and knowing my luck by then the fees will be at 20k per year. I am praying for a lottery win.

Anonymous said...

I am that mother - I have a daughter about to start medical school and it is terrifying - and so unjust.

Anonymous said...

Actually one can exactly dodge repaying your loan by working elsewhere - as masses of new Zealanders have been since they did fees, saved NHS dentistry though - but no dentists in NZ!

halfanurse said...

I wouldnt mind paying back the loan. I would just like to be able to get one to help with fees in the first place.

Graduate entry medicine said...

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