In January 2003 the government released the long awaited white paper, The Future of Higher Education,[1] which proposed a number of changes to tertiary education funding in England and Wales. With significant deficits in university funding, the government committed to 50% of 18-24 year olds being in higher education by 2010, and student debt reaching record levels, it was unlikely that the document would satisfy everyone.

Currently, UK students studying in England who started after September 1998 are required to make a means tested contribution to their tuition. Their parents' income is assessed and fees are charged on a sliding scale accordingly. For 2002/2003 the maximum tuition fee is £1,100 regardless of the institution or course. Medical students in their fifth year onwards can have their fees paid by the Department of Health and are eligible for a means tested non-repayable bursary.

In the white paper the government proposes the abolition of up front tuition fees in autumn 2006. Instead universities will be able to charge up to £3,000 per year and set different fees for different courses. Fees may be paid up front or deferred until after graduation and graduates will not be required to start paying back until they are earning over £15,000. The government contribution of £1,100 for students whose parents earn less than £20,000 and the existing sliding scale of contributions for students whose parents earn between £20,000 and £30,000 will continue. In addition a £1,000 grant per year will be reinstated for the very poorest students.

Due to the popularity of medicine as a degree, the expense associated with training medical students and the relative wealth of medical students' families, it is likely that the majority, if not all medical schools will charge the maximum £3,000 a year in tuition fees. This increase will make it significantly more difficult for the Department of Health to continue paying tuition fees for fifth year medical students and may result in many medical students incurring debts of £18,000 before they even begin to pay living expenses.

Problems specific to medicine

Significant extra costs are already associated with studying medicine. The length of the course requires students to fund themselves for two or three years longer than most students. The intensity of the curriculum limits the opportunities to undertake part time work and the problem is exacerbated by the cost of books and equipment, professional dress for ward rounds, electives and travel to peripheral attachments. In addition to this, student loans are calculated not only on the basis of a thirty week university year, but also on the understanding that during vacation periods students can earn more than they spend. Thus clinical medical students with shorter vacations are doubly disadvantaged.

In 1997 the average medical student debt was £6,758, twice that of other students.[2] By 2002 this had risen to £10,966 and 12% reported debts of over £20,000.[3] The Department of Education and Skills has admitted that, if introduced, the proposals in the white paper will result in debts of well over £40,000 and a number of projections put this figure closer to £55,000. Students on four year postgraduate medical degrees could attract a debt of upwards of £63,000 on completion of their second degree.[4]

Nonetheless it is important to keep things in perspective. Even if the proposals are implemented in full, for many a career in medicine will remain a very attractive proposition. Graduates can look forward to a reasonably stable and secure future with a high earning potential.[5] When compared to opportunities for those in Latin America and sub-Saharan Africa for even the most basic education, students in the UK remain extremely privileged and in relation to medical students in other western countries, UK debt levels will still compare well.

Yet sadly medicine is already the domain of the privileged. In 2001 80% of medical students were from managerial and professional backgrounds, arguably making medicine the most socially elite course at university.[6] The widening access regulations suggested by the government are not course specific and would allow universities to charge maximum fees for medicine whilst meeting their outreach quotas by charging minimal fees on other less popular courses.

How should Christians respond?

All medical students are affected by the changes above, but some effects will be specific to Christians. There will very likely be a knock-on effect on students taking part in summer mission trips, as they will have less money to pay for them, and less time to go as they are more likely to work during long holidays to pay off debts. It may also make it less likely for students to attend conferences if they are more worried about debt. It certainly underlines the need for Christian doctors to continue subsidising student ministry, as has been so hugely beneficial in CMF UK over the years.

Looking further ahead, young Christian doctors with large debts may be less likely to commit to long term medical mission until these are paid. In the USA, Project MedSend has been established to help healthcare professionals get into mission by paying their loan repayments.[7] Perhaps the time will come when this will be necessary in the UK.

Yet, as mentioned above, UK students are still relatively wealthy in world terms. We should remain grateful to God for this and remember to be generous with what we do have.[8] This is good practice for when we have more money as graduates, and practical advice has already been given previously in Nucleus.[9]

Conclusion

Widening participation initiatives in recent years have been hampered by the debt aversion that is most prevalent in people from ethnic minorities, lone parent families and those from the lowest socio-economic groups.[10]

If medicine is ever to stop disadvantaging the most vulnerable groups in the UK and become a profession that reflects the population it serves, it is these students that the government must focus on. Access to medicine should be based on aptitude and potential, not on ability to pay. Initiatives must be put in place to encourage less privileged school leavers to apply and efforts should concentrate on establishing bursaries for the most disadvantaged school leavers in order to help support them through the course.

Finally, at a time when the UK population is plunging deeper and deeper into personal debt with all its associated problems, we must challenge the government's position that it is right and proper to have to take on significant debts in order to follow a desired career path.