 "I
never had to sacrifice financially until I got into medical
school," says Kirsten Wentlandt, a third-year med
student at Queen's. She never imagined student debt would
become such a big issue in her life.
That's all changed now. Pretty much all her decisions
these days are based on how much they'll cost her. This
summer she grudgingly opted to do her research elective
close to home, in Toronto, instead of somewhere exotic
like Europe or South Africa, routes chosen by some of
her more well-heeled classmates. She says she just can't
allow for these kinds of luxuries. "I know I'm not
going to do electives in the places I want because I can't
afford it," she says ruefully. With a year left in
med school, then a residency and possibly a fellowship,
she estimates that her debt will hover somewhere around
$150,000 when all's said and done.
 100
NOT-SO-GRAND
Med school tuition in Canada has been steadily rising
for the better part of a decade, leaving many new docs
knee-deep in the red. "I think it's pretty sick,"
says Dr Jeffrey Kwong, a resident at University of Toronto
and lead author of a study published in the April 2002
issue of the Canadian Medical Association Journal
(CMAJ) that looked at the effect of tuition increases
on students and class compositions. One major change
in the post-secondary education landscape -- deregulation
of tuition fees -- inspired Dr Kwong and some fellow
students to write the study. In 1998, Ontario became
the first province to make the move and that year alone
tuition rose by nearly $2,000 and kept on rising. Today
the average med school tuition is about $15,000 a year
in Ontario.
Since Dr Kwong's study, the situation has taken a turn
for the worse. In 2002, British Columbia followed Ontario's
lead and did their own deregulating; in one academic
year medical tuition there nearly doubled. That set
a dangerous precedent and now all provinces have jacked
up tuition fees, though in Quebec fees only climbed
for out-of-province students.
Canada, which once prided itself on its cheap post-secondary
education -- especially compared to its Southern neighbours
-- now has many students topping the $100,000 debt mark,
and government co-signed student loans just don't cough
up that kind of coin. "It's crazy," says Dr
Kwong. "Students in med school now need to have
good financial support from their family or get involved
with a bank." Many med students are forced to turn
to banks because of insufficient government funding.
Despite the fact that med students pay significantly
more for their education, the government only doles
out the same loans they allot to every other student.
Like Ms Wentlandt, several have the biggest chunk of
their debt in a bank loan. "My credit-line interest
payments are up to $200 a month," she says.
MISSED CHANCES
"I certainly worry that students don't have the
same chance to take some time and explore different
disciplines in medicine," says Dr Ian Johnson,
a professor at U of T and the co-author and facilitator
of Dr Kwong's CMAJ study. "When I graduated
I got to go up to Labrador to get some experience. It
was nice that I didn't have a huge debt."
Ms Wentlandt agrees. "The freedom they had back
then isn't happening now," she says.
But higher tuition fees aren't only cutting into students'
liberty, they're also spooking some gifted young people
into not applying to med school. "The costs of
medical school, both in terms of tuition fees and in
terms of lost income, are exorbitant," says Dr
Irfan Dhalla, former Vice-President of Education at
the Canadian Federation of Medical Students and another
of Dr Kwong's co-authors. "Many people of limited
financial means simply don't even consider medicine
as a career."
Dr Dhalla explains that their study showed that increases
in tuition fees in Ontario were followed by a decline
in the number of students of modest means. "[This]
lends support to the notion that raising fees deters
individuals from lower-income families."
A lack of enrollment in family medicine is a second
repercussion of high tuition fees. "Students with
higher debts will gravitate toward lucrative specialties,"
notes Dr Dhalla. "Is it any surprise that the specialties
with the most earning power -- dermatology, ophthalmology
and plastic surgery -- are the most competitive?"
"Some people are picking specialties and thinking
of paying off their debt," confirms Ms Wentlandt.
But her choice to pursue a specialty in either neurology
or pediatrics isn't because of the money. "The
way I figure it, if I'm going to go through financial
hell and only get a piece of paper that says MD, I'd
better get to do something I enjoy in the end."
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