Will tuition fees end the prospects of mature medical students?

As expected, the rise in tuition fees has produced a fall in university applicants this year. Of all the students to be hit with rising costs of higher education, student doctors will probably receive the least sympathy. Studying for five or six years, medical students will end up with larger debts than most, but unlike the majority of graduates we are almost certainly guaranteed a well paid recession proof job for life.  The £45,000 in tuition fees that tomorrow’s doctors might end up owing is also minimal in comparison to the actual cost to the tax payer of  putting us through medical school which is probably more like £250,000 per doctor trained.

For many of the people that I went to medical school with, £9000 per year tuition fees will be considerably less than the private school fees that were paid by their parents for the earlier part of their education. Medical school is still a fairly elite aspiration and the stereotype of a doctor remains something like this. For those of you who can’t be bothered to click on the link, it’s of a very posh sounding doctor with a bow tie demonstrating a neurological exam on a nervous looking woman with a 1980s hair cut. I like the way he patronises her politely for not looking at his face. I’m sure this doctor is an excellent neurologist, but he does demonstrate how as a profession, we don’t really represent the population that we serve.

The coalition government would argue that the change in tuition fees will enable more disadvantaged students to get in to medical school but the truth is this seems unlikely. When I started medical school in 1996 there were no tuition fees, but there was also a distinct lack of anyone who could be considered to be from a disadvantaged background on my course. For a state school boy, even a middle class one like me, medical school was a massive eye opener to the world of the privileged. Culturally it was an extension of public school with hockey club dinners, summer balls and rugby boys drinking each others vomit.

I’m no sociologist but the lack of working class kids becoming doctors is fairly understandable when you consider the huge number of hoops that have to be jumped through in order to successfully gain entry to medical school. Not only do you need to get top A-level results but you need to be able to pad out you application with tales of work experience, charity do-gooding, sporting prowess and musical genius. You then have to be adequately well spoken to impress during the medical school interview. With around 10 applicants for every place, the average 17 year old entering this process, profits greatly from the help and support offered by a combination of an elite school and pushy middle class parents. Successful applicants have often benefited from expensive interview preparation courses, work experience provided by medical relatives and word perfect references and personal statements that have been carefully edited by well practised tutors.

Interestingly the one group of medical students who seem to be bucking the trend with regard to social class are the mature students. Katie, the final year medical student I am supervising at the moment is 29 and a single mum. She grew up in a very normal working class household and rather than spending her mid teens cramming for chemistry exams and having piano lessons, she had a more typical adolescence spent bunking off school and drinking cider in the park.

An unplanned pregnancy, shotgun wedding and then a short and unsuccessful marriage meant she had to grow up quickly. With the help of her parent’s offering childcare, Katie then decided to study for a psychology degree. After belatedly realising her true potential, she took the big step of applying to medical school. Katie is by far the best medical student I’ve ever taught. She is bright and learns quickly, but most importantly she has a fantastic bedside manner and her ability to put patients at ease appears effortless. She is the sort of person you meet and think “I wish you were my doctor!” Katie and her family are making a massive sacrifice for her to study medicine. As a mature student who already has a degree, were she to be starting medical school in 2012, she would almost certainly have to pay her tuition fees up front regardless of her low household income. Even just finding the £9000 to cover her first year would make studying medicine an absolute impossibility for her.

I’m not suggesting that a person’s social class has any baring on his or her ability to be a good doctor, but when the NHS is all about delivering universal health care to all, it seems a shame that the medical profession seems so unable to break through class boundaries within its own ranks. The extra life experience and more varied social backgrounds that mature medical students bring to our profession is refreshing. Although there is no guarantee that these mature students will automatically make better doctors, their more worldly outlook on life has to be a positive for UK medicine and be encouraged. This year applications to university by mature students have fallen sharply, I am not sure if this correlates to applications to medical school aswell, but I can’t help but worry that the tuition fees debarcle will have made studying medicine unattainable to a whole generation of potentially excellent doctors.

Dr Benjamin Daniels is the author of “Confessions of a GP”

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