Medical students and doctors are at increasing risk of experiencing financial difficulty throughout their careers, with reasons ranging from illness and disability to high training costs and student debt, according to a new study led by researchers at UCL.
Published in the Journal of the Royal Society of Medicine, the study reviewed research and wider literature concerning financial need among medical students and doctors in the UK between 2011 and 2021, and conducted interviews with 25 experts who work with medical students and professionals in financial need.
The authors identified five main pathways to financial difficulty:
Dr Rowena Viney (UCL Medical School), joint first author of the study, said: "Our research really highlights that financial difficulty can happen for many reasons and at different points in a medical career. Some of these reasons are universal, but some are relatively unique to medicine, particularly the financial demands of studying and training for many years."
The study, supported by the Royal Medical Benevolent Fund, also outlines particular scenarios where financial difficulty can occur, depending on social background and career-stage.
Medical students can be affected by study expenses and high living costs - particularly if they are from widening participation backgrounds or from overseas where financial support from family may not be available. Medicine is a long course, with long term times and high workloads, meaning less time for additional paid work to help with living costs.
Medical trainees can be affected by student debt and the cost of training. Foundation year doctors can have student debt as high as £100,000. They also have costs such as exam fees and courses. Surgical trainees, for example, may spend as much as £70,000 to achieve mandatory requirements for qualification.
Overseas doctors can have high costs to set up in the UK and unfamiliarity with UK systems can lead to administrative problems. This can include visa costs and legal fees, plus fewer options for financial support.
Doctors can be short on or out of work, for example because they are suspended from work by the GMC or they are in a less secure position, such as needing to reduce their hours to provide care for family.
Pandemic factors, such as shielding or long COVID, can affect all medical students and professionals.
Dr Asta Medisauskaite (UCL Medical School), joint first author, said: "As in many sectors, pay and conditions have become more challenging in recent years and this is increasing the financial pressure that medical students and doctors are under. Further investigation into financial need in medicine would help us to match support to where it is most needed. We also need more open conversations about financial need, which still carries a stigma that may discourage people from seeking support."
Researchers also note that the findings come at a time when healthcare in the UK is under the spotlight, with working conditions in many NHS hospitals making the headlines and reports of a recruitment and retention crisis that means all hospitals are under-staffed. The past year has seen unprecedented industrial action by junior doctors and nurses over pay and conditions. It is estimated that a junior doctor’s income is 26% lower in real terms than in 2008. Concern about finances can have a negative impact on medical students’ and professionals’ mental health, and their progression through education and training; this in turn can have repercussions to issues of workforce.
Professor Ann Griffin (UCL Medical School), senior author of the study, said: "Though medicine ultimately becomes a well-paid profession, this isn’t necessarily the case early on. Today we recruit medical students and doctors from a wider range of social demographics, so there are larger proportions of students and doctors whose families are less able to support them financially than may have been the case in the past. If we are to make it so that anyone with the ability can become a doctor regardless of how wealthy their family is, not to mention address the 10% staffing shortfall in the NHS, we need to seriously consider the findings of this study."
This research was supported by the Royal Medical Benevolent Fund, the UK charity for doctors, medical students and their families.
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